Choosing a Nursing Home: A Practical Checklist

Medicare SNF coverage and 2026 costs, Medicare vs. Medicaid for long-term care, staffing questions for visits, and the ombudsman.

Choosing a nursing home often happens quickly, sometimes during a hospital discharge. This checklist walks through how coverage works, how to use CMS data to build a shortlist, and what to look for and ask about when you visit. The figures below are for 2026.

Step 1: Understand what Medicare covers

Medicare Part A covers short-term skilled nursing facility (SNF) care, such as rehabilitation after a hospital stay. It doesn't cover long-term living in a nursing home. According to Medicare.gov, coverage generally requires:

• A medically necessary inpatient hospital stay of at least 3 days in a row. Time spent under observation or in the emergency room doesn't count toward the 3 days, so ask the hospital whether your family member has been admitted as an inpatient.
• Entering a Medicare-certified SNF within a short time (generally 30 days) after leaving the hospital.
• A need for daily skilled care related to the hospital stay.

Medicare covers up to 100 days per benefit period. A benefit period ends when someone has gone 60 days in a row without inpatient hospital or SNF care. For 2026, the Medicare costs fact sheet lists:

• Days 1 to 20: $0
• Days 21 to 100: $217 per day coinsurance
• After day 100: all costs

The 100 days are a maximum, not a guarantee. Coverage ends when daily skilled care is no longer needed. Medicare Advantage plans may waive the 3-day hospital stay requirement and may charge copayments during the first 20 days, so check with the plan.

Step 2: Plan for long-term (custodial) care

Medicare doesn't pay for long-term care, also called custodial care, which is help with daily activities over an extended period. Families usually pay for it with personal funds, long-term care insurance, or Medicaid. Nursing facility services are a required Medicaid benefit for eligible adults age 21 and older. Each state sets its own financial eligibility and level-of-care rules (Medicaid.gov). If a spouse will remain at home, federal spousal impoverishment rules protect some of the couple's income and assets for that spouse.

Two practical questions to ask each home:

• Is the home certified for both Medicare and Medicaid?
• If your family member starts as a private-pay or Medicare resident and later qualifies for Medicaid, can they keep the same room or bed?

Your state Medicaid agency can explain eligibility. For advice on your own situation, consider an elder law attorney.

Step 3: Build a shortlist with Care Compare

Use Medicare.gov Care Compare (or this directory, which is built on the same CMS data) to review each candidate:

• The overall star rating and the three separate ratings. Look especially at the health inspection rating, which counts the most.
• Recent inspection citations, especially any at level G or higher (actual harm or immediate jeopardy).
• Fines and payment denials in the last three years.
• The red abuse icon or the yellow Special Focus Facility warning sign.
• Staffing hours per resident per day, including weekend and RN hours, and staff turnover.

Step 4: Visit, and look closely at staffing

CMS's rating methodology measures total nursing hours, RN hours, and weekend hours, plus turnover of nurses and administrators, because staffing is closely tied to quality of care. Numbers only go so far, so see it for yourself:

• Check the posted staffing. Federal rules (42 CFR 483.35) require homes to post, at the start of each shift, the number of RNs, LPNs/LVNs, and certified nurse aides on duty, the hours they work, and the resident census. Look at the posting when you visit.
• Visit more than once, at different times, including an evening or a weekend if you can. CMS reports weekend staffing separately, so compare what you see with the home's weekend numbers.
• Ask about turnover. How long have the administrator and director of nursing been in their jobs? How much do they rely on agency staff?
• Ask about assignments. How many residents does each aide care for on day, evening, and night shifts? Are the same aides usually assigned to the same residents?
• Watch how call lights are answered and how staff speak to residents.

Step 5: Questions and observations checklist

1. Are residents clean, dressed, and out of bed? Are they taking part in activities?
2. Does the building smell clean? Are common areas and rooms in good repair?
3. Can you see the most recent inspection results? Homes must post them where visitors can easily see them (42 CFR 483.10). Ask how the home fixed any serious citations.
4. How is the care plan developed, and how are families involved?
5. Which doctors see residents, and how often? How are after-hours medical problems handled?
6. For rehab stays: how often is therapy provided, and how are discharge plans made?
7. For memory care: what training do staff have, and how does the home handle wandering and changes in behavior?
8. What is included in the daily rate, and what costs extra?
9. What are the visiting policies, and how does the home communicate with families?
10. Talk with residents and family members you meet, if they are willing.

Step 6: Contact the long-term care ombudsman

Every state has a Long-Term Care Ombudsman program, authorized under the Older Americans Act and overseen by the Administration for Community Living. Ombudsmen are advocates for residents. They help resolve complaints about care, rights, and quality, and their services are free. Before you choose, a local ombudsman can often share general information about homes in your area. After admission, they can help if problems come up. The ACL page links to a directory for finding your local program.

If you have concerns about care after admission, you can also file a complaint with your state survey agency, which is required to review it. This checklist is general information and not medical, legal, or financial advice.

Updated 2026-09-30.