What a nursing home is and when you might need one
A nursing home is a residential facility where people live and receive medical care from nurses and aides. Unlike assisted living, which helps with daily tasks like bathing and meals, nursing homes provide 24-hour skilled nursing care — wound care, medication management, physical therapy, and monitoring for people with serious medical needs. You might consider a nursing home after a hospital stay, when you can no longer manage at home even with family help, or when your medical condition requires constant professional oversight.
Nursing homes are regulated by your state's health department and must meet federal standards set by the Centers for Medicare & Medicaid Services (CMS). Each facility has a medical director, a director of nursing, and staff on duty around the clock. The size and quality vary widely — some are part of large chains, others are independent. The difference in daily experience can be substantial, so visiting and asking specific questions matters more than the facility's reputation alone.
Key Takeaways
- Nursing homes provide 24-hour skilled nursing care for people who cannot manage medical needs at home, and are regulated by state health departments and federal standards.
- Medicare covers skilled nursing care for a limited time after hospitalization if specific conditions are met, while Medicaid covers long-term care for people who meet income and asset limits.
- You can find facilities through your hospital discharge planner, your state's long-term care ombudsman office, or the Nursing Home Compare tool on Medicare.gov.
- Before choosing a facility, visit in person, review its inspection reports, ask about staffing levels, and speak with current residents and their families.
- Nursing homes must have a written care plan for each resident, and you have the right to see it, request changes, and report concerns to your state health department.
How Medicare and Medicaid pay for nursing home care
Medicare covers skilled nursing care only after a hospital stay of at least three days, and only if you need daily skilled care that cannot be provided at home. The coverage lasts up to 100 days, but you pay a daily copay after day 20. Medicare does not cover custodial care — help with bathing, dressing, and meals — which is what most long-term nursing home residents actually need. Once Medicare coverage ends, you pay out of pocket unless you switch to Medicaid.
Medicaid covers long-term nursing home care, including custodial care, but only for people whose income and assets fall below your state's limits. The income limit varies by state but is typically around $2,500 per month for a single person. Assets are also limited — your state may allow you to keep your home and car, but savings above a certain amount (often $2,000 to $3,000) disqualify you. Medicaid is a state program, so rules differ by location. If you think you might need long-term care, speak with an elder law attorney or your state Medicaid office about planning ahead.
Private pay means you or your family covers the full cost out of pocket. Nursing home costs range from $6,000 to $15,000 per month depending on location and facility type, though these figures vary significantly by region. Long-term care insurance, if you purchased it years ago, may cover part of the cost. Some people use a combination: Medicare for the first 100 days, then Medicaid once assets are spent down, or private pay supplemented by Medicaid later.
Finding and comparing nursing homes in your area
Start with your hospital discharge planner if you are leaving a hospital — they often have relationships with nearby facilities and can tell you which ones have beds available. If you are planning ahead, contact your state's long-term care ombudsman office, which is a free resource that investigates complaints and can point you toward facilities with good records. You can also search the Nursing Home Compare tool on Medicare.gov, which shows inspection results, staffing levels, and resident complaints for every Medicare-certified facility in the country.
When you narrow your list, visit each facility in person during different times of day — morning, afternoon, and evening if possible. Walk the halls, look at the cleanliness, listen to the noise level, and observe how staff interact with residents. Ask to see the most recent state inspection report, which is public record. Pay attention to deficiencies listed — minor violations are normal, but repeated failures in areas like infection control or medication errors are red flags. Ask the administrator how many nurses and aides work each shift and whether those numbers are consistent or fluctuate.
Talk to residents and their families if you can. Ask whether staff respond quickly when called, whether the food is adequate, and whether activities and outings happen regularly. Ask about the process for handling complaints and whether the facility has a family council that meets regularly. These conversations reveal what daily life is actually like in ways that marketing materials cannot.
Understanding costs and what is included
The facility's base rate covers room, board, nursing care, and basic activities. What it does not always cover — and what you need to ask about — includes medications, medical supplies, therapy services, haircuts, laundry, and activities outside the facility. Some facilities bundle these into the base rate; others charge separately. Ask for a written list of what is included and what costs extra before you move in.
If you are on Medicaid, the facility must accept the Medicaid rate, which is lower than private pay. Some facilities limit the number of Medicaid residents they accept, so confirm that they will continue to accept Medicaid if your private funds run out. Ask whether the facility charges "bed-hold" fees if you leave temporarily for a hospital stay — some do, some do not, and this can affect your decision to go to the hospital.
