A nursing home is a residence with licensed nurses and aides on duty around the clock, for people who need more care than they can get at home. Medicare pays only for a limited skilled stay after a hospital admission. Long stays are paid by Medicaid for people who qualify, or privately.
A skilled nursing facility (SNF) is the Medicare term for a nursing home certified to give skilled care, such as therapy and nursing after a hospital stay. Many homes do both short rehab stays and long-term care. This guide covers what a nursing home includes, who pays, how CMS rates homes and what to check before you choose.
What a nursing home is and who works there
MedlinePlus says a nursing home is a place for people who do not need to be in a hospital but cannot be cared for at home, and that nursing homes are not only for older adults but for anyone who needs 24-hour care. Most have nursing aides and skilled nurses on hand 24 hours a day. Some are set up like a hospital, with medical care and physical, speech and occupational therapy. Others aim for a home-like neighborhood feel. Some have special units for people with serious memory problems.
Federal staffing rules require sufficient licensed nurses and other nursing staff on a 24-hour basis. They also require a registered nurse on duty for at least eight consecutive hours a day, seven days a week, a full-time director of nursing, and a charge nurse on each shift. A state can waive some of these where a facility has been unable, despite diligent efforts, to recruit staff.
Who nursing homes are for
Nursing homes serve two groups. One is people recovering after a hospital stay who need daily therapy or nursing for a time. The other is people who need ongoing help and supervision that cannot safely be given at home or in a lower level of care. The choice between a nursing home and assisted living usually turns on how much nursing care someone needs. Read assisted living vs nursing home.
What Medicare covers in a nursing home
Medicare.gov says Part A covers a semi-private room, meals, skilled nursing care, physical, occupational and speech-language therapy if needed to meet your health goal, medical social services, medications, medical supplies and equipment used in the facility, ambulance transportation when other transportation endangers your health, and dietary counseling.
Medicare does not cover long-term care, meaning mostly help with basic personal tasks of everyday life. Medicare.gov says you pay all costs for non-covered services, including most long-term care.
Nursing homes vs nearby care options
- Assisted living. State-licensed housing with help, not 24-hour nursing.
- Memory care. Residential care built for dementia. Some nursing homes have memory care units.
- Home health care. Skilled care at your own home, part-time, ordered by a doctor.
- Hospice. Comfort care at the end of life. It can be given in a nursing home, but Medicare hospice does not pay the home's room and board.
- Board and care homes. Small residential homes with fewer services.
Who pays for nursing home care
Medicare (short stays). Medicare.gov sets these conditions for SNF coverage:
- A medically necessary inpatient hospital stay of at least 3 days in a row. The admission day counts and the discharge day does not. Time under observation or in the emergency room does not count.
- You generally enter the SNF within 30 days of leaving the hospital.
- You need daily skilled care in a Medicare-certified SNF, for a condition treated in the hospital or a new one that began during the SNF stay for that condition.
- The 3-day rule can be waived if your doctor is in an ACO with a waiver, or by some Medicare Advantage plans.
Part A limits coverage to 100 days in each benefit period. For 2026 you pay $0 a day for days 1 to 20, after the Part A deductible of $1,736. You pay $217 a day for days 21 to 100, and all costs from day 101. Medicare Advantage plans may charge copayments in the first 20 days, so ask your plan. See what Medicare pays for.
Medicaid (long stays). Medicare.gov says you may be eligible for long-term care through Medicaid if you meet eligibility requirements in your state. Medicaid has income and asset rules, and moving money before applying can delay coverage. Read Medicaid, the look-back period and spend down. Federal rules say a nursing home must have identical transfer, discharge and service policies regardless of payment source. For Medicaid-eligible residents, a facility must not charge, solicit, accept or receive extra payment as a precondition of admission or continued stay.
VA. VA lists nursing home options: Community Living Centers (VA-run), community nursing homes VA contracts with, and State Veterans Homes run by states. Nursing home benefits depend on income and the level of service-connected disability. See VA benefits.
Long-term care insurance and private pay. Some policies pay toward nursing home care. The terms vary, so check what yours says and when benefits start. See long-term care insurance and private pay.
