Nursing Homes & Skilled Nursing Facilities

Medicare Part A covers skilled nursing facility care for up to 100 days per benefit period after a qualifying hospital stay of at least 3 days. Days 1–20 are covered at 100%. Days 21–100 require a daily copayment (over $200/day in 2024). After day 100, Medicare pays nothing. Coverage requires that the patient receive skilled care — nursing, physical therapy, or speech therapy — on a daily basis. Custodial care (help with daily activities without skilled needs) is not covered by Medicare.

The Centers for Medicare and Medicaid Services (CMS) assigns nursing homes a 1–5 star rating based on health inspections, staffing levels, and quality measures. A 5-star rating is above average; a 1-star rating is below average. The rating is a useful screening tool but not a complete picture. Families should read the full inspection reports — not just the star summary — and pay particular attention to the "Health Inspections" sub-rating, which reflects actual survey findings rather than self-reported data.

In practice, many nursing homes function as both. Short-term rehabilitation is the skilled nursing care Medicare covers after hospitalization — physical therapy, occupational therapy, and recovery. Long-term care nursing home beds are for individuals who need ongoing 24-hour skilled nursing or custodial support that cannot be provided at home or in assisted living. The same building may have both short-term rehab and long-term care units, often with different staffing models and environments.

Medicaid covers nursing home care for individuals who meet both medical and financial eligibility criteria. Financially, Medicaid is means-tested — most states require that an individual spend down their assets to very low levels before Medicaid kicks in. Rules vary by state, and elder law attorneys often help families navigate the spend-down process, asset protection strategies, and Medicaid application. Planning ahead is critical because Medicaid look-back rules can affect gifts and transfers made up to 5 years prior.

Concerns about nursing home care can be reported to the state long-term care ombudsman program, which advocates for residents and investigates complaints. The state licensing agency (which conducts inspections) also accepts complaints that can trigger an unannounced survey. CMS's national complaint database also accepts reports. Each state's regulatory hub on SilverTech links directly to the ombudsman and complaint intake resources for that state.