Nursing Home Requirements: Who’s Eligible?

Most seniors hope to stay independent for as long as possible, but sometimes declining health or a major medical crisis, like a debilitating stroke or serious fall, can make everyday tasks harder to manage. In those cases, a nursing home can provide the extra support, rehabilitation and around-the-clock care needed to keep someone safe and comfortable.

“Preserving older adults’ ability to remain independent should be a fundamental goal, but when they need help, there are many high-quality facilities that can provide comprehensive care,” says Deborah Franklin, senior director of quality affairs at the Florida Health Care Association in Tallahassee, Florida.

An estimated 1.2 million older adults were living in nursing homes in 2025, according to KFF. As the baby boomer generation continues to age, demand for nursing home care is expected to grow, driven by longer life expectancy, higher rates of chronic illness and increasing care needs.

[Read: 11 Signs it’s Time for Senior Care: Expert Advice]

Nursing Home vs. Skilled Nursing: What Levels of Care Are Provided?

Nursing homes, also known as skilled nursing facilities, are a type of long-term care facility that offers medical services for residents who need comprehensive care. According to the CDC, there are more than 15,000 nursing facilities across the country.

Nursing homes provide a wide range of care, including:

Custodial care: Assistance with activities of daily living (ADLs), such as dressing, eating and medication management, and dietary support through meals tailored for health conditions and nutritional needs

Skilled medical care: 24/7 supervision from trained staff, care for chronic conditions like Parkinson’s disease, specialized memory care for residents with dementia, and emergency medical responses for health crises

Therapeutic services: On-site access to physical, occupational and speech therapy to maintain or improve function

Quality of life services: Recreational and social activities to promote engagement, mental stimulation and socialization among residents

[READ: Nursing Homes vs. Assisted Living.]

Nursing Home Services: More Than Just Medical Care

You should consider a nursing home if you or your loved one’s needs cannot be safely met in a home or in other housing, such as assisted living.

There are two types of nursing home stays: short-term and long-term.

Short-term care

Short-term care at a nursing home involves skilled medical care or rehabilitation following a hospital stay. Common reasons include:

— Recovery after surgery, stroke, serious illness or injury

Physical, occupational or speech therapy to regain strength and independence

In some cases, individuals stay temporarily because they are too weak or unstable to return home safely, need time to arrange home care or equipment or require respite care while family caregivers regroup.

These short-term stays are focused on recovery, stabilization and transitioning to a lower level of care, such as moving to assisted living.

“Two-thirds of people admitted to a nursing home for short-term post-acute nursing or rehabilitation care are able to return home,” adds Holly Harmon, senior vice president of quality, regulatory and clinical services at the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) based in Washington, D.C.

Long-term care

There are a variety of reasons why older adults reside long-term in nursing homes, including:

— Advanced chronic illnesses

Alzheimer’s disease or other forms of dementia

— Complex medication management needs

— Inability to safely live independently

— Need for 24/7 medical supervision

— Need for specialized care, such as feeding tubes or oxygen therapy

— Significant physical limitations, such as being bedridden or requiring help with most or all ADLs

For many families, long-term nursing care brings peace of mind by ensuring safety, medical oversight and support that may no longer be feasible through home care alone.

[READ: When Home Care Isn’t Enough: Recognizing When to Move to Assisted Living or Skilled Nursing Care]

How Much Does a Nursing Home Cost?

The cost of a nursing home can vary, but the monthly median cost of a semi-private room in a nursing home is $9,581, and the monthly median cost of private room is $10,798, according to CareScout’s Cost of Care survey.

Medicare vs. Medicaid: Who pays for long-term care?

[CHART]

For short-term stays, Medicare Part A will provide coverage, if you meet eligibility requirements.

For long-term stays, however, Medicare will not provide coverage. In fact, according to a KFF poll, 41% of those age 65 and older mistakenly assume Medicare will foot the bill.

Medicaid is actually the primary payer for 63% of nursing home residents, KFF reports. Medicaid is a combined federal and state program, and since eligibility rules vary by state, you should contact your state’s Medicaid agency to see if you qualify.

For those who are eligible, Medicaid will pay for the complete cost of nursing home care, including room and board, but some facilities only have a few Medicaid-certified beds, meaning there sometimes can be a long wait.

