Many families face this choice in a hurry. A parent is in the hospital, the team says they can't go straight home, and you are asked to pick a nursing home within a day or two.
This guide covers both kinds of nursing home stay: short-term rehab after a hospital stay, and long-term care for someone who needs nursing care every day. It explains what Medicare pays for, how to check quality quickly, and how to speak up for your parent once they move in.
Chapter 1Rehab or long-term care
Two very different kinds of stay
Nursing homes care for two groups of people. Knowing which group your parent is in shapes everything else, including who pays.
Short-term rehab
- Usually follows a hospital stay for a fall, surgery, stroke or serious illness
- Daily physical, occupational or speech therapy
- Skilled nursing, such as IV medicines or wound care
- The goal is to get strong enough to go home or to a lower level of care
- Medicare Part A may pay for a limited time (chapter 3)
Long-term care
- For people who need nursing care around the clock, for months or years
- Help with bathing, dressing, eating, using the toilet and medications
- Nurses on site, and a doctor who oversees care
- Paid from savings, Medicaid, insurance or the VA
- Medicare does not pay for this kind of care
Other places a hospital may suggest
| Option | Usually a fit when |
|---|---|
| Home with home health care | Your parent can be safe at home with visits from a nurse or therapist, and family or paid help fills the gaps |
| Inpatient rehab facility | Your parent can handle more intensive therapy than a nursing home usually provides |
| Long-term care hospital | Medical needs stay complex for a long time, such as extended breathing support |
| Assisted living | Daily help is needed, but skilled nursing every day is not |
Chapter 2When the hospital needs a decision
Choosing well in a few days
Hospitals often give families very little time. You can still make a good choice if you take these steps in order.
- Ask for the case manager or social workerAsk when discharge is planned, what care the team recommends, and why.
- Ask whether your parent is an inpatient or under observationAsk every day. It can decide whether Medicare pays for the nursing home.
- Ask for the listThe hospital must give you a list of Medicare nursing homes that serve the area you choose. You have the right to choose among them, and the hospital must help you compare them using quality information.
- Check each home on Care CompareLook up the star ratings, inspection results and staffing at medicare.gov/care-compare. Chapter 7 shows what to look at.
- Call your top threeAsk if they have a bed, take your parent's insurance, and can meet their needs. Use the questions in chapter 8.
- Visit if you can, even brieflyTwenty minutes in the building tells you a lot. If you can't go, ask a relative or friend nearby to visit with the checklist in chapter 9.
Chapter 3What Medicare covers
Medicare and short-term rehab
Medicare Part A can pay for a stay in a skilled nursing facility (the Medicare term for nursing home rehab) for a limited time. All of these must be true.
- Your parent was admitted to the hospital as an inpatient for at least 3 days in a row. The day of admission counts. The day they leave does not.
- They move to the nursing home within a short time after the hospital, generally 30 days.
- A doctor says they need skilled nursing or therapy every day.
- The nursing home is certified by Medicare, and they have days left in their benefit period.
| Days in the nursing home | Your parent pays (2026) | Details |
|---|---|---|
| Days 1 to 20 | $0 a day | After the Part A deductible of $1,736. It isn't charged again if it was already paid for the hospital stay in the same benefit period. |
| Days 21 to 100 | $217 a day | Many Medigap (supplement) policies help pay this. Check the policy. |
| Day 101 and after | All costs | Part A covers up to 100 days in each benefit period. |
Up to 100 days is a limit
Medicare pays only while daily skilled care is needed. Many rehab stays end well before day 100. Skilled care to keep someone from getting worse can count, as well as care that helps them improve.
Benefit periods
A benefit period starts when your parent is admitted to a hospital or skilled nursing facility. It ends after 60 days in a row with no inpatient hospital or skilled nursing care. Some Medicare Advantage plans and doctor groups can waive the 3-day rule. Ask.
Source: medicare.gov, Skilled nursing facility care and Inpatient or outpatient hospital status, checked October 2026.
Chapter 4When Medicare stops paying
When rehab coverage ends
Medicare does not pay for long-term custodial care. That is help with everyday tasks, such as bathing, dressing, eating and using the toilet, when that help is the main thing someone needs. Medigap policies don't pay for it either.
