What is a nursing home?
Nursing homes, or skilled nursing facilities, provide residents a wide range of medical care and services that are not able to be provided in an assisted living community or personal care home setting. This type of care typically includes nursing care, 24-hour medical care, and assistance with everyday activities as well as rehabilitation services like physical therapy, occupational therapy and speech therapy.
Some people stay at a nursing home for a short time after being in the hospital. After they recover, they return home whether that be living independently or in another senior living setting. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require around-the-clock care.
I need to find a nursing home for me or a loved one. Where do I start?
If you or a loved one need to go to a nursing home after a hospital stay, the hospital staff can help you find one that will provide the level of care that's best for you. If you are looking for a nursing home for you or a loved one, ask your doctor's office for recommendations.
Once you know what choices you have, it's a good idea to:
- Consider what you need. What is important to you—nursing care, meals, physical therapy, a religious connection, hospice care, or special care units for dementia patients? Do you want a place close to family and friends so they can easily visit?
- Talk to your friends and family. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care.
- Call different nursing homes. Get in touch with each place on your list. Ask questions about how many people live there and what it costs.
- Visit each nursing home you're considering. Make plans to meet with the director and the nursing director. The Medicare Nursing Home Checklist has some good ideas to consider when visiting. For example, look for:
- Medicare and Medicaid certification
- Handicap access
- Residents who look well cared for
- Warm interaction between staff and residents
- Ask questions during your visit. Don't be afraid to ask questions. You might want to find out how long the director and heads of nursing, food, and social services departments have worked at the nursing home.
If you or a loved one are considering long-term care, we recommend that you also talk with someone who can help you to understand your own financial situation, such as a hospital discharge planner, your local Area Agency on Aging office or your county's Medical Assistance office.
Paying for Long-Term Care
Many older adults and caregivers worry about the cost of medical care and other help they may need. These expenses can use up a significant part of monthly income, even for families who thought they had saved enough.
How people pay for care in a nursing home depends on their financial situation and the kinds of services they use. Some people believe that their current health or disability insurance will pay for their long-term care needs, but most of these insurance policies include limited, if any, long-term care benefits. Often, people must rely on a variety of payment sources, including personal funds, government programs, and private financing options.
Personal funds (out-of-pocket expenses)
At first, many older adults pay for care in part with their own money. Roughly 20 percent of all skilled nursing facility residents pay for care using their own savings and assets. Frequently, when people enter a skilled nursing facility for extended long-term care, they first pay for their care out of their own assets and then expend their resources and apply for Medicaid.
Private insurance
For the most part, private medical insurance does not cover the cost of personal care or skilled nursing facility care except in specific circumstances.
Long-term care insurance can be purchased to provide some coverage for skilled nursing facility care. The Pennsylvania Department of Insurance offers more information about long-term care insurance in Pennsylvania, including a list of companies that are licensed to sell long-term care insurance.
Medicare
Some Medicare supplemental insurance policies, often referred to as “Medigap” insurance, may provide some limited benefits. Medicare does not provide a comprehensive long-term care component and covers only those skilled nursing facility services rendered to help someone recover from an acute illness or injury. Medicare is administered by the federal government’s Centers for Medicare and Medicaid Services (CMS) and is divided into two parts: Hospital Insurance (Part A) and Medical Insurance (Part B).
Medicaid
Medicaid is a joint federal-state government program designed to provide health care assistance to those with limited income or assets, and it has become the major payer of services for care in skilled nursing facilities across the country. In Pennsylvania, the state’s Medicaid program pays for nearly two out of every three skilled nursing facility residents’ care.
For more about Medicaid eligibility in Pennsylvania, visit Medicaid.gov’s state overview resource or visit the Pennsylvania Department of Human Services’ Medical Assistance portal.