Nursing homes

A nursing home is a place where people live when they need nursing care and help with daily life around the clock. Nurses and aides are on duty day and night, and a doctor serves as medical director.^1,10

Choosing a nursing home is hard, and many caregivers feel guilt or grief. This page explains when a nursing home makes sense, how to pay for it, how to judge quality, and what rights your loved one keeps after the move.

What a nursing home is

Nursing homes are licensed by the state and regulated by the federal government.¹ Most offer medical care, meals and nutrition, care planning, activities and spiritual support.¹

There are two kinds of stays, and the difference matters for payment:

• Short-term (rehab) stays. A person goes after a hospital stay to get skilled nursing or therapy, then goes home. Medicare often pays for this.²
• Long-term stays. A person lives there because they need daily help and supervision that home can no longer provide. This is called custodial care (help with daily tasks like bathing, dressing and eating). Medicare does not pay for it.³

Many nursing homes have a dementia unit, often a separate floor or wing. These units vary a lot, so ask what training, activities and staffing the unit offers.¹

How it compares with other options

For details, see assisted living, memory care and PACE, a program that helps some people stay at home longer.

When a nursing home may be needed

There is no single right moment. Families often start looking when one or more of these is true:

• The person needs help with almost every daily task, such as eating, moving, toileting and bathing. This is common in late-stage dementia.
• They have medical needs that call for a nurse, such as wound care, feeding problems or frequent infections.
• They need two people to help them move, or they fall often. See preventing falls.
• Care at home is no longer safe, even with in-home care, adult day care or respite care.
• The main caregiver is sick, injured or worn out. Your health matters too. See caregiver burnout.

A move is not a failure. Often it is how a family keeps the person safe and stays close in a new way.

Who pays for a nursing home

Nursing home care is costly. National median figures cited by the Alzheimer's Association are about $115,000 a year for a shared room and about $130,000 a year for a private room.¹ Costs vary by area. See what dementia care costs.

Medicare: short stays only

Medicare Part A can cover a skilled nursing stay if the person had a hospital inpatient stay of at least 3 days in a row and needs daily skilled nursing or therapy.² Time spent "under observation" or in the emergency room does not count toward the 3 days, even overnight.² Ask the hospital whether your loved one is an inpatient. See hospital stays.

For 2026, Medicare's costs per benefit period are:²

Medicare Advantage plans may charge different amounts.² Neither Medicare nor Medigap (supplement) policies pay for long-term custodial care.³ See what Medicare covers in dementia.

Medicaid: help with long stays

Medicaid must cover nursing home care for adults who qualify and need it. States cannot put people on waiting lists for this benefit.⁴ Coverage applies only in a Medicaid-certified nursing home.⁴

In Virginia, a person must have a long-term services and supports (LTSS) screening to show they need this level of care. The screening looks at help needed with daily activities, health, and ongoing medical or nursing needs. It is done by community teams (local social services and health department staff) or by hospital staff at discharge.⁵ Income and savings are checked too. Many residents on Medicaid pay part of their income toward their care. Virginia calls this the "patient pay."⁶ You can call Cover Virginia at 1-855-242-8282 with questions.⁶

Medicaid has strict rules on income, savings, gifts and protections for a spouse who stays at home. Read Medicaid and long-term care and think about talking with an elder law attorney before you apply.

Other payers can include long-term care insurance and VA benefits.¹

How to use Care Compare star ratings

Medicare's Nursing Home Care Compare website (medicare.gov/care-compare) lets you search nursing homes by location. Each home gets an overall rating of 1 to 5 stars. Five stars means much above average, and one star means much below average.⁷

The overall rating is built from three parts:⁷

• Health inspections. What state inspectors found, including problems called deficiencies (rule violations).
• Staffing. How well the home is staffed, including staff turnover and weekend staffing.
• Quality measures. Measures of how residents are doing and the care they get, drawn from resident health records.

Stars compare homes to each other. They are not a grade against a fixed standard.⁷ CMS itself says ratings do not cover everything, such as how good a home is at dementia care.⁷ A home close to family may be a better choice than a higher-rated home far away, because regular visits can improve a resident's care and quality of life.⁷

1. Search Care Compare for homes near the people who will visit most.
2. Look at the overall stars, then at each of the three parts. A low health inspection score deserves questions.
3. Read the inspection reports, not just the stars. Ask the home for its latest report too.¹
4. Visit each home at least twice, at different times. Make one visit unannounced, and one at mealtime.¹
5. Ask the Long-Term Care Ombudsman what they know about the homes on your list.⁷

See how to choose a care place for a full tour checklist.

