- To qualify for entry to a nursing home, a senior has to require extensive care. Have a doctor assess your loved one’s healthcare needs.
- To cover costs, check if your loved one qualifies for government programs like Medicaid, Medicare, veteran’s benefits, or Social Security.
- Give required documents to the nursing home, including the physician’s order for admission, your loved one’s medical history, and any health care tests.
Checking if Your Loved One Qualifies for a Nursing Home
Check local nursing home admission requirements to see if they qualify. Generally, nursing homes are meant for seniors with serious health issues or conditions that need frequent supervision and round-the-clock care by licensed professionals. To be admitted, a senior needs to meet the state’s criteria for nursing home care, and any medical conditions they have must be documented and confirmed by a doctor. The Center for Medicare & Medicaid Services (CMS) requires U.S. states to follow a few general guidelines, however, they can create their own requirements within those rules.
Have your loved one’s medical conditions confirmed by a doctor. To verify that your loved one meets your state or area’s requirements for a nursing home, a physician will perform a medical exam and assess their health care needs. If your loved one isn’t currently in the hospital, make an appointment with their primary care doctor to assess whether they qualify for a nursing home. If your loved one is in the hospital, staff may complete the assessment during their stay. If the doctor determines that your loved one needs day-to-day care but doesn’t meet nursing home requirements, they might be able to join an assisted living community.
Covering the Cost of Care
Medicaid Pending approach Find a nursing home in your area that accepts Medicaid Pending clients, move your loved one in, apply for Medicaid, and wait to be approved. Pros: This option may protect your assets, requires no out-of-pocket cash, and you might not be required to provide an alternate payment if your loved one is rejected by Medicaid. Cons: Few nursing homes accept Medicaid Pending residents without an alternate guarantor of payment and the care quality of these homes tend to be lower. If your loved one is rejected by Medicaid, they will be immediately evicted. Most nursing homes that accept Medicaid won’t accept new residents without a way to pay for their care, and Medicaid won’t accept an applicant until they’ve been admitted. Applying as a Medicaid pending resident is one of the ways to get around this.
Private pay and spend down for Medicaid approach If your loved one’s countable assets (like cash, savings, stocks, etc.) go over your state Medicaid limit, move them into a nursing home and have them pay for care out of pocket until they only have the limit remaining. Pros: You can time the application process and switch to Medicaid when your loved one becomes eligible. Cons: Your loved one has to spend their own money on their care when they could have reserved that money for their spouse or children to use later. Consider working with an elder law attorney or Medicaid Planning Professional to help determine your loved one’s eligibility and guide you through the Medicaid application process. Even if your loved one wasn’t qualified for Medicaid in the past, the income limits for nursing home care are now higher, so they might be eligible now. Your Medicaid application can be rejected and sent back if anything is missing.
Family private pay and spend down for Medicaid approach If the above options aren’t available and you’re related to your loved one, find a nursing home that accepts both private pay and Medicaid. Tell the nursing home that the resident is applying for Medicaid and have them agree in writing to refund your payments when funding kicks in. Then, apply for Retroactive Medicaid. Pros: Medicaid can be approved retroactively for up to 3 months before the nursing home Medicaid application. If approved, the nursing home can refund your out-of-pocket money. Cons: If something goes wrong in the Medicaid application process, the money you spend can’t be refunded and you may have to spend more money out-of-pocket for your loved one to stay in the nursing home.
Medicare-to-Medicaid approach If your loved one enters a nursing home that accepts Medicare and Medicaid as a Medicare-funded resident, you may be able to apply for Medicaid. Although Medicare doesn’t cover long-term care in a nursing home, it can cover up to 100 days of skilled nursing home care after a stroke, hip fracture, or other health event that requires at least 3 days of medical care. Medicare can also cover hospital care, doctor services, and medical supplies (like prescriptions) for individuals 65 and older. Pros: If your loved one is approved, they will be able to stay in the nursing home for longer than the 100 days provided by Medicare. Cons: 100 days might be a short window to apply to Medicaid and the nursing home. The nursing home might also try to make the candidate or their family responsible for payment if they’re denied by Medicaid.
Veteran’s benefits If your loved one is enrolled in the Department of Veterans Affairs (VA) health care services, they may be eligible for benefits you can use for nursing home care, including: The VA Pension and VA Survivors Pensions: Veterans and their surviving spouses can receive monthly payments if they were in active duty before September 7, 1980, and meet the income and net worth limits set by Congress each year. Military Pension Plan: Veterans who served for 20 years or more may be eligible for a military pension based on an average of your highest 36 months of basic pay. The VA Aid and Attendance Benefits or Housebound Allowance: In addition to a pension, veterans who need help with daily activities (like bathing, feeding, or dressing) or are housebound may be able to apply for supplemental income. While pension money can be used however your loved one chooses, Aid and Attendance benefits are only to be used for senior living, long-term care, and caregiver support. VA Nursing Homes, Assisted Living, and Home Health Care: If the VA concludes that your loved one needs to be placed in a nursing home or assisted-living center to help with their ongoing treatment and personal care, they may cover the cost.
