A nursing home, also called a skilled nursing facility, gives 24-hour care and supervision to people with serious health needs. For some, it's a short stay to recover after a hospital visit. For others, it becomes home. Which of those situations your loved one is in decides who pays, so it's worth understanding the difference before the hospital discharge planner calls.
Skilled care vs. custodial care
Skilled care is medical care that must be given by, or under the supervision of, licensed nurses or therapists. Examples include wound care, IV medications, and daily physical therapy after a stroke or hip fracture. It usually follows a hospital stay and aims to help the person recover, or to keep them from declining.
Custodial care is help with everyday activities such as bathing, dressing, eating, and using the bathroom. Most people who live in a nursing home long term are there for custodial care, often combined with ongoing medical oversight.
Many nursing homes provide both, sometimes on different floors. The difference matters because Medicare pays for limited skilled care but not for custodial care when that is the only care needed. Medicare.gov states plainly that it "does not provide long-term care coverage or custodial care unless medical care is needed."
What Medicare pays in 2026
Original Medicare Part A covers care in a Medicare-certified skilled nursing facility when all of these are true:
- The person had a medically necessary inpatient hospital stay of at least 3 days in a row. Time under "observation" or in the emergency room doesn't count.
- They generally enter the facility within 30 days of leaving the hospital.
- A provider says they need daily skilled care.
- They have Part A days left in the benefit period.
| Days in the facility (per benefit period) | What you pay in 2026 |
|---|---|
| Days 1–20 | $0 per day, after the $1,736 Part A deductible (not owed again if already paid for the hospital stay in that benefit period) |
| Days 21–100 | $217 per day |
| Day 101 and beyond | All costs |
Coverage ends sooner if your loved one no longer needs daily skilled care, even if they haven't used 100 days. Medicare Advantage plans have their own rules and may charge copays from day one. For more, see what Medicare covers and after a hospital stay.
Ask: "Is Mom admitted or under observation?"
If your loved one is in the hospital, ask whether they are formally admitted as an inpatient. Observation days don't count toward the 3-day requirement, which can leave families with an unexpected bill for the nursing home stay that follows.
What a nursing home costs
The CareScout 2025 Cost of Care Survey (released March 2026) found these national medians:
- Semi-private room: $315 a day, or about $114,975 a year
- Private room: $355 a day, or about $129,575 a year
Costs vary a lot by state and city. At these prices, many families spend down savings quickly, which is why Medicaid pays for a large share of long-term nursing home care nationwide. Medicaid rules on income, assets, and the 60-month look-back are complex, so read Medicaid for long-term care and consider talking with an elder law attorney early. Veterans may have options through VA Community Living Centers, State Veterans Homes, or contracted community nursing homes; see VA long-term care.
Using Care Compare star ratings
Medicare's Care Compare website lets you look up every Medicare- and Medicaid-certified nursing home. Each one gets an overall rating from 1 star ("much below average") to 5 stars ("much above average"), built from three separate ratings:
- Health inspections: results of state inspections and complaint investigations
- Staffing: how many nursing hours residents get, including registered nurse time
- Quality measures: outcomes for residents, such as falls, pressure sores, and use of certain medications
Look at all three, not just the overall score. A home with five stars overall but low staffing may feel very different from what the headline number suggests. Read the actual inspection reports, which describe what inspectors found.
CMS itself cautions that "no rating system can address all of the important considerations" in choosing a nursing home. It recommends visiting in person and using local resources such as your state's Long-Term Care Ombudsman. It also notes that frequent family visits can improve a resident's quality of life and care, so a good home close to family may be a better choice than a higher-rated one far away.
Residents' rights
Nursing homes that take Medicare or Medicaid must follow federal residents' rights rules, and many states add more. Residents have the right to:
- Be treated with dignity and respect
- Be free from abuse and neglect, and from physical or chemical restraints used for discipline or staff convenience
- Be fully informed about their care and take part in care planning
- Make their own choices about daily life, such as when to sleep and who visits
- Privacy in their care, communications, and personal records
- Manage their own money, or choose who does
- Voice complaints without fear of retaliation
- Get written information about their rights at or before admission
Protection against unfair discharge. Under federal rules, a nursing home may transfer or discharge a resident only for specific reasons, such as needs the facility can't meet, improved health, danger to others, or nonpayment after reasonable notice. In most cases the home must give at least 30 days' written notice, and the notice must include contact information for the State Long-Term Care Ombudsman. Residents can appeal.
