What are the types of nursing home care?

The distinction between intermediate and skilled facilities has been eliminated due to government regulations. Now, both types are simply classified as nursing facilities. However, designation of level of care is still important because it affects who pays for the care. Most private insurance companies and Medicare pay only for the "skilled" level of care. If you are seeking payment under these programs, it is important to clarify the following before admission to the nursing facility:

  • The level of care required
  • The level of care that the nursing facility is certified to deliver
  • If reimbursement will be approved
  • What therapies are needed (Physical Therapy, Occupational Therapy, Speech Therapy)

You can ask your physician and nursing home staff to help answer these questions.

What services do nursing homes offer?

The services nursing homes offer vary from facility to facility. Services often include:

  • Room and board
  • Monitoring and administration of medications
  • Personal care (including dressing, bathing, and toileting assistance)
  • 24-hour emergency care
  • Social and recreational activities

How can I find the right nursing home facility?

Finding the right nursing home takes time. You often have a long waiting period for accommodations. Beginning the search for a suitable nursing home well in advance of seeking admission to the facility is important. Planning ahead also can make the transition of moving into a nursing home much easier.

Talk with your family and caregivers about what services you will need. Take time to consider what services are important to you before calling different nursing homes. Think about these questions:

  • What daily activities do I need help with (bathing, dressing, toileting, eating)?
  • How often do I need help?

Before scheduling a visit to the nursing homes you are interested in, ask about vacancies, admission requirements, level of care provided, and participation in government-funded health insurance options.

What should I look for in a nursing home facility?

The following checklist will help you and your family evaluate different nursing homes. Review the checklist included below and on the following pages before your visit to the facility. Be sure to take this checklist with you.

Nursing home consumer checklist


  • Does the nursing home provide the level of care needed, such as skilled or long-term residential care?
  • Does the nursing home meet local and/or state licensing requirements?
  • Does the nursing home's administrator have an up-to-date license?
  • Does the nursing home meet state fire regulations (including a sprinkler system, fire-resistant doors, and a plan for evacuating residents)?
  • What are the visiting hours?
  • What is the policy on insurance and personal property?
  • What is the procedure for responding to a medical emergency?
  • What is Medicare star rating? (Visit www.medicare.gov and insert zip code for your area nursing rating by Medicare.)


  • Is there a waiting period for admittance?
  • What are the admission requirements?

Fees and financing

  • Are fees competitive?
  • Have fees increased significantly in the past few years?
  • Is the fee structure easy to understand?
  • What are the billing, payment and credit policies?
  • Are there different costs for various levels or categories of services?
  • Are the billing and accounting procedures understandable?
  • Does the nursing home reveal what services are covered in the quoted fee and what services are extra?
  • What governmental financing options are accepted (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income and others)?
  • When may a contract be terminated? What is the refund policy?

Needs assessment

  • Is there a written plan for the care of each resident?
  • What is the procedure for assessing a potential resident's need for services? Are those needs reassessed periodically?


  • Do the nurses, social workers and administrators have geriatric experience and/or education?
  • Are staff available to meet scheduled and unscheduled needs?
  • Do staff members seem to genuinely enjoy working with the residents?
  • Do staff members treat residents as individuals?
  • Are staff available to assist residents who experience memory, orientation or judgment losses?
  • Does a physician or nurse visit the resident regularly to provide medical checkups?
  • Is your physician approachable?
  • What is the nurse-to-patient ratio?
  • Is the staff capable of providing compassionate end-of-life care?

Residents and atmosphere

  • Do residents appear happy and comfortable?
  • Do residents, other visitors and volunteers speak favorably about the nursing home?
  • Are residents clean and adequately dressed?
  • Are the rights of residents clearly posted?
  • Are there programs that encourage residents to stay physically active?

Facility design

  • Do you like the appearance of the building and its surroundings?
  • Is the decor attractive and home-like?
  • Is the floor plan easy to follow?
  • Do doorways, hallways and rooms accommodate wheelchairs and walkers?
  • Are elevators available?
  • Are handrails available?
  • Are shelves easy to reach?
  • Are carpets secured and floors made of a non-skid material?
  • Is there good natural and artificial lighting?
  • Is the residence clean, odor free, and appropriately heated/cooled?
  • Are hospice and palliative care services available?

Medication and healthcare

  • What is the policy regarding storage of medication and assistance with medication?
  • Is self-administration of medication allowed?
  • Who coordinates visits from a physical, occupational, or speech therapist if needed?


Is staff available to provide 24-hour assistance with activities of daily living, if needed? Daily activities include:

  • Dressing
  • Eating
  • Mobility
  • Hygiene and grooming
  • Bathing, toileting and incontinence
  • Using the telephone

Room features

  • Are rooms for single and double occupancy available?
  • Is a 24-hour emergency response system accessible from the room?
  • Are bathrooms private? Do they accommodate wheelchairs and walkers?
  • Can residents bring their own furnishings? What may they bring?
  • Do all rooms have a telephone? How is billing handled for long-distance calls?
  • Are rooms free of objects or obstructions that may cause falls or accidents?

Social and recreational activities

  • Is there an activities program?
  • Are the activities posted for residents?
  • Do most of the residents at an activity seem to be participating?

Food service

  • Does the nursing home provide three nutritionally-balanced meals a day, seven days a week?
  • Is the food hot, attractive and tasty?
  • Are snacks available?
  • May residents request special foods?
  • Is drinking water always accessible?
  • Are common dining areas available or do residents eat meals in their rooms?
  • May meals be provided at times the resident prefers or are there set meal times?
  • How are special diets (such as for patients with diabetes, hypertension, heart failure, kidney failure) handled?
  • Is assistance available for residents who need help with eating?

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