To put your mom in a nursing home, you need four things lined up in roughly this order: a physician’s documentation that she needs nursing-level care, legal authority to act on her behalf if she can’t sign for herself, a verified way to pay the monthly bill, and a signed admission agreement with a facility that has an open bed. The process usually starts with either a hospital discharge planner or her primary care doctor, and it moves faster when you know what each step requires before you get there.
Where to Start
If your mother is in the hospital right now, ask to meet with the discharge planner or hospital social worker as soon as possible. Only a physician can authorize discharge, but the discharge planner coordinates what comes next: evaluating whether she needs skilled nursing care, identifying facilities with open beds, and helping you compare options. Beds fill up and paperwork takes time, so early is better than tidy.
If she’s still at home and care needs have gradually outrun what the family can manage, start with her primary care doctor. The doctor can order the medical assessments a nursing home requires, refer you to a social worker for placement help, and document the level of care she needs. Either way, no facility will consider an application until it has formal medical documentation showing she needs the kind of care only a nursing home provides.
The Medical Documentation Facilities Require
Every Medicaid-certified nursing home must screen prospective residents through a Preadmission Screening and Resident Review, known as PASRR. Congress created the requirement in 1987 to prevent people from being placed in nursing facilities unnecessarily, particularly people with mental illness or intellectual disabilities.1Medicaid.gov. Fact Sheet – Preadmission Screening and Resident Review (CMS-2418-P) The Level I screen is brief, usually about 15 minutes with a hospital discharge planner or social worker, and flags whether the person may have a mental health condition or intellectual disability.2Federal Register. Medicaid Program – Preadmission Screening and Resident Review If it raises a concern, a longer Level II evaluation determines whether a nursing home is actually the right setting.
Separately, a physician must complete a Level of Care determination, sometimes called a certificate of medical necessity. This document spells out the specific help your mother needs: assistance with bathing, dressing, transferring, medication management, or wound care. The facility uses it to confirm it has the staff and equipment to meet those needs. Without it, both government and private payers can refuse to cover the stay.
Legal Authority to Sign Her In
If you’re handling the admission for your mother, the facility will ask for proof that you have the legal right to do so. A Durable Power of Attorney for Healthcare is the standard document. Make sure it specifically grants you authority to consent to residential placement and to access medical records. A general power of attorney covering only finances will not satisfy a nursing home.
Under federal privacy rules, a person with legal authority to make healthcare decisions for your mother qualifies as her “personal representative” and can access her full medical records.3U.S. Department of Health and Human Services. Individuals’ Right Under HIPAA to Access Their Health Information You’ll rely on that authority throughout her stay when you review care plans, lab results, and medication lists.
If your mother can no longer understand or sign legal documents, a power of attorney is off the table, because it has to be signed while the person still has mental capacity. At that point the family typically has to petition a court for guardianship. A judge reviews medical evidence of incapacity and appoints someone to make decisions on her behalf. Court filing fees range widely, from roughly $20 to over $1,000 depending on the jurisdiction, and the process usually involves attorneys and sometimes a court-appointed evaluator. It’s slower and more expensive than a power of attorney, which is why estate-planning attorneys urge families to get these documents in place while a parent is still competent.
Facilities will also ask whether your mother has advance directives. A living will states general preferences about end-of-life care. A POLST form (Physician Orders for Life-Sustaining Treatment) is more specific and immediately actionable: it includes physician orders about CPR, intubation, antibiotics, and feeding tubes, and it travels with the patient between care settings. Having these ready at admission prevents confusion during a medical emergency.
What If She Refuses to Go
This is one of the hardest situations families face, and there is no easy workaround. If your mother is mentally competent, meaning she understands her situation and the risks of staying home, she has the legal right to refuse a nursing home even if the decision looks unwise from the outside. You cannot override that choice.
If a physician or neuropsychologist determines that she lacks the mental capacity to make safe decisions about living arrangements, guardianship becomes the path forward. A court must formally find her incapacitated before a guardian can authorize placement. In some cases, Adult Protective Services may initiate this process if a parent is in danger from self-neglect. Courts follow a least-restrictive-option principle: a guardian can’t simply choose a nursing home if a less intensive arrangement would keep her safe.
How the Bill Gets Paid
Nursing home costs are steep. The national median for a semi-private room runs about $9,500 a month, and a private room typically exceeds $10,000. Most families cover it through some combination of Medicare, Medicaid, private funds, long-term care insurance, and veterans’ benefits. Each source works differently, and understanding what each one covers before you sign an admission agreement is essential.
