What does it take for a nursing home to get you in?

Not totally sure, I was in a semi-senior place with a friend that was disabled and I was fine they only excepted him because I was fine.
Very expensive

here are some General Requirements

  1. Nursing home services are ideal for seniors with serious or debilitating conditions. This includes anyone who needs frequent medical supervision and round-the-clock care.
  2. Nursing facilities require certain documents for admission. These documents include physician’s orders, medical history, admissions paperwork, and more.
  3. Nursing homes require a financial assessment. This process ensures that the patient has the means to pay for care.
  4. Medicaid can sometimes help defray nursing home costs. Eligible seniors may be able to receive government assistance to help pay for nursing home care.


“The process is not always simple, and it can be tedious,” says senior care professional Mark Pavlovich, owner of Yardstik Behavioral Analytics and member of the workforce and customer experience committees at the American Health Care Association. “But it can be easier if you know who you need to talk to and are aware of the documents needed beforehand.”

Learn more about nursing home qualifications, what documents to bring, and who to talk to when filling out paperwork for government programs, like Medicare or Medicaid.

What qualifies a person for a nursing home?​

Nursing home services are generally intended for seniors with debilitating health issues or serious conditions that require frequent medical supervision and round-the-clock care. In order to be admitted to a nursing home, a senior needs to meet the state’s criteria for nursing home care, and any medical conditions must be documented and confirmed by a physician.

State requirements for nursing home placement​

The requirements for nursing home placement generally vary by state. The Centers for Medicare & Medicaid Services (CMS) requires states to follow some general guidelines. However, states retain the flexibility to create their own assessments within CMS’s rules.

Therefore, it’s possible for a senior to meet nursing home admission requirements in Iowa or Kansas, but not in California or New York. Be sure to contact your local Medicaid or government county agency to learn more about your state’s specific nursing home testing standards and how to qualify for a nursing home.

Assessment of health care needs​

To verify that your loved one meets state requirements for nursing home care, a physician will assess their health care needs.

If your aging relative is currently in the hospital, attending staff will likely complete the assessment during the hospital stay. If your loved one is not currently in the hospital, you can make an appointment with their primary care doctor.

Need a nursing home? We can help.​

Our free tool provides nursing home options based on your unique situation.
Take our free care quiz
Some states may provide free health care assessments for seniors. For example, the Maryland state government offers the Adult Evaluation and Review Service (AERS) program. An AERS evaluation is performed by a nurse or social worker and can identify whether a senior meets nursing home qualifications or would benefit more from other long-term care options.

If your loved one requires day-to-day care, but does not meet requirements for nursing home placement, they may be a good candidate for an assisted living community.

Documents required for nursing home admission​

Before your loved one is admitted to a nursing home, you will need to provide the facility with the documents listed below. The first five items on this list are completed by hospital staff or by your loved one’s primary care doctor.

  1. Physician’s order for admission to a nursing home. This order is similar to writing out a prescription. A must confirm the patient needs to nursing home-level care.
  2. Physician’s order for medications and treatment. Your loved one will have a new physician and caregivers at the nursing home. In order to provide care, they’ll need orders from a primary care physician or hospital staff.
  3. Medical history and physical examination. The nursing home’s attending physicians need up-to-date information about your loved one. The primary care physician should perform a physical exam and report to provide current medical history.
  4. State-required form. Every state has a required form for nursing home admittance. It certifies that a patient meets state nursing home qualifications. It also means the person’s medical needs can be fulfilled by a nursing home. Either the hospital or the primary care physician will fill out and sign this form. It can be obtained at any nursing home in the state where your loved one will be receiving care.
  5. Health care tests. Nursing homes are required to offer flu shots, pneumonia vaccines, and tuberculosis (TB) tests within three days of admission. If newly admitted patients have had these services recently, the nursing home may ask for proof.
  6. Completed admissions paperwork. Paperwork can usually be filled out before or on the day of admission. Although the process varies depending on the individual community and a senior’s state of residence, it’s common for essential forms to be filled out at the facility with a staff member. The patient or their agent, the legally responsible party under Power of Attorney, will sign their name several times after learning about nursing home policies, responsibilities, legal certificates, and the cost and care provided. Because nursing homes are regulated by state and federal laws, the community needs written proof the patient learned this information. Part of the paperwork includes the patient’s consent to be treated. As part of the application process, you may need to bring your loved one’s Social Security card, documentation related to Medicare or Medicaid, and insurance cards.
The process of admitting a loved one into a nursing home can take several hours or more, says Pavlovich. As part of the nursing home admissions process, community staff may also ask for other documentation:

