How to Carefully Select Skilled
Nursing Care

Nurse Reading

Use these tips to know what to watch for—and what to ignore—when searching for
24-hour senior care.

When Monta Huber, 79, needed back surgery in 2008, her doctor suggested she spend a few weeks in skilled nursing after her hospital discharge. With skilled nursing care, Huber received the rehabilitation services, physical therapy and personal care services she needed to regain her independence.

Her surgeon recommended the Jean Weaver Health Center, the skilled nursing community at Redwood Terrace, a senior living community in Escondido, California. The center offers private rooms, private baths and an outdoor patio for each room. After visiting other skilled nursing centers in the area, Huber spent three weeks post-surgery at Redwood Terrace.           

“I got such good care that I had no qualms coming back a few years later when I had a knee replacement,” says Huber. Thanks in part to her experience in skilled nursing, Huber moved permanently to Redwood Terrace’s independent senior living community in 2012.

Skilled nursing provides the highest level of care available outside a hospital for those who need to recover for a short time and those who need 24-hour care for the long term. But no two skilled nursing communities are alike. “It can be especially stressful if you are in crisis mode after a hospitalization or accident,” says Lisa Francis, director of nursing at Redwood Terrace.

Here are five steps to make your search easier.

Step 1: Understand the basics of skilled nursing care.

If you know next to nothing about skilled nursing, don’t worry—most people don’t until they need it. Sophia Lukas, executive director at Redwood Terrace, shares these pointers with prospective residents:

  • Skilled nursing includes medical care for a variety of conditions as well as custodial care (help with eating, bathing, dressing and getting in and out of bed).
  • Care is provided by a mix of professionals, including physicians, occupational and physical therapists, speech pathologists, audiologists and nurses.
  • Short-term skilled nursing (up to 100 days) is typically covered all or in part by Medicare if it follows a hospital stay. Long-term care in skilled nursing may be paid for out-of-pocket, with long-term care insurance or by Medicaid.
  • Skilled nursing communities may also offer a few days or weeks of “respite care” for people with medical conditions who receive their health care at home.


Step 2: Make a list of senior living communities you are considering.

Location is often the most important factor when choosing a skilled nursing community. Francis suggests asking the hospital’s discharge planner for recommendations in the area or generating a list by entering your ZIP code into Medicare’s online tool, Nursing Home Compare.

Step 3: Ask for senior living community referrals.

Friends, family and neighbors can be a good source of information. Ask if they have any personal experiences to share. “I knew the food was good at Redwood Terrace because I had eaten here with friends,” Huber says.  

Online directories like, A Place for Mom, and even offer ratings or reviews of skilled nursing communities. Ratings are also available on Yelp, Facebook and Google, though reliability and trustworthiness are uncertain. 

Step 4: Compare skilled nursing survey results.

To ensure seniors receive high-quality care, state health departments annually inspect skilled nursing communities. The findings are available online and in the skilled nursing community’s lobby or main office.

Medicare-certified skilled nursing communities must meet more than 180 standards designed to protect residents’ health, safety and quality of life. If a community falls short on any of these standards, inspectors issue a “deficiency,” and the community is expected to correct it. Deficiencies are rated by severity and scope.

“We’re really proud because we had zero deficiencies this year,” says Francis, of Redwood Terrace's most recent inspection.

A deficiency citation doesn’t necessarily mean that the care in a skilled nursing community is poor. The average number of deficiencies per facility is 8.4 nationwide and 10.5 in California. Even the best communities may receive minor citations. “One year we received a deficiency because there was a dented can on the shelf of the pantry,” Francis says.           

If a skilled nursing community has received deficiencies, discuss it with the community’s administrator. “What have they done to correct the deficiency?” Lukas says. “Do they own it and take responsibility for it, or are they trying to hide it? How they respond to deficiencies really matters.”

Step 5: Tour senior living communities.

Once you have a list, you or someone in your family can schedule a tour.

During your visit, staff will show you common areas, dining venues, bedrooms, bathrooms, therapy areas and other key spaces. You also can ask about insurance coverage, visiting hours, availability, daily activities and other topics.

After your visits, contact administrators with any follow-up questions, and feel free to return for a second visit. The more information you obtain, the better equipped you will be to choose the right community for you—even in a rush.

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