What drives the cost of nursing home care
We do not publish an average price because the sources we trust do not give one that applies to your state. What changes the bill:
- Whether Medicare, Medicaid or you pay for the stay, and which day of the stay you are on
- Room type. MedlinePlus notes single rooms may cost more than shared ones
- Whether the stay is short rehab or long-term care
- Extras Medicare or Medicaid does not cover, which the home must explain
- The state, because Medicaid rules and rates differ
Use the care cost comparison and ask for the full admission agreement before you decide.
How CMS rates nursing homes
CMS gives each certified home an overall rating from 1 to 5 stars plus separate ratings for health inspections, staffing and quality measures. A 5-star home is described as much above average quality, and a 1-star home as much below average. CMS says no rating system can address all of the important considerations, such as specialty care or how easy visits are for family, and suggests using the ratings with a visit and state or local organizations like the State Ombudsman program.
Things worth knowing about how the ratings work:
- CMS's 2015 fact sheet says quality measures are calculated from information the nursing homes report, and that health inspection ratings compare homes within the same state.
- A June 2025 CMS memo says the oldest standard survey cycle is dropped from the health inspection rating, performance data for nursing home chains is posted on Care Compare, and the long-stay antipsychotic measure is due to be updated in January 2026 to add claims data.
- CMS added staff turnover and weekend staffing measures to Care Compare in January 2022 and used them in the rating from July 2022.
Our care ratings by state and methodology explain how we show CMS data.
The abuse icon on Care Compare
CMS began showing a consumer alert icon on Nursing Home Compare on October 23, 2019, for facilities cited on inspection reports for abuse that led to harm of a resident within the past year, or abuse that could potentially have led to harm in each of the last two years. CMS refreshes it monthly and removes it once the most recent inspections show the cited issues were remedied. A facility with the icon can still show its star ratings. Check Care Compare for the current criteria.
Special Focus Facilities explained
CMS runs a Special Focus Facility (SFF) program required by the Social Security Act, aimed at nursing homes with a persistent record of noncompliance leading to poor quality of care. CMS says the persistently poorest performing facilities selected in each state must be inspected no less than once every six months, with increasingly severe enforcement when warranted. CMS does not display star ratings for SFFs on Care Compare. They are identified with an icon and text that shows their status. CMS posts the SFF list on cms.gov monthly.
How to choose a nursing home
- Use Care Compare and check all four ratings, the abuse icon and SFF status.
- If the home is not listed, MedlinePlus says to check whether it is Medicare or Medicaid certified, and that an uncertified home should probably come off your list.
- Ask the hospital social worker or discharge planner for names. Visit more than once, on different days and at different times.
- Read the most recent inspection report and the admission agreement.
- Ask your state's long-term care ombudsman about the home.
Questions to ask each nursing home
- Is there licensed nursing staff 24 hours a day, and a registered nurse at least eight hours every day?
- Are staff assigned to specific residents? What is the ratio of staff to residents?
- Are you taking new residents, and are rooms single or shared?
- Do you accept Medicare and Medicaid, and is there a Medicaid bed available?
- Do you offer the specialized care we need, such as rehabilitation or dementia care?
- How do you handle bed holds if my relative goes to the hospital?
- What background checks do you run on staff?
Residents' rights and red flags to watch for
Federal rules say residents have the right to be free from abuse, neglect, misappropriation of property and exploitation, from involuntary seclusion and from restraints used for discipline or convenience. Facilities must report an alleged violation involving abuse or serious bodily injury immediately, and no later than two hours after the allegation, and must investigate and report results to the State Survey Agency within five working days.
On discharge, a facility must let residents stay unless a listed reason applies. It must give written notice in a language the resident understands, generally at least 30 days before the move, with a copy to the State Long-Term Care Ombudsman, stating the reason, the effective date, the destination and appeal rights. A resident cannot generally be discharged while an appeal is pending.
Warning signs on a visit and in the records:
- The abuse icon, SFF status or repeated serious inspection findings
- Strong odors, high noise levels, residents who look unclean or uncomfortable
- Staff who are impolite or do not use residents' names
- No clear answer on nursing coverage overnight and on weekends
- A request for extra payment as a condition of admission for a Medicaid-eligible resident
- Pressure to sign a stay agreement on the first visit
About the nursing homes listed below
Carevo is a directory and connection platform. It does not place residents, assess care needs or vouch for any nursing home. CMS rates, states license, and we report what they publish. The lists below come from CMS data. Check each home yourself, and use get matched if you want help finding options near you.