  • Power of attorney (POA) papers
  • Do not resuscitate (DNR) paperwork
  • End-of-life care wishes
  • Dietary requirements
  • Medical orders for life-sustaining treatment (MOLST)
  • Living will

Nursing home financial assessment: What questions will I be asked?​

Nursing homes are obligated to determine if incoming residents meet the criteria for any state or federal funding. This process is similar to someone providing financial information to get a mortgage.

This step ensures each patient has the means to pay for nursing home care. The patient and their family will need to disclose financial information and complete paperwork to answer questions such as the following.

  • Is the patient currently enrolled in Medicare (Part A or B) or Medicaid? Do they plan to apply?
  • Does the patient have supplemental insurance?
  • Does the patient receive VA benefits, railroad retirement, SSI funds, or a private or government pension?
  • What are the patient’s assets, including cash, checking and savings accounts, stocks, bonds, CDs, trust funds, and real estate holdings?
  • Does the patient have any paid-up life insurance, burial insurance, or long-term care insurance policies?
  • Has the patient transferred assets in the last 3-5 years?
  • What’s the patient’s current living situation?
  • How much is their current monthly rent or mortgage payment?

Does Medicare cover nursing home costs?​

Medicare is a federal health insurance program that provides coverage for individuals 65 and older, as well as younger people with certain disabilities. A majority of older adults in the U.S. rely on Medicare for preventative services, outpatient care, and prescription medications.

Medicare doesn’t cover long-term help with activities of daily living or care in a nursing home. However, it may provide coverage for up to 100 days of short-term rehabilitation following a stroke, hip fracture, or other health event that resulted in a hospital stay of three days or more.

Regardless of whether Medicare pays for your nursing home stay, it will likely cover doctor services, medical supplies, and prescription drugs while you’re there, although the exact coverage depends on your Medicare plan.

Does Medicaid cover nursing home care?​

Medicaid is a federal program that extends health coverage to low-income individuals. Standards for income thresholds and asset limitations vary depending on each state. Additionally, seniors can qualify if their state considers them “medically needy,” meaning that they have significant health conditions and expenses.

To qualify for nursing home care covered by Medicaid, your senior loved one must have a medical need. This requirement is consistent across the country; however, each state defines “medical need” in its own way. Contact your state’s Medicaid agency to learn more about which health conditions are required to qualify. Admissions staff at Medicaid-certified nursing homes will also have information about the qualification process.

An elder law attorney or social worker can be a helpful partner in the Medicaid application process, determining eligibility, and guiding seniors on how to qualify for a nursing home covered by Medicaid. The entire application can be rejected and sent back if any information is missing, says Pavlovich.

The Centers for Medicare and Medicaid Services created a Nursing Home Toolkit to explain nursing home Medicaid benefits to providers and beneficiaries and can help you learn more.
 
I have no plans to go into one. Besides, I do not qualify. I would like a place with someone that can stop by with help.
 

Robert59 said:
A good income?
A good social security income?
Can't walk?
Keep falling?
No family to take care of you?
Click to expand...
For a couple of years now, you've been asking the same question over and over. For heaven's sake, Robert! Doubtful that anybody on this forum is qualified to respond with answers that will resolve the problem.

Rather than asking here and getting no real help, start with your local senior services or council on aging or whatever it's called. Are you asking for yourself or for the GF?

If for the GF, you can't do a darned thing. Obviously, she needs care that you simply cannot provide. It isn't helping either of you for her to be shoved from one place to another.

If she has a legal guardian (her sister?), the guardian has to initiate it. If she has no legal guardian, call your local legal aid society and ask for help getting to the right people who can help. It sounds more and more like she needs to be made a ward of the state and turn over all responsibility to the state.

