Choosing a nursing home for your elderly parent? I recently made the very difficult decision to move my father from assisted living into a skilled nursing facility. While intellectually I knew he needed, and deserved, more care than he could get in assisted living, emotionally I struggled with the loss of independence and privacy that come with moving to a nursing home, and so I wanted to make sure I found him the best possible home.

I read plenty of articles on how to choose a facility, I visited Nursing Home Compare at Medicare.gov to review quality ratings and health inspections, and I scheduled a day off from work so I could visit as many places as possible. I was prepared with a checklist of things to look out for and questions to ask. And then, lucky for me, and my father, I read an article by Ann Brenoff at The Huffington Post the night before my visits and it gave me an idea to add one more step to my evaluation process – something none of the other articles mentioned, but something I am convinced helped me find the best place for my father.

Brenoff wrote, “A nursing home is, of course, only as good as its most disgruntled worker.” Truer words…  A few weeks before, I had sent my father for a short-term stay at a skilled nursing facility so he could rehab after a hospital stay. I grilled the hospital discharge worker for her recommendations on where to send him, I consulted with the wellness director at assisted living, I asked friends for recommendations, and I consulted the Medicare site. I thought I picked a good place – highly recommended, clean, and close to home. I was wrong.

In the four days my father was there, the staff sent him back to the ER twice, once due to a fall. When I brought him back to the rehab after the first hospital visit, I asked the staff to put an alarm on his bed so that they would know if he got up unattended. But when I came back the next day he was sitting up in a chair – with no alarm. The same thing happened the day after that. I had it installed and about an hour later, I accidentally set it off. Rather than turn it off myself, I waited. Four minutes later an aid shuffled into the room, disconnected the alarm, and turned to leave.

“He could have fallen!” I said.

“I was down the hall,” the aid said and turned to leave.

“But he could have fallen!”

“Do you need something?” he replied.

I appreciate that many of the workers in the eldercare industry are underpaid and overworked. I don’t blame the people – many of whom are working two jobs to get by – for low levels of care and service. I blame the system. But regardless of where the fault lies, I wanted more for father. So after reading Ann Brenoff’s article, and reflecting on my experience at the rehab, I added a step to my evaluation process.

At each facility I visited, I sat in my car in the parking lot, and I waited and watched. I waited for staff to show up for work and I observed how they approached the building. Did they drag themselves into work or did they have a pep in their step? Did they look pleasant or were they scowling? Were they holding their head up or was it hanging down? Once in the building I continued to watch the staff. Did they make eye contact or look at the floor? Did they joke and talk to coworkers or were they on autopilot?

And based on what I observed, I chose a place for Dad. I weighed the results of my parking lot evaluation over the typical criteria – smell, whether or not the place had a family council, appearance, and location. And while it’s only been a month since my father moved in to his new home, I think my litmus test worked. The staff let’s my father follow his own schedule. They transfer information from one shift to the next. When I walk down the halls, everyone from the admissions director, to the nursing director, to the custodian, greet me and my father, and usually by name. Yesterday, my father and I went to the activity room with some other residents to hear a concert. There was a frail woman sitting in a wheelchair and I noticed she was waving her arm around; I didn’t know why. Then I saw an aide cross the room, stand next to her and hold her hand. And they stayed like that until the concert ended. It was the same man whose shift started when I was first visiting and he showed up for work with a big smile on his face and a bigger bounce in his step.

Download the Working Daughter Checklist for Choosing a Nursing Home.