Nearly all nursing homes in the United States are certified to accept Medicare payments for skilled nursing facility care, so the real challenge is not finding one that takes Medicare but finding one that provides good care, has an available bed, and fits your specific coverage situation. Medicare’s online Care Compare tool at medicare.gov lists every certified facility in the country and lets you filter by location, star rating, and inspection history. But the search gets more complicated depending on whether you have Original Medicare or a Medicare Advantage plan, whether you meet the eligibility requirements for coverage, and how you define quality once you start comparing facilities side by side.
What Medicare Actually Covers in a Nursing Home
Medicare does not pay for long-term custodial care in a nursing home. It covers short-term skilled nursing facility stays for people who need rehabilitation or medical care after a hospital stay. Traditional Medicare requires that you spend at least three consecutive inpatient days in a hospital before a skilled nursing facility stay qualifies for coverage.1PubMed Central. Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase That three-day clock starts from the day of admission but does not count the day of discharge, and “observation status” in the hospital does not count toward the requirement even if you physically spend three nights there.
Once you qualify, Medicare covers the first 20 days in a skilled nursing facility at no cost to you. Days 21 through 100 require a daily copayment, and after day 100, Medicare stops paying entirely. The care must be medically necessary and ordered by a physician. This means Medicare will cover things like physical therapy after a hip replacement, IV medications, or wound care, but it will not cover a nursing home stay simply because someone needs help with daily activities like bathing and dressing.
The three-day rule matters more than most people realize. Research shows that reinstating the rule after a temporary waiver during the pandemic led to a measurable increase in hospitals keeping patients for at least three inpatient days, particularly among those headed to skilled nursing facilities.2PubMed Central. Changes in Inpatient and Skilled Nursing Facility Care After the Medicare 3-Day Rule Reinstatement If your hospital stay falls short of three days or is classified as observation rather than inpatient, you could be stuck paying the full cost of skilled nursing out of pocket. Before you leave the hospital, confirm your admission status in writing.
Using Care Compare to Start Your Search
The most direct way to find Medicare-certified nursing homes is the Care Compare tool on medicare.gov. Every facility that accepts Medicare or Medicaid is listed there, and you can search by ZIP code or city. The tool assigns each facility an overall star rating from one to five stars, based on three components: health inspection results, staffing levels, and quality measures drawn from the facility’s own reported data and resident assessments.
Star ratings are a reasonable starting point, but they have real limitations. The inspection component depends on state surveyors who visit facilities roughly once a year and sometimes less frequently. The staffing data is now based on payroll records rather than self-reports, which improved accuracy, but the quality measures still rely partly on what the facility reports about its own residents. Facilities with the same star rating can look very different once you dig into the underlying data.
A more useful approach is to look beyond the overall star rating and examine the individual inspection reports, which are publicly available on the same site. Each deficiency cited during an inspection is assigned a scope and severity level, ranging from minor isolated problems to widespread patterns that cause serious harm. A facility with two serious deficiencies is a very different proposition from a facility with ten minor ones, even if they end up with similar overall ratings. Researchers have developed scoring methods that weight deficiencies by severity, and those weights vary enormously: a minor isolated deficiency might score 5 points, while a widespread deficiency causing immediate jeopardy scores 100.3ScienceDirect (Journal of the American Medical Directors Association). Scope and Severity Index: A Metric for Quantifying Nursing Home Survey Deficiency Number, Scope, and Severity Adjusted for the State-Related Measurement Bias Reading the actual narrative descriptions of deficiencies, which are included in each inspection report, gives you more useful information than any single number.
Why the Hospital Discharge Process Often Fails You
Most people start looking for a nursing home under pressure, usually while still in the hospital or while a family member is being discharged. This is where the process tends to break down. Research consistently shows that hospital discharge planners typically hand patients a list of facility names and addresses without sharing any data about those facilities’ quality.4PubMed Central. Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals Patients and families have described receiving bare-bones lists with minimal involvement from hospital staff in the actual selection process.5PubMed Central. Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives
Hospital staff often believe that federal patient-choice regulations prevent them from recommending specific facilities or steering patients toward higher-quality options. The reality is more nuanced. Federal rules do require that patients be free to choose their facility, but nothing prevents hospitals from sharing publicly available quality data to help patients make informed decisions. The result is a gap where patients are handed a list and left to make one of the most consequential healthcare decisions of their lives with almost no guidance.
If you find yourself in this situation, ask the discharge planner directly for help interpreting the Care Compare data. Ask which facilities on the list the hospital has the best working relationships with, which ones have availability for your specific care needs, and whether any have a track record of problems. You are legally entitled to choose any Medicare-certified facility that has a bed and can meet your care needs, so the discharge team cannot force you into a particular facility. But they also cannot keep you in the hospital indefinitely while you decide, so doing research in advance or having a family member start the search as soon as a nursing home stay looks likely gives you more time and leverage.
