What a nursing home is and who lives there
A nursing home is a residential facility where people receive round-the-clock medical care, personal information, and supervision. Unlike assisted living, where residents are mostly independent, nursing homes employ licensed nurses and certified nursing assistants who help with bathing, dressing, toileting, medication management, and medical monitoring. Most residents are older adults, but nursing homes also serve younger people with severe disabilities, chronic illnesses, or recovery needs after hospitalization.
Nursing homes are regulated by your state's Department of Health or Department of Aging, and they must meet federal standards set by Medicare and Medicaid. Each facility has a medical director, a nursing staff, and often therapists, social workers, and dietary staff. The level of care varies widely — some homes focus on short-term rehabilitation after surgery or injury, while others provide long-term custodial care for people with dementia or advanced illness.
Key Takeaways
- Nursing homes provide 24-hour nursing care and personal information, which is different from assisted living or independent senior housing.
- Your state's Department of Health publishes inspection reports and violation records for every nursing home, which you can read before choosing one.
- Medicare covers short-term skilled nursing care after hospitalization if certain conditions are met, but long-term care is usually paid by Medicaid, private funds, or long-term care insurance.
- Visiting the facility in person, talking to current residents and their families, and reviewing staffing levels are the most reliable ways to judge quality.
- Nursing homes must have a written care plan for each resident and allow family involvement in medical decisions.
How to find and compare nursing homes in your area
Start by searching the Nursing Home Compare tool on Medicare.gov, which lists every Medicare-certified nursing home in the United States. The tool shows inspection results, staffing numbers, quality measures (like pressure ulcer rates and hospital readmissions), and resident complaints. You can filter by location, and the results include the facility's phone number and website.
Your state's Department of Health also maintains a searchable database of all licensed nursing homes and their inspection reports. These reports detail violations, from minor paperwork issues to serious problems like medication errors or neglect. Reading the actual inspection report — not just a summary — tells you what went wrong and how the facility responded. Call your state's long-term care ombudsman office (a free service) if you want someone to explain a report or visit a home with you.
Once you have a short list, visit each home in person during different times of day. Talk to residents, families, and staff. Ask about staffing ratios (how many residents each nurse or aide cares for), whether the facility has a waiting list, and what happens if a resident needs hospital care. Request a tour of the rooms, dining areas, and activity spaces. Pay attention to cleanliness, odors, noise levels, and whether residents look engaged or neglected.
Understanding costs and payment sources
Nursing home costs vary by location and level of care, but a private room typically costs more than a semi-private room. You will need to contact facilities directly for current rates, as costs change and vary widely even within the same city. Some homes charge a flat daily rate; others charge separately for room, board, and services.
Medicare covers up to 100 days of skilled nursing care after a hospital stay of at least three days, but only if the care is for a condition treated in the hospital. You pay nothing for days 1–20, and a daily copay for days 21–100. After 100 days, Medicare stops paying and you must use other sources.
Medicaid covers long-term nursing home care for people with limited income and assets, but rules vary by state. Some states cover more days or charge lower copays than others. You must meet your state's income and asset limits, and Medicaid may require you to spend down savings before coverage begins. Contact your state Medicaid office or a local Area Agency on Aging to learn your state's rules.
Private pay means you or your family pay out of pocket. Some people use long-term care insurance, which you must purchase before you need care. Veterans and their spouses may be may have access to to Aid and Attendance benefits, which help pay for nursing home care — contact the Veterans Benefits Administration to learn whether you may have access to.
What to know about admission and the first weeks
Before admission, the nursing home will conduct an assessment to determine your medical needs and care level. You will sign admission paperwork that includes the facility's policies, your rights as a resident, and the care plan. Bring copies of your medical records, current medications, insurance information, and any legal documents like a power of attorney or living will.
The first few weeks are an adjustment period. You will meet your care team, establish routines, and begin activities and therapies. The facility must create a written care plan within seven days of admission, and you have the right to participate in planning your care. If you or your family disagree with the plan, you can request changes in writing. The nursing home must involve you in decisions about your medical treatment, and you can refuse treatment if you choose.
