How to choose a nursing home and know your rights as a resident

Few decisions in retirement carry as much weight as choosing a nursing home, for yourself, a spouse or a parent. It often has to be made quickly, right after a hospital stay, when a discharge planner hands the family a list of names and asks for an answer. Knowing what to look for, how to check a facility's record and what rights a resident keeps after moving in makes that moment far less overwhelming.

This guide walks through the whole process: what nursing home care is, what Medicare does and does not pay for, how to use Medicare's Care Compare tool and its star ratings, the questions to ask on a visit, what to watch for in the admission agreement, and the federal rights and complaint options every resident has. It is based on two publications from the Centers for Medicare & Medicaid Services (CMS), Your Guide to Choosing a Nursing Home and the fact sheet Your guide to living in a nursing home, both September 2025 editions, along with Medicare & You 2027.

What nursing home care is

CMS describes nursing homes as facilities for people who usually need 24-hour care. They provide skilled nursing or rehabilitation care for people with short-term needs, and they may also offer long-term and specialized care, including care for people with Alzheimer's disease and other types of dementia. People go to a nursing home because they are sick, hurt or recovering from surgery, or because a chronic condition or disability requires ongoing nursing care.

CMS groups nursing home care into three kinds:

• Short-term rehabilitation after surgery, like physical therapy after a hip or knee replacement.
• Short-term skilled nursing to recover from an illness, like pneumonia.
• Long-term care for people who need help with activities of daily living, like bathing, dressing or eating.

The difference matters because Medicare treats the first two very differently from the third, and that difference shapes who pays the bill.

Does Medicare pay for a nursing home?

Medicare may cover short-term nursing and related care. The CMS booklet breaks it down by part:

• Part A (Hospital Insurance) covers short-term nursing home or rehab care, up to 100 days, in a Medicare-certified nursing home after a hospitalization.
• Part B (Medical Insurance) covers doctor visits and physical, speech or occupational therapy, even if you get these services while in a nursing home.
• Part D (drug coverage) covers prescription drugs you need while in a nursing home.

Then comes the sentence families most need to hear early: Medicare generally does not cover long-term nursing home stays. Medicare & You 2027 is more specific. Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), do not pay for non-medical long-term care services, including care in a nursing home or in the community. That includes personal care assistance, like help with dressing, bathing and using the bathroom.

The short-term stay: what you pay in 2026

When Part A does cover a stay in a skilled nursing facility, the costs in Original Medicare are tied to the benefit period:

Using every day from 21 through 100 means 80 days of coinsurance; at $217 a day, that adds up to $17,360 in 2026. The qualifying hospital stay, the daily skilled care requirement and what the coverage includes are explained in our skilled nursing facility guide.

The long-term stay: who pays

For long-term care, Medicare & You 2027 lists three routes: Medicaid, if you meet your state's eligibility requirements; private long-term care insurance; or paying the costs yourself. The CMS nursing home booklet adds that your state's Medicaid program may cover long-term nursing home care if you qualify, even though Medicare does not, and that Medicaid may also help cover:

• Home- and community-based services, like at-home care, home-delivered meals, home modifications and adult day care.
• Services in an assisted living facility, depending on your needs and the state you live in.

Contact your State Medical Assistance (Medicaid) office with questions. Medicaid.gov has a map with each state's contact information. If you have Medicaid and live in a nursing home, Medicare & You 2027 says you pay nothing for your covered drugs. Our pages on Medicare Savings Programs and Extra Help cover related programs for people with limited income and resources.

Two Medicare options built around nursing home-level care

• Institutional Special Needs Plans (I-SNPs). These are Medicare Advantage Plans for people who live, or are expected to live, for at least 90 days straight in a facility like a nursing home or skilled nursing facility. They are also open to people who live in the community but need the level of care a facility offers. You can filter for Special Needs Plans at Medicare.gov/plan-compare.
• PACE (Program of All-inclusive Care for the Elderly). PACE is a Medicare and Medicaid program, offered in many states, that lets people who would otherwise need a nursing home-level of care stay in the community for as long as possible. To qualify you must be 55 or older, live in a PACE organization's service area, be certified by your state as needing a nursing home-level of care, and be able to live safely in the community with PACE's help when you join. With Medicaid, there is no monthly premium for the PACE benefit; with Medicare but not Medicaid, you are charged a monthly premium that includes your Part D drug coverage.