Before you sign the admission papers

Read the admission contract slowly. Federal rules protect residents in several ways:

• No forced guarantee. A nursing home cannot require a family member to personally guarantee payment as a condition of admission. A person who manages the resident's money may sign to pay from the resident's own funds, without personal liability.⁹
• No giving up Medicare or Medicaid. A home cannot require someone to promise not to apply for Medicare or Medicaid.⁹
• Arbitration is optional. Some contracts include a binding arbitration agreement, which means giving up the right to go to court over disputes. A home cannot make signing it a condition of admission or care. If you sign, you can cancel it within 30 calendar days.¹⁰

If you hold power of attorney or are a health care agent, sign only in that role, and say so on the form.

Your loved one's rights as a resident

Moving into a nursing home does not take away a person's rights. Under federal rules, residents have the right to:⁸

• Be treated with dignity and respect, and make choices about their daily schedule and care.
• Take part in planning their care, ask for care plan meetings and see the plan.
• Be told about care, risks and options in a language and format they understand.
• Refuse treatment and make an advance directive.
• Choose their own doctor.
• Have privacy in care, phone calls, mail and visits, and see their own records.
• Manage their own money, or have it handled with proper accounting.
• Complain without fear of payback, including anonymously, and get a written answer.
• Join resident and family councils, which the home must listen and respond to.

When a person with dementia cannot speak up, their legal representative can use many of these rights for them.

Medicines for behavior

People with dementia in nursing homes are sometimes given antipsychotics and other mind-altering medicines to calm agitation. Federal rules limit this. These medicines must be for a diagnosed condition written in the record. The home must try lowering the amount over time and use non-drug approaches, unless that is not safe.¹¹ "As needed" antipsychotic orders last no more than 14 days unless the prescriber checks the resident again.¹¹ A pharmacist must review each resident's medicines at least once a month.¹¹

At care plan meetings, ask which medicines are for behavior and whether there is a plan to reduce them. See medicines for agitation. Talk with the doctor before any change.

Visiting

Residents have the right to receive visitors they choose, at times they choose. They can also refuse a visit.⁸ Family and others the resident agrees to see must be allowed in, with only reasonable clinical and safety limits. Each home must have a written visiting policy.⁸

Some ideas that help visits go well for a person with dementia:

• Keep visits short and frequent, at their best time of day.
• Bring something to do together: photos, music, a simple snack they like, hand lotion for a gentle hand massage.
• Get to know the aides by name. They give most of the hands-on care.

See moving a parent into care for help with the first weeks.

If the home wants your loved one to leave

A nursing home can discharge a resident against their wishes only for set reasons. These include needs the home cannot meet, a danger to others, unpaid bills after notice, or the home closing.⁹ Usually the home must give 30 days' written notice. The notice must state the reason, the right to appeal, and how to reach the State Long-Term Care Ombudsman.⁹ A copy must go to the ombudsman. In most cases, the resident can stay while an appeal is pending.⁹

Before a hospital transfer, the home must also explain its bed-hold policy (how long it will hold the bed).⁹ If you get a discharge notice, call the ombudsman right away.

When something is wrong

For problems that are not emergencies:

• Talk to the staff first. Start with the nurse or social worker, then the administrator. Put concerns in writing.
• Call the Long-Term Care Ombudsman. This free program investigates and resolves complaints for residents, gives information and speaks up for residents' rights. Every state has one.¹² The most common nursing home complaints include discharges, slow response to calls for help, and unattended symptoms.¹² To find your local office, call the Eldercare Locator at 1-800-677-1116.¹⁵
• File a complaint with the state. In Virginia, nursing home complaints go to the Virginia Department of Health, Office of Licensure and Certification. Call 1-800-955-1819 or file online. Phone complaints need your name and contact details. Anonymous complaints must be in writing.¹³
• Report abuse or neglect. See signs of elder abuse and neglect for how to report to Adult Protective Services.

Hospice in a nursing home

A resident can get Medicare hospice care while living in a nursing home. Hospice adds a team focused on comfort when a person is in the last months of life. Medicare hospice does not pay for nursing home room and board, so that cost stays with the family or Medicaid.¹⁴ See hospice care for dementia.

Common questions

Will my parent lose all their money?

Not always. Many people pay privately until their savings fall to Medicaid's limits, then Medicaid takes over. There are special protections for a husband or wife who still lives at home. Rules are complex, so get advice early. See Medicaid and long-term care.

Is a nursing home the same as memory care?

No. Memory care is usually a secured part of an assisted living community. A nursing home offers more medical and nursing care. Some nursing homes also have dementia units. See memory care.

What if I promised never to put my parent in a nursing home?

Many caregivers made that promise when needs were very different. Keeping someone safe and well cared for keeps its spirit. You remain their advocate and family. See grieving someone still here.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.