How to get someone admitted to a nursing home usually comes down to a care need, a payment plan, and the records the facility must verify.
When home isn’t safe anymore, nursing home admission can feel like you’re racing a clock with missing pieces. Beds are tight. Paperwork is strict. Phone calls pile up.
You can cut most delays by doing two things early: describe the care need in plain detail, and line up the payment path before you start calling every building in town. The steps below are the same steps admissions teams use on their side of the desk.
A notebook log keeps dates, names, and next steps straight today.
Admission routes at a glance
Start here. Match your situation to the route facilities use, then follow the step list that fits.
| Situation | Who starts it | What gets checked first |
|---|---|---|
| Hospital discharge to rehab (short stay) | Hospital case manager | Skilled need + timing rules + bed |
| Hospital discharge to long stay | Case manager + family | Clinical match + payer + paperwork |
| Direct admit from home | Family or primary clinician | Assessment packet + payment plan |
| Medicaid long-term care admit | Family + state Medicaid office | Eligibility + level-of-care screen |
| Private pay admit | Family | Rate/contract + clinical fit |
| Resident transfer between facilities | Current facility social worker | Reason for transfer + records + bed |
| Out-of-town placement planning | Family decision-maker | Authority to sign + complete packet |
| Memory or behavior needs in a nursing facility | Family + admissions | Care level + staffing capacity |
How to Get Someone Admitted to a Nursing Home step by step
This is the working sequence. Keep it simple, move in order, and write things down as you go.
Step 1: Write a one-paragraph care snapshot
Facilities decide “fit” from details, not labels. In one paragraph, list diagnoses, recent hospital stays, mobility level, fall history, continence, cognition, wound care, oxygen, feeding needs, and any behaviors that could affect roommates or staff. Add current equipment (walker, wheelchair, hospital bed) and what help is needed for transfers.
If you don’t know a detail, say so. Guessing creates rework later.
Step 2: Pick the right entry point
From a hospital: ask the discharge planner or case manager to send referrals. They can transmit records faster than families can and they can coordinate transport.
From home: call the admissions line for each facility and ask if they accept direct admits. Some do. Some only take hospital referrals.
Step 3: Lock in the payment path early
Admissions teams need to know how the stay will be paid for before they hold a bed. Ask what payers the facility accepts for the bed type you need.
- Medicare skilled care: linked to skilled services and timing after a hospital stay. Medicare lays out the conditions on its page about skilled nursing facility care.
- Medicaid long stay: state-run, usually requires a financial review plus a level-of-care screen.
- Private pay: often fastest if funds are ready and contract terms are clear.
- Long-term care insurance: may reimburse, but many facilities still require an up-front plan.
Ask for daily or monthly rates, what’s included, and what costs extra (therapy copays, transportation, special supplies). Get numbers by email so you can compare cleanly.
Step 4: Build the admission packet once
Most buildings ask for the same categories of records. Medicare lists a practical checklist for information nursing homes need to admit you.
- Insurance cards, policy numbers, and pharmacy details
- Recent physician notes, medication list, allergies
- Recent labs, imaging summaries, therapy notes if rehab is needed
- Wound orders, oxygen settings, diet orders if relevant
- Contact list: emergency contacts and clinician names
- Legal authority: health care proxy, power of attorney, guardianship papers if they exist
Create one digital folder you can email and one printed folder you can bring to intake. Label files clearly, like “Med list” or “Hospital discharge summary.”
Step 5: Do a fast fit call before you tour
Use your care snapshot and ask five questions:
- Do you have a bed soon, or a wait list?
- Can you meet these care needs safely?
- Which payers do you accept for this bed?
- What records do you need to review a referral?
- Once accepted, what’s the earliest intake time?
If a facility can’t meet the care needs, ask what they can accept. That answer helps you target the next calls.
Step 6: Tour with a short script
Tours can be useful, but keep your eyes on daily basics. Look at staff response to call lights. Watch a meal if you can. Ask how medication changes are handled on day one and who updates the care plan.
Ask to see the room type you can actually get soon. It saves a lot of heartburn.