Social Security benefits Unlike other government benefits, Social Security can be used however your loved one would like, including to cover nursing home costs. Social Security retirement benefits: Retirees receive money each month based on their previous income. These benefits aren’t subject to investment risks or market fluctuations and are adjusted for inflation. The average monthly Social Security amount in October 2023 was $1,843.96. Supplemental Security Income: Provides monthly payments (up to $914 per month) to people with disabilities or older adults who have little to no income.
Paying out-of-pocket If you or your loved one has money saved, you may be able to pay nursing home costs from your personal finances. Consult a financial planner to weigh your options. In 2016, the average nationwide cost of nursing home care for a private room was $7,698 per month, or about $92,376 a year.
Selecting a Nursing Home Facility
Make a list of the nursing homes your loved one qualifies for. To find nursing homes in your area, ask people you trust, contact your local senior and community activity center, or use the online Eldercare Locator. You can also call an Eldercare Locator Information Specialist at 1-800-677-1116 or email them at [email protected]. Use this tool to find and compare Medicaid-certified nursing homes in your area.
Visit nursing homes and ask the staff questions about the care there. Call and book an appointment ahead of time. If possible, take your loved one along so they can get a feel for the nursing home. During your visit, don’t be afraid to ask questions and ask the staff to explain anything that you don’t understand. Some questions to consider include: How does this home help your loved one participate in social, religious, or cultural activities that are important to them? Is transportation provided to community activities? What kind of private spaces does the nursing home offer when your loved one has visitors? Who are the doctors that will care for them? Does the nursing home make sure residents get preventative care to help keep them healthy? Will the same nursing staff take care of your loved one day-to-day, or do they change? How many residents is a Certified Nursing Assistant assigned to work with during each shift and during meals? What type of therapy is available? What type of meals does the nursing home serve? Does the nursing home have a screening program for vaccinations, like flu and pneumonia? Does the nursing home offer care for people with dementia? If so, kind? Observe how the staff treats their patients, and if possible, ask a resident how they are treated and if they recommend the nursing home to other seniors. Consider the feelings of your loved one and let them give input on their care. Even if you disagree, listening to their opinions can help make them feel independent and heard.
Provide the nursing home with all the necessary paperwork. Although the admission process can feel overwhelming, take a deep breath and use this list of required documents to help you prepare. These items, completed by hospital staff or your loved one’s primary care doctor: Physician's order for admission to a nursing home. This is a confirmation that your loved one needs a long-term skilled level of care. Physician’s order for medications and treatment. Medical history and physical examination results. This is so new attending doctors and nurses can have up-to-date medical information about your loved one. State-required form. You can get this form from the nursing home. The form varies state-by-state and certifies that your loved one meets nursing home admission requirements. Negative tuberculosis (TB) test or X-ray. Nursing homes are required to offer flu shots, pneumonia vaccines, and TB tests within 3 days of admission. Completed admissions paperwork. Paperwork provided by the nursing home can usually be signed before or on the day of admission. Although the process varies, paperwork usually includes: Agreements to nursing home policies, responsibilities, legal, certificates, cost, and provided care. Your loved one’s consent to be treated by the nursing home. Proof of Insurance or Payment: Depending on your payment plan, you may need to bring your loved one’s Social Security card, Medicare or Medicaid documents, or insurance cards. Nursing home staff might also ask for: Power of Attorney (POA) papers. Do Not Resuscitate (DNR) paperwork. End-of-life care wishes. Dietary requirements. Medical Orders for Life-Sustaining Treatment (MOLST). Your loved one’s living will. After you’re approved, the nursing home will place your loved one on a waitlist. When a spot opens up, they’ll provide you with information about your loved one’s move-in date.
Emergency Nursing Home Admittance
Contact an Area Agency on Aging (AAA) if they need immediate care. Sometimes, someone can be admitted to a nursing home if they have a sudden illness or injury or if their primary caregiver is ill and unable to care for them. Typically, nursing homes have waitlists that can be weeks or months long, but an emergency placement can reduce these wait times. If your loved one needs immediate placement, contact your local AAA for resources. AAAs are nonprofit agencies designed by the state to address the needs and concerns of seniors. Depending on the state’s requirements, emergency admissions may need to provide the documents listed in the previous section but go through an expedited admissions process. For example, some states might postpone certain assessments until after the resident is admitted.
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