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To choose a nursing home in North Dakota, first confirm that the person needs nursing-facility-level care, then compare only facilities that can meet those needs. Check current state and federal survey findings, ask about staffing and services, visit at different times if possible, get a resident-specific cost estimate, and read the admission agreement before signing. A tour or rating alone cannot tell you whether a home is the right fit.
1. Confirm that nursing-facility care is the right level
North Dakota’s Long-Term Care Decision Tree describes nursing facilities as serving people with complex needs who require 24-hour nursing care and supervision. Start by asking the person’s clinician and family whether that level of care is needed, rather than treating a nursing home as the default whenever help at home becomes difficult.
Before contacting facilities, describe what the person needs throughout a typical day and what could require a quick response. This helps you assess whether the person needs nursing-facility care, identify homes that may be able to provide it, and compare their answers. If the person’s needs may be met in another setting, compare basic care and home- or community-based supports too. North Dakota’s Care Choice directory lists state long-term-care and support resources, and the Aging and Disability Resource Link is available at 1-855-462-5465.
Make a resident-specific needs list
- Diagnoses, medications, allergies, treatments, and expected changes in health.
- Mobility, transfers, fall risks, and how quickly the resident may need assistance.
- Memory or behavioral support, communication needs, language preferences, and decision-making support.
- Diet, meal assistance, personal routines, privacy, religious or cultural preferences, and preferred activities.
- Rehabilitation or other therapies, including how often they are expected and who will provide them.
- Preferred towns, family travel distance, room preferences, and desired visiting arrangements.
Include both clinical needs and the details that make daily life comfortable. For example, note what assistance is needed with transfers, what communication approach works, and whether the person has a routine or dietary preference the facility should understand. Ask the person’s clinician and each prospective home whether the facility can safely meet these needs now and how it would respond if they change.
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Ask which services are available on site and which are provided by outside clinicians. If a service is external, ask how it is arranged and coordinated. Clarify what happens when a resident’s condition changes, who assesses the need for additional support, and how the facility communicates with the resident or representative. Avoid relying only on a general assurance that the home can “handle” a need; ask who provides the care and how it fits into the resident’s routine.
Ask about current openings and wait lists early. North Dakota’s resident-rights booklet notes that a chosen facility may not have an immediate opening, so availability may affect timing even when a home appears to be a strong fit. If there is no opening, ask how the wait list works and whether the facility can provide an estimate, while continuing to assess other appropriate options.
2. Find candidates and examine their survey records
Use the North Dakota HHS Skilled Nursing Facilities directory to identify candidates and confirm their current status and contact details. Facility information can change, so verify it again when you contact a home or prepare to visit. Start with facilities that serve the towns and locations the family can realistically reach, but do not let convenience replace the first question: can this facility meet the person’s care needs?
Review the state and federal survey information linked from HHS. Survey packets may include health, life-safety, and state licensing findings. Treat a finding as a prompt for a focused question, not as a complete prediction of the care one particular resident will receive. Look at the actual issue and whether it relates to the person’s likely needs—for example, whether a finding concerns an area of care the resident depends on.
Read findings for substance, not page count
North Dakota HHS cautions that report length does not indicate the severity or scope of survey findings. For each finding relevant to the person’s likely care, look at the cited regulation, what the survey describes, its scope and severity, and the facility’s response or plan of correction. Ask the facility what changed, how it checks that the correction is working, and whether the issue could affect this resident.
HHS also notes that “the goal is substantial compliance which is not the same as total compliance.” Read the actual findings and correction information rather than assuming a report with no lengthy narrative is automatically better—or that a longer packet necessarily means more serious problems. A useful comparison considers the substance of findings, their relevance, and the steps the facility says it took to address them.
When discussing a finding, ask for a plain-language explanation. You might ask what the facility identified as the cause, what correction it made, and how it monitors the situation now. Compare the answer with the written finding and plan of correction. If the response is unclear, ask who can explain it or where to find the supporting information. The point is not to make a judgment from a page count, but to understand what happened and whether the response addresses the concern.