Where to get help planning

The Administration for Community Living (ACL), a federal agency, funds community programs for older adults, people with disabilities and their caregivers. CMS and Medicare & You 2027 point to these resources:

• The Eldercare Locator, 1-800-677-1116 or eldercare.acl.gov, to find help in your community.
• ACL.gov/ltc, for information on planning for long-term care.
• Your Long-Term Care Ombudsman, or ltcombudsman.org, for help with services and your rights.
• Your State Insurance Department, for information on long-term care insurance.
• "A Shopper's Guide to Long-Term Care Insurance" from the National Association of Insurance Commissioners.

CMS also suggests talking with someone you trust, like a family member, your health care provider or a social worker, before you make any decision about long-term care.

Step 1: Find and compare nursing homes on Care Compare

Medicare's search tool lives at Medicare.gov/care-compare. Every nursing home listed there is Medicare-certified, which CMS says means it offers services at a level of quality Medicare approves and has passed certain inspections. To search:

1. Select "Nursing homes including rehab services."
2. Enter your location, or the name of the nursing home you are interested in, and select "Search."
3. Select a nursing home. Use the "Compare" feature to see up to 3 nursing homes side by side.

For each facility you can review star ratings, health and fire safety inspection results, staffing levels, quality measures such as whether residents got their flu shots, any penalties the federal government has issued, and whether the home has been cited for abuse.

Step 2: Understand the star ratings

Each nursing home gets an overall rating from 1 to 5 stars: 1 means quality much below average, 3 means average, and 5 means quality much above average. The overall rating combines three separate ratings.

Health inspections

State inspectors check nursing homes for compliance with Medicare and Medicaid regulations, usually every year, and issue a citation for any failure to meet federal standards. Select "View Inspection Results" to read the full reports, which cover three years of each type:

• Health inspections. The comprehensive health and safety reviews.
• Complaint inspections. When a resident or someone else, like a family member, files a complaint about quality of care that the home did not resolve, the State Survey Agency may visit to investigate and issue a citation.
• Infection control inspections. Reviews focused on the home's infection control policies.

Reading the reports, not just the stars, shows you what was cited. A single citation and a pattern of the same problem year after year tell very different stories.

Staffing

Select "View Staffing Information" for two numbers:

• Nurse staff hours per resident per day, for all nursing staff, including registered nurses. It describes the average time staff are available to spend with each resident each day. It does not show how many staff are present at a given moment or how much care any one resident gets. When comparing homes, a higher number is better.
• Staff turnover, including nursing and administrative staff. CMS explains that staff who stay longer become more familiar with residents and procedures, and may better understand residents' preferences and spot changes in their condition. A lower number is better.

Quality measures

This rating uses information Medicare collects on specific areas of care, such as whether residents got flu shots, were hospitalized, were injured by falling or are getting antipsychotic medications. It is calculated from both short-stay and long-stay measures. Select "View Quality Measures" for the complete set. CMS notes these measures reflect a home's average performance, not any single resident's experience.

Two symbols to look for

• Special focus facility alert. If this symbol appears instead of a star rating, the home has a history of serious quality issues. These homes are not rated, are inspected more often, face penalties and may lose the ability to be paid for care to people with Medicare or Medicaid. If that happens, residents with Medicare or Medicaid are moved to a nursing home certified to give their care.
• Abuse alert. This symbol next to a home's name means it has been cited for issues related to abuse. Medicare.gov has a page on preventing abuse and what to do if you suspect it.

Check the owner

Care Compare also lets you look past the single building. Select "Open affiliated entity performance information" to see every facility owned by or affiliated with the same owner, like a chain, and whether that group has high or low quality ratings overall. "Ownership Details" shows more about the facility, including the owners' names.

CMS is clear that star ratings are not a substitute for visiting. They are a way to build a short list.

Step 3: Visit, and ask the right questions

CMS recommends scheduling a visit before choosing, and talking with current residents and their family members if you can. As you tour, watch for signs that staff are slow to respond, strong odors, residents calling out, or safety risks like residents walking around unsupervised. The booklet lists questions by topic.