Your free advocate: the Ombudsman
Every state has a Long-Term Care Ombudsman program that helps residents and families resolve problems with care, rights, and discharges. Find yours through the Eldercare Locator or call 1-800-677-1116.
If you believe a resident is in immediate danger, call 911. You can also report abuse or neglect to your state's survey agency or Adult Protective Services.
When a short stay becomes a long one
Many people enter a nursing home for rehab after a hospital stay, expecting to go home in a few weeks. Sometimes recovery stalls. When Medicare-covered skilled care ends, the facility must give written notice, and your loved one can request a fast appeal if they disagree. The notice explains how.
If your loved one won't be able to return home, the family has some decisions to make quickly: whether to stay in the same facility as a long-term resident, how to pay once Medicare stops, and whether to apply for Medicaid. Talk with the facility's social worker early, before the last covered day. It's also a good time to make sure a power of attorney is in place so someone can handle finances and paperwork.
Choosing a nursing home
- Clarify the need. Short-term rehab, long-term care, or both? Ask the hospital team.
- Search Care Compare for certified homes near family and read inspection reports.
- Visit unannounced, including evenings or weekends. Notice smells, call lights, and how staff speak to residents.
- Ask about Medicaid. Confirm the home accepts it in case savings run out.
- Read the admission agreement. Federal rules bar nursing homes that take Medicare or Medicaid from requiring a third-party guarantee of payment as a condition of admission. Don't sign as "responsible party" without understanding what it means.
Check before you decide
Benefit rules, dollar amounts, and state programs change, and every family's situation is different. This guide is general information, not medical, legal, or financial advice.
- Confirm eligibility and current amounts with the agency itself: Medicare, your state Medicaid office, or the VA.
- For legal documents and Medicaid planning, talk with a licensed elder law attorney in your state.
- For health questions, talk with the person's doctor. In an emergency, call 911.
Common questions
How long will Medicare pay for a nursing home?
Medicare Part A can cover up to 100 days of skilled nursing facility care per benefit period after a qualifying 3-day inpatient hospital stay, as long as daily skilled care is needed. In 2026, days 1–20 cost $0 after the Part A deductible and days 21–100 cost $217 a day.
Does Medicare pay for long-term nursing home care?
No. Medicare doesn't pay for custodial care when that's the only care needed. Most long-term nursing home stays are paid privately or by Medicaid. See Medicaid for long-term care.
Can a nursing home evict a resident?
Only for specific reasons allowed under federal rules, such as nonpayment after notice or needs the facility can't meet. Usually the home must give 30 days' written notice that includes how to reach the state Long-Term Care Ombudsman.
Are nursing home star ratings reliable?
They're a useful starting point, not the whole story. CMS itself says to combine ratings with in-person visits and help from your state Ombudsman.
Sources
- Skilled nursing facility care — Medicare.gov. medicare.gov/coverage/skilled-nursing-facility-care
- Long-term care — Medicare.gov. medicare.gov/coverage/long-term-care
- Five-Star Quality Rating System — CMS. cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS
- Rights & protections in a nursing home — Medicare.gov. medicare.gov/what-medicare-covers/what-part-a-covers/rights-protections-in-a-nursing-home
- 42 CFR 483.10 Resident rights — eCFR. ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.10
- 42 CFR 483.15 Admission, transfer, and discharge rights — eCFR. ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-B/section-483.15
- Long-Term Care Ombudsman Program — ACL. acl.gov/programs/Protecting-Rights-and-Preventing-Abuse/Long-term-Care-Ombudsman-Program
- CareScout Releases 2025 Cost of Care Survey Results — Genworth Financial. investor.genworth.com/news-events/press-releases/detail/1054
Last reviewed October 19, 2026. General information only, not medical, legal, or financial advice. Benefit rules and amounts change, so confirm with the agency before you decide. See our disclaimer.