What to Ask a Nursing Home’s Director of Nursing Before Admission
The director of nursing can answer questions that marketing staff should not be expected to answer.
For a resident with complex needs, the family should understand how nursing care actually works on the proposed unit.
Ask about capability, escalation, continuity, and the resident’s specific needs—not simply “How many nurses do you have?”
Start with the proposed unit
Ask:
- Which unit would my parent likely enter?
- Who supervises nursing on that unit?
- What resident needs are common there?
- What clinical needs would make the unit inappropriate?
Facility-wide answers may not describe the actual floor.
Ask how nursing coverage works
Federal rules require sufficient nursing staff with appropriate competencies to meet resident needs, but a family needs more operational detail.
Ask:
- How do you adjust staffing when acuity changes?
- How are call-outs covered?
- How much agency/temporary staffing is used?
- Who is the nursing supervisor after hours?
- What happens when several residents deteriorate at once?
Do not demand a fixed staff-to-resident ratio that may not be the applicable regulatory standard.
Ask about the resident’s high-risk needs
Bring a short list:
- wound care;
- oxygen/respiratory care;
- injections/IV therapy;
- feeding tube;
- dialysis coordination;
- bariatric equipment;
- complex transfers;
- dementia-related behaviors; or
- frequent medical appointments.
Ask the DON to explain whether the facility currently supports the exact need.
Ask how changes reach a clinician
Federal nursing-home rules require physician supervision and 24-hour provision/arrangement of physician services for emergencies.
Ask:
- Who evaluates a new change first?
- When is the physician/NP/PA called?
- Is there telehealth?
- Who covers nights/weekends?
- When is 911 used?
- How does family get notified?
Ask about continuity
Questions:
- Do residents usually see the same nursing team?
- How is handoff handled between shifts?
- How is a new order communicated?
- How are consultant recommendations incorporated?
- How are medication discrepancies resolved?
Ask how the care plan becomes daily care
Federal rules require person-centered care planning.
Ask for a concrete example of how a resident preference or clinical need changes the daily schedule.
DON interview card
Proposed unit: ______
Nursing supervisor: ______
After-hours coverage: ______
Resident-specific need reviewed: ______
Facility confirms capability: ______
Escalation path: ______
Primary clinician model: ______
Family notification process: ______
Biggest limitation identified: ______
Frequently asked questions
Will the DON meet every touring family?
Not always. Ask for an appropriate nursing leader or clinical reviewer when the resident has important clinical needs.
Is the director of nursing the resident’s doctor?
No. Nursing leadership and physician/practitioner roles are different.
What answer should worry us?
A vague “we handle everything” is less useful than a clear description of capabilities and limits.
The practical goal
The best clinical interview ends with a realistic statement:
These are the needs we can manage, this is how we respond when they change, and these are the needs that would require another plan.
Related NHP guides
- Questions to Ask a Nursing Home: Tour Checklist
- Nursing Home Infection Prevention: What to Ask and Observe on a Tour
Primary sources checked
- eCFR — 42 CFR §483.35 Nursing services
- eCFR — 42 CFR §483.30 Physician services
- eCFR — 42 CFR §483.21 Care planning
*Editorial/source review: October 15, 2026. General education only; state licensure, facility capability, survey interpretation, and admission suitability require current site-specific verification.*