Request an itemized estimate in writing before admission. This protects you from surprise charges and gives you something to reference if a bill seems wrong. Keep copies of all agreements, fee schedules, and correspondence. If costs change, the facility must give you written notice before the change takes effect.
Your rights as a resident and how to report problems
Federal law gives nursing home residents specific rights: the right to be treated with dignity, the right to make decisions about your own care, the right to see your medical records, the right to refuse treatment, and the right to voice complaints without fear of retaliation. The facility must provide you with a written statement of your rights when you arrive. Read it, and keep a copy.
Every resident must have a written care plan that describes their medical condition, medications, therapy, and goals. You have the right to see this plan, ask questions about it, and request changes. If you disagree with a treatment decision, you can refuse it or ask for a second opinion. If the facility will not listen to your concerns, you can file a complaint with your state health department's long-term care licensing office — this is free and can be done anonymously.
Your state's long-term care ombudsman is another resource. This office investigates complaints about nursing homes, advocates for residents, and can help resolve disputes without filing a formal complaint. The ombudsman's phone number is posted in the facility and is also available through your state's aging office. If you suspect abuse, neglect, or financial exploitation, report it when ready to both the ombudsman and your state health department.
The admission process and what to bring
Once you have chosen a facility, you will complete an admission agreement and provide medical records from your doctor and hospital if applicable. The facility will ask about your insurance, payment method, and emergency contacts. They will also conduct a health assessment to understand your needs and create your initial care plan. This process usually takes a few days to a week.
Bring copies of your insurance cards, Medicare card, Medicaid card if you have one, a list of all current medications with dosages, and records of any allergies or adverse reactions. Bring comfortable, durable clothing labeled with your name — facilities often lose items in laundry. Bring a small amount of personal money if you want to purchase items from the facility's shop or pay for activities, but do not bring large sums of cash. The facility will hold money in a resident trust account and provide statements.
Ask about visiting hours, phone access, and whether you can bring a family member to help during the first few days. Ask what happens if you need to go to the hospital — will your bed be held, and for how long? Ask about the process for updating your care plan and how often you will meet with the care team. These details matter for your adjustment and for staying involved in your own care.
Adjusting to life in a nursing home and staying connected
The first weeks are often difficult. You are in a new environment with new routines, new people, and less independence than you had at home. This is normal. Many facilities have a social worker or activities director who can help you adjust. Ask about orientation programs, group activities, and outings. Participating in activities helps you meet other residents and gives structure to your days.
Stay connected with family and friends. Ask them to visit regularly and at different times so you see different people. Use the phone, video calls, or email if you are able. Attend family meetings if the facility offers them — these are chances to ask questions and voice concerns in a group setting. If you have concerns about your care, bring them up with your nurse or care coordinator first. If the issue is not resolved, escalate to the administrator or file a complaint with your state health department.
Keep a journal of your medications, doctor visits, and any changes in how you feel. This helps you track your own health and gives you information to share with your doctor. Ask your doctor to visit regularly — do not assume the facility's medical director is your primary doctor. You have the right to choose your own doctor and to have them involved in your care decisions.
Frequently Asked Questions
Can I leave a nursing home whenever I want?
Yes, you have the right to leave at any time, though the facility may ask you to sign a form acknowledging that you are leaving against medical information. If you are on Medicaid, leaving may affect your benefits, so check with your caseworker first. If you are concerned about your safety or care, talk to the social worker or ombudsman before you leave — they may be able to help resolve the issue.
What if I cannot afford a nursing home?
Medicaid covers nursing home care for people who meet income and asset limits. If you own a home, Medicaid may allow you to keep it while you receive benefits, though your state's rules vary. Speak with an elder law attorney or your state Medicaid office about planning and protecting assets. Some facilities also have charitable funds or sliding-scale fees for people with limited income.
How do I know if a nursing home is safe?
Review the facility's state inspection report on Nursing Home Compare, which lists violations and complaints. Visit in person and observe how staff interact with residents. Ask about staffing levels and turnover. Talk to residents and families. If you see signs of neglect, abuse, or unsanitary conditions, report it to your state health department and the long-term care ombudsman when ready.
Can I bring my own doctor to a nursing home?
Yes. You have the right to choose your own physician. The facility must cooperate with your doctor and include them in your care planning. Some doctors visit nursing homes regularly; others do not. Ask your doctor whether they visit facilities before you move, and ask the facility which doctors commonly visit there.
What happens if I disagree with my care plan?
You have the right to request changes to your care plan. Ask to meet with your care team — usually the nurse, social worker, and doctor — and explain your concerns. If they will not make the changes you want, you can request a second opinion from another doctor or file a complaint with your state health department.