For a solo ager, choosing a nursing home or assisted living facility carries extra weight: there may not be a family member checking in weekly, noticing a decline in care, or pushing back on your behalf. Doing the research before you need one — rather than under pressure after a hospital discharge — gives you the ability to actually compare options rather than take whatever bed is available.
Start with Medicare's Care Compare tool
The U.S. government's official tool for this is Care Compare, at medicare.gov/care-compare. It's free, publicly available, and covers essentially every Medicare- and Medicaid-certified nursing home in the country. Search by facility name or location and you'll find an overall star rating, but don't stop there — the overall rating is built from three separate components (health inspections, staffing, and quality measures) and it's worth looking at each one individually, since a facility can score well on one and poorly on another. Care Compare also publishes the facility's recent health inspection reports, any cited deficiencies, complaint history, and penalties, which is far more informative than the star rating alone.
Check for recent ownership changes
Ownership history is worth investigating specifically. Elder-care research and advocacy organizations have repeatedly flagged that facilities which have changed ownership recently — particularly when acquired by private equity firms or large multi-facility chains — warrant extra scrutiny, since new ownership sometimes brings staffing cuts or cost-cutting before quality metrics catch up to reflect it. This doesn't mean every chain-owned or recently-sold facility provides worse care, but it's a reasonable prompt to look closer rather than assume nothing has changed. Ask directly, either during your Care Compare research or on a tour: has this facility changed ownership in the last two to three years, and who owns it now? A facility unwilling to answer plainly is itself worth noting.
Staffing ratio is a practical proxy for care quality
Of all the metrics available, staffing levels — particularly registered nurse hours per resident per day — are among the most consistently linked to actual care quality in research on the topic. Care Compare publishes staffing data down to this level of detail, and it's worth checking whether staffing is reasonably consistent across the days included in the data, rather than propped up by one strong shift that pulls the average up. Low or inconsistent staffing tends to show up downstream as everything from slower response times to missed medications to more frequent falls.
Your state's long-term care ombudsman
Every state has a long-term care ombudsman program, funded under the federal Older Americans Act, whose job is to advocate for residents of nursing homes and assisted living facilities independent of the facility itself. You can search "[your state] long-term care ombudsman" to find your state's program. Ombudsman staff and volunteers can often tell you about a specific facility's recent complaint history, help you understand a resident's rights, and mediate disputes if you or a loved one ever need to file a complaint. It's a resource worth knowing about before you need it, not just after.
What to watch for on an in-person tour
- Call lights that go unanswered for an extended period while you're walking the halls — a strong signal of short-staffing in practice, not just on paper
- What current residents' family members say if you happen to encounter them — ask directly about staff turnover and whether the same aides and nurses are around from visit to visit
- Persistent odor issues beyond what's typical for such a facility; an occasional incident is normal, but a pervasive smell throughout common areas often points to understaffing rather than a one-off
- Whether residents appear engaged, dressed, and attended to, or are left unattended in hallways or common areas for long stretches