When the nursing home decides your parent no longer needs daily skilled care, Medicare coverage ends. Your parent can stay, but someone else has to pay.
The notice and your right to a fast appeal
- Look for the "Notice of Medicare Non-Coverage"The nursing home should give it at least 2 days before covered care ends. If you don't get one, ask for it.
- Decide quickly whether to appealIf you think your parent still needs skilled care, follow the directions on the notice no later than noon the day before the end date.
- An independent reviewer decidesThe reviewer, called a BFCC-QIO, looks at the records and asks for your side. It usually decides by the end of the day after it has what it needs.
- Ask for the reasons in writingThe nursing home must give you a "Detailed Explanation of Non-Coverage." Talk with the therapists about what progress they have seen.
Source: medicare.gov, Long-term care, Skilled nursing facility care and Fast appeals, checked October 2026.
Chapter 5What it costs
What families pay
In our data, nursing homes cost about twice as much as assisted living. Prices vary a lot by state, by city, and by whether the room is private or shared.
Source: Lilisity review of private rates published by five states (Connecticut, Florida, Illinois, Minnesota and North Dakota) and nursing home websites, October 2026. Most of these prices come from those five states, so rates where you live may be higher or lower.
Usually included in the daily rate
- Room, meals and snacks
- Nursing care around the clock
- Help with bathing, dressing and eating
- Housekeeping and laundry
- Activities
Charges to ask about
- Private room versus shared room
- Therapy after Medicare ends
- Medications and pharmacy charges
- Incontinence supplies
- Hair care, phone, cable and personal items
- Holding the bed during a hospital stay
Chapter 6Paying for long-term care
Paying for a long stay
Most families start by paying from savings and income. When savings run low, Medicaid can help pay for long-term nursing home care.
Medicaid, in plain terms
- Who qualifies. People who need nursing home care and meet their state's income and asset limits. Each state sets its own rules. Many people qualify after their savings are spent on care.
- The look-back. The state reviews gifts and transfers made in the 5 years (60 months) before the application. Giving money away, or selling something for less than it's worth, can delay coverage.
- Protection for a spouse at home. If one spouse needs nursing home care and the other stays home, federal rules protect part of the couple's savings and some income for the spouse at home.
- After death. States try to recover what Medicaid spent on nursing home care from the person's estate, with some exceptions.
- Before you move money. Talk with an elder law attorney before giving gifts, adding names to accounts or selling a home. Your Area Agency on Aging can point you to one.
Long-term care insurance
Check the daily benefit, the waiting period before payments start, and whether the policy covers nursing homes. Call the insurer early. Claims take paperwork.
Veterans benefits
The VA offers nursing home care in its own Community Living Centers, contracted community nursing homes and State Veterans Homes. Eligibility depends on income and service-connected disability. Ask a VA social worker.
Sources: medicaid.gov (spousal impoverishment); Social Security Act section 1917, 42 U.S.C. 1396p (look-back); va.gov. Checked October 2026.
Chapter 7Checking quality
Look before you choose
Every nursing home that takes Medicare or Medicaid is inspected, and the results are public. Medicare's Care Compare puts most of what you need in one place.
On Care Compare (medicare.gov/care-compare)
Each home gets an overall rating from 1 to 5 stars, plus separate star ratings in three areas.
| Rating | What it shows | What to look for |
|---|---|---|
| Health inspections | Problems state inspectors found on site visits and complaint investigations | Serious or repeated problems, and harm to residents |
| Staffing | Nurse and aide hours per resident each day, staff turnover and weekend staffing | Registered nurse hours, high turnover, and thin weekend staffing |
| Quality measures | Results for short-stay (rehab) residents and long-stay residents | For rehab, how many people went home and how many went back to the hospital. For long-term care, falls with injury and pressure sores. |
Reading an inspection report
- Open the full report for each home. It lists each problem the inspectors found and how many residents it affected.
- Look for problems that showed up in more than one inspection, and for complaint inspections.
- Ask the home about anything that worries you, and what it changed. Residents have the right to see the most recent inspection results and the plan of correction.
- Your state health department may also post reports. Search your state's name plus "nursing home inspection reports."
Source: cms.gov, Five-Star Quality Rating System, checked October 2026.
