Nursing Home Care: Costs, Services, and What to Expect

Written by Sarah Gleim
Medically Reviewed by Zilpah Sheikh, MD on April 08, 2025
8 min read

When you have a loved one who's aging and needs to move into a nursing home or long-term care facility, finding the right place can be very difficult. You may have many questions, such as how you can be sure that they will be safely taken care of and how much this will cost. We'll break down what caregivers need to know about nursing home care.

Long-term care refers to a wide range of medical, personal, and social services designed to meet the physical, social, and emotional needs of people who are chronically ill or disabled. A nursing home facility may be the best choice for people who require 24-hour medical care and supervision.

Nursing homes offer the most extensive care a person can get outside of a hospital. Nursing homes offer what's called custodial care, including help with:  

  • 24-hour supervision
  • Nursing care
  • Bathing 
  • Getting dressed 
  • Eating three meals a day

Some nursing homes also provide skilled nursing care, which includes care, medical monitoring, and treatments given by a registered nurse. Skilled care also includes services offered by specially trained professionals, such as physical, occupational, and respiratory therapists.

The services nursing homes offer vary from facility to facility. Services often include:

  • Room and board
  • Monitoring of medication
  • Personal care (including dressing, bathing, and toilet assistance)
  • 24-hour emergency care
  • Social and recreational activities

Finding the right nursing home takes time. It is important to begin the search for a suitable nursing home well in advance. There are often long waiting periods for available accommodations. Planning ahead can also make moving into a nursing home much easier.

Talk with your family member about what services they'll need. Take time to consider what services are important before calling different nursing homes.

Think about these questions:

  • What daily activities does your family member need help with (bathing, dressing, toileting assistance, eating)?
  • How often do they need help?

Before scheduling a visit to the nursing homes you are interested in, ask about vacancies, admission requirements, level of care offered, and participation in government-funded health insurance options.

As you assess your family member's long-term care needs, it's important to consider financing options. Payment for nursing home care can be made through Medicare (see limitations below), Medicaid, private insurance, and personal funds. When deciding on nursing homes, it's important to ask the administrative staff what payment options they accept. Here's a summary of some of the financing options.

Medicare for nursing homes

Medicare is a federal health insurance program that offers health care benefits to all Americans aged 65 and older. It offers insurance protection to cover major hospital care regardless of income. Most nursing homes provide what's called custodial care, which is when you need help bathing, dressing, going to the bathroom, and eating. Medicare doesn't cover custodial care. Medicare only covers short-term stays in a skilled nursing facility when medically necessary, such as for help with things like changing sterile dressings. A Medicare Advantage Plan (Part C) or other Medicare health plan may cover nursing home care, but only if your loved one meets certain requirements. Talk to your loved one's Medicare provider to see if they cover nursing home coverage.

Medicaid for nursing homes

Medicaid is a joint federal/state health insurance program providing medical care benefits to low income Americans who meet certain requirements. Nursing home care is covered through Medicaid, but the requirements and covered services vary widely from state to state. Medicaid nursing home facility services are available only when you don't have any other options to pay and you're eligible for Medicaid. And Medicaid pays for only approved nursing homes. This means you'll have to pay for a nursing home care out of pocket initially. It may be a good idea to work with a lawyer who specializes in elder law to determine if you're loved one is eligible for Medicaid.

Private long-term care insurance

Private long-term care insurance is a health insurance option that covers nursing home care. Each policy has its own eligibility requirements, restrictions, costs, and benefits. Policy premiums vary significantly based on where you live, your age when you purchase it, the annual benefit, and your gender, but cost less than $1,000 a month. If you're considering long-term insurance for you or a loved one, carefully consider your needs and get quotes from multiple insurers, as premiums vary greatly depending on personal and policy factors.

Medicare has a website to find and compare Medicare-certified nursing homes in your area. You simply enter your ZIP code, and you'll see a list of nursing homes you can filter based on location, overall rating, number of beds, or other options. Medicare provides each facility with an rating of 1 to 5 stars based on three factors: health inspections, staffing, and quality measures. You can click on individual nursing homes to view the latest inspection reports. 

In addition, our checklist below will help you and your family evaluate different nursing homes. Review it before your visit a facility and take it with you when you go on a tour so you know what questions to ask.

Here's a list of important questions to ask when considering a nursing home:

General care and licensing

  • Does the nursing home offer the level of care we need?
  • Does the nursing home meet local and/or state licensing requirements?
  • Does the nursing home's administrator have an up-to-date license?
  • Does the nursing home meet state fire regulations (including a sprinkler system, fire-resistant doors, and a plan for evacuating residents)?
  • What are the visiting hours?
  • What is the policy on insurance and personal property?
  • What is the procedure for responding to a medical emergency?

