To be admitted to a nursing home, a senior needs to meet the state’s criteria for needing a nursing home level of care. Although these criteria vary from state to state, they generally address a person’s physical abilities, health issues, cognitive status, and behavioral history. Once it’s been determined that someone meets the admission criteria, the process of nursing home admission includes additional assessments of a potential resident’s medical needs and financial status. When emergency admission to a nursing home is required, the process is the same but is accelerated.
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Before someone can be admitted to a nursing home, a physician or another qualified member of the medical team must evaluate them and certify that they need a nursing home or nursing facility level of care.[01]
Alice Bonner, Ph.D., a Senior Advisor for Aging with the Institute for Healthcare Improvement, notes that nursing home admission requirements vary by state, but do share similarities. The following four areas are generally included in these evaluations:
When someone moves from the hospital to a nursing home, the attending hospital staff will likely assess them before they leave the hospital. If they’re not currently in the hospital, their primary care doctor can perform the assessment.
To understand whether someone’s physical and functional abilities meet a state’s criteria for nursing home admission, a physician or medical care team will evaluate their ability to complete activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Health care professionals typically use formal assessment tools, such as the Katz Index of Independence in Activities of Daily Living, the Barthel ADL Index, or the Functional Independence Measure (FIM) to evaluate and document how much help someone needs to complete basic tasks of everyday life and more complex tasks needed to function independently.
The U.S. Centers for Medicare and Medicaid Services (CMS) require all nursing homes and nursing facilities that accept Medicare or Medicaid payments to document current and potential residents’ health issues and medical needs using a tool called the Minimum Data Set.[01]
The Minimum Data Set is an assessment tool for evaluating a person’s health. Examples include but aren’t limited to:
There’s some overlap between what assessment tools for ADLs and IADLs measure and what the CMS Minimum Data Set measures. Your loved one’s physician and medical care team will follow the documentation requirements set forth by state and the nursing home itself.
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There isn’t a universal standard for how old someone must be before they can be admitted to a nursing home. The most important requirement for nursing home admission is whether someone needs round-the-clock care and supervision. That said, the average age of nursing home residents at admission is 81.[02]
In addition to documentation that a potential resident needs a nursing home level of care, nursing homes also need:
As part of the admissions process, community staff may also ask for other documentation, such as:
Read more:A Guide to Choosing a Nursing Home
Though the process of getting a loved one admitted into a nursing home can take several hours and can seem daunting, it’s significantly easier once you know what most facilities need for admission.
After a physician has decided that a nursing home level of care is needed and an assessment has been done to document that need, there are several forms to complete, possibly additional assessments and vaccines to complete, and likely a financial assessment.
“The process isn’t always simple, and it can be tedious,” says senior care professional Mark Pavlovich , a member of the workforce and customer experience committees at the American Health Care Association. “But it can be easier if you know who you need to talk to and are aware of the documents needed beforehand.”
Paperwork for admission to a nursing home can usually be filled out before or on the day of admission. Although the process varies depending on the nursing home and state, it’s common for essential forms to be filled out at the facility with a staff member. The patient or their agent — the legally responsible party under POA – will sign their name several times after learning about nursing home policies, responsibilities, legal certificates, the cost and care provided, and consent to be treated.
Read more: A Comprehensive Guide to Understanding Medicaid and Nursing Homes
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Emergency admittance to a nursing home can happen when someone’s need for a nursing home level of care is unexpected, such as when someone is injured in an accident or their primary caregiver becomes ill.
Whatever the case may be, most nursing homes are equipped to handle unexpected or emergency nursing home placements. Typically, nursing homes have waitlists that can be weeks or months long, but an emergency placement indicates a need for immediate admission, which often reduces wait times.
If your loved one needs immediate placement in a nursing home, your local Area Agency on Aging (AAA), a nonprofit agency designated by the state to address certain needs of seniors, can give you information on local support resources, such as health insurance counseling, the long-term care ombudsman, and more.
Once you find a nursing home that meets your loved one’s needs, next steps may vary slightly depending on a facility’s emergency placement policies and procedures. Typically, you’ll still go through the regular admissions process and provide the required documents listed above. The only difference is that the process is accelerated.
For example, in some states, the PASSRR that Medicaid requires can be postponed for up to seven days (or 14 days if respite is the reason for admission).[05] This way, admittance is expedited, but nursing homes still obtain the information they need to provide proper care.
Requirements for nursing home admission are intentionally rigorous: It’s important to ensure seniors receive the correct level of care for their condition. For example, if your loved one requires day-to-day care but doesn’t meet requirements for nursing home placement, they may be a good candidate for an assisted living community. They’ll still get the help they need, but in a less restrictive environment.
Whether it’s a nursing home, assisted living community, or memory care community, moving a loved one somewhere new can be stressful. Connect with A Place for Mom’s Senior Living Advisors to help find the right care option. Though they can’t refer seniors directly to nursing homes, they can make the transition process easier. They can help you figure out which care option is best and point you toward local resources that can help – all at no cost to your family.
Yes, for the most part. A POA designates an agent acting on behalf of the principal to make significant health care decisions, like nursing home admission. Local elder law or estate planning attorneys can determine the best type of POA and answer state-specific questions.
A court-appointed guardian or conservator are the only people who can make life-changing decisions like moving someone into a nursing home. Courts appoint guardians to make health care decisions, while conservators take care of a person’s finances and personal affairs.
Emergency placement can get someone admitted into a nursing home quickly. It’s typically the same process as regular admission, but is expedited due to something serious, such as a senior’s primary caregiver falling ill and being unable to care for them.
Yes, nursing homes require full financial disclosure before or upon admission to ensure residents can pay out-of-pocket or through Medicaid or other benefits.
Yes, nursing homes often require a security deposit or “community fee” to be paid prior to move-in.
Institute for Healthcare Improvement. (2024, March 28). Nursing home basics: who qualifies, who pays, and other helpful facts.
A Place for Mom. Average age of nursing home residents: age by percentage and demographic.
U.S. Centers for Medicare and Medicaid Services. (2024, Aug. 8). State Operations Manual. Appendix PP – guidance to surveyors for long-term care facilities.
U.S. Centers for Medicare and Medicaid Services. Preadmission screening and resident review. Medicaid.gov.
Texas Health and Human Services Commission. (2024). Expedited Admission Process.
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