Nursing Home Admission Requirements for Seniors

When a parent’s health takes a sudden turn or a caregiver becomes unexpectedly unavailable, families may find themselves needing emergency nursing home placement. These facilities are equipped to provide 24/7 medical care for seniors with serious conditions such as stroke, injury, or progressive decline—especially when assisted living is no longer sufficient. 

Even in non-urgent situations, the nursing home admissions process can feel overwhelming. It typically involves a physician’s assessment, intake interviews, financial and legal paperwork, and coordination with family members. Understanding the steps ahead of time can help families feel more confident and prepared. ^1,2

Who Needs Nursing Home Care? 

Nursing homes, also called skilled nursing facilities, offer 24-hour support for medical needs and assistance with daily tasks like bathing, dressing, and eating. These facilities also offer services such as rehabilitation therapy, medication management, meals, and social activities—all designed for individuals who need a high level of medical and personal care on an ongoing basis. 

This type of care is typically appropriate for seniors recovering from a serious illness or injury, or those experiencing chronic conditions, cognitive decline, or significant mobility issues. A physician must confirm that nursing home care is medically necessary, and the individual must meet the state’s eligibility criteria before admission can proceed. Seniors who need less hands-on care may be better served in an assisted living setting. ^1,2 

Medical Eligibility Requirements 

Admission to a nursing home typically begins with a medical evaluation to determine if a senior meets the required level of care. A physician or clinical team must document that daily skilled nursing and personal care are necessary—often due to serious health issues, limited mobility, or cognitive decline. Key components of this assessment include: 

1. Medical History
   Documentation of chronic conditions, medications, and recent hospitalizations. 
2. Functional Assessment
   An evaluation of how well the person can perform Activities of Daily Living (ADLs), such as dressing, bathing, eating, and moving around safely. 
3. Physician Certification
   A signed statement from a doctor confirming that nursing home care is medically necessary. 
4. Level of Care Assessment
   Some states use formal tools or screening processes to verify the need for 24-hour care. 

Each of these elements helps ensure the individual receives the appropriate type of support in the right setting. ² 

Financial Eligibility and Payment Options 

Nursing home care can be costly, and a financial assessment is required to determine how it will be paid for. This process is similar to applying for a mortgage—it involves reviewing income, assets, and any insurance or benefits the individual may have. Most residents rely on one of the following four payment methods: 

1. Private Pay
   Seniors who have sufficient income or savings may pay for care out-of-pocket. Monthly costs can range from $12,000 to $17,000, depending on location and services needed. 
2. Long-Term Care Insurance
   Some individuals carry insurance policies specifically designed to cover long-term care costs. Benefits vary based on the plan. 
3. Medicaid
   Medicaid is the most common payer for long-term nursing home care. Medicaid Eligibility is based on state-specific income and asset limits and includes a financial screening for seniors. Applicants must also meet non-financial requirements and may be subject to a look-back period for recent asset transfers. 
4. Medicare (Short-Term Only)
   Medicare Part A may cover a short stay in a nursing home following a qualifying inpatient hospital stay—typically up to 100 days—for rehabilitation or medically necessary skilled care. 

During the financial review, expect questions about insurance coverage, pensions, Social Security, veteran benefits, bank accounts, real estate, and any recent asset transfers. An elder law attorney or social worker can help families understand eligibility and prepare documentation, especially when applying for Medicaid. ^1,2,3

Required Documentation for Admission 

In addition to the medical records and physician assessments mentioned earlier, facilities will also request key legal and financial documents—especially if someone is making decisions on the resident’s behalf. Common paperwork includes: 

1. Power of attorney or guardianship documentation 
2. Insurance cards (Medicare, Medicaid, supplemental) 
3. Advance directives (living will, DNR, MOLST) 
4. Social Security card and personal ID 
5. Financial paperwork for billing and eligibility 

Having these materials ready can help avoid delays and ensure a smoother transition. ⁴ 

Pre-Admission Assessments and Interviews 

Before admission, most nursing homes conduct an intake interview to confirm eligibility and gather care-related details. This process often involves a social worker or admissions coordinator and may include reviewing medical history, confirming legal documents, and discussing initial care plan goals. 

Families typically complete consent forms and designate a primary contact person—someone who will stay in close communication with the care team. This meeting is also a good time to ask questions, clarify expectations, and ensure a smooth move-in process. ² 

Please reach out to your local nursing home directors for more specific or additional information. If you’re interested in care at our Brewster, MA nursing home, we’d love to hear from you.