Step 7: Sign the agreement the right way
Read the admission agreement slowly. Pay attention to who is listed as the “responsible party” and how billing works if a third party will pay. If you’re signing as an agent under power of attorney, sign in that role, not as a personal guarantor.
Before you leave, ask what to bring on day one and how prescriptions are transferred to the facility pharmacy.
Taking someone into a nursing home when the answer is “no”
A denial often comes from one of three issues: no bed, mismatch of care needs, or payer limits. Ask which one applies, then take the next best move below.
No bed available
Get on the wait list and ask what gets you a call faster (flexible room type, flexible admit day). Then widen your search and call two more facilities the same day.
Care needs exceed what they can handle
This can mean complex wounds, frequent IV meds, unmanaged behaviors, intensive respiratory needs, or constant supervision. Ask what level they can accept. Then target higher-acuity facilities and resend your packet with the updated notes.
Payer mismatch
If Medicaid is the plan, ask if they accept Medicaid at admission or only after a private-pay period. If private pay is the plan, ask for the rate sheet and any deposit terms in writing.
Missing authority to sign
If the resident can’t sign and there’s no legal agent, admissions may pause. Ask the hospital social worker about emergency guardianship steps in your area, or ask the primary clinician for documentation of decision-making capacity.
How coverage rules change timing
Money decisions shape admission speed. You don’t need to master every rule, but you do need a clear plan.
Medicare skilled stays after a hospital visit
If the goal is rehab, ask the hospital case manager to confirm that the stay qualifies and that the facility is Medicare-certified. Also ask what happens when skilled goals are met, since that’s when the next payer decision lands in your lap.
Medicaid long stays
Medicaid often requires two tracks: a clinical screen for level of care and a financial eligibility review. Start gathering ID, income proofs, bank statements, insurance policies, and housing documents early. If the person is in the hospital, ask if there’s a Medicaid eligibility worker assigned.
Private pay and long-term care insurance
Private pay can move quickly, yet you still want clear terms on rate changes and what counts as an add-on charge. If long-term care insurance is part of the plan, ask the insurer what documentation they require for reimbursement and keep copies of invoices.
Track your paperwork and timing
This tracker keeps your calls tidy and helps you spot gaps before admissions requests another round of records.
| Item | Who supplies it | When to have it ready |
|---|---|---|
| Insurance cards and policy numbers | Family | Before first admissions call |
| Recent physician notes and diagnoses | Hospital or clinician | Before clinical review |
| Medication list and allergies | Hospital or clinician | Before intake appointment |
| Therapy notes and mobility level | Hospital therapy team | Before rehab placement |
| Wound or oxygen orders | Clinician | Before acceptance call |
| Proxy, power of attorney, guardianship papers | Family | Before signing the agreement |
| Financial documents for Medicaid | Family | Start gathering right away |
| Advance directive and code status info | Resident or agent | Before day one |
What to do in the first week after admission
The first week is when routines get set and small problems can snowball. A few quick checks can prevent a lot of frustration.
Schedule the care plan conversation
Ask when the initial assessment happens and when the first care plan meeting is set. Bring your care snapshot and add daily details staff might not see in chart notes: sleep habits, pain cues, preferred bathing times, and what calms agitation.
Set up one point of contact
Pick one family point person and share one phone number and email with staff. Ask who to call after hours and how updates are handled when there’s a change in condition.
Verify meds and personal items
Within 24–48 hours, confirm the medication list matches what the resident was taking. Check that glasses, hearing aids, dentures, and mobility devices are present and labeled.
A short checklist you can copy into your notes
- Write the care snapshot.
- Choose the route: hospital referral or direct admit.
- Confirm the payment path and accepted payers.
- Build one admission packet and keep it updated.
- Do fit calls, then send records to the best matches.
- Tour only places that can take the resident soon.
- Read the agreement and sign in the correct legal role.
- Arrange transport and day-one personal items.
- Ask for the care plan meeting date in week one.
If you hit a wall, return to the three basics: care need, payer plan, records. That’s how to get someone admitted to a nursing home with fewer dead ends and less backtracking.