Admission

  • Is there a waiting period for admission?
  • What are the admission requirements?

Fees and financing

  • Are fees competitive?
  • Have fees increased significantly in the past few years?
  • Is the fee structure easy to understand?
  • What are the billing, payment, and credit policies?
  • Are there different costs for various levels or categories of services?
  • Are the billing and accounting procedures understandable?
  • Does the nursing home reveal what services are covered in the quoted fee and what services are extra?
  • What governmental financing options are accepted (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and others)?
  • When may a contract be terminated? What is the refund policy?
  • Is there an entrance fee?

Needs assessment

  • Is there a written plan of care for the residents?
  • What is the procedure for assessing a potential resident's need for services? 
  • Are those needs reexamined periodically?

Professional staff

  • Do the nurses, social workers, and administrators have geriatric experience and/or education?
  • Are staff members available to meet scheduled and unscheduled needs?
  • What is the staff-to-resident ratio?
  • Do staff members seem to genuinely enjoy working with the residents?
  • Do staff members treat residents as individuals?
  • Is staff available to assist residents who experience memory, orientation, or judgment losses?
  • Does a doctor or nurse visit the resident regularly to provide medical checkups?
  • Do residents appear happy and comfortable?
  • Do residents, other visitors, and volunteers speak favorably about the nursing home?
  • Are residents clean and adequately dressed?
  • Are the rights of residents clearly posted?

Facility design

  • Do you like the appearance of the building and its surroundings?
  • Is the décor attractive and home-like?
  • Is the floor plan easy to follow?
  • Do doorways, hallways, and rooms have enough space for wheelchairs and walkers?
  • Are elevators available?
  • Are handrails available?
  • Are the shelves easy to reach?
  • Are carpets secured and floors made of a non-skid material?
  • Is there good natural and artificial lighting?
  • Is the residence clean, odor-free, and properly heated/cooled?

Medication and health care

  • What is the policy regarding the storage of medication and help with medication?
  • Is self-administration of medication allowed?
  • Who coordinates visits from a physical, occupational, or speech therapist if needed?

Services

  • Is staff available to provide 24-hour assistance with activities of daily living, if needed? Daily activities include:
  • Is staff available to provide 24-hour assistance with activities of daily living, if needed? Daily activities include:
  • Dressing
  • Eating
  • Mobility
  • Hygiene and grooming
  • Bathing, toileting, and incontinence
  • Using the telephone

Room features

  • Are rooms for single and double occupancy available?
  • Is a 24-hour emergency response system accessible from the room?
  • Are bathrooms private? Do they accommodate wheelchairs and walkers?
  • Can residents bring their own furnishings? What all may they bring?
  • Do all rooms have a telephone? How is billing handled for long-distance calls?

Social and recreational activities

  • Is there an activities program?
  • Are the activities posted for residents?
  • Do residents take part in most activities?

Food service

  • Does the nursing home provide three nutritionally balanced meals a day, seven days a week?
  • Is the food hot, attractive, and tasty?
  • Are snacks available?
  • May a resident request special foods?
  • How are special diets handled? 
  • Is drinking water always accessible?
  • Are common dining areas available, or do residents eat meals in their rooms?
  • Can meals be provided at times a resident prefers, or are there set meal times?
  • Is assistance available for residents who need help with eating?

What services do nursing homes provide?

Most nursing homes provide nursing care, 24-hour supervision, three meals a day, and help with everyday activities. Some also offer rehab services such as physical, occupational, and speech therapy.

How do I choose the right nursing home?

It's very important to consider your loved one's needs. Also, ask your friends and network about their experiences with nursing homes. Were they happy with the care or not? Your doctor might also be able to suggest a good place. Once you've decided on a few possibilities, call them and set up in-person visits. Find out about immediate availability. Many nursing homes have waiting lists. Plan meetings with the nursing home's staff, including the director, head doctor, and nurse. Ask as many questions as possible, including what it costs. Visit ones you like again, unannounced, perhaps during mealtime. How do the dining room and the food look? Once you choose the right nursing home, read the contract carefully before you sign it.

What is the difference between a nursing home and assisted living?

Most nursing homes provide several types of nursing, personal, and health care services to their residents. Assisted living, on the other hand, offers some levels of care, but not as much as nursing homes provide. Assisted living is usually for residents who need help with things such as their medication, housekeeping, and laundry, and they usually provide all meals and a wide range of social activities.