Your care

• How am I involved in developing my care plan? Can I ask for certain equipment or supplies, or help set my health goals?
• How does the nursing home help arrange transportation to doctor visits and medical appointments?
• How many staff are assigned per resident during the day, overnight and on weekends?
• What is the average number of residents each nurse aide is responsible for?
• What rehabilitative services does the nursing home provide?
• What happens in a medical emergency?
• How do I report concerns about my care, and will I be told how they were resolved?
• Will the nursing home provide care for my specific needs? Give examples of the care that matters to you.

Dementia care

• Is there a designated dementia care unit?
• How are staff trained to care for people with dementia?
• Is the dementia unit locked, with safe access to an outdoor area?
• What non-medication approaches does the home offer for dementia or behavioral symptoms?
• How does the home avoid antipsychotics whenever possible? CMS notes these drugs carry health risks for elderly people with dementia.
• How does the home keep residents from wandering into areas where their safety could be at risk?

Fees and payment

• Does the nursing home accept Medicare, Medicaid or both?
• Can I get a list of the services included in the private-pay rate, and of what is charged separately?

If there is any chance the stay becomes long term and savings run down, whether the home accepts Medicaid is one of the most important answers on this list.

Activities and visitors

• How do I schedule outings other than medical appointments?
• What activities are available, like music or crafts? Can I get a copy of the activity or social calendar?
• Will I get to help plan or choose the activities?
• Is there a private space to visit with guests, other than my room?
• Are there outdoor areas I can use, and will staff help me go outside?
• Will I have access to the internet, a computer, a personal phone and a television?
• Are there amenities, like haircuts or styling, snacks, coffee or a gift shop?

Resident preferences

• Can I bring some of my own furniture and decorations?
• Is there a place to lock up my belongings?
• Will I have a choice of roommates?
• How does the home respect my preferences for when I leave the facility, get up, go to sleep, eat meals, and shower or bathe?
• How will you handle concerns or complaints I might have?

Dining

• What dining options and food choices are there at every meal?
• How are special diets handled, like low-salt or no-sugar-added?
• How does staff help residents eat and drink at mealtimes, if needed?
• Is there a policy on outside food and drink? Are snacks available 24/7, and what are they?
• Is there a microwave and refrigerator residents can use?

Bring this list, write down the answers, and compare homes on the same questions.

Step 4: Read the admission agreement carefully

Once you choose a home, it may ask you to sign an admission agreement. CMS's fact sheet says you are not required to agree to everything in it. A nursing home is not allowed to:

• Make a third party, like your family, pay your bill. It may only ask your family to use your money to pay, if your family has legal access to your funds.
• Require binding arbitration. It cannot make you agree to resolve issues outside of state or federal courts as a condition of being admitted or getting care.

The agreement must be clear about what the basic rate covers and what may be charged separately, and the home must tell you about extra charges when you are admitted and periodically during your stay. If you disagree with something, CMS says to cross out the item with a pen or marker before signing to show you do not agree. If you have a lawyer, you can ask them to review the agreement first.

Your rights once you live there

Under federal law, nursing home residents have rights and protections. Nursing homes must follow these rules to be paid by Medicare and Medicaid, and they must meet your needs no matter how they are paid. They must also give you information to help you apply for and use both benefits.

Your preferences

Nursing homes must recognize and respect your preferences. You have the right to:

• Make your own schedule, like when you go to bed, wake up and eat.
• Keep personal items, unless that would violate the rights, health or safety of others.
• Privacy. For example, staff should knock and ask permission before entering your room.
• Have visitors at any time, for as long as you want, although visits may be limited under reasonable clinical and safety restrictions.
• Take part in activities that interest you, including activities outside the nursing home.
• Make choices about your meals and diet. The home should make a reasonable effort to get specific food you ask for, and all food and drinks must be served at a safe temperature.

All nursing homes must have enough staff to care for you safely and meet your needs and preferences.

Decisions about your care

• Care planning. The home must develop a comprehensive care plan, with you and a health care team, that addresses your medical, physical and mental needs. You and your representatives have the right to take part and to ask for specific care, and the home should keep discussing the plan with you as your goals change.
• Treatments. You have the right to accept or refuse treatments or medications. The home must tell you the risks and benefits of all medications, and you can accept, decline or choose alternatives. Because drugs like antipsychotics can carry health risks and may be unnecessarily sedating, CMS suggests non-medication approaches like music or crafts, activities tied to your interests, exercise and additional staff support. Talk with your doctor or care team about them first.
• Advance directives. You have the right to make an advance directive, also called a living will, including choosing an agent or saying how you want decisions made if you cannot make them yourself. Tell the staff your wishes so they can help make sure they are respected.
• Resident and family councils. Ask whether the home has one and how to get involved. These councils work with the home to improve care and resolve issues.

