Nursing Homes (Skilled Nursing Facilities): What They Are, Who They Help, and How to Pay

Nursing homes—also called skilled nursing facilities (SNFs)—provide 24/7 licensed nursing, rehabilitation, and daily living support in a residential setting. They serve two main groups:
  • Short-term rehabilitation patients: People recovering after a hospital stay, illness, or surgery. Typical stays are measured in weeks.
  • Long-term care residents: People who need ongoing nursing care and help with daily activities over months or years.
Nursing home staff providing skilled medical care and daily support to senior residents.

Who Nursing Homes Are For

Senior receiving short-term rehabilitation after hospital stay with physical therapy support.

Short-term rehabilitation (post-hospital)

  • Common reasons: hip or knee replacement, stroke, heart failure, pneumonia, serious falls.
  • Services: skilled nursing; physical, occupational, and speech therapy; medication management; wound care; IV therapy.
  • Goal: regain strength and function, then return home or to a lower level of care.

Long-term care

  • For seniors with chronic conditions, complex medication needs, frequent clinical monitoring, or advanced mobility/cognitive challenges.
  • Services: 24/7 nursing oversight, help with activities of daily living (ADLs), specialized diets, memory support, social activities, and care planning.
Senior resident receiving long-term care and daily support in a nursing home.
Different senior care alternatives such as assisted living, in-home care, and adult day programs.

Alternatives You May Consider

  • Home care and home health: personal care and/or medical services delivered at home.
  • Assisted living: help with ADLs, medication support, meals, and activities in a community setting.
  • Memory care: secure communities tailored for dementia/Alzheimer’s.
  • Adult day programs: daytime supervision, socialization, and care.
  • PACE (Program of All-Inclusive Care for the Elderly): in some areas, a coordinated alternative to nursing home care.
  • Respite care: short-term relief stays for caregivers.

What It Costs and How People Pay

Costs vary by state, room type (semi‑private vs private), and services. Charges typically include:
  • A per-day room rate.
  • Ancillary services (therapy, labs, supplies) itemized separately.
  • Potential differences in private pay vs insurance-covered rates (varies by state and facility).

Ways to pay

  • Medicare: Covers short-term skilled nursing and rehab after a qualifying hospital stay when clinical criteria are met. Coverage is time-limited and often requires coinsurance after an initial period. Medicare Advantage plans have their own rules, co-pays, and prior authorization. Always check your plan’s benefits.
  • Medicaid: A state-administered program for people with limited income and assets. It commonly covers long-term nursing home stays for those who meet financial and medical eligibility. States also offer Home- and Community-Based Services (HCBS) waivers that may fund care at home or in assisted living; availability and rules vary by state.
  • Veterans benefits: Eligible veterans may qualify for VA community living centers, contracted nursing homes, or Aid & Attendance benefits that help with care costs.
  • Long-term care insurance: Policies often pay a daily or monthly benefit for nursing home or home/assisted living care, subject to policy terms and elimination periods.
  • Private pay: Out-of-pocket payment from income, savings, or family support.

Important notes about coverage

  • Medicare typically requires a recent inpatient hospital stay and skilled nursing/rehab needs; not all stays qualify, and full 100-day coverage is uncommon.
  • Medicare Advantage plans differ from traditional Medicare; co-pays can start on day one and approvals may be time-limited.
  • Medicaid financial and clinical eligibility varies by state; spousal protections typically allow the healthy spouse to keep the home, vehicle, and a share of assets. States may seek estate recovery after both spouses pass (rules vary).
  • Speak with an elder law attorney or benefits counselor about spend-down, exemptions, and planning.

How Pricing Works—and How to Plan

  • Daily rate: base cost for room and board (semi‑private or private).
  • Care level: some facilities bundle care; others charge based on acuity or services needed.
  • Therapy and supplies: may be billed separately; request an itemized estimate.
  • Tip: Ask for a transparent fee schedule and a sample bill before admission.

Ways to potentially reduce out-of-pocket costs

  • Verify all insurance benefits (Medicare/Medicare Advantage, retiree plans, Medigap, LTC insurance, VA benefits).
  • Consider alternatives like home care or assisted living if clinically appropriate and less expensive.
  • Explore HCBS waivers and state-specific programs; some have waitlists—apply early.
  • Involve family in care where allowed (e.g., transportation, accompaniment to therapy) to potentially reduce add-on services.
  • Work with a discharge planner, social worker, or care navigator to avoid unnecessary days and optimize transitions.

Choosing the Right Nursing Home

  • Quality and safety: review staffing, inspection reports, and quality ratings on official sources (e.g., Medicare’s Care Compare).
  • Care fit: ask about clinical expertise (e.g., cardiac, wound care, memory care), therapy hours, and physician oversight.
  • Daily life: meals, activities, religious/spiritual support, visiting hours, and private vs semi‑private rooms.
  • Access: location, transportation, and ability for loved ones to visit.
  • Communication: how the care team updates families and includes them in care planning.
  • Tour checklist:
    • Is it clean, well-lit, and free of strong odors?
    • Are staff respectful, warm, and responsive?
    • Are residents engaged in activities?
    • Are call lights answered promptly?
    • Are menus and therapy schedules posted and explained?

Your Next Best Step (Call to Action)

  • Speak with a care advisor now: We can explain your coverage, estimate costs, check bed availability, and schedule tours.
  • Call us: (800) 989-8137

Frequently Asked Questions

Does Medicare cover nursing home care?
Medicare covers short-term skilled nursing and rehab after a qualifying hospital stay and when clinical criteria are met. Coverage is limited and may require coinsurance. Full 100-day coverage is uncommon.
How is Medicare Advantage different?
Medicare Advantage plans have plan-specific rules, co-pays from day one in many cases, prior authorization, and defined day limits. Always confirm with your plan.
Will I lose my home if I use Medicaid?
Medicaid includes spousal protections and certain exemptions. Many states pursue estate recovery after both spouses pass, but rules vary. Consult a local elder law attorney.
Can I get care at home instead of a nursing home?
Often yes—if it meets your medical and safety needs and is supported by your benefits. Many states fund home- and community-based care through waivers, though availability varies.
How long do people stay in nursing homes?
Rehab stays typically last weeks. Long-term residents may remain months or years, depending on health needs and goals of care.
What is included in the daily rate?
Room, meals, basic nursing services, and routine supplies. Therapy, labs, medications, and specialized equipment may be billed separately. Request an itemized estimate.