Getting into a nursing home involves meeting medical eligibility criteria, choosing a facility, arranging payment, and completing an application with extensive documentation. The process can happen quickly after a hospital stay or take weeks when planned from home. Either way, understanding the steps in advance makes the transition smoother for everyone involved.
Who Qualifies for Nursing Home Care
Nursing homes, also called skilled nursing facilities, are designed for people who need more medical attention than assisted living or home care can provide. The key difference is round-the-clock nursing supervision. Assisted living helps with daily routines like meals and medication reminders, but nursing homes offer licensed nurses on-site 24 hours a day, rehabilitative therapies, and the ability to manage complex medical needs.
To qualify, a person typically needs to show deficits in basic Activities of Daily Living (ADLs): bathing, eating, toileting, dressing, transferring in and out of a bed or chair, and walking. A physician or clinical team evaluates whether these needs require daily oversight from a licensed nurse rather than a family caregiver or home aide.
Specific medical conditions that often trigger nursing home placement include wound care for pressure ulcers, management of feeding tubes, respiratory therapy such as oxygen or suctioning, dialysis, and diabetes that requires daily physiological monitoring. Behavioral issues like wandering or combativeness, frequent falls, and acute psychological symptoms can also justify placement, especially when they appear alongside other health problems.
Two Common Paths In
After a Hospital Stay
Many people enter a nursing home directly from the hospital. If your loved one has been hospitalized and can’t safely return home, a hospital discharge planner or social worker will help coordinate the transfer. They’ll assess what level of care is needed, identify facilities with open beds, and handle much of the initial paperwork. This is also the path that activates Medicare coverage for skilled nursing care, which requires a qualifying inpatient hospital stay of at least three consecutive days (not counting the discharge day).
During this process, you still have a choice of facilities. Ask the discharge planner for a list of options rather than simply accepting the first recommendation. You can request time to visit or research facilities, though bed availability sometimes limits your options.
From Home or Assisted Living
When the move isn’t triggered by a hospitalization, the process starts with a visit to the person’s doctor. The physician will need to certify that nursing home-level care is medically necessary. From there, you contact facilities directly, schedule tours, and complete their admission applications. Most facilities have an admissions coordinator who walks families through the process and conducts their own clinical assessment before accepting a resident.
How to Choose a Facility
The federal government rates every Medicare- and Medicaid-certified nursing home on a five-star scale through the CMS Five-Star Quality Rating System. Each facility receives an overall rating plus separate scores in three categories: health inspections, staffing levels, and quality measures. You can look up any facility’s rating on Medicare’s Care Compare website. A five-star rating doesn’t guarantee a perfect experience, but facilities with one or two stars have documented problems worth understanding before you commit.
Beyond the ratings, visit in person. Walk through during mealtimes or activity hours when you can see how staff interact with residents. Notice whether call lights go unanswered, whether common areas are clean, and whether residents appear engaged or parked in front of televisions. Ask about staff turnover, the ratio of nurses to residents, and how the facility handles emergencies. Talk to families of current residents if possible.
Location matters more than people expect. Families who visit frequently contribute to better care outcomes, so choosing a facility within a reasonable drive from the primary family caregiver pays off over months and years.
What It Costs
Nursing home care is expensive. The national median cost in 2025 is $315 per day for a semi-private room and $355 per day for a private room. That translates to roughly $9,581 per month for a semi-private room and $10,798 for a private room. Costs vary significantly by state and region, with some metropolitan areas running considerably higher.
Most families cannot pay these rates out of pocket for long, which is why understanding your payment options early is critical.
Paying Through Medicare
Medicare covers skilled nursing facility care only under specific conditions: you must have had a qualifying inpatient hospital stay of at least three days, you must enter the nursing home within 30 days of that stay, and you must need skilled care (like physical therapy or wound care) rather than custodial care alone.
When those conditions are met, Medicare pays the full cost for days 1 through 20 of each benefit period after you meet a deductible of $1,736 (in 2026). For days 21 through 100, you pay a daily coinsurance of $217. After day 100, Medicare stops paying entirely. This makes Medicare a short-term solution for rehabilitation after surgery, a stroke, or a serious illness. It was never designed to cover long-term nursing home stays.
Paying Through Medicaid
Medicaid is the primary payer for long-term nursing home care in the United States. Unlike Medicare, Medicaid can cover an indefinite stay, but qualifying requires meeting strict financial limits.
In most states, your countable assets must be below $2,000 as an individual. Your monthly income generally cannot exceed $2,901 (which is 300% of the federal SSI benefit level in 2025), though some states have slightly different thresholds. Your home is usually exempt from the asset count as long as your equity is below $730,000 in most states, with some states setting the cap as high as $1,097,000. A car, personal belongings, and certain prepaid burial plans are also typically exempt.
One important detail: Medicaid looks back 60 months (five years) at your financial history. If you gave away assets or sold property below market value during that window, you may face a penalty period during which Medicaid won’t pay for your care. This is why families who anticipate needing Medicaid should plan well in advance, ideally with the help of an elder law attorney.
Documents You’ll Need
Applying for Medicaid-funded nursing home care requires extensive documentation. Gathering these records before you start the application can save weeks of delays.
- Identification: Government-issued photo ID (even expired) and Social Security card
- Legal documents: Durable power of attorney, any living trust paperwork, divorce decree or spouse’s death certificate if applicable
- Bank records: Official statements for every account going back 60 months, plus closing statements for any accounts closed during that period
- Retirement accounts: Recent IRA or 401(k) statements showing current balances
- Investment records: Current statements for stocks, bonds, and mutual funds
- Insurance policies: Life insurance statements showing face value, cash surrender value, and beneficiaries
- Property records: Deeds for all real estate, vehicle titles, and recent property tax statements
- Income verification: Social Security award letter, pension statements, veteran’s benefits letter, pay stubs or tax returns going back up to 60 months, and documentation of any rental income
- Burial plans: Prepaid funeral, burial, or cremation policies showing type, value, and whether they’re revocable or irrevocable, plus burial plot deeds
The 60-month lookback requirement for bank records and closed accounts is the biggest hurdle for most families. If statements are missing, you’ll need to request them from the financial institution, which can take time.
If You Can’t Afford Private Pay and Don’t Qualify for Medicaid
Many families fall into a gap where they have too many assets for Medicaid but not enough savings to cover years of private-pay nursing home costs. In this situation, the most common path is to begin paying privately and apply for Medicaid once assets are spent down to the qualifying threshold. Most nursing homes accept a mix of private-pay and Medicaid residents, but some have limited Medicaid beds, so ask about this policy before admission.
Long-term care insurance, if purchased years earlier, can cover some or all of the cost depending on the policy. Veterans and their surviving spouses may qualify for the VA Aid and Attendance benefit, which provides a monthly supplement to help cover care costs. These options won’t appear during a crisis, which is why planning ahead, even by a year or two, opens doors that aren’t available at the last minute.