Use national comparisons as one input
Current Medicare Care Compare can be useful for national comparisons. North Dakota’s older Long-Term Care Decision Tree refers to Nursing Home Compare, so do not rely on its older interface directions; verify the current Medicare page and information. Ratings, where available, are a starting point for questions, not a substitute for reading survey records, asking about care, and visiting.
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No single star rating or summary can show whether a facility can meet an individual’s particular clinical, communication, cultural, and daily-life needs. Use any national comparison to identify questions and differences to investigate. Then consider it alongside state and federal survey information, what staff tell you, and what you observe on visits.
3. Ask how care and staffing work on an ordinary day
Ask who is responsible for nursing care on the shifts when the resident is likely to need help. Find out how assignments are made, what happens when staff members are absent, and how the home handles changes in condition. Request current staffing information and ask the facility to explain how it should be interpreted alongside survey findings. Staffing information can change, so ask when the figures or details were current and what they mean for the resident’s needs.
Ask how staff know which residents need assistance and how the facility handles requests for help. If the person needs support with transfers, medication or treatments, memory, meals, or communication, ask who is expected to provide that assistance and how the facility maintains continuity. Ask how staff absences are covered and who makes decisions when a resident’s condition changes. Compare the answers at each home instead of accepting broad statements that staffing is adequate.
Ask who coordinates primary care, specialist visits, pharmacy services, and emergencies. Clarify how the facility communicates a change in condition, a hospital transfer, or a concern from the resident to the family member or representative. Ask whom the family should contact, how communication is handled, and how family meetings are arranged. If the resident needs a particular treatment, therapy, memory support, or communication accommodation, ask who will deliver it and how the facility ensures continuity.
Speak with direct-care staff as well as leadership when you can. Specific answers about daily routines are more useful than broad assurances. During a visit, notice whether residents appear to receive assistance in a timely way and whether staff speak to them respectfully. A tour is only a snapshot, so compare what you observe with the records and the facility’s answers.
4. Tour the home and assess whether it fits
Visit when residents are active, and, if possible, make a second visit at a different time. Ask to see the room type the resident would likely use, dining areas, activity or outdoor spaces, and any area relevant to the person’s needs. If a resident or family member is comfortable speaking with you, ask about communication and daily routines without pressuring them to share private information.
Use the visit to check daily life
- Notice whether residents appear to receive help in a timely way and whether staff speak to them respectfully.
- Look at whether resident rooms and common areas appear clean and calm.
- Ask what residents can choose about their routines, meals, activities, personal belongings, and privacy.
- Clarify visiting practices, how family meetings are arranged, and whom to contact with a concern.
- Ask how the home accommodates language, religious, cultural, dietary, and room preferences.
- Ask how primary care, specialists, pharmacy services, and urgent or emergency needs are coordinated.
Use the same questions at each home. Record the answers, who gave them, and any follow-up promised. Ask to see spaces that matter to the resident, not only the main common areas. If activities, outdoor access, a particular room type, or dining arrangements matter, ask how residents use those spaces and what choices they have in their daily routine.
Ask residents or families about communication and routines when appropriate, but respect their privacy and choice not to talk. During a tour, keep observations specific: what you saw, when you saw it, and what you would like clarified. A busy or quiet moment alone does not establish what care is usually like, which is one reason a second visit and follow-up questions can be useful.
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Use the same set of questions at every facility so you can compare answers rather than relying on memory. Note who responded and whether an answer was specific or needs follow-up. Compare clinical fit, survey findings and corrections, staffing, location and availability, resident dignity and routine, written costs, and communication—not one star rating or a polished tour. A good-looking building cannot answer questions about care, and a survey report cannot show every part of daily life.
5. Compare the full cost and payment policies
Request a written estimate based on the resident’s needs. Ask what the daily charge includes, which items or services could cost extra, how charges may change if care needs change, and what happens to billing during a hospital stay. Ask which insurance or public benefits the facility bills and what the resident or family may owe. Request explanations for charges that are not clear, and compare written estimates on the same basis where possible.
