Understanding the Process: How Does One Get Admitted to a Nursing Home?

Oct 19, 2025 4 min read •

senior care long-term care Healthcare Planning

According to a 2024 report, Medicaid covers 63% of nursing home residents in the U.S., making it a primary funding source. Understanding the pathways and requirements, including how does one get admitted to a nursing home, is crucial for families and individuals preparing for this significant life transition.

Quick Summary

This guide covers the essential steps for nursing home admission, from medical and functional assessments to gathering documents, understanding financial options, and finding the right facility.

Key Points

Medical Necessity is Key: A physician must certify that a person requires a "nursing facility level of care" based on their medical needs, functional abilities, and cognitive status.
Extensive Documentation is Required: Gathering all necessary medical orders, history, test results, legal documents (like a POA), and financial records is a major step in the admission process.
Hospital-Initiated Admissions are Common: For many, the process begins during a hospital stay, with a discharge planner facilitating the assessment and placement.
Funding Varies by Stay Length: Medicare typically covers only short-term skilled nursing care, while Medicaid is the primary funder for long-term care, subject to state-specific financial criteria.
Visit and Compare Facilities: Using resources like Medicare's Care Compare and conducting in-person visits are essential to assessing facility quality, staffing, and overall environment.
Power of Attorney May be Needed: If the individual lacks the mental capacity to make their own decisions, a medical Power of Attorney can act on their behalf. Otherwise, court-appointed guardianship may be necessary.

Understanding the Admission Triggers

The need for nursing home admission often arises from a significant health event or a progressive decline in an individual's condition. Unlike assisted living, nursing homes are for those requiring 24/7 skilled nursing care and supervision. Common triggers include:

A hospitalization that reveals a need for post-acute care or long-term support.
A decline in physical functional ability, such as difficulty with Activities of Daily Living (ADLs) like dressing, bathing, or eating, that can no longer be managed at home.
Changes in cognitive function or behavioral issues, such as those caused by dementia, which necessitate a more structured and secure environment.
The sudden unavailability of a primary caregiver, requiring emergency placement.

Step-by-Step Nursing Home Admission Process

1. The Medical and Functional Assessment

The first and most critical step is a medical evaluation to determine if the individual meets the state's criteria for a "nursing facility level of care" (NFLOC). This assessment is a federal requirement for facilities accepting Medicare or Medicaid.

Required Evaluation: A physician or a qualified medical team member must perform this evaluation. In many cases, it is completed by a hospital's discharge planner or the individual's primary care physician.
The Minimum Data Set (MDS): As part of the Resident Assessment Instrument (RAI), this standardized tool is used to evaluate the resident's health, functional capacity, and cognitive status. It helps create an individualized care plan.

2. Gathering Required Documentation

Before admission, a significant amount of paperwork is required. Organizing these documents in advance can greatly expedite the process. Essential items to gather include:

Medical Orders: A physician's order for admission, as well as specific orders for medications and treatments.
Medical History: A detailed medical history and the results of a recent physical examination.
Test Results: Proof of recent health screenings, such as a negative tuberculosis (TB) test or chest X-ray.
Legal Documents: Any relevant legal papers, including a Power of Attorney (POA), living will, and advance directives.
Personal Information: Identification, such as a Social Security card, and insurance details for Medicare, Medicaid, or private insurance.
Financial Records: Documents related to income, assets, and other resources to determine payment eligibility, especially if seeking Medicaid.

3. Finding and Vetting Facilities

Finding the right nursing home is crucial for ensuring a high quality of life. The following steps can help you make an informed decision:

Use Online Resources: The federal government's Medicare.gov/care-compare tool provides ratings and inspection results for certified nursing homes. The Eldercare Locator can also help find local resources.
Conduct In-Person Visits: Schedule tours and visit multiple facilities. Pay attention to cleanliness, the responsiveness of staff, and the overall atmosphere.
Ask Key Questions: Inquire about staffing levels, specialized care units (e.g., for memory care), activities, and visiting policies. Talking to current residents and their families can provide valuable insight.

4. Financial Planning and Application

The cost of nursing home care is a major concern for many families. Understanding the payment options is essential.

Medicare: Only covers short-term skilled nursing care, not long-term stays. It can cover up to 100 days after a qualifying hospital stay, with a daily copayment for days 21–100.
Medicaid: The primary payer for long-term care for those with limited income and assets. Eligibility criteria and the "spend-down" process vary by state.
Private Pay and Insurance: Many individuals use personal savings, long-term care insurance, or a combination of resources to pay out of pocket.

5. Completing the Admission Paperwork

Once a facility is chosen, the final step involves completing and signing the admissions paperwork. An admissions coordinator at the facility will guide you through this process, which covers everything from consent for treatment to financial agreements.

Comparison: Assisted Living vs. Nursing Home Admission

This table highlights the fundamental differences in admission criteria and care between assisted living and nursing homes.


Feature	Assisted Living Admission	Nursing Home Admission
Level of Care	For those needing help with ADLs but can maintain some independence.	For those with complex medical conditions requiring 24/7 skilled nursing care.
Medical Oversight	Licensed nurses may be on-site part-time, but direct medical care is limited.	Licensed nurses are on-site 24/7, providing intensive medical care and supervision.
Admission Requirements	Based on a functional assessment by facility staff to determine needs; typically no doctor's order required.	Requires a physician's order certifying the need for skilled nursing care.
Primary Payment Source	Primarily private pay, though some Medicaid waiver programs exist depending on the state.	Long-term care covered mainly by Medicaid, with Medicare covering short-term stays.
Independence Level	High degree of independence, with support for daily tasks.	Lower level of independence, with extensive hands-on assistance.

Conclusion: Planning for a Smoother Transition

Getting admitted to a nursing home is a multi-step process that requires careful attention to medical, financial, and legal details. Proactive research and planning can significantly reduce stress and help ensure the best possible care for the individual. Understanding the distinct roles of Medicare and Medicaid and gathering all necessary documentation in advance are key to a smooth transition. Above all, involving the prospective resident in the decision-making process whenever possible respects their autonomy and makes the move less jarring. For more information on quality oversight, visit the Centers for Medicare & Medicaid Services (CMS) website to review their guidelines and requirements.

Frequently Asked Questions

A medical Power of Attorney (POA) can be used to admit someone if they lack the mental capacity to decide for themselves. Without a POA or if the individual is competent, a court-appointed guardianship may be necessary.

Yes, primarily through Medicaid for long-term care. Eligibility is based on limited income and assets, and a "spend-down" process may be required where an individual uses their assets to pay for care until they reach the eligibility threshold.

No, Original Medicare only covers short-term, medically necessary stays in a skilled nursing facility (SNF) for up to 100 days following a qualifying hospital stay. It does not cover permanent, long-term nursing home residency.

The RAI, which includes the Minimum Data Set (MDS), is a standardized assessment used by nursing homes to evaluate a resident's medical needs, functional abilities, and create an individualized care plan.

Emergency placements, often from a hospital, follow an expedited version of the standard admission process. A hospital discharge planner facilitates the move due to an urgent medical need, such as a sudden illness or injury.

Yes, a nursing home can discharge a resident for non-payment, but they must provide sufficient written notice, typically at least 30 days. The resident has the right to appeal this decision.

You can start by using Medicare's Care Compare tool, visiting facilities in person to assess cleanliness and staff-resident interactions, and checking inspection reports. Considering location, staffing, and amenities is also important.

Nursing homes provide 24/7 skilled medical care for residents with complex needs, while assisted living is for those who need some help with daily tasks but can maintain a greater level of independence.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.