The process starts with a doctor's assessment, then a family meeting, then paperwork with the facility
Placing someone in a nursing home is not a single decision — it is a series of steps that usually take weeks or months. It begins when a doctor says the person needs more care than home or assisted living can provide. From there, you gather medical records, tour facilities, check what their insurance covers, and sign admission paperwork. The person being admitted (if they are able) must also consent, or a legal guardian must make the decision on their behalf.
The timeline depends on urgency. If someone is leaving a hospital, the process can compress into days. If you are planning ahead, you might start six months early. Either way, the steps stay the same: assessment, facility search, financial review, and admission.
Key Takeaways
- A doctor must document that the person needs skilled nursing care — this is not optional and determines which facilities can admit them.
- You will need medical records, insurance information, and a list of current medications before any facility will accept an admission process.
- Nursing homes have waiting lists, so starting the search early matters even if admission is months away.
- Medicare, Medicaid, and private insurance each cover different lengths of stay and have different requirements — you must know which one applies before you tour.
- The person being admitted has the right to refuse, unless a court has appointed a legal guardian who can override that refusal.
Getting a doctor to assess whether nursing home care is needed
The first step is a conversation with the person's primary care doctor or the hospital discharge planner if they are leaving a hospital. Tell them directly: "We are considering a nursing home." The doctor will evaluate whether the person needs skilled nursing care — meaning daily medical services like wound care, medication management, or physical therapy that cannot be safely done at home.
The doctor's assessment becomes a written order or referral. This document is what nursing homes actually require before they will even discuss admission. Without it, you cannot move forward. If the primary care doctor says nursing home care is not medically necessary, most facilities will not admit the person, even if the family wants them there. In that case, assisted living or in-home care may be the only options.
If the person is in a hospital, the discharge planner does this assessment automatically. If they are at home, you may need to request a formal evaluation. Ask the doctor's office: "Can you write an order for a nursing home assessment?" Some doctors will do this in an office visit; others may require a home visit or a hospital stay first.
Gathering medical records and insurance information
Once you have a doctor's referral, collect these documents before you contact any facility:
- A list of all current medications with dosages
- Recent lab results and test reports
- A summary of medical conditions (diabetes, heart disease, dementia, etc.)
- Insurance card (Medicare, Medicaid, private insurance, or Veterans benefits)
- Social Security number
- The doctor's written referral or assessment
You do not need every medical record ever created, but you do need enough for the nursing home to understand what care the person requires. Call the doctor's office and ask them to send records directly to the facility once you have chosen one. Most offices can do this within a few days.
Insurance information matters because it determines cost and which facilities will accept the person. Medicare covers up to 100 days of skilled nursing care after a hospital stay (with conditions). Medicaid covers long-term care but only after savings fall below a state-set limit. Private insurance and out-of-pocket payment have different rules. The nursing home's admissions staff will ask about insurance first, so have the card or policy number ready.
Touring facilities and checking their current capacity
Call nursing homes in your area and ask: "Do you have an opening in the next [timeframe you need]?" Many homes have waiting lists, especially for Medicaid beds. Some will tell you when ready whether they can admit someone; others will ask you to come in for a tour first.
During a tour, ask these specific questions:
- What is your current wait time for admission?
- Do you accept [Medicare/Medicaid/private insurance — whichever applies]?
- Can you provide the level of care this person needs? (For example: dementia care, wound care, dialysis support.)
- What is the monthly cost, and what does it include?
- Can I see the room where the person would stay?
- What is your staffing ratio — how many nurses and aides per resident?
Do not rush this step. A nursing home is where the person will live, possibly for years. If a facility says they cannot meet the person's medical needs, keep looking. If they have no opening for months, ask to be placed on a waiting list and continue your search elsewhere.
Understanding costs and what insurance covers
Nursing home costs vary widely by location and level of care. Some facilities cost $6,000 to $8,000 per month; others cost more. What insurance covers depends on the type:
Medicare covers up to 100 days of skilled nursing care, but only if the person was hospitalized for at least three days first and is admitted within 30 days of hospital discharge. After 20 days, the person pays a daily copay. After 100 days, Medicare stops paying and the person (or family) must pay out of pocket or switch to Medicaid.
Medicaid covers long-term nursing home care for people whose income and assets fall below state limits. Each state sets these limits differently. Medicaid pays for the room and board, but the person usually must contribute their income (Social Security, pensions) toward the cost. Medicaid does not cover the first month or two in most states — you must pay privately until Medicaid is approved, which can take 30 to 60 days.
Private insurance and out-of-pocket payment mean the family pays the full monthly cost. Some long-term care insurance policies cover nursing home stays, but coverage varies. Check the policy or call the insurance company to confirm.
Before you admit someone, ask the facility's business office: "What will the first month cost, and what will insurance cover?" Get this in writing. Do not assume.
Completing the admission paperwork and consent
Once you have chosen a facility and confirmed they have an opening, the admissions office will send you forms to complete. These typically include:
- A personal information sheet (name, date of birth, emergency contacts)
- Medical history and current medications
- Insurance information
- A financial agreement stating the monthly cost and payment terms
- Consent forms for medical care and treatment
- A resident rights document
Read every form before signing. If something is unclear, ask the admissions staff to explain it. Pay special attention to the financial agreement — make sure the cost matches what you were quoted and that you understand when payment is due.
The person being admitted must sign the consent forms if they are mentally able to do so. If they cannot — because of dementia, stroke, or another condition — a legal guardian, power of attorney, or healthcare proxy must sign on their behalf. If no legal authority exists and the person cannot consent, the family may need to pursue guardianship through the court before admission can proceed. This can add weeks to the timeline.
What happens on admission day
Bring the person to the facility on the scheduled date with any personal items they want (clothes, photos, toiletries). The nursing staff will do an intake assessment, checking vital signs and reviewing medications. They will assign a room and a primary nurse.
The first few days are an adjustment. The person may be confused, upset, or resistant — this is normal. The facility should provide orientation to the building, meal times, and activities. You can visit whenever you want (facilities cannot restrict visiting hours). If something seems wrong — medication errors, poor hygiene, neglect — report it to the nursing supervisor when ready and document it in writing.
After the first week, ask to meet with the care team to discuss how the person is adjusting and whether any changes to their care plan are needed.
Frequently Asked Questions
Can I put someone in a nursing home against their will?
Not without legal authority. If the person has mental capacity to refuse, they have the right to refuse admission, even if family members think it is necessary. If they lack capacity due to dementia or another condition, a court-appointed guardian, healthcare proxy, or power of attorney can make the decision. Without legal authority, you cannot force admission.
How long does the whole process take?
If the person is leaving a hospital, admission can happen within days. If you are planning ahead, allow two to six months to tour facilities, check waiting lists, and complete paperwork. Some homes have long waiting lists, so starting early matters.
What if the person's doctor says they do not need nursing home care?
Then most nursing homes will not admit them. If the person needs care but not skilled nursing care, assisted living, adult day programs, or in-home care may be better options. Talk to the doctor about what level of care is actually needed.
Do I have to use a nursing home near where the person lives?
No. You can choose any facility that has an opening and accepts the person's insurance. Some families choose homes closer to their own house for easier visiting. Others choose based on the facility's reputation or the care they provide. Location is your choice.
What if the person wants to leave after admission?
If they have mental capacity, they can leave. The facility may ask them to sign a form saying they are leaving against medical information, but they cannot be held there. If they lack capacity, the legal guardian decides whether they can leave. If the person is unhappy, talk to the care team about what is wrong and whether changes can be made before considering a move.