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Finding the best fit in a nursing home

Carol Bradley Bursack, Forum columnist Michael Vosburg / Forum Photo Editor

Dear Carol: My parents have lived together in assisted living for several years and loved their lifestyle, but now my mother, due to a massive stroke, will require nursing home care. I'm aware that we must consider available openings, but we'd like to have options. From the talk around the assisted living facility, nursing homes in our community are all quite good but some seem better than others. Any tips? — MC

Dear MC: It's tough to make these choices and, in the end, you'll have to go by your instincts, but there are two major online tools that can help. One is Medicare's Nursing Home Compare and the other is the business rating site Yelp. They actually represent two ends of the spectrum.

Nursing Home Compare rates nursing homes nationwide with five-star and below ratings. Some of the ratings come from government tracking, but much is self-reported. One negative is that there have been accusations of nursing homes being able to "game" the rating system. I can't tell you how widespread this is, but there is a point to the skepticism since self-reporting isn't necessarily going to provide fool-proof ratings.

The other end of the spectrum is the business rating site Yelp. This platform is generally used by people who have had experience with a particular facility. The issue here is that people are more likely to complain than compliment. Therefore, someone may rate a nursing home very low because they are furious about a particular issue and this rating may not reflect fairly on the facility. People who are pleased may not think to write a review. Use Yelp cautiously, understanding that it, too, is an imperfect tool.

My own criteria? Visit the facilities yourself. Stop in unannounced. How is the staff relating to the people they are caring for? Do they look them in the eyes? Do they smile while interacting? How do they relate to one another? Are the hard-working, hands-on aides treated respectfully by social workers and/or floor nurses? This kind of interaction is telling about the culture of the home and the caregivers and, to me, the staff is the leading factor when it comes to finding a good facility.

Investigate the programs as well. While bingo is still popular with many older residents, a good facility should have moved beyond that. They should offer a chance to make art, enjoy music, exercise, play games and interact as the residents are able. Some facilities will have children from day care centers visit. Pets are a plus, as are living plants. In other words, signs of life rather than a feeling of impending doom are what you are looking for. Smiles, respect, calm behavior in a crisis, these are all important.

If possible, try to obtain references from families who've had loved ones living in a particular facility. Perfection doesn't exist, so don't be unrealistic about facility care, but expect them to be up-to-date on the idea of person-centered care rather than the old rigid models.

Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of Minding Our Elders: Caregivers Share Their Personal Stories. Bradley Bursack hosts a website supporting caregivers and elders at She can be reached at