Original Medicare Versus Medicare Advantage
The distinction between Original Medicare and Medicare Advantage matters enormously when it comes to skilled nursing facility access. Under Original Medicare, you can go to any Medicare-certified nursing home in the country. Under a Medicare Advantage plan, your choices are typically limited to facilities within the plan’s network.
Medicare Advantage plans actively manage where patients go for post-acute care. Stakeholder research has found that plans attempt to control costs by providing patients with a list of in-network facilities and authorizing stays for a specific number of days, often without much guidance on how to make the allowed time work clinically.6PubMed Central. Medicare Advantage control of postacute costs: perspectives from stakeholders The practical result is that Medicare Advantage enrollees tend to have shorter nursing home stays. Between 2015 and 2021, the average skilled nursing facility stay decreased more sharply for Medicare Advantage beneficiaries than for those on traditional Medicare, with a difference of roughly six additional days of reduction in Medicare Advantage on a baseline of about 35 days.7JAMA Network Open. Postacute Care Use and Outcomes Among Medicare Advantage vs Traditional Medicare Beneficiaries
Some Medicare Advantage plans also impose copayments for skilled nursing facility care from day one, whereas Original Medicare covers the first 20 days without a copayment. Research on plans that introduced first-dollar cost-sharing found it reduced the total number of skilled nursing days used without significantly changing whether people used the benefit at all.8PubMed Central. First-dollar cost-sharing for skilled nursing facility care in medicare advantage plans Whether that reduction reflects efficient use of resources or premature discharge depends on the individual case, but it is something to be aware of when evaluating your plan.
If you have a Medicare Advantage plan, call the plan before you need a nursing home and ask for the current list of in-network skilled nursing facilities. Find out what prior authorization is required, how many days are typically approved initially, and what the appeal process looks like if you need an extension. Knowing this ahead of time removes one layer of confusion from an already stressful situation.
Staffing Levels Are the Single Best Predictor
If you only have time to check one thing about a nursing home, check the staffing data. The number and type of staff per resident is the quality indicator most consistently linked to better outcomes in the research literature, and it is the one most likely to affect your day-to-day experience.
The relationship between staffing and outcomes is not as simple as “more staff equals better care,” though. Different types of nursing staff affect different outcomes. Research using rigorous methods has shown that higher registered nurse staffing is associated with fewer hospitalizations and fewer emergency room visits, while higher certified nursing assistant staffing is linked to better daily functioning and mobility for residents.9JAMDA. The Relationship Between Nursing Home Staffing and Health Outcomes Revisited Pressure sore rates dropped with more registered nurses, while residents’ ability to perform daily activities improved with more certified nursing assistants. Both matter, but in different ways.
Care Compare now reports staffing levels based on payroll data, broken down by registered nurses, licensed practical nurses, certified nursing assistants, and total nursing hours per resident per day. Look for facilities where the staffing numbers are at or above the state average across all categories. A facility that looks good on total hours but achieves it by employing primarily the least-trained staff is not the same as one with strong registered nurse coverage.
Ownership Type and What It Tells You
About 70 percent of nursing homes in the United States are for-profit. The rest are split between nonprofit and government-owned facilities. This matters because ownership type correlates with measurable quality differences.
A systematic review and meta-analysis of the research found that nonprofit facilities delivered higher-quality care on two of the four most commonly measured indicators: they had more and higher-quality staffing and lower rates of pressure ulcers.10PubMed Central. Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis The largest for-profit chains performed even worse on average. Research on the ten biggest for-profit chains found they had roughly 36 percent more deficiencies and 41 percent more serious deficiencies than government-owned facilities.11PubMed Central. Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies
None of this means every for-profit facility is bad or every nonprofit is good. Individual facilities vary widely within each ownership category. But when you are comparing two facilities that look similar on paper, ownership type is a useful tiebreaker. You can usually find ownership information on the Care Compare site or by asking the facility directly.
What to Do if You Are in a Rural Area
Finding a Medicare-certified nursing home is significantly harder in rural parts of the country. Hundreds of rural nursing homes have closed over the past two decades, and the distance to the nearest available facility can be dramatic. In rural ZIP codes that have experienced a nursing home closure, the average distance to the closest facility providing post-acute care was about 6.4 miles, compared to less than a mile in urban areas. For long-term care, the gap was even wider at 7.2 miles versus 1.1 miles.12PubMed. Nursing home closures and access to post-acute care and long-term care services in rural areas Those averages mask the worst cases: somewhere between 6 and 16 percent of rural ZIP codes with a nursing home closure or no nursing home at all had no post-acute or long-term care provider of any kind within 25 miles.
If you live in a rural area, your options may realistically come down to one or two facilities, which changes the calculus. Rather than comparing multiple facilities against each other, you may be weighing a single nearby facility against a higher-rated one much farther away. Distance matters for visitors, for the patient’s social connections, and for how quickly staff can get the patient to a hospital in an emergency. A facility with fewer stars that is 10 miles away might be a better practical choice than a five-star facility 60 miles away, depending on the person’s care needs and family situation.
