Questions to Ask a Nursing Home or Assisted Living Community

Book Two Visits, and Make the Second One Unannounced

One visit tells you what the home wants to show you. Two visits, at different times of day, tell you how it runs. Book the first tour properly and turn up for the second without an appointment, mid-afternoon or early evening, when staffing is thinner and nobody has tidied for you.

Go with a plan for what to notice rather than what to feel. Sound is the most reliable signal in a building like this: call bells ringing unanswered, televisions at volume in empty rooms, or simply nobody talking. Look at whether residents are dressed, whether staff use names, and whether anyone is doing anything other than sitting.

Ask your questions in the same order at every home so that your sheets line up. Take the same person with you both times if you can. Two people notice roughly twice as much, and afterwards you have someone to disagree with, which is more useful than a second opinion that matches your own.

• Book the formal tour, then return unannounced at a different time of day
• Note the time you arrived and how long before anyone spoke to you
• Listen: call bells, television volume, conversation between staff and residents
• Look at the residents, not the furniture
• Ask the same questions in the same order at every home

Questions About the Room and the Contract

Ask to see the actual room that is available. Show rooms are staged, sometimes larger, and often on a nicer corridor. If the available room is not ready to view, ask when it will be and come back.

The contract questions matter as much as the room and are far easier to forget while you are standing in a bedroom trying to picture your parent's chair in it. Get the fee, the inclusions and the exclusions in writing on the day, along with the date of the last increase.

The hospital question at the end of this group is the one families most often wish they had asked. Find out now what the fee does while a room stands empty.

• May I see the actual room that is available, not a show room?
• What is already in the room, and what does my parent bring?
• Is the room shared, and how is a roommate chosen or changed?
• What is the monthly fee, and exactly what does it include?
• What is charged separately, and may I see the current price list?
• How much notice is given before a fee increase, and how much was the last one?
• How long is the contract, and what notice do we give to leave?
• What happens to the fee if my parent is in hospital for two weeks?

Questions About Staff and the Daily Routine

Staffing is the single thing that shapes a resident's day, and it is the answer most likely to be given in ratios that mean nothing on their own. Ask for numbers at specific hours instead: how many people are on this floor at three in the afternoon, and how many at three in the morning.

Ask how long the staff on this corridor have worked here. High turnover is not a moral failing, but it tells you how often your parent will explain themselves to someone new.

The routine questions are about whether the day belongs to the resident or the rota. A home that can describe what happens when someone wants breakfast at ten has thought about it. A home that says everyone is up by eight has told you something too.

• How many staff are on this floor at 3pm, and how many at 3am?
• Who is the named person responsible for my parent, and how do I reach them?
• How long have the staff on this floor worked here?
• What time do residents wake, eat and go to bed, and how flexible is that?
• Who helps with washing and dressing, and how is that scheduled?
• How are medicines stored, and who is responsible for handing them out?
• How do you record what happened each day, and can family read that record?
• How do you tell families about a change, and how quickly?

Questions About Visits, Food and Belongings

Eat there. Not the arranged lunch on tour day — ask to buy a guest meal on your unannounced visit and sit in the dining room while it is busy. You will learn more in forty minutes than the brochure will tell you in a year.

The belongings questions are practical and they matter to your parent more than the fee does. What furniture can come. Whether pictures can go on the wall and who hangs them. Whether the cat is a conversation or a refusal.

Laundry is worth pressing on. Ask specifically how clothes are labelled and who does the labelling, because clothes going missing is one of the most common and most demoralising complaints families make.

• What are the visiting hours, and are they ever restricted?
• Can I take my parent out for the day, and what do I sign?
• May I see this week's menu, and what happens if my parent will not eat what is served?
• Can I buy a guest meal today, and what does it cost?
• What can my parent bring — furniture, pictures, a kettle, a pet?
• How is laundry handled, and how are clothes labelled?
• Where are valuables kept, and who holds a key?
• Is there a phone line and internet in the room, and who pays for it?

Questions About Money, Notice and Moving In

These are the questions people leave until the second visit and then forget. Ask them at the end of the first tour while you still have the manager's attention.

The two that carry the most weight are the ones about leaving. Under what circumstances would you ask a resident to leave, and what happens when funds run out. A straight answer to either is a good sign in itself. A vague answer is data.

Ask to read the most recent inspection report and ask for it as a document, not a summary. Ask to speak to two families — not the ones on the wall, two whose relatives live on the floor your parent would live on. Then ask for the next five steps with dates, which turns a nice afternoon into a decision you can actually make.

• What is the deposit, and under what conditions is it returned?
• Which payment sources do you accept, and what happens if funds run out?
• What paperwork do you need before a move-in date can be set?
• Who decides whether you can meet my parent's needs, and when does that happen?
• Under what circumstances would you ask a resident to leave?
• Where can I read your most recent inspection report?
• May I speak to two families whose relatives live on this floor?
• If we said yes today, what are the next five steps and their dates?

How to Record the Answers So Two Homes Can Be Compared

One sheet per home, questions in the same order every time, so that when the sheets sit side by side on the kitchen table you are comparing like with like rather than comparing your mood on Tuesday with your mood on Thursday.

Add two columns. The first is the answer. The second is a score out of three — clear answer, vague answer, or would not answer. The score column is what you will actually read a week later, and "would not answer" is often the most informative entry on the page.

At the top of each sheet write the date, the time of day, the name of the person who showed you round, and how long you waited at the door. At the bottom, write three sentences before you start the engine: what you saw, what you heard, what you would want to check on a second visit.

Photograph the sheet and send it to whichever sibling could not come. It is far harder to argue with two filled-in sheets than with two impressions.

• One sheet per home, questions always in the same order
• Column one: the answer. Column two: clear, vague, or refused
• Header: date, time of day, who showed you round, how long you waited
• Three sentences written in the car before you drive off
• Send a photograph of the sheet to the family the same day

Questions