Nursing Home Requirements for Seniors

Nursing home services are generally for seniors with debilitating health issues or serious conditions that require frequent medical supervision and round-the-clock care. To be admitted to a nursing home, a senior needs to meet the state’s criteria for nursing home care, and a physician must document and confirm any medical conditions. The minimum age requirement for a nursing home varies based on the facility, but most only admit residents aged 62+. Moreover, there are laws and regulations governing nursing home admission, so it’s crucial to determine if this type of care is needed.

One of the biggest reasons nursing home qualifications are so extensive is to ensure seniors receive the correct level of care for their condition. For example, if your loved one requires day-to-day care but does not meet requirements for nursing home placement, they may be a good candidate for an assisted living community. They’d still get the help they need, but in a less restrictive environment.

“The process is not always simple, and it can be tedious,” says senior care professional Mark Pavlovich, owner of Yardstik Behavioral Analytics and member of the workforce and customer experience committees at the American Health Care Association. “But it can be easier if you know who you need to talk to and are aware of the documents needed beforehand.”

The Centers for Medicare & Medicaid Services (CMS) requires states to follow some general guidelines. Nevertheless, states retain the flexibility to create their own assessments within CMS’s rules.

Because of this, it’s possible for a senior to meet nursing home admission requirements in Iowa or Kansas, but not in California or New York. Be sure to contact your local Medicaid or county government agency to learn more about your state’s specific nursing home testing standards and how to qualify for a nursing home.

Alice Bonner, Ph.D. and the Institute for Healthcare Improvement’s Senior Advisor for Aging, notes that nursing home admission requirements vary by state, but do share similarities.

To verify that your loved one meets state requirements for nursing home care, a physician will assess their health care needs.

If your aging relative is currently in the hospital, attending staff will likely complete the assessment during the hospital stay. If they’re not currently in the hospital, you can make an appointment with their primary care doctor.

Though the process of getting a loved one admitted into a nursing home can seem daunting, it’s significantly easier once you know what most facilities need for admission. Obtaining a senior’s medical and physical history may seem obvious, but there are also numerous forms to acquire beforehand, possibly medical tests to take, and even a financial assessment.

Read more:A Guide to Choosing a Nursing Home

Is a nursing home the right fit?

Before your loved one is admitted to a nursing home, you’ll need to provide the facility with the documents listed below. The first five items on this list are completed by hospital staff or your loved one’s primary care doctor.

1. Physician’s order for admission to a nursing home. This order is like writing out a prescription. It must confirm the patient’s need for nursing home-level care.
2. Hospital staff or primary care physician’s order for medications and treatment. Your loved one will have a new physician and caregivers at the nursing home. To provide care, they’ll need orders from a primary care physician or hospital staff.
3. Medical history and physical examination. The nursing home’s attending physicians need up-to-date information about your loved one. A primary care physician should perform a physical exam and report to provide current medical history.
4. State-required form. Some states have a required form for nursing home admittance to certify a patient meets state nursing home qualifications. It also means the person’s medical needs can be met at a nursing home. Either the hospital or the primary care physician will fill out and sign this form. Because this form is required for admission, you should pick it up from the nursing home your loved one will be staying at before submitting all the other listed documents.
5. Health care tests. Nursing homes are required to offer flu shots, pneumonia vaccines, and tuberculosis (TB) tests within three days of admission. If newly admitted patients have had these services recently, the nursing home may ask for proof.
6. Completed admissions paperwork. Paperwork can usually be filled out before or on the day of admission. Although the process varies depending on the nursing home and state, it’s common for essential forms to be filled out at the facility with a staff member. The patient or their agent — the legally responsible party under power of attorney (POA) — will sign their name several times after learning about nursing home policies, responsibilities, legal certificates, the cost and care provided, and consenting to be treated.

The process of admitting a loved one into a nursing home can take several hours or more, says Pavlovich. As part of the nursing home admissions process, community staff may also ask for other documentation:

• Power of attorney (POA) papers
• Do not resuscitate (DNR) paperwork
• End-of-life care wishes
• Dietary requirements
• Medical orders for life-sustaining treatment (MOLST)
• Living will

This step ensures each patient has the means to pay for nursing home care. The financial assessment is similar to providing financial information to get a mortgage.

The patient will need to disclose financial information and complete paperwork to answer questions like the following:

• Is the patient currently enrolled in Medicare or Medicaid? Do they plan to apply?
• Does the patient have supplemental insurance?
• Does the patient receive veterans benefits, SSI funds, or a private or government pension? (Eligible veterans may be able to use VA nursing homes.)
• What are the patient’s assets? This includes cash, checking and savings accounts, stocks, bonds, CDs, trust funds, and real estate holdings.
• Does the patient have any paid-up life insurance, burial insurance, or long-term care insurance policies?
• Has the patient transferred assets in the last 3-5 years, disqualifying themselves from Medicaid due to the look-back period?
• What’s the patient’s current living situation?
• How much is their current monthly rent or mortgage payment?

In certain situations, Medicare can help with medical expenses while Medicaid will pay for nursing home care. An elder law attorney or social worker can be a helpful partner in the Medicaid application process, determining eligibility, and guiding seniors on how to qualify for a nursing home covered by Medicaid. To find a local elder law attorney, use the National Academy of Elder Law Attorneys (NAELA)’s Find a Lawyer search tool.

Read more:A Comprehensive Guide to Understanding Medicaid and Nursing Homes

Nursing homes questions? Get expert help

Sometimes, placement in a nursing home is unexpected, usually due to sudden illness or injury. Emergency placement might also be necessary if a senior’s primary caregiver becomes ill and can’t care for them. Whatever the case may be, most nursing homes are equipped to handle unexpected or emergency nursing home placements. Typically, nursing homes have waitlists that can be weeks or months long, but an emergency placement indicates a need for immediate admission, which often reduces wait times.

If your loved one needs immediate placement in a nursing home, your first step should be to contact your local Area Agency on Aging (AAA), a nonprofit agency designated by the state to address certain needs of seniors. Your AAA can give you information on local support resources, such as health insurance counseling, the long-term care ombudsman, and more.

Once you find a nursing home that meets your loved one’s needs, the next steps can vary slightly depending on a facility’s emergency placement policies and procedures. Typically, you’ll still need to go through the regular admissions procedure and provide the required documents listed above. The only difference is that the process is accelerated.

For example, Texas nursing homes require a Preadmission Evaluation (PE), an extensive screening for mental illness, intellectual disability, or a developmental disability, before being admitted. However, when it comes to emergency admission, nursing facilities in Texas can postpone the assessment for up to seven days (or 14 days if respite is the reason for entry).^[01] This way, admittance is expedited, but nursing homes still obtain the information they need to provide proper care.

Whether it’s a nursing home, assisted living community, or memory care community, moving a loved one somewhere new can be stressful. Connect with A Place for Mom’s Senior Living Advisors to help find the right care option. Though they can’t refer seniors directly to nursing homes, they can make the transition process easier. They can assist with figuring out which care option is best and point you toward local resources that can help – all at no cost to your family.