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Key Takeaways
The most useful questions to ask before choosing a nursing home are about the weeks after move-in. Almost no family gets to ask them calmly. A hospital discharge planner hands you a short list on a Tuesday, a bed opens Thursday, and you are expected to judge a place you had never heard of while your mother waits.
Guilt makes it harder, and so does the feeling that you should already know what to ask. At The Elder Justice Firm, we read facility records after something has gone wrong, and the warning signs were usually answerable in advance. Ask our team what to listen for while the decision is still open.
Before comparing buildings, settle what your parent needs and what your family can sustain. Those answers shorten the list faster than any tour.
A few questions belong in your own notes before you call anyone:
Answering these first leaves you with a shorter list and a clearer head. Our guide to matching the level of care to your parent’s needs and budget covers that groundwork.
Ask who is responsible for your parent’s medical care, and how often that person will lay eyes on them. Federal rules set both answers, so an administrator should not need to improvise.
A resident has the right to choose their attending physician. That physician must be licensed and must meet the requirements that apply inside a facility.
The facility must also keep your parent informed of the name, specialty, and contact information for the physician responsible for their care. Ask what the facility does when a chosen doctor stops showing up.
Federal rules require a resident to be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days after that. A visit counts as timely if it occurs within 10 days of the due date.
After the initial visit, a skilled nursing facility may alternate required visits between the physician and a physician assistant, nurse practitioner, or clinical nurse specialist. Ask who handles each one. Also, ask how the building reaches a doctor at night, since it must arrange physician services 24 hours a day for emergencies.
Medication is where quiet harm often begins, and families are least likely to raise it on a tour. A facility running a careful program answers in specifics.
Start with who reviews the whole list. A licensed pharmacist must review each resident’s drug regimen at least once a month and report any irregularities to the attending physician, the medical director, and the director of nursing.
Then ask about mistakes. Facilities must keep medication error rates below 5 percent and keep residents free of significant medication errors, so a shrug is worth noting.
Psychotropic drugs deserve their own question. As-needed orders for them are limited to 14 days, and an as-needed antipsychotic order cannot be renewed unless the prescriber evaluates the resident first. Ask who obtains consent before such a drug is started, and how quickly you would hear about it.
Sedation used for staff convenience rather than a diagnosed condition is one form of overmedication in nursing homes, and it is easier to ask about now than later.
If the answers you are hearing already sound rehearsed, we can tell you what a facility’s records would show. Call The Elder Justice Firm at (855) 880-4500 for a free case evaluation.
Three risks drive a large share of the cases we handle: Pressure injuries, falls, and emergencies nobody planned for. Each one raises questions that go beyond the brochure.
A resident must receive care consistent with professional standards of practice to prevent pressure ulcers, and must not develop them unless a clinical condition made them unavoidable. That is a standard, not an aspiration.
Push for specifics: Who repositions your mother, how often, and where is it written down? Facilities that genuinely prevent bed sores and pressure ulcers answer that without checking with anyone.
The same rule requires the resident environment to remain as free of accident hazards as is possible. It requires each resident to receive adequate supervision and assistance devices to prevent accidents. Ask how supervision is decided for a resident who wanders.
Then ask what happens after a first fall. Many of the nursing home falls we review followed an earlier fall that didn't change anything in the care plan.
Facilities must maintain an emergency preparedness plan, review and update it at least annually, and base it on an all-hazards risk assessment that includes missing residents. That plan matters most in fire and heat season.
The plan must include a way to share information with residents and their families, and the facility must implement emergency and standby power systems. Ask where residents go during an evacuation, and how you would be told.
The hardest surprises arrive months later: A hospital stay, a bed given away, or a discharge notice nobody saw coming. All three are easier to ask about before a signature than after.
Under California’s standard admission agreement for skilled nursing facilities, a facility transferring a resident to an acute hospital for seven days or less must notify you that it is willing to hold the bed. You then have 24 hours after that notice to say whether you want to hold it.
Medi-Cal pays for up to seven days of holding the bed when it covers the resident’s care, and Medicare does not cover those costs. If the facility skips the notice procedure, it must offer the next available appropriate bed.
Ask what happens when a hospital stay runs longer. At a participating facility, a Medi-Cal-eligible resident away for more than seven days must be readmitted to the first available semi-private room bed if they still need that care and wish to return.
Federal rules permit a transfer or discharge only for defined reasons. They include needs the facility cannot meet, and health that has improved enough. The rest cover danger to the safety of others, danger to the health of other residents, nonpayment after reasonable and appropriate notice, and closure.
In most situations, you must give notice at least 30 days before the move, send a copy to the State Long-Term Care Ombudsman, and explain appeal rights. Ask to see a blank copy of that notice.
A facility may not carry out the discharge while an appeal is pending, unless keeping the resident would endanger health or safety. Appeals of a facility-initiated discharge, and of a refusal to readmit after a hospital stay, go to the Department of Health Care Services hearings office.
Ask directly whether the facility participates in Medi-Cal, and what changes on the day private funds run low. Facilities must maintain identical transfer and discharge policies and practices for everyone, regardless of the source of payment.
Under the state’s standard admission agreement, no California facility participating in Medi-Cal may require a resident to remain in private pay status for any period of time before converting to Medi-Cal coverage. Get the facility’s answer on that in writing.
Nobody remembers six tours clearly by the end of the week. Families who get through this well write things down as they go.
A simple routine keeps the answers usable:
Notes made at the time carry weight that memory never does.
Pay attention to the shape of an answer as much as its content. Staff who cannot describe their own policy, or who promise something the paperwork does not say, have told you a great deal. Many signs of a bad nursing home never appear anywhere near the lobby.
Families comparing facilities most often ask these questions.
Yes. She has the right to choose her attending physician, as long as that physician is licensed and meets the facility's requirements.
No. Medicare does not cover the cost of holding a bed, though Medi-Cal pays for up to seven days when it covers his care.
No facility participating in Medi-Cal may require a resident to remain in private pay status before converting. Ask for that policy in writing.
Generally no. The facility may not transfer or discharge a resident while the appeal is pending, unless keeping that resident there would endanger health or safety.
Rates must stay below 5 percent, with no significant medication errors. A facility that cannot tell you its own rate deserves a closer look.
Its emergency plan must include a way to share information with residents and their families. Ask exactly how you would be reached during a wildfire or power outage.
If your parent was harmed inside a facility whose answers sounded reassuring on the tour, the records usually tell a different story. Our attorneys handle elder and nursing home abuse claims throughout the state, and we have recovered more than $200 million for families.
We request the chart, care plan, medication records, and transfer and discharge file, then compare what happened with what the rules required. Our Los Angeles office serves families across California, and we handle these cases on a contingency fee basis.
A free case evaluation costs nothing and can tell you whether the record supports a claim. Call us at (855) 880-4500 or reach us through our contact page to have your loved one’s case reviewed.
Rob Marcereau founded The Elder Justice Firm on a single conviction: Seniors deserve a lawyer who prepares every case for trial.
He is an award-winning trial attorney, licensed in California since 2000, who has built his practice around institutions that harm the people in their care. Nursing homes, assisted living facilities, and their insurers arrive with defense counsel already retained and a strategy already in motion. Families arrive with grief, a stack of medical records they cannot read, and a facility that has stopped returning calls.
Closing that gap is the reason this firm exists. To speak with a California elder abuse attorney about what happened to someone you love, call The Elder Justice Firm at 855-880-4500.
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