Red Flags Families Often Miss

Warning signs to watch for when touring nursing homes and evaluating potential facilities for your loved one.

Trust Your Instincts

While this guide provides specific warning signs to watch for, your gut feeling matters. If something feels "off" during your visit—even if you can't pinpoint exactly what—take that seriously and investigate further or consider other facilities.

Remember: A few minor issues may be normal, but patterns of problems or multiple red flags should raise serious concerns.

• ✗Strong urine odor in hallways or resident rooms

• ✗Residents in soiled clothing or bedding during your visit

• ✗Visible dirt, stains, or clutter in common areas

• ✗Bathrooms that are unclean or lack basic supplies

• ✗Food spills or trash not promptly cleaned

• ✗Pest problems or signs of infestation

• ✗Staff appear rushed, stressed, or unable to respond to call buttons promptly

• ✗High turnover with many new or unfamiliar faces during repeat visits

• ✗Difficulty finding staff members or getting questions answered

• ✗Residents left unattended for long periods or crying out without response

• ✗CNAs or aides performing tasks beyond their scope of practice

• ✗No registered nurses visible on the floor during your visit

Staffing Warning Signs

Hygiene Issues

You don’t need to see every red flag to be concerned. One serious issue—or a pattern of smaller ones—is enough to pause and reassess.

• ✗Staff are defensive or evasive when answering questions

• ✗Refusal to show you certain areas of the facility

• ✗Inability to provide clear information about costs or contracts

• ✗Pressure to make immediate decisions or sign contracts quickly

• ✗Vague answers about staffing ratios, qualifications, or turnover

• ✗No clear process for addressing concerns or complaints

• ✗Multiple residents with visible pressure sores or skin breakdown

• ✗Residents appearing excessively sedated or "zoned out"

• ✗Unexplained bruises, cuts, or injuries on residents

• ✗Residents restrained in chairs or beds without clear medical need

• ✗Poor grooming, unkempt hair, or overgrown nails

• ✗Residents calling for help repeatedly without response

Resident Condition Red Flags

Communication & Transparency Issues

• ✗Any signs of physical or emotional abuse

• ✗Residents expressing fear of staff members

• ✗Medication errors or improper medication storage observed

• ✗Fire hazards or blocked emergency exits

• ✗Immediate jeopardy citations in recent inspection reports

• ✗Residents in obvious distress with no staff intervention

• ✗Recent change in ownership or management

• ✗Multiple serious health violations in recent inspections

• ✗Unaddressed safety hazards (broken equipment, poor lighting, etc.)

• ✗Residents have little to no personal belongings or decorations

• ✗No structured activities or residents sitting idle all day

• ✗Difficulty scheduling tours or being turned away without notice

Operational Considerations

Serious Immediate Concerns

What to do If You Spot Red Flags

1. Document What You Observe

Take notes during your visit, including dates, times, and specific observations.

2. Ask Direct Questions

Bring up your concerns with administrators and note their responses and willingness to address issues.

3. Visit Multiple Times

Schedule unannounced visits at different times of day to see if problems persist.

4. Consider Other Options

If serious red flags persist, move on to evaluate other facilities. Your loved one's safety and well-being are paramount.

Ask Direct Questions

Don't be afraid to ask questions. Facilities welcome the opportunity to educate families about what to expect about the care of their loved one.

Red Flags

Spot warning signs that may affect your loved one's care quality.

Staffing

Inadequate staff numbers or frequent turnover can compromise care.

Cleanliness

Unclean rooms or common areas may signal neglect or poor management.

Watch for unpleasant odors or visible dirt in living spaces.

Communication