When I owned and operated a nursing home and an assisted living community, I met most families on the hardest day of their year. A parent had just left the hospital. The family had to decide quickly, and a stack of admission papers was waiting on the desk. This guide covers what every family should know before nursing home admission.
I also saw the fear that comes before the paperwork. A new resident, still settling into an unfamiliar room, would worry less about his or her own care than about whether the cost would leave a spouse at home with nothing. Often there are protections for that spouse that the family has never heard of. The families who struggled most learned the rules after they had run out of time or money.
If a hospital discharge is still being planned, start with our companion article, Hospital Discharge to a Nursing Home: What a Former Nursing Home Owner Wants You to Know. Once admission papers are in hand, here is what I wish every family knew.
1. Before nursing home admission, know that the spouse at home has protections
This is the fear I saw most, so I want to address it directly. Federal and Pennsylvania rules exist to protect the spouse who stays at home. They help keep that spouse out of poverty when the other spouse needs nursing home care. The spouse at home may keep a meaningful share of the couple’s assets and, in some cases, part of the income. The rules generally protect the home while that spouse lives in it.
The exact figures change every year. How a couple owns assets, and how Medicaid counts them, matters a great deal. Many couples spend down far more than they need to because they never learned these protections existed. Read our guide to protecting the healthy spouse, and then get a review of your own situation before any money moves.
2. Know what Medicare will and will not pay
Many families assume Medicare covers a nursing home stay. It covers short-term skilled care or rehab, but only after a qualifying stay of at least three days in a row as a hospital inpatient. Time under observation does not count, even if your parent stayed overnight. Medicare covers the first 20 days with no daily co-payment, then requires a daily co-payment through day 100. It does not pay for long-term custodial care, which is the care most residents need.
Medicare’s page on skilled nursing facility care lays out the conditions, and our guide to Medicare vs. Medicaid for long-term care explains the difference.
3. Read the admission agreement before nursing home admission is final
Admission paperwork is long, and facilities usually hand it over under time pressure. Pay close attention to the capacity in which you are signing. Federal rules say a nursing home may not require a family member or other third party to guarantee payment as a condition of admission or continued stay (42 CFR 483.15). A facility may ask a representative who has legal access to the resident’s money to sign a contract to pay from the resident’s own income and resources, but that signature should not make you personally liable.
Be cautious about phrases such as “responsible party” or “joint and several liability,” which can signal an attempt to hold you personally responsible. If a document is unclear, ask for a copy to review, and consider having an elder law attorney read it.
4. Facility staff mean well, but they are not Medicaid planners
In my experience, most nursing home staff do not have a deep understanding of the Medicaid rules. They generally know that long-term care Medicaid pays at a lower rate than private pay, and they know the Medicaid asset and income limits. What many do not know are the rules that allow families to protect assets.
When a family asks what to do about the bills, the advice they hear is often to spend savings down to the asset limit. Staff members don’t give that advice in bad faith. It comes from not knowing the other options. For a family, however, it can mean spending far more than necessary. Some options may no longer be available once the money is gone.
Their job is to run the facility, and the good ones are kind and helpful with billing. Planning a family’s finances is a different job. A Medicaid planner works for you, and when a situation calls for legal documents, an elder law attorney prepares them. Before you spend down savings on anyone’s advice, get a review of your own situation. Our spend-down guide explains what counts, what’s exempt, and why “spend everything first” is not the only path.
5. Before nursing home admission, gather your records and pause before giving anything away
Medicaid reviews five years of financial history. Pull together bank, retirement and investment statements, insurance policies, deeds, vehicle titles and burial arrangements. Large deposits and withdrawals will need explanations, so it helps to find them before the county caseworker does.
In a crisis, families want to act fast. They might add a name to an account, give money to a child, sell a car for a dollar. Transfers inside the five-year look-back period can trigger a penalty period. During this penalty period, Medicaid will not pay for care. Talk to someone before you move anything. Our look-back guide shows how penalties are calculated.
What I would do this week before nursing home admission
Whether your parent is about to enter a nursing home, or already has, take three steps:
- Ask the facility how it handles Medicaid when the time comes.
- Collect five years of records.
- Talk with a Medicaid planner before spending down savings or moving any money.
Has someone told you to spend down savings? Call before you do. Schedule a free consultation or call (610) 627-1010, and I will tell you what is realistic for your family before you commit to anything.
Fieldstone Medicaid Planning is not a law firm and does not provide legal advice. This article is general information, not advice for your situation. Last reviewed: October 2026.