Expect some trial and error as staff learn your preferences and needs. Communicate clearly with your nurse or care coordinator about what is working and what is not. Most facilities have a family council or resident council where you can raise concerns. If a problem is not resolved, contact your state's long-term care ombudsman.
Resident rights and what to do if you have concerns
Federal law guarantees nursing home residents specific rights, including the right to be treated with dignity, to make decisions about their own care, to have privacy, to receive visitors, and to manage their own money. Residents also have the right to complain without fear of retaliation and to see their medical records.
If you witness or experience neglect, abuse, or poor care, report it first to the facility's administrator or ombudsman. If the problem is not corrected, contact your state's Department of Health or the long-term care ombudsman. You can also file a complaint with Medicare or Medicaid. These agencies investigate and can impose fines or other penalties on the facility.
Keep detailed notes of any concerns — dates, times, what happened, and who was involved. Take photos if appropriate (for example, of a resident's untreated wound). Request copies of medical records and incident reports. If you believe a crime has occurred, contact local law enforcement. Many states have a hotline for reporting nursing home abuse; search "[your state] nursing home abuse hotline" to find it.
Questions to ask before and after admission
Before choosing a home, ask the admissions staff: What is the staff-to-resident ratio? How many registered nurses work during day and night shifts? What is the turnover rate for nursing staff? What activities and therapies are offered? What is the process for handling medical emergencies? What happens if a resident needs hospital care? Can family members be present during care? What is the visiting policy?
Ask about specific services you or your loved one needs — physical therapy, wound care, dementia care, hospice, or psychiatric services. Ask whether the facility has experience with your condition and what the outcomes are. Request references from families of current residents.
After admission, stay involved. Visit regularly and talk to your loved one about their experience. Attend care plan meetings. Ask staff questions about medications, treatments, and daily activities. Build a relationship with the nursing staff and social worker. The more present you are, the better the care tends to be.
Short-term rehabilitation versus long-term care
Some nursing home stays are short-term — typically two to three weeks after surgery, a fall, or hospitalization. The goal is recovery and return home. These residents receive intensive physical therapy, occupational therapy, and nursing care. Medicare usually covers short-term stays if the person was hospitalized first.
Other residents stay long-term because they cannot live independently due to advanced age, dementia, severe disability, or chronic illness. Long-term residents may never return home. The focus shifts from recovery to comfort, quality of life, and managing ongoing medical needs. Long-term care is usually paid by Medicaid or private funds.
A facility may serve both populations, or it may specialize in one. If you are admitted for short-term care, ask the care team early about the discharge plan — where you will go, what support you will need at home, and how to arrange it. If long-term care is the plan, discuss goals and preferences with your family and the care team, including what kind of care you want if your health declines.
Frequently Asked Questions
Can I visit my loved one anytime, or are there visiting hours?
Federal law guarantees residents the right to receive visitors. Most nursing homes have open visiting policies, though some may restrict visits during certain care activities or if a resident has a contagious illness. Ask about the facility's visiting policy during your tour, and report any restrictions that seem unreasonable to your state's long-term care ombudsman.
What if my loved one wants to leave the nursing home?
Residents have the right to leave at any time, except in rare cases where a court has ordered them to stay. If your loved one wants to leave against medical information, the facility will ask them to sign a form acknowledging the risk. If you believe your loved one is being held against their will, contact your state's long-term care ombudsman or law enforcement.
How often do nursing homes get inspected?
Medicare-certified nursing homes are inspected at least once every three years, though many are inspected more frequently. Inspectors check for compliance with federal standards and investigate complaints. Inspection results are public and available on Medicare.gov and your state's Department of Health website.
What should I bring when my loved one moves into a nursing home?
Bring comfortable, straightforward-to-wash clothing, personal hygiene items, glasses or hearing aids if needed, and a few meaningful items like photos or a favorite blanket. Label everything with your loved one's name. Ask the facility what items are not allowed (some restrict candles, hot plates, or certain electrical items for safety). Leave valuable jewelry at home.
Can a nursing home force my loved one to take medication or treatment?
No. Residents have the right to refuse any treatment, including medication, as long as they are mentally able to make that decision. If your loved one lacks decision-making capacity, a healthcare proxy or legal guardian can make decisions on their behalf. These decisions must be documented in the medical record.