Unless you are prepared for non-stop required paperwork and big legal bills, do not ask to have yourself appointed her guardian.

Just a week or two ago you posted about finding a new GF. What?

ETA: A nursing home doesn't "get" you in. Your pocketbook does. The average cost of a private pay nursing home is a bit less than $100K/year.
 
Last edited:
Georgiagranny said:
For a couple of years now, you've been asking the same question over and over. For heaven's sake, Robert! Doubtful that anybody on this forum is qualified to respond with answers that will resolve the problem.

Rather than asking here and getting no real help, start with your local senior services or council on aging or whatever it's called. Are you asking for yourself or for the GF?

If for the GF, you can't do a darned thing. Obviously, she needs care that you simply cannot provide. It isn't helping either of you for her to be shoved from one place to another.

If she has a legal guardian (her sister?), the guardian has to initiate it. If she has no legal guardian, call your local legal aid society and ask for help getting to the right people who can help. It sounds more and more like she needs to be made a ward of the state and turn over all responsibility to the state.

Unless you are prepared for non-stop required paperwork and big legal bills, do not ask to have yourself appointed her guardian.

Just a week or two ago you posted about finding a new GF. What?

ETA: A nursing home doesn't "get" you in. Your pocketbook does. The average cost of a private pay nursing home is a bit less than $100K/year.
Click to expand...
This is for me only. She's been placed in a nursing home by her sister. At one time years ago by a nursing home told her she was to heathy when she can walk and now she has dementia which makes her reason she go in a nursing home.
 
I think most people end up in nursing homes by doctors orders. Your health is failing or you suffer an injury or illness and the doctors decide you can't live at home any longer, so off you go. I can't think of anyone I have ever known that voluntarily admitted themselves to a nursing home, senior assisted living yes, nursing home no.

Where you end up will be determined by what assets you have more than the type of care you need.

Sadly we lose our option of saying no once the doctor says you must go. Your only chance of escape at that point may be a poison pill under a tooth crown.lol
 
If asking for yourself, why a nursing home? Is your health so bad that you can no longer take care of yourself?

If manageable health problems but difficulty living alone, maybe investigate assisted living facilities instead. A good idea might be to find a place where you can transition from assisted living to some sort of intermediate care, then more nursing care, but all in the same facility.
 
I have a friend who came from a family of ten kids. They had a huge home and as the kids left they began to plan for their retirement. They worked with their closest family and fiends and decided that when the time came they would move in together in the big house . As time went on a few were widowed including my friends Mom. In the end she filler her home with her life long friends; widows, widowers, and two couples. They hired housekeepers, grounds keepers, etc. Last I heard they had one live in caretaker, a nursing student and 2 visiting caregivers. Now THAT'S planning.
 
Most people go into long term care from the acute hospital. If it's rehab only, the person will have the rehab covered by medicare (if they have it) or their insurance. If it becomes long term, then they go on medical. Most nursing home residents are on medical. These nursing homes can discharge people they deem as no long needing the long term care. They have discharged them to homeless shelters.
 
Wigglestein said:
I have a friend who came from a family of ten kids. They had a huge home and as the kids left they began to plan for their retirement. They worked with their closest family and fiends and decided that when the time came they would move in together in the big house . As time went on a few were widowed including my friends Mom. In the end she filler her home with her life long friends; widows, widowers, and two couples. They hired housekeepers, grounds keepers, etc. Last I heard they had one live in caretaker, a nursing student and 2 visiting caregivers. Now THAT'S planning.
Click to expand...
It's really nice if people can do that. We need more community like this. But it's lacking or people (like myself) would never feel comfortable in such a setting.

There will be no one to help me, so I don't know how my old age will play out if I get there.
 
You can’t be forced into a nursing home unless you are mentally incompetent which will be decided by a judge if someone tries to get control over you. Usually people are talked into it by their kids or have no choice if they can’t take care of themselves.
 
I do not want to place one toe in a Nursing Home. My daughter has already told me that if I ever can't stay in my own home alone, she will take me in and take care of me.
 
