Resident Preferences in Nursing Homes: Recording What a Good Day Looks Like
A nursing-home resident can receive every required task on a checklist and still have a day that feels wrong.
Maybe breakfast arrives before she is fully awake. Maybe staff choose clothes she would never wear. Maybe she prefers a quiet morning but is repeatedly invited to large-group activities. Maybe she needs extra time to answer questions and becomes frustrated when people assume silence means agreement.
These details are not trivial. Federal nursing-home guidance emphasizes person-centered care—care that treats the resident as the center of control and incorporates personal goals, routines, cultural preferences, choices, and desired outcomes.
A family can help by creating a short, practical description of what a good day looks like for this particular person.
Start with the resident, not the family’s assumptions
Whenever possible, ask the resident directly.
Useful prompts include:
- What time do you like to wake up?
- Do you want quiet time before breakfast?
- What foods do you especially like or dislike?
- How do you like to be addressed?
- What helps you feel comfortable during personal care?
- Which clothes make you feel most like yourself?
- Do you prefer group activities, one-to-one visits, independent activities, or a mix?
- When do you like family to call or visit?
- What makes a day feel successful?
- What usually makes a day harder?
If communication is limited, the resident may still express preferences through words, gestures, facial expressions, behavior, pictures, communication devices, or repeated choices. Family history can add context, but it should not automatically replace the resident’s current preferences.
Record the daily rhythm
A useful routine profile is short enough that staff can actually use it.
Morning
Record preferences such as:
- usual wake time;
- whether the resident likes blinds opened immediately or gradually;
- preferred order for toileting, washing, dressing, and breakfast;
- whether the resident wants coffee, tea, music, television, or quiet;
- whether mornings are typically the resident’s strongest or weakest time of day.
Meals
Include:
- favorite and disliked foods;
- usual beverage preferences;
- preferred dining location when options exist;
- whether the resident likes company or quiet;
- culturally or religiously important foods;
- how much time the resident usually needs to eat; and
- any clinically assessed assistance or diet requirements that staff must follow.
Do not use a family preference sheet to override a prescribed diet, swallowing plan, allergy restriction, or other clinical order. If the resident dislikes the current plan, ask the appropriate clinician or dietitian to review it rather than changing it informally.
Personal care and privacy
Ask the resident what matters during bathing, toileting, dressing, grooming, and other hands-on care.
Examples:
- door closed;
- privacy curtain used;
- explanation before each step;
- preference for a particular time of day;
- preferred clothing or grooming routine;
- who may be present; and
- words or approaches that feel respectful.
Federal resident-rights guidance protects privacy during personal care and supports the resident’s participation in care decisions.
Activities and quiet time
A good day does not have to be busy.
Record what the resident actually enjoys:
- religious services;
- gardening;
- sports;
- music;
- crafts;
- television;
- reading;
- walks;
- sitting outdoors;
- phone or video calls;
- naps;
- visits; or
- simply having uninterrupted quiet time.
The goal is not to fill every hour. It is to make preferred activity and rest possible.
Include communication preferences
A short communication section can prevent repeated misunderstandings.
Examples:
- “Please face me before speaking.”
- “Give me extra time to answer.”
- “I hear better on my left side.”
- “Use my hearing aids before discussing important decisions.”
- “Offer two choices rather than asking a broad open-ended question.”
- “My daughter may help clarify my history, but ask me first.”
Do not label a resident “noncompliant,” “difficult,” or “confused” simply because the communication approach is not working.
Add what comfort looks like
The profile can include nonmedical comfort preferences:
- room temperature;
- favorite blanket;
- lighting;
- preferred chair;
- music;
- sleep routine;
- pain communication cues already known to the team;
- spiritual practices; and
- who the resident wants contacted when distressed.
Clinical pain assessment and treatment still belong to the care team. The family profile should help staff recognize the resident as a person, not substitute for clinical assessment.
Write down important “please avoid” items carefully
These may include:
- a nickname the resident dislikes;
- waking the resident unnecessarily when a task can safely wait;
- discussing private information in front of visitors;
- turning on a television the resident does not want;
- moving personal belongings without explanation; or
- a known trauma trigger that the resident has chosen to share.
If a preference affects safety or clinical care, ask the interdisciplinary team to work with the resident on an individualized solution. A preference sheet is not authority to ignore a clinical risk.
Put the most important preferences into the care-planning conversation
Federal comprehensive care-planning rules require nursing homes to develop and implement a person-centered care plan that addresses the resident’s needs, goals, and preferences.
Ask:
- Which preferences belong in the formal care plan?
- How are they communicated across shifts?
- How will temporary or agency staff learn the critical items?
- Who updates the plan when the resident’s preferences change?
- Can the resident request a revision?
The one-page profile can support the process, but it does not replace the facility’s assessment or clinical care plan.
Revisit the profile after the resident settles in
Preferences can change after a move.
A resident who initially wanted meals in the room may later enjoy the dining room. A person who once enjoyed large activities may prefer smaller groups. Sleep patterns, energy, mobility, sensory needs, grief, illness, and new friendships can all change the day.
Ask the resident again rather than treating the admission profile as permanent.
A one-page “good day” template
Preferred name: ____________________
Best way to communicate with me: ____________________
Typical wake time: ____________________
Morning routine that works best: ____________________
Food/drink preferences: ____________________
Personal-care/privacy preferences: ____________________
Clothing/grooming preferences: ____________________
Activities I enjoy: ____________________
Quiet/rest time I value: ____________________
People/rituals that are important to me: ____________________
Things that usually upset or overwhelm me: ____________________
What helps me feel better: ____________________
What a good day feels like to me: ____________________
Frequently asked questions
Is the facility required to follow every preference exactly?
Not every preference can always be accommodated exactly, especially when safety, clinical needs, other residents’ rights, or practical limitations are involved. The important point is that the resident’s choices and goals should be taken seriously and incorporated into person-centered planning to the extent practicable.
Can family members create the profile if the resident has dementia?
Family can contribute important history and observations, but the resident should still be included to the extent possible. Current reactions and choices matter, even when verbal communication is limited.
What if a preference conflicts with a clinical order?
Do not simply ignore the order. Ask the clinical team to review the concern with the resident and, when appropriate, the representative. The goal is a safe plan that respects the resident’s choices as much as possible.
The practical goal
A useful profile gives staff a fast answer to one question:
“What helps this resident feel like himself or herself during an ordinary day?”
That information belongs alongside the clinical facts—not instead of them.
Primary sources checked
- eCFR — 42 CFR § 483.10, Resident Rights
- eCFR — 42 CFR § 483.21, Comprehensive Person-Centered Care Planning
- CMS State Operations Manual, Appendix PP — Long-Term Care Facility Guidance
- CMS — Person-Centered Care
Editorial/source review: October 16, 2026. General U.S. education only. Individual care plans, representative authority, facility capabilities, clinical orders, and state requirements vary.
Next step for families: Browse senior-care communities to compare local options, or use the Care Finder to organize the care needs and your next questions. Always verify current services, staffing, clinical capability, costs, and availability directly with the provider.
