First you need to determine what nursing homes are available in the area for your loved one. You can go to the telephone book, ask friends, relatives, ministers, hospitals and anyone else that you think might be able to give you useful information. While you are talking to them, be sure to ask which ones they would choose to be in themselves and why. You will probably want to try to make sure your loved one's friends and/or other relatives are close enough to conveniently visit them.

Go to http://www.medicare.gov/ and search for nursing homes in your area. You will find the government's evaluation of each nursing home. You can also call 1-800-MEDICARE (1-800-633-4227) and a Customer Service Representative will read the information to you. TTY users should call 1-877-486-2048. Also check out our own Family Tree of Elder Caregiving under the Resources tab on this site for a selection of Residential Care Facilities.

Call the nursing homes. At this point, all you need to talk about is the cost and level of care your loved one needs. Don't worry, this won't be your only chance to ask questions.

When you know which ones meet the above criteria, make an appointment with the administrator. Go over the finances and level of care again during this visit, but there are other questions you need to ask. Here are some questions you should ask, but don't forget to evaluate your loved one's situation individually and include questions specific to their needs:

Special Services - Does the home have special services in a separate section when needed? Is there usually a bed available in that unit? This would include sections like an Alzheimer's unit or rehabilitation unit.

Time Frame - How long does it usually take to get someone into the home after making an application? Sometimes you can get your loved one in immediately and sometimes there is a waiting list.

Patients - How many beds do they have and how much care and medication do the existing residents require?

Staffing - How many nurses, CNAs, and other employees do they have to take care of patients? What doctors and hospitals do they use? How often do the doctors visit? How far is the hospital?

Visits - What is their policy on visits from friends and relatives? Do they allow friends and relatives to eat with the patient without a prior reservation?

Restraints - When do they use restraints, and what restraints do they use? When and why do they sedate patients? What alternatives do they use rather than restraints and sedation?

Personal Belongings - How do they take care of your loved one's personal things such as jewelry and watches.

Meals - Can a resident choose within reason what they want to eat? Ask to see a week's menu. Can you eat there occasionally?

Contact With You - Will they let you know whenever there is a fall, cut or any physical problem? Are you expected to become involved with decisions regarding your loved one? How much physical involvement in the patient's care do they expect from you? Remember that you of course should visit, but they should take care of your loved one - that's why you're looking into homes in the first place.

Problems - How do they handle things when there are problems. What procedures are in place when something is missing or your loved one is bruised or suffers a fall that shouldn't have happened or could have been prevented? How should you report a problem or something missing?

Other Questions - Ask any other questions you might want to know. Now is the time.

While you are there, ask for a tour of the site. Notice how the home smells, whether the building is clean, how the patients look (grooming), what activities are going on at the time, what the kitchen looks like, whether there are any bells ringing for an extended period of time (yes, this happens!), and anything else that is either apparent or not so apparent.

Talk with a couple of residents, if you can, to get their impression of where they live. Ask what they like most and what they dislike most. If you are not allowed to talk with them, ask the administrator why. Depending on the answer, this could be a trouble sign.

At this point, if you haven't already, discuss the possible homes that suit your standards with your loved one. They may prefer a certain home if they have friends there. They may already have good or bad impressions of certain homes.

The next step is to make two or three unannounced visits at different times of day, including nights and weekends. Notice whether the patients seem happy, what activities are going on and whether patients are taking part in them or just sitting there, whether they appear healthy, clean and comfortable, whether the staff treats them with respect, whether the staff appears happy.

Also take a closer look at details of the home: are the sheets clean, are rooms well lighted and ventilated, is the room temperature comfortable, are there handrails and grab bars in the halls, rooms and bathrooms; and last but not least, is the food inviting and does the staff make sure everyone has plenty to eat?

Always remember that a nursing home doesn't provide the intimate care your loved one would receive at home, but these facilities are there to give your loved one the best possible quality of life. And remember that your choice of a home need not be permanent; if your loved one does not receive the care you and they expect, you can move them to a different nursing home.