Medicare
Medicare is not long-term care coverage. It pays for skilled nursing facility care only under specific conditions and only for a limited time. Your mother must have been an inpatient in a hospital for at least three consecutive days, enter the nursing facility within 30 days of discharge, and need daily skilled care such as IV medications, physical therapy, or wound treatment.4Medicare.gov. SNF Care Coverage If those requirements are met, Medicare pays the full cost for days 1 through 20 after a $1,736 deductible in 2026. For days 21 through 100, she pays $217 per day in coinsurance. After day 100, Medicare pays nothing.5Medicare.gov. Medicare and You Handbook 2026
Coverage also ends the moment she no longer needs daily skilled services, regardless of whether 100 days have passed. Many families are caught off guard by this.
Private Pay
Families paying out of pocket will need to show the facility that funds exist to cover the monthly rate. Most facilities ask for two to three months of recent bank statements, proof of income such as Social Security or pension statements, and a list of debts or financial obligations. They want to verify that payment isn’t going to stop three months in.
Long-Term Care Insurance
If your mother has a long-term care insurance policy, gather the policy number and the Outline of Coverage document that describes what the plan pays and under what conditions. The facility will typically ask her (or you, as representative) to sign an Assignment of Benefits form, which authorizes the insurance company to pay the nursing home directly rather than reimbursing the policyholder.6LTCFEDS. Assignment of Benefits Form Start this paperwork early. Insurance verification can take weeks, and delays complicate the admission timeline.
Veterans’ Benefits
Veterans who need help with daily activities may qualify for the Aid and Attendance pension. In 2026, the maximum annual benefit is $29,093 for a single veteran with no dependents and $34,488 for a veteran with one dependent.7Veterans Affairs. Current Pension Rates for Veterans Eligibility requires that the veteran’s net worth not exceed $163,699 (as of December 1, 2025, through November 30, 2026). This won’t cover a full nursing home bill on its own, but it can offset monthly costs when combined with other income.
Medicaid and the Five-Year Look-Back
Medicaid pays for the majority of long-term nursing home stays in the United States, and its financial requirements are the most complex piece of the payment picture. To qualify, your mother must meet both income and asset limits set by the state. The traditional federal floor for countable assets is $2,000 for an individual, though many states have adopted significantly higher limits in recent years. Contact the state Medicaid office or an elder law attorney for the current threshold where she lives.
The biggest trap in the Medicaid application is the five-year look-back. When she applies, the state reviews every financial transaction from the previous 60 months (bank statements, property transfers, investment records, tax returns) looking for assets that were given away or sold below fair market value. Gifts to grandchildren, adding a child’s name to a bank account or property deed, and selling a home to a family member at a discount can all trigger a penalty period during which Medicaid will not pay for nursing home care. The penalty is calculated by dividing the value of transferred assets by the average daily cost of nursing home care in your state, producing a specific number of days she must wait before coverage begins.
During that penalty period, the family is on the hook for the full cost of care. Families who made innocent gifts years earlier, like holiday checks to grandchildren, sometimes discover these transfers create real Medicaid problems. If you think Medicaid is a likely eventual payer, consulting an elder law attorney well before the five-year window is far cheaper than dealing with a penalty afterward.
Protection for a Spouse Who Stays Home
When one spouse enters a nursing home on Medicaid, federal law prevents the program from impoverishing the spouse who remains in the community. The at-home spouse can keep a protected share of the couple’s combined assets (the Community Spouse Resource Allowance) and a minimum monthly income allowance to cover living expenses.8Medicaid.gov. Spousal Impoverishment For 2026, the minimum monthly income the community spouse can retain is $2,643.75 in most states.9Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards If the community spouse’s own income falls below that floor, the nursing home resident’s income can be diverted to fill the gap before any of it goes toward the facility bill. Exact thresholds vary by state.
Choosing the Facility
The federal government maintains a free comparison tool called Care Compare, run by the Centers for Medicare and Medicaid Services, that rates every Medicare- and Medicaid-certified nursing home on a five-star scale. The ratings reflect health inspection results, staffing levels, and quality measures like how often residents develop pressure sores or end up in the hospital. Don’t stop at the star rating. Read the facility’s Statement of Deficiencies (Form CMS-2567), which is the actual inspection report showing where the facility fell short of federal standards.10Centers for Medicare and Medicaid Services. Release of CMS-2567 – Statement of Deficiencies and Plan of Correction These reports are public and become available within 14 days after the facility receives them.
Pay close attention to staffing. A federal rule finalized in 2024 had established minimum nursing hours per resident per day, but HHS repealed those requirements in December 2025.11U.S. Department of Health and Human Services. HHS Cleanup of Federal Nursing Home Minimum Staffing Standards Rule Staffing now depends largely on state regulations and individual facility decisions. When touring, ask how many registered nurses and nurse aides are on the floor per shift and how many residents each aide is responsible for. A facility that’s vague about these numbers is a red flag.