Medicare coverage for nursing-home care is limited. Do not assume Medicare will pay for a long-term stay. North Dakota Medicaid has financial and level-of-care rules, so use state or county eligibility channels for eligibility questions rather than relying on a facility’s informal estimate. Ask the appropriate state or county eligibility contact about eligibility; a facility’s estimate of charges is not an eligibility decision.
Ask directly about Medicaid-pending admission
Skilled nursing facilities set their own admission policies. Some may not accept a resident whose Medicaid application is pending. Ask each home whether it accepts Medicaid-pending residents, whether it requires a private-pay period or deposit, and what happens if an application is delayed or denied. Get the facility’s answer and any applicable terms in writing before making a decision. Do not assume that a policy at one home applies at another.
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Understand the North Dakota rate classification
North Dakota Medicaid materials explain that facility daily rates include indirect costs, such as property costs, and direct costs tied to care. Beginning January 1, 2026, classification notices use a three-letter ND PDPM classification: speech-language pathology, nursing, and non-therapy ancillaries. The facility completes an assessment every three months, and the classification helps set the daily rate.
Ask which classification applies to the resident, how the written estimate was calculated, and when the amount may change. Ask how the facility will communicate a change after an assessment. The classification is a rate-setting tool; it is not a substitute for asking what the resident will actually be charged or which services are included. Check that the estimate, included services, and explanation of possible changes are understandable before comparing it with another facility’s quote.
Evaluate long-term-care insurance on its terms
If the resident has or is considering long-term-care insurance, review the policy rather than assuming it will cover the chosen home. Compare its benefit triggers, elimination period, daily benefit, benefit duration, inflation protection, exclusions, and whether it covers the setting the resident needs. The North Dakota Insurance Department says policies vary, coverage is not guaranteed, and consumers should verify that an insurer’s product is approved for sale in North Dakota. No single policy is appropriate for every family.
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Ask the insurer how the policy’s terms apply to the setting under consideration and what information it requires to determine whether benefits are payable. Do not treat a policy as a guarantee that a particular stay or charge will be covered. Compare the policy’s limitations with the facility’s written cost estimate and ask for clarification before relying on expected benefits.
6. Read the admission agreement and understand resident rights
North Dakota’s resident-rights booklet, updated August 1, 2025, says a resident or representative has the right to review the admission agreement, rules, and policies before admission. Read the full agreement before signing, even if staff have already explained the main charges. Ask for copies of the agreement and referenced policies so the resident or representative can review them carefully.
Check the written terms for services, charges, notice requirements, discharge, room changes, handling of personal funds, and complaint procedures. Ask how the contract describes the resident’s services and what may lead to a change in charges or room assignment. Ask for a plain-language explanation of anything unclear, and request important answers in writing. Keep copies of the agreement, estimates, and related correspondence.
The booklet says payment source cannot be the basis for discrimination in admission, a written reason for denial can be requested, and a facility cannot require family or friends to pay the bill from their personal funds. If a facility asks a family member to sign, clarify whether that person is signing as a representative or agreeing to a personal financial obligation; do not rely on an oral explanation of a contract term. If admission is denied, the resident or representative may request a written reason.
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Do not rush through questions about who is responsible for charges, how personal funds are handled, how notices work, or how to make a complaint. Confirm that the agreement and the facility’s verbal explanation match. If a term is not clear, ask for it to be explained in writing before signing. Keep the final signed agreement and related documents where the resident or representative can find them later.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.7. Know where to take questions or concerns
North Dakota HHS’s Health Facilities Unit lists skilled nursing facility survey results, rules, nurse aide registry information, complaint contacts, and the Long-Term Care Ombudsman Program. Use the Ombudsman for resident-directed advocacy and the Health Facilities Unit for regulatory concerns. These are different kinds of help: an Ombudsman can support a resident’s interests, while the Health Facilities Unit handles regulatory concerns.