Hospitals with swing beds, which are hospital beds that can be used for skilled nursing care, are another option in rural areas. These are more common in small rural hospitals and are Medicare-certified. They do not show up on Care Compare in the same way a freestanding nursing home does, so ask the hospital directly whether swing-bed care is available.
Visiting and Asking the Right Questions
No amount of online research replaces an in-person visit. If at all possible, visit any nursing home you are considering, ideally during a meal time or in the mid-afternoon when staffing may be thinner. What you see and smell during a visit tells you things that no database captures.
When you visit, pay attention to how staff interact with residents, whether call lights are answered promptly, and whether residents are engaged or parked in hallways in wheelchairs with nothing to do. Ask specific questions:
- Staff turnover: How long have the director of nursing and the administrator been in their roles? Frequent leadership turnover is a red flag.
- Staffing on weekends: Many facilities cut staffing sharply on weekends and holidays. Ask what the registered nurse coverage looks like on a Saturday night.
- Bed availability: A facility that always has open beds may signal something about its reputation in the community.
- Discharge planning: If you are coming in for a short-term Medicare stay, ask how the facility handles discharge planning and whether they have a social worker or case manager who coordinates the transition home.
- Therapy services: Ask whether physical, occupational, and speech therapy are provided by facility employees or contracted out, and how many therapists are on staff.
Also talk to residents and families if you can. People who are already living in the facility or visiting a loved one are often surprisingly candid about their experience. Ask open-ended questions about what they like and what they wish were different.
The Ombudsman Program as a Resource
Every state has a Long-Term Care Ombudsman Program, funded in part by the federal Older Americans Act, that advocates for residents in nursing homes and other long-term care facilities. Ombudsmen regularly visit facilities, help resolve complaints, and assist with discharge planning.13PubMed Central. Trends in Long-Term Care Ombudsman Program Funding and Its Relationship to Nursing Home Resident Care They are an underused resource.
Your local ombudsman can tell you things that do not show up in the data. They know which facilities in your area have a history of complaints, which ones have improved recently, and which ones are responsive when problems arise. They can also help if you run into trouble after admission, whether that is a billing dispute with Medicare, concerns about the quality of care, or a disagreement about discharge. You can find your local ombudsman through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116.
Socioeconomic Disparities in Facility Quality
Not everyone has equal access to high-quality nursing homes, even when Medicare is paying. Research has documented a two-tier system in which facilities that serve predominantly Medicaid residents, roughly 15 percent of all non-hospital-based nursing homes, have fewer nurses, more health-related deficiencies, and higher rates of program termination. These lower-resourced facilities are disproportionately located in poorer counties and serve a higher proportion of African American residents.14PubMed Central. Driven to tiers: socioeconomic and racial disparities in the quality of nursing home care
People who are dually eligible for both Medicare and Medicaid face a compounded challenge. Research has found that compared to people with Medicare only, dual-eligible individuals are more likely to end up in nursing homes with low nurse-to-patient ratios, and they are more likely to become long-term residents if placed in those lower-staffed facilities.15PubMed Central. Dual Eligibility, Selection of Skilled Nursing Facility, and Length of Medicare Paid Postacute Stay The pattern reinforces itself: facilities that depend heavily on Medicaid reimbursement, which pays less than Medicare, have fewer resources to invest in staffing, which leads to worse outcomes, which makes them less attractive to people who have other options.
If you or a family member is dual-eligible, being proactive about facility selection is even more important. Use the same Care Compare data and staffing metrics, but recognize that the facilities most readily available to you may not be the best ones. Advocating early, involving the ombudsman, and pushing back against placement in the nearest available bed rather than the best available bed can make a real difference in outcomes.
Specialty Units and Specific Care Needs
If you need care for a specific condition like Alzheimer’s disease or recovery from a complex surgery, not all Medicare-certified nursing homes offer the same level of specialized programming. Some facilities operate dedicated memory care units or subacute rehabilitation units with staff trained in those areas. The availability of these units varies widely by region and facility size.
When evaluating specialty care, ask what makes the unit genuinely different from the rest of the facility. A dedicated Alzheimer’s unit should have secured doors, staff with dementia-specific training, structured activities designed for cognitive impairment, and a lower resident-to-staff ratio than the general population. Some facilities market a “memory care wing” that amounts to a locked hallway with no meaningful programming differences. Ask how many hours of specialized training staff receive, whether a geriatrician or psychiatrist is available, and what the daily activity schedule looks like.
For post-surgical rehabilitation, the intensity and availability of therapy services matters most. Medicare’s skilled nursing benefit is specifically designed to cover this kind of care, but the therapy hours you actually receive can vary. Some facilities provide therapy seven days a week while others scale back significantly on weekends. Ask about the typical therapy schedule for someone with your condition and how many therapists are on staff versus how many residents they serve. A facility where each therapist covers 15 residents will deliver a very different experience from one where each covers 30.