Even though I don't want to go to one I believe I'd end up in one if I needed to be cared for and there was no one else to do it.
 
After what was done to my friend, will not even bother getting help now or going on social security, I am still on regular insurance plans, and they keep asking for this and that test, but nothing will help.

In this state, one can op for end-of-life, but cannot get medication for pain. No more tests or new meds.
 
Contact you state ARDC. Google ardc and your state. Then find your county office, They have staff to answer your questions. They are federally funded and that's their job. ARDC= Aging and Disability Resource Center..
 
On another forum, they discussed the "A place for Mom" (Typically women out live men, so....) And it's a "Referral agency" they get paid to place you, prescreening and you need $250-500K to walk in.

But they won't give you time if day if you're not well off. They'll just hang up. You're a "Cash Cow" and there's many places they'd love to milk you for cash.
 
Disgustedman said:
On another forum, they discussed the "A place for Mom" (Typically women out live men, so....) And it's a "Referral agency" they get paid to place you, prescreening and you need $250-500K to walk in.

But they won't give you time if day if you're not well off. They'll just hang up. You're a "Cash Cow" and there's many places they'd love to milk you for cash.
Click to expand...
I had wondered about those advertisements. I figured that money was needed. But had no idea it was that much. Those assisted living places require real money to live there. I think they start at 3 grand plus for a studio. I can only imagine the profits those owners make.
 
We heard from a friend this week who had come to the decision that his Mom needed 24 hour care. They toured facilities in their small town and she chose one. They agreed to take her after she had a complete physical, etc. She visited the doc and her son, our friend, waited in the waiting room. The results were sent to the facility. They called our friend and said they could not take his mom because the doctor said she was "Noncompliant" . He's fit to be tied. Now Mom says she won't go anywhere else. I told him to have a sit down with the doc and find out why he put that in the chart. Was she non compliant during the physical exam? Is there a way he could help fix the issue?
 
Disgustedman said:
On another forum, they discussed the "A place for Mom" (Typically women out live men, so....) And it's a "Referral agency" they get paid to place you, prescreening and you need $250-500K to walk in.

But they won't give you time if day if you're not well off. They'll just hang up. You're a "Cash Cow" and there's many places they'd love to milk you for cash.
Click to expand...

I've posted in a couple of other threads here about researching senior living. I will share some of what I've learned in the last few months.

I did talk to someone from "A Place For Mom". They will give you a lot of information but not all of it is accurate. The lady that was assigned to me was from another state and didn't know much about my state. Some of the info she sent me was for a different town. The pricing she sent was outdated. That may have to do with asking for it right after the first of the year which is likely the time that prices are raised. They also have info about help in your home.

The worst thing about PFM is that they keep in touch way too much. I've finally convinced her that email is better than phone calls. She is very nice and she was helpful so I don't want to be rude but I never answer the calls and only some of the emails.

It's going to be more accurate to get the correct fees and set up your tours by calling the place you are interested in directly.

There is another website at caring.com that has info about senior living places all over the country. I did not contact them directly after learning my lesson about that but I looked up local places on their site.

I've toured one local place and will likely tour a couple more. I don't plan to move into senior living right away but I think it's good to know what's available, what the cost is and what they are like. I guess I'd rather choose for myself than leave it for my kids to do.
 
Chris21E said:
Not totally sure, I was in a semi-senior place with a friend that was disabled and I was fine they only excepted him because I was fine.
Very expensive

here are some General Requirements

  1. Nursing home services are ideal for seniors with serious or debilitating conditions. This includes anyone who needs frequent medical supervision and round-the-clock care.
  2. Nursing facilities require certain documents for admission. These documents include physician’s orders, medical history, admissions paperwork, and more.
  3. Nursing homes require a financial assessment. This process ensures that the patient has the means to pay for care.
  4. Medicaid can sometimes help defray nursing home costs. Eligible seniors may be able to receive government assistance to help pay for nursing home care.


“The process is not always simple, and it can be tedious,” says senior care professional Mark Pavlovich, owner of Yardstik Behavioral Analytics and member of the workforce and customer experience committees at the American Health Care Association. “But it can be easier if you know who you need to talk to and are aware of the documents needed beforehand.”