Discharge and transfer

At admission, the home will ask about your discharge goals, and in most cases you and the home should understand and agree on a discharge date. Beyond that, a home can transfer or discharge you only in limited circumstances, like when:

• It is necessary for your health and safety because the home cannot meet your needs, like a transfer to a hospital in an emergency. If you go to a hospital, the home must let you return if it can still meet your needs, and it must make a good faith effort to do so.
• Your health has improved enough that you no longer need nursing home care.
• Your clinical or behavioral condition endangers your health or safety or that of others.
• The home has not been paid, and only after reasonable and appropriate notice.
• The home stops operating.

The home must give you and your representative written notice, usually 30 days in advance, and in some cases notify the long-term care ombudsman. You have the right to appeal a discharge. The steps vary by state, but in most cases you send an appeal request to the state, and a state administrative law judge usually holds a hearing where you and your representatives can testify, submit information and make arguments. The home must tell you how to appeal.

That state process is separate from Medicare's appeal process. If Medicare-covered skilled care is ending and you disagree, see our guide on how to appeal a Medicare denial.

When something goes wrong

CMS lays out a ladder. Start by talking with the staff involved. If that does not fix it, ask to talk with the supervisor, the social worker, the director of nursing, the administrator or your doctor. If the concern is still not resolved, you can:

1. Contact a member of the resident council, if the home has one.
2. File a grievance with the nursing home.
3. Contact your local long-term care ombudsman.
4. File a complaint with your State Survey Agency.

You have the right to complain without fear of discrimination or punishment, about care you got or did not get, the behavior of staff or other residents, or anything else about your stay. You can contact the ombudsman at any time; you do not have to go in order.

The grievance process

Every nursing home must have a grievance process and a Grievance Official whose job is to accept, investigate, respond to and resolve concerns in a timely manner, keep them confidential and keep you updated. If you ask, the home must give you its grievance policy and how to reach that person. You can raise a concern out loud or in writing, but the home's answer must be in writing and include:

• The date your concern was shared with the Grievance Official.
• A summary of your concern.
• The steps taken to investigate it.
• A summary of the home's conclusions.
• Whether your concern was confirmed.
• Any corrective action taken.

Keep a copy. A written answer is also a record if you later go to the ombudsman or the state.

The long-term care ombudsman

An ombudsman advocates for residents of nursing homes and other adult care facilities. Their duties include working with you to resolve problems, including financial issues; visiting homes and talking with residents to make sure their rights are protected; explaining your rights and care; and answering questions like how many complaints they have received about a specific home, what kind, and whether they were resolved in a timely manner. That last one is worth asking before you choose a home, too. Find your local ombudsman at theconsumervoice.org/get-help, which CMS also lists for free, personalized help choosing a home.

The State Survey Agency and Medicare Regional Offices

State Survey Agencies oversee and inspect nursing homes that take part in Medicare and Medicaid, and they will investigate complaints about quality of care or quality of life. Give as much detail as you can so the investigator can do a thorough job. CMS publishes each state's contact information. If a complaint is not addressed after working with the State Survey Agency, contact your Medicare Regional Office; CMS lists the regional offices on its website.

A short checklist

• Ask early whether the stay will be short-term rehab or long-term care; Medicare's coverage depends on it.
• Build a short list on Medicare.gov/care-compare and compare up to 3 homes side by side.
• Read the inspection reports, not just the stars, and look for the special focus and abuse alerts.
• Compare staffing hours per resident and staff turnover.
• Check the owner's other facilities with the affiliated entity information.
• Visit, and talk with residents and families.
• Ask whether the home accepts Medicare and Medicaid, and get the list of what the basic rate includes.
• Do not sign a binding arbitration clause or a promise that family will pay; cross out what you do not agree to.
• Make or update an advance directive and give the staff a copy of your wishes.
• Save the ombudsman's phone number before you need it.

No rating replaces a visit, and no visit replaces knowing your rights. With both, families can make this decision with their eyes open, and residents can keep a say in how they live after they move in.