Nursing Homes

Skilled nursing homes provide medical, health, and personal care, as well as supervision to people who need it. Nursing home residents generally have severe illness, disability, or cognitive impairment (problems with thinking, learning, or memory).

The Federal government sets quality standards for nursing homes that serve people who have Medicare or Medicaid coverage. These rules require that nursing homes provide skilled nursing, rehabilitation, and other types of therapies that people may need. State licensure of nursing homes generally follows the federal standards.

Note that the Federal government doesn’t regulate assisted-living and these homes don’t have to offer skilled nursing services like nursing homes do. States regulate assisted living and their rules vary across the country.

Who Lives in Nursing Homes?

About one-third of older adults will live in a nursing home at some point in their lives. People living in them are often women age 85 or older.

Care Settings - Nursing Homes

Risk Factors for Admission

There are several risks related to living in a nursing home:

  • Age. The chance of entering a nursing home increases with age.
  • Low income.
  • Few family members available and little social activity.
  • Physical or mental difficulties. 
  • Race/ethnicity. White people are more likely than other groups to go into a nursing home.
  • Geriatric syndromes (such as frailty, frequent falls, pressure sores, dementia, etc.) also increase the risk of being in a nursing home.

Reasons for Living in a Nursing Home

People in nursing homes go there for four general reasons:

  1. Short-term Skilled Care. About 20 percent of of people currently in nursing homes have been there for 3 months or less. They generally need skilled nursing or rehabilitation and other therapy services for a short period of time. They often don’t need services for more than a few months. Their need for skilled care often relates to:
    • Having been in the hospital for infection or another illness
    • Having a need for rehabilitation or other type of therapy due to a temporary disability or after a surgery, such as a hip replacement
    • Needing care at the end of their lives
  2. Long-term Needs. They have a long-term set of disabilities and skilled nursing needs that cannot be delivered in their home. For example, people in nursing homes may have had a stroke that prevents them from taking care of their own needs, such as  bathing, dressing, or eating. 
  3. Around-the-clock Supervision. They may need supervision because they have a dementia like Alzheimer’s disease that causes cognitive problems. Or, they have a mental health condition, like severe depression, that leaves them unable to care for themselves.
  4. Memory Care. Dementia and some mental health problems can cause some people to depend on others for reminders to carry out daily activities or help in doing them. Problems can also include difficult behaviors, such as abusing others, wandering, or problems communicating. These people may need supervision, along with other types of help.

People can have more than one type of problem. For example, most residents have cognitive impairment and need help with their daily activities.

Characteristics of Nursing Homes

Nursing homes increasingly offer medical services similar to those of hospitals for people with short-term needs.  Medical services vary, but often include:

  • Skilled nursing care
  • Orthopedic care (care for muscle, joint, and bone problems)
  • Breathing treatments
  • Support after surgery
  • Physical, occupational, and speech therapy
  • Intravenous therapy and antibiotics
  • Wound care 

Nursing homes also provide:

  • Nutritional counseling, social work services, and recreational activities
  • Respite care (short breaks for family caregivers and end-of-life care, including hospice.

Nursing homes don’t provide the same intense medical care that hospitals do. These homes don’t have as many doctors and nurses available. Homes generally don’t have services, such as labs and radiology.

Choosing a Nursing Home

Your healthcare professional (likely a home health nurse or social worker) can recommend nursing homes for you to consider, if needed.

 The U.S. Centers for Medicare and Medicaid Services Care Compare website provides detailed information that can help you compare the quality of different nursing homes. 

The website gives scores for nursing home quality measures, including data about people having:

  • Vaccines, like the flu vaccine
  • Physical restraints that keep them from moving
  • Falls
  • Pressure sores
  • Weight loss

Older adults or their family members can visit several homes to get a sense of the overall feeling and quality of care. A visit may last an hour or two and involve talking with the admissions staff, nursing home administrators, directors of nursing, and social workers.

Questions to Ask When Visiting a Nursing Home

Older adults or family can use a checklist to help them evaluate nursing home quality, available services, convenience, and costs. The following questions may be helpful: 

Condition of the Facility

  • Is the nursing home clean and well maintained?
  • Do the residents look well cared for?
  • Are the rooms big enough and, if people are sharing rooms, do they have privacy?
  • What recreational and private spaces are available?
  • Are there safety features, such as railings and grab bars?

Licensing and Staffing

  • Is the home licensed by the state and certified by Medicare and/or Medicaid?
  • How many nurses and nursing assistants are there compared to residents? Ask about these staff ratios and how they compare to state and national averages.
  • Do the administrators and medical professionals have special training in geriatrics or long-term care?
  • Does the medical director have specialized training to be an active engaged medical director? Do they have a Certified Medical Director (CMD) status?
  • Are key professionals (administration, rehabilitation, nursing, activities, etc.) full-time or part-time?
  • How long have the managers and nursing staff worked at the nursing home?
  • Is vaccination against influenza and COVID required for all staff members? If the vaccination is not required, what percent of staff members get these vaccines?
  • Who will be the physician or nurse practitioner serving the resident, and how accessible are these professionals?

Other Concerns

  • How does the nursing home handle an older adult’s transfers from a hospital to nursing home and from nursing home to hospital? Medical record transfer is an important quality concern here.
  • Does the nursing home have special care units, for example one that focuses on people with dementia?
  • How does the nursing home handle end of life care?
  • How close is the nursing home to family members? How close is it to the nearest hospital?
  • What is the food like? Look at a sample menu and ask to see a planned weekly menu.

Financial Concerns

  • How much do basic services cost and what services are covered?
  • What additional services are available? How much do they cost?
  • What happens if a person runs out of money and needs medical aid from the Medicaid program? Does the nursing home serve people who rely on Medicaid for coverage.

No nursing home is perfect, and all will likely be very different from a person's current home. Going into a nursing home can be scary and depressing. The move can fill people with a sense of betrayal and failure.

Family involvement is important in helping the older adult make the transition to living in a nursing home. Families can offer company and help with daily activities, if they wish. Families may be better able to communicate with and reassure the older adult and provide insight to staff on a resident’s behavior.

Paying for Nursing Home Care

Nursing homes receive payment from four major sources.

  1. Medicare pays for part of the cost for stays of 100 days or less following a three day period in a hospital. The older adult’s costs are covered only if they need skilled nursing or therapies.
  2. The Department of Veterans Affairs pays for nursing home care under some circumstances for Veterans.
  3. People use their own money to pay for their nursing home care if they don’t meet Medicare or Veterans Affairs rules for payment.
  4. Medicaid often covers nursing home care for older adults who have spent down their money on nursing home care and have few financial assets left.


Last Updated June 2023

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