Learn more about nursing home qualifications, what documents to bring, and who to talk to when filling out paperwork for government programs, like Medicare or Medicaid.

What qualifies a person for a nursing home?​

Nursing home services are generally intended for seniors with debilitating health issues or serious conditions that require frequent medical supervision and round-the-clock care. In order to be admitted to a nursing home, a senior needs to meet the state’s criteria for nursing home care, and any medical conditions must be documented and confirmed by a physician.

State requirements for nursing home placement​

The requirements for nursing home placement generally vary by state. The Centers for Medicare & Medicaid Services (CMS) requires states to follow some general guidelines. However, states retain the flexibility to create their own assessments within CMS’s rules.

Therefore, it’s possible for a senior to meet nursing home admission requirements in Iowa or Kansas, but not in California or New York. Be sure to contact your local Medicaid or government county agency to learn more about your state’s specific nursing home testing standards and how to qualify for a nursing home.

Assessment of health care needs​

To verify that your loved one meets state requirements for nursing home care, a physician will assess their health care needs.

If your aging relative is currently in the hospital, attending staff will likely complete the assessment during the hospital stay. If your loved one is not currently in the hospital, you can make an appointment with their primary care doctor.

Need a nursing home? We can help.​

Our free tool provides nursing home options based on your unique situation.
Take our free care quiz
Some states may provide free health care assessments for seniors. For example, the Maryland state government offers the Adult Evaluation and Review Service (AERS) program. An AERS evaluation is performed by a nurse or social worker and can identify whether a senior meets nursing home qualifications or would benefit more from other long-term care options.

If your loved one requires day-to-day care, but does not meet requirements for nursing home placement, they may be a good candidate for an assisted living community.

Documents required for nursing home admission​

Before your loved one is admitted to a nursing home, you will need to provide the facility with the documents listed below. The first five items on this list are completed by hospital staff or by your loved one’s primary care doctor.

  1. Physician’s order for admission to a nursing home. This order is similar to writing out a prescription. A must confirm the patient needs to nursing home-level care.
  2. Physician’s order for medications and treatment. Your loved one will have a new physician and caregivers at the nursing home. In order to provide care, they’ll need orders from a primary care physician or hospital staff.
  3. Medical history and physical examination. The nursing home’s attending physicians need up-to-date information about your loved one. The primary care physician should perform a physical exam and report to provide current medical history.
  4. State-required form. Every state has a required form for nursing home admittance. It certifies that a patient meets state nursing home qualifications. It also means the person’s medical needs can be fulfilled by a nursing home. Either the hospital or the primary care physician will fill out and sign this form. It can be obtained at any nursing home in the state where your loved one will be receiving care.
  5. Health care tests. Nursing homes are required to offer flu shots, pneumonia vaccines, and tuberculosis (TB) tests within three days of admission. If newly admitted patients have had these services recently, the nursing home may ask for proof.
  6. Completed admissions paperwork. Paperwork can usually be filled out before or on the day of admission. Although the process varies depending on the individual community and a senior’s state of residence, it’s common for essential forms to be filled out at the facility with a staff member. The patient or their agent, the legally responsible party under Power of Attorney, will sign their name several times after learning about nursing home policies, responsibilities, legal certificates, and the cost and care provided. Because nursing homes are regulated by state and federal laws, the community needs written proof the patient learned this information. Part of the paperwork includes the patient’s consent to be treated. As part of the application process, you may need to bring your loved one’s Social Security card, documentation related to Medicare or Medicaid, and insurance cards.
The process of admitting a loved one into a nursing home can take several hours or more, says Pavlovich. As part of the nursing home admissions process, community staff may also ask for other documentation:

  • Power of attorney (POA) papers
  • Do not resuscitate (DNR) paperwork
  • End-of-life care wishes
  • Dietary requirements
  • Medical orders for life-sustaining treatment (MOLST)
  • Living will

Nursing home financial assessment: What questions will I be asked?​

Nursing homes are obligated to determine if incoming residents meet the criteria for any state or federal funding. This process is similar to someone providing financial information to get a mortgage.

