How to evaluate an Italian care home when you cannot visit: a remote checklist

The problem with choosing from 6,000 km away

Everything families are told about choosing a care home assumes you can walk in: look at the residents, smell the corridor, watch how staff speak to people. From another country you have a phone, an email address and a website that was written by a marketing agency.

The good news is that most of what actually predicts quality can be extracted by phone — if you ask for numbers rather than reassurance. Homes will always say yes to "do you have activities?" and "is there a nurse?". They cannot bluff a ratio, a date or a document.

Start with the paperwork that proves the basics

Before anything else, establish what kind of place this is. Ask for these by email:

• Is the home accreditata with the region, and does it hold publicly funded places? An accredited home has met regional standards and is inspected. A purely private, authorised-but-not-accredited home may be perfectly good — but you should know which you are dealing with.
• The carta dei servizi. Every Italian care home must have one. It sets out services, staffing, meal arrangements, visiting and complaints. Ask for the PDF. A home that cannot email it within a day is telling you something about its administration.
• The blank contract and the price list. Ask for the standard contratto and the retta breakdown before you are emotionally committed. Read the clauses on notice, deposit, absence for hospital stays, annual increases, and what happens on death.
• What is included in the daily rate and what is billed on top — incontinence pads, physiotherapy, hairdressing, transport to appointments, extra laundry. Ask for the extras list in writing. This is where the real monthly cost is decided.

The numbers that separate homes

Ask these exactly, and write down what you are told with the date. If a home will not answer, that is your answer.

1. "How many staff are physically in the building between 10pm and 7am, and for how many residents?" The night is where quality is decided, and it is the one figure nobody volunteers.
2. "Is a nurse present overnight, or on call?" Present means a fall gets assessed and pain gets treated. On call means an ambulance and a night in an emergency department.
3. "What time are residents put to bed?" If most are in bed by 6.30pm, that is a thin roster, not a sleep routine.
4. "What is your staff turnover this year?" High churn is the single best predictor of poor care, and continuity is what makes someone notice your mother is not herself.
5. "What proportion of residents are on antipsychotics?" A home that has never counted has told you something. A home that answers precisely is usually a good home.
6. "Is there a nucleo Alzheimer, physically separate, or do residents with dementia live on general floors?" If dementia is in the picture, this decides everything.
7. "How many residents per doctor, and who is medically responsible at 3am?"

The visit you cannot make — and who can

Send someone. A cousin, a neighbour, an old family friend, a former colleague of your father's. It does not have to be a relative and it does not have to be an expert.

Give them a short brief, because untrained eyes see the right things when told what to look for:

• Go at 6pm on a weekday, not at 11am. Late afternoon is when homes are thinnest and most honest.
• Where are the residents? In a lounge, engaged with something, or lined up in front of a television nobody is watching? Are people dressed, or in nightwear at five in the afternoon?
• Listen to how staff speak to residents — by name, at eye level, or across the room in the third person.
• Smell. A brief smell near a bathroom is normal. A persistent smell in corridors and lounges is understaffing.
• Look at the residents' hands and mouths — nails, shaving, teeth. Personal grooming is the first thing to go when a home is short-staffed.
• Count the staff visible in ten minutes, and note the time.

Ask them to send you photos of the actual room offered — not the show room — and of the dining room at a mealtime.

What a video call can and cannot do

Ask for a video walk-through, and take it for what it is: a curated tour. Still, it is worth doing, and two things make it more useful. Ask to see the specific room being offered, and ask to be shown the corridor and lounge without stopping — the unedited walk between two points shows you more than any single room.

Ask also to speak by phone with the coordinatore or the head nurse, not only the admissions office. The person who runs the floor answers differently from the person who fills beds.

Two things to check that have nothing to do with the building

• Distance from whoever will actually visit. A better home ninety minutes away that nobody visits is worse than a good home fifteen minutes from a cousin. Attention follows visitors, and this is the single most underweighted factor in every decision made from abroad.
• Whether they will communicate with you across a time zone. Ask directly: who is my named contact, what is their email, and will they reply in writing? A home that only does phone calls at 9am Italian time will become a problem in month two.

Red flags you can detect remotely

• Refusal to send the carta dei servizi or the blank contract.
• Pressure to decide immediately, or a deposit requested before you have seen the contract.
• Vague answers to numerical questions — "we always have enough staff".
• Nobody will name the doctor or the coordinator.
• A place with immediate availability in an area where everyone else has a waiting list. Sometimes that is luck. Often it is turnover.

Before you sign

Get the contract by email and read the clauses on notice period, deposit, hospital absences, annual increases and what happens on death. Ask whether the health-care share of the fee will be stated separately on the invoice, because that portion is deductible on the Italian tax return. And make sure someone has the legal authority to sign — an Italian procura if your parent can still sign, or an amministratore di sostegno if not, which takes months and should be started first.

If the calling is the part you cannot do

Extracting these answers, in Italian, across a time difference, from homes that answer the phone for two hours a morning, is genuinely hard — and it is the part we do. Tell us the area, your parent's needs and your timeframe, and you get a shortlist of homes worth calling, for $89. If you don't receive at least 3 homes matching the area and criteria you gave us, we refund you in full. Start here

This article is general information for families, not legal, tax or medical advice. Accreditation, staffing standards and funding rules are set regionally in Italy and change over time. Curalune does not allocate beds and does not guarantee availability.