Visit in person at different times of day, including evenings and weekends when staffing tends to thin out. Talk to residents and family members if you can. Look at whether call lights get answered promptly, whether residents are clean and dressed, and whether common areas smell like cleaning products rather than urine. The data on Care Compare tells you about past inspections; your visit tells you what the place is like today.
The Admission Application
Once you’ve chosen a facility, the admissions coordinator will hand you an application package that gathers everything from the earlier steps. You’ll need to provide:
- Medical records: the PASRR screening results, the Level of Care determination, recent hospital discharge summaries, a current medication list, and the name and contact information for your mother’s primary care physician.
- Legal documents: the Durable Power of Attorney for Healthcare, any guardianship orders, and advance directives (living will, POLST, or DNR orders).
- Financial verification: documentation appropriate to the payment source, whether Medicaid application materials, Medicare information, insurance policy details, or private-pay bank statements and income proof.
- Emergency contacts: names and phone numbers for the people authorized to make decisions in a crisis.
The package also includes a Physician’s Order for Admission, signed by the doctor who will follow her care at the facility. It covers diet, therapy needs, wound care, and other medical instructions. Check that everything in the medical records matches the physician’s orders; discrepancies create delays when the facility’s medical director reviews the file.
What to Watch in the Admission Agreement
After the facility approves the application, you’ll sit down to sign the admission agreement. It’s a legally binding contract that spells out included services, the daily rate, and what happens if payment is interrupted. Read every page. Three provisions deserve particular attention.
You cannot be required to personally guarantee payment. Federal law prohibits a nursing home from making you or any other family member sign as a personal guarantor as a condition of admission.12eCFR. 42 CFR 483.15 – Admission, Transfer, and Discharge Rights The facility can require a representative who has legal access to the resident’s income or assets to sign a contract agreeing to pay from those resources, but that makes the resident financially responsible, not you personally. If the paperwork includes language that would make you personally liable, cross it out or refuse to sign that section. Some facilities still try this despite the federal ban.
Arbitration agreements are optional. Many facilities will ask you to sign a binding arbitration agreement, sending future disputes to a private arbitrator instead of court. Federal regulations allow facilities to offer this but prohibit them from making it a condition of admission or continued care.13eCFR. 42 CFR 483.70 – Administration The facility must tell you clearly that signing is optional. If you do sign, you have 30 days to rescind. Arbitration can limit your legal options if something goes wrong with her care, so weigh it carefully.
Residents’ rights document. The facility must hand you a written copy of the residents’ rights at or before admission. Federal regulations guarantee residents the right to privacy, the right to participate in their own care planning, the right to access their medical records within 24 hours of asking, and the right to voice grievances without retaliation.14eCFR. 42 CFR 483.10 – Resident Rights The document must include contact information for the State Long-Term Care Ombudsman, the state survey agency, and adult protective services. Keep it.
Ask for a written list of extra charges not included in the daily rate. Haircuts, personal laundry, telephone service, and certain supplies may be billed separately. Knowing these costs upfront prevents billing surprises in the first few months.
Move-In Day
On arrival, a nurse will perform an intake assessment that establishes a health baseline: a full skin check documenting any existing wounds, bruises, or pressure areas; vital signs; weight; and a review of current medications. This baseline matters. If a new wound or injury appears later, the intake record is proof it wasn’t there on arrival.
Staff will also create a written inventory of every personal item your mother brings, including clothing, glasses, dentures, hearing aids, photos, and any other belongings. Ask for a copy. Personal property goes missing in nursing homes more often than facilities like to admit, and the inventory is your evidence if you need to file a claim.
Within the first few days, the facility will schedule a care-plan meeting that typically includes a nurse, a social worker, a dietary aide, and often a family member. This is where the team maps out daily care: bathing schedule, therapy goals, dietary restrictions, and activity preferences. Attend. It’s the best chance to make sure the staff understands your mother’s needs and habits before routines harden.
After Admission: Discharge Protections
Once she’s admitted, the facility can’t simply ask her to leave. Federal law requires at least 30 days’ written notice before any involuntary transfer or discharge, except in emergencies involving the resident’s health, the safety of other residents, or an urgent medical need.12eCFR. 42 CFR 483.15 – Admission, Transfer, and Discharge Rights The notice must state the reason for discharge, the effective date, where the facility plans to send her, and how to appeal.
If you receive a discharge notice you believe is unjustified, your mother has the right to request a hearing, and the facility generally cannot transfer her while the appeal is pending. Contact the State Long-Term Care Ombudsman right away. Ombudsman programs are specifically authorized to advocate for residents in discharge disputes, and they know the procedural requirements facilities must follow. The Eldercare Locator at 1-800-677-1116 can connect you with the ombudsman program in your state.
One related point: if she’s ever temporarily hospitalized during her stay, ask the facility about its bed-hold policy in writing. Rules vary by state, and knowing whether the bed will be held (and at what charge) prevents an unwelcome surprise on the way back.