This step ensures each patient has the means to pay for nursing home care. The patient and their family will need to disclose financial information and complete paperwork to answer questions such as the following.

  • Is the patient currently enrolled in Medicare (Part A or B) or Medicaid? Do they plan to apply?
  • Does the patient have supplemental insurance?
  • Does the patient receive VA benefits, railroad retirement, SSI funds, or a private or government pension?
  • What are the patient’s assets, including cash, checking and savings accounts, stocks, bonds, CDs, trust funds, and real estate holdings?
  • Does the patient have any paid-up life insurance, burial insurance, or long-term care insurance policies?
  • Has the patient transferred assets in the last 3-5 years?
  • What’s the patient’s current living situation?
  • How much is their current monthly rent or mortgage payment?

Does Medicare cover nursing home costs?​

Medicare is a federal health insurance program that provides coverage for individuals 65 and older, as well as younger people with certain disabilities. A majority of older adults in the U.S. rely on Medicare for preventative services, outpatient care, and prescription medications.

Medicare doesn’t cover long-term help with activities of daily living or care in a nursing home. However, it may provide coverage for up to 100 days of short-term rehabilitation following a stroke, hip fracture, or other health event that resulted in a hospital stay of three days or more.

Regardless of whether Medicare pays for your nursing home stay, it will likely cover doctor services, medical supplies, and prescription drugs while you’re there, although the exact coverage depends on your Medicare plan.

Does Medicaid cover nursing home care?​

Medicaid is a federal program that extends health coverage to low-income individuals. Standards for income thresholds and asset limitations vary depending on each state. Additionally, seniors can qualify if their state considers them “medically needy,” meaning that they have significant health conditions and expenses.

To qualify for nursing home care covered by Medicaid, your senior loved one must have a medical need. This requirement is consistent across the country; however, each state defines “medical need” in its own way. Contact your state’s Medicaid agency to learn more about which health conditions are required to qualify. Admissions staff at Medicaid-certified nursing homes will also have information about the qualification process.

An elder law attorney or social worker can be a helpful partner in the Medicaid application process, determining eligibility, and guiding seniors on how to qualify for a nursing home covered by Medicaid. The entire application can be rejected and sent back if any information is missing, says Pavlovich.

The Centers for Medicare and Medicaid Services created a Nursing Home Toolkit to explain nursing home Medicaid benefits to providers and beneficiaries and can help you learn more.
Click to expand...
Excellent information Chris! The article below lists the monthly cost for nursing home care in N.J. ($11,254 - one of the 10 most expensive) compared to other states. It also mentions the criteria for admission, which is at least a 3 day stay in the hospital as well as other requirements. The page was published in 2021. Scroll down to this topic to read more about what Medicare, then Medicaid covers:
Does Medicare Cover Nursing Home Care in New Jersey?
https://www.caring.com/senior-livin...dicare-cover-nursing-home-care-in-new-jersey?
 
Pepper said:
I'd kill myself first. Would rather be dead than in a nursing home. JMHO
Click to expand...
I found myself in a nursing home quite by accident a couple of years ago when I fell and injured my leg and went to the hospital. After a week in the hospital the doctors didn’t want to release me home since I live alone in my house and was on a walker due to the accident. A social worker came to my hospital room and convinced me to spend a week in a nursing home to give myself time to arrange for household help at home. She said Medicare would pay for the nursing home so I agreed. I didn’t fill out any paperwork or application or anything. The nursing home was a horrible experience with bad food and bad service. Most of the nurses aides or CNAs felt they were there only to draw a paycheck and not to assist the elderly. I’m now convinced the elderly need an organization to communicate with each other and look out for each other. People in their sixties and some in their seventies have no clue about the needs of the elderly over 80. I worked full time until I was 70 and I was clueless about the needs of the elderly myself.
 
Pepper said:
I'd kill myself first. Would rather be dead than in a nursing home. JMHO
Click to expand...
I agree!
garyt1957 said:
No you wouldn't. We all say it, but when the time comes it just isn't that easy
Click to expand...
You could be right, but I would like the chance to make that decision myself when and if the time comes.
 

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