Chapter 8Questions to ask
Questions to ask every home
Staffing
- How many residents does each aide care for on days, evenings and nights?
- When is a registered nurse in the building?
- How long have the administrator and director of nursing been here?
- How much do you rely on agency (temporary) staff?
Therapy
- How many days a week, and how long each day, will my parent get therapy?
- Are therapists on staff, and do you have therapy on weekends?
- How do you decide when therapy ends?
Doctors and medical care
- Which doctor will oversee my parent's care, and how often do they visit?
- Can my parent keep their own doctor?
- Can you handle their needs (dialysis, oxygen, IV medicines, wound care, dementia)?
- How often do residents go back to the hospital, and why?
Care plans and communication
- When is the first care plan meeting, and can family join by phone?
- Who is my main contact, and how do I reach a nurse at night?
- How will you tell me about falls, illness or a change in condition?
Falls and infections
- What do you do to prevent falls, and what happens after one?
- How do you prevent and track infections?
- How do you prevent pressure sores for people who stay in bed?
Money and the long term
- Do you take my parent's Medicare plan and supplement?
- Do you accept Medicaid, and can my parent stay if they switch to it?
- What is the private-pay rate, and what costs extra?
- What is your bed-hold policy during a hospital stay?
Chapter 9Tour checklist
What to notice on a visit
Print one copy for each home. Visit at a meal, or in the evening, if you can.
Staff
Residents
Building
Room
Therapy
Your overall feeling
Chapter 10Warning signs
Reasons to keep looking
One of these alone may have a good explanation. Ask about it. Several together are a reason to choose another home if you can.
Chapter 11Comparison worksheet
Compare side by side
Fill this in after each call or visit, while it's fresh.
Swipe the table sideways to see every column.
| Home 1 | Home 2 | Home 3 | |
|---|---|---|---|
| Name | |||
| Bed available (date) | |||
| Takes our Medicare plan | |||
| Accepts Medicaid | |||
| Stars: overall / inspections / staffing | |||
| Therapy days per week | |||
| Private-pay rate | |||
| Can meet medical needs | |||
| Staff (1 to 5) | |||
| Cleanliness (1 to 5) | |||
| Distance from family | |||
| Inspection concerns | |||
| Overall feeling |
Chapter 12Being an advocate during the stay
Stay close and speak up
Medicare notes that family visits can improve a resident's care. You also know your parent best.
The care plan
- A basic care plan must be in place within 48 hours of admission.
- A full assessment follows within 14 days, and the full care plan within 7 days after that.
- Your parent has the right to take part in planning their care and to choose who joins. Ask to be invited to every care plan meeting.
- A doctor must see your parent at least every 30 days for the first 90 days, then at least every 60 days.
Everyday habits that help
- Visit at different times, including meals and evenings.
- Keep a notebook of names, dates and what you were told.
- Raise small problems early with the charge nurse, then the director of nursing.
Your parent's rights
- To choose their own doctor
- To have visitors of their choosing, at the times they choose
- To be fully informed about their health and take part in their care plan
- To voice complaints without fear of punishment
- To see the latest inspection results
- To written notice at least 30 days before a discharge, with some exceptions such as urgent medical needs
- To written bed-hold information before a move to the hospital
Sources: 42 CFR 483.10, 483.15, 483.20, 483.21, 483.30; ltcombudsman.org.
Chapter 13Planning what comes next
Leaving rehab safely
Planning for discharge should start in the first week. Ask at the first care plan meeting what the goal is, and when the team expects your parent to be ready.
- Agree on where your parent will goHome, home with more help, assisted living, or a long-term bed in the same home. Ask the team what level of help they will need each day.
- Get the home readyAsk whether a therapist can review the home for safety, and what equipment is needed, such as a walker, shower chair or hospital bed.
- Line up helpAsk the social worker to set up home health care if needed, and decide who in the family covers which days.
- Review every medicationAsk which medicines changed, stopped or started, and why.
Before your parent leaves
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Get the printable PDFThis guide is general information and is not medical, legal or financial advice. Prices and program rules change; confirm details with each community and program. Lilisity is part of Senior Living Alliance. © 2026 Senior Living Alliance.