Out-of-pocket costs and private pay options

Other ways to cover the costs include:

Long-term care insurance

Veterans benefits

— Paying privately with savings or family contributions

[READ: How to Pay for Nursing Home Costs.]

The Admission Process: Assessments and Paperwork

Before a resident may move into a nursing home, they are required to undergo a thorough medical evaluation to determine that they meet a nursing facility level of care, or NFLOC. These assessments provide a holistic view of a prospective resident’s medical, physical and cognitive needs, says Ann Orffeo, nurse care manager at Elder Care Solutions of WNY in Snyder, New York. They also determine the person’s existing health conditions, any specialized care requirements and how independent they are with ADLs.

These assessments vary by location. In New York, nursing homes use a Patient Review Instrument, or PRI. In Florida, the 3008 form is the standard assessment.

The assessments are typically conducted by a nurse and often require review and signature by a doctor. In some cases, a multidisciplinary team, including social workers, therapists and dietitians, may contribute to the assessment. In some states, the individual’s primary care doctor needs to sign the assessment.

Nursing homes will also want to discuss payment options, including eligibility for Medicare or Medicaid. Once a determination is made, a care plan, which will be updated regularly, will be developed to ensure your loved one will be getting the support they need. At that point, arrangements can be made as to when they can move in.

[SEE: How to Decorate a Nursing Home Room to Feel Like Home]

7-Step Nursing Home Transition Checklist

Whether you’re just beginning the journey to determine nursing home eligibility for a family member or at the final stages of a decision, these steps can help make the process easier:

Caregiver and family role. Designate at least one person as the primary caregiver for the nursing home resident to serve as the main contact involved in participating and discussing the individual’s care plan. Primary caregivers will need support from other family members to be involved and available to help and share in the responsibilities.

Elder care services. Families can engage the professional services of geriatric care managers or aging life specialists to determine short-term and long-term care needs and explore Medicare and Medicaid eligibility requirements.

Legal matters. Make sure your loved one has an up-to-date health care proxy and power of attorney. These legal documents will allow a designated friend or family member to make health care decisions on behalf of their loved one living in the nursing home. A living will is also recommended to show what types of treatments the person wants or doesn’t want to keep them alive.

Move-in day: Be sure that you and other family members accompany your loved one as they transition to their new surroundings. The nursing home director of admissions and staff will be there to help make the move as simple and seamless as possible. Be prepared for your loved one to experience a mix of emotions as they settle in and get used to their new environment.

Personal items. Before your loved one moves to a nursing home, make sure to pack about seven to 10 days’ worth of clothing and write their initials or names on each item to avoid confusion with other residents’ clothing. Ask the staff whether you can bring their favorite chair, pictures of family and friends and other personal mementos.

Regular meetings. Most nursing homes will arrange semi-regular meetings to discuss your family member’s care plan and changes in their needs and medical care. Make sure these meetings happen on at least a quarterly basis with the key members of the nursing and administrative team.

Research thoroughly. Some may have concerns about neglectful care, poor conditions or other red flags in nursing homes. Touring the facility, talking with staff and residents, reading reviews and thoroughly vetting the nursing home are important steps to make sure it’s the right fit for your loved one. “There is a stigma associated with nursing homes that can make families hesitate to move a family member into one. That’s why it’s important for families to do thorough research,” Orffeo says.

Resources. The Department of Health and Human Services has developed several useful booklets, including: “Your Guide to Choosing a Nursing Home or Other Long?Term Services & Supports” and “Medicare Coverage of Skilled Nursing Facility Care.” Also, utilize Medicare’s provider search tool to find Medicare-certified nursing homes in your area. These facilities are regularly inspected to meet federal health and safety standards set by Medicare.

Bottom Line

While most seniors want to remain independent for as long as possible, nursing homes play a critical role when health, safety or medical needs increase. They provide round-the-clock supervision, skilled nursing care and access to medical services that are often not feasible at home. Understanding what nursing homes offer, whom they serve, how care is paid for and how to choose the right facility can help families make informed, confident decisions during a challenging time and ensure their loved one receives appropriate and compassionate care.

More from U.S. News

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Nursing Home Requirements: Who?s Eligible? originally appeared on usnews.com

Update 04/24/26: This story was published at an earlier date and has been updated with new information.

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