Your Complete Guide to Living in a Nursing Home
Understand your rights, coverage options, and what to expect when living in a Medicare-covered nursing home. This guide covers Medicare and Medicaid benefits, resident rights, care planning, and how to file a complaint if needed. Medicare publication 12217.
Who Should Read This
This publication is written for people of all ages who are currently living in a nursing home or who may need to move into one soon. It is also very helpful for family members, caregivers, and loved ones who are helping someone make decisions about nursing home care.
If you are on Medicare or Medicaid, or if you are planning ahead for long-term care, this guide is especially important for you. Adult children helping an aging parent navigate nursing home options will also find this information very useful.
Quick Overview
This publication from the Centers for Medicare and Medicaid Services explains what you can expect when you or a loved one lives in a nursing home. It covers your rights as a resident, how Medicare and Medicaid help pay for nursing home care, and what protections are in place to keep residents safe and treated with dignity.
The guide walks through key topics including how to choose a nursing home, what services are covered, resident rights, and how to file a complaint if something goes wrong. It is written in plain language and designed to be easy to understand for older adults and their families.
Key Takeaways
- Medicare covers short-term skilled nursing facility care under specific conditions, but it does not cover long-term custodial care.
- Medicaid may help pay for long-term nursing home care if you meet income and asset requirements.
- Every nursing home resident has legal rights, including the right to be treated with dignity and respect.
- You have the right to make decisions about your own care, including the right to refuse treatment.
- Nursing homes must provide a written plan of care for every resident.
- If you have a complaint about a nursing home, you can contact your State Long-Term Care Ombudsman for help.
- Nursing homes that accept Medicare or Medicaid must meet federal health and safety standards.
Publication Summary
Understanding Nursing Home Care
A nursing home, also called a skilled nursing facility, provides care for people who need more help than can be given at home or in an assisted living setting. Nursing homes offer medical care, help with daily activities like bathing and dressing, and therapy services. Some people stay in a nursing home for a short time to recover from an illness or surgery, while others live there on a long-term basis.
How Medicare Covers Nursing Home Care
Medicare Part A may help cover a short stay in a skilled nursing facility after a qualifying hospital stay. To qualify, you must have been admitted to a hospital as an inpatient for at least three days before moving to the nursing home. Medicare covers certain services during this stay, including skilled nursing care, therapy, and some medications. Medicare does not pay for long-term custodial care, which includes help with everyday activities when no skilled care is needed.
How Medicaid Covers Nursing Home Care
Medicaid is a joint federal and state program that can help pay for long-term nursing home care for people who have limited income and resources. Each state has its own rules about who qualifies and what is covered. If you think you may need Medicaid to help pay for nursing home care, it is important to look into your state's rules as early as possible. Some people spend down their own savings before becoming eligible for Medicaid.
Your Rights as a Nursing Home Resident
Every person living in a nursing home has important legal rights. These rights are protected by federal law. Nursing home residents have the right to be treated with dignity and respect at all times. You have the right to privacy, the right to make your own care decisions, and the right to be free from abuse and neglect. You also have the right to be informed about your medical condition and your care plan.
Residents have the right to choose their own doctor and to take part in planning their own care. You have the right to refuse any treatment or medication. If you are not able to speak for yourself, a family member or legal representative may help make decisions on your behalf.
Care Planning and Services
When you move into a nursing home, the staff must create a written care plan just for you. This plan describes what kind of care you will receive and who will provide it. The plan must be reviewed regularly and updated as your needs change. You and your family have the right to take part in care planning meetings.
Nursing homes that accept Medicare or Medicaid are required to provide certain services. These include nursing care, help with daily activities, social services, meals, and activities. The nursing home must also provide or arrange for doctor visits, dental care, and other services you may need.
Choosing a Nursing Home
Choosing the right nursing home is an important decision. You should visit several facilities before making a choice. Ask about the types of care offered, the staff-to-resident ratio, and the activities available. You can also check the quality ratings of nursing homes using the Medicare Care Compare tool at Medicare.gov. This tool shows inspection results, staffing levels, and quality measures for every Medicare and Medicaid certified nursing home in the country.
Filing a Complaint
If you or a family member has a concern about the care being provided in a nursing home, there are steps you can take. You can talk directly with the nursing home staff or management. If the problem is not resolved, you can contact your State Long-Term Care Ombudsman. The Ombudsman is a free and confidential resource that helps residents and families resolve complaints. You can also contact your state's health department to report serious concerns.
Frequently Asked Questions
Does Medicare pay for long-term nursing home care?
No. Medicare only helps pay for short-term skilled nursing facility care after a qualifying hospital stay. It does not cover long-term custodial care, such as help with bathing and dressing when no skilled medical care is needed.
What is the difference between skilled care and custodial care?
Skilled care is medical care provided by licensed professionals such as nurses or therapists. Custodial care is help with everyday tasks like eating, bathing, and getting dressed. Medicare covers skilled care but not custodial care. Medicaid may cover custodial care for those who qualify.
Can a nursing home make me leave if I run out of money?
If you are a Medicaid beneficiary, a nursing home that accepts Medicaid cannot make you leave just because you have used up your personal savings and are now on Medicaid. However, not all nursing homes accept Medicaid, so it is important to ask about this before choosing a facility.
What should I do if I think a nursing home resident is being abused or neglected?
If you believe a resident is being abused or neglected, contact the nursing home's management right away. You should also report the situation to your State Long-Term Care Ombudsman and your state's health department. In an emergency, call 911.
How do I find the quality ratings for a nursing home?
You can look up quality ratings for any Medicare or Medicaid certified nursing home using the Medicare Care Compare tool available at Medicare.gov. The tool provides information on inspections, staffing, and quality of care measures.
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Publication Number: 12217
Publication Date: September 2025
Length: 8 pages