The HHS facility-concern form asks whether the family has discussed the concern with the administrator or director of nursing, or with the provider or medical director. Its concern email is not monitored 24/7. If a matter needs immediate attention, contact facility staff rather than relying on email. The Care Choice directory lists the Ombudsman Program at 1-855-462-5465, option 3.
For a concern that can be raised with the facility, note what happened and whom you contacted, and ask how the facility will follow up. The HHS form’s question about prior discussion is a reminder to consider the appropriate facility contact, but do not wait for an email response if a matter requires immediate attention. Keep the Health Facilities Unit and Ombudsman contacts available after admission as well as during the selection process.
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Make the decision with a consistent checklist
Compare only facilities that can safely meet the resident’s needs. For each candidate, keep notes on the care services available, relevant survey findings and correction plans, staffing answers, location and opening status, observations from visits, total written cost, payment policies, and the clarity of the agreement. Resolve unanswered questions before admission, especially those about clinical fit, Medicaid-pending policies, charges, and who to contact when care changes.
A simple comparison sheet can help keep the decision grounded. For each home, record: whether it can meet the resident’s current needs and likely changes; the survey findings that matter and the facility’s response; what staff explained about assignments and absences; what you observed on one or more visits; whether there is an opening; the written estimate and possible extra charges; its Medicaid-pending policy; and any unclear agreement terms. Write down follow-up answers rather than relying on memory.
There may not be one perfect facility on every measure. Prioritize the resident’s necessary care first, then compare the factors that matter to this person: clinical services and specialty fit, inspection findings and corrections, staffing availability and continuity, location and family access, daily routine and dignity, total cost and payment policy, and clear communication. No single rating, tour, or estimate answers all of these questions. A careful decision is one based on specific evidence, direct answers, and written terms the resident or representative understands.
Frequently Asked Questions
How do I choose a nursing home in North Dakota?
First confirm with the person’s clinician and family that nursing-facility care is appropriate for complex needs requiring 24-hour nursing care and supervision. Then compare homes that can meet those needs using current state and federal survey information, staffing and service answers, visits, availability, written costs, payment policies, and admission terms.
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What should I look for when touring a nursing home?
Visit when residents are active and, if possible, at another time too. Ask to see the likely room type, dining and activity areas, and spaces relevant to the resident. Notice whether residents receive timely help and are treated respectfully, and ask about daily choices, privacy, visiting, family meetings, and care coordination.
How do I compare nursing home inspection reports?
Look at the cited regulation, the substance of each finding, its scope and severity, and the facility’s response or plan of correction. North Dakota HHS says report length does not indicate severity or scope. Ask what changed and how the facility checks that its correction is working.
Does Medicare pay for a nursing home?
Medicare coverage for nursing-home care is limited, so do not assume it will pay for a long-term stay. Ask the facility which benefits it bills and what the resident may owe, and check current Medicare information for the person’s situation.
Will a North Dakota nursing home accept Medicaid pending?
Policies vary by facility, and some skilled nursing facilities may not accept residents whose Medicaid applications are pending. Ask each candidate directly about its policy, any private-pay period or deposit, and what happens if an application is delayed or denied. Confirm eligibility questions through state or county channels.
What should I ask before signing a nursing home admission agreement?
Review the agreement, rules, and policies before admission. Clarify services, charges, notice and discharge terms, room changes, personal funds, and complaint procedures. Ask whether a family member is signing as a representative or taking on a personal financial obligation, request unclear explanations in writing, and keep copies.
The Bottom Line
Choose among homes that can meet the resident’s needs, not by rating or tour alone. Review current survey findings and correction plans, ask specific questions about staffing and services, visit more than once if possible, compare written cost and payment terms, and read the agreement before signing. North Dakota’s Care Choice directory, Health Facilities Unit, and Long-Term Care Ombudsman Program can help families find resources and raise concerns.
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