Guide to the Nursing Home Admission Process: 6 Steps to Know

Contributing writer, former long-term care admissions counselor and social worker

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Choosing to go to a nursing home full-time is a difficult but common decision for many families with older parents. However, the process to find, review, and apply may feel very daunting for senior citizens and their families. There is a lot of conflicting information out there regarding the care at a nursing home, and figuring out how to navigate the process may not be easy. 

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To help smooth the process out, we have developed, collected, and compiled a six-step guide to follow illustrating the best way to tackle the nursing home admission process from start to finish.

Step 1: Why Do You Want Nursing Home Care?

Having a realistic discussion with your loved one about the need for nursing home care and benefits is the first necessary step in the process. Some family members may have dissenting opinions about nursing homes, while others may welcome the suggestion.

It’s wise to review pamphlets and/or websites to get an idea of the available facilities in your desired location, and perhaps even tour the facilities and see what a typical room would be like.

Your loved one may be at home, in the hospital or at another facility when the talk comes up. If they are in a facility already, the idea of moving to a nursing home may be a little easier. Bringing in available staff like social workers can help you and your loved ones understand the practical needs that may be fulfilled at a nursing home.

Below are some reasons some consider nursing home care:

  • Socialization: Moving into a nursing home offers the opportunity to meet dozens of people their age. Much like other long-term care facilities, there are activities offered daily and they can get out and do things with others.
  • Consistent care: A nursing home provides regular check-ins and routine care all in one facility. It can be relieving for you or your loved one, especially if you may have some questions about how to provide increasing assistance from a medical perspective.
  • Medication management: This part of daily care can be very stressful for you or your loved one. Anyone can mix up their medications and with age, some folks may require more than just a few reminders to take their medications. At a nursing home, this burden is off your shoulders as nursing staff deliver medications to residents on the daily.
  • Meal Preparation: No more cooking (or dishes).
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Step 2: Provide Necessary Paperwork 

If you and your loved ones have decided to move forward on a nursing home, you’ll have to have a handful of necessary paperwork at the ready.

Nursing home facilities require the following: 

  • PRI (Patient Review Instrument): This is a tool used to evaluate and score an individual to determine if they are appropriate for a skilled nursing facility. A PRI is completed by a registered nurse and may be covered by insurance. In other cases, you may need to pay for it out-of-pocket. Check with your insurance providers to see what is covered. 
  • Medical Screen: The screen goes hand-in-hand with the PRI, as it is also a way to evaluate the level of care appropriate for you or your loved one.
  • History and Physical: Your loved one will need to be seen by their primary care physician, also known as a PCP, to get their history, physical, listed medication, diagnosis list, and other supplemental documentation to provide to the nursing home.  
  • Financial History: This will vary depending on the individual, but most facilities will need to see proof of resources and assets. This will likely lead to a five-year financial review and a Medicaid application if it was not already started. 

Through the PRI, screen, and conversations with your primary doctor, you will receive a detailed assessment to see if nursing home care is the best move for your loved one.

If alternate placement is recommended, your doctor might also suggest assisted living for a lower level of care, or conversely a dementia unit for a higher level of care.

In a memory care facility such as a dementia unit, residents receive specified care, and staff are trained to work with residents regarding their memory care. If this is appropriate for your loved one, the conversation with your PCP and the above documentation should be able to assist with this decision.

Finally, alongside the medical paperwork, it is also useful if not recommended to have advanced directives written out and listed. These are integral parts of any end-of-life planning discussions as well. 

Many nursing home facilities will either ask or recommend that you have the following prepared alongside an application: a MOLST Form (Medical Orders for Life-Sustaining Treatment), a DNR Order (Do Not Resuscitate), a health care proxy, power of attorney papers, and a living will. 

Step 3: Complete Application(s) 

To ensure your loved one is admitted to the facility smoothly, a completed application needs to be submitted and reviewed by the facility's admissions and nursing staff.

As mentioned above, the application will ask for medical, financial, and any other pertinent information to determine what is needed for successful admission. 

The application will give the facility an idea of how much income your loved one receives monthly and if you can cover nursing home costs. The application will also provide detailed questions on what you and your loved one need in terms of medical care.

The team can determine if the facility can manage these needs at the facility. Facilities may differ across the board from what they can care for from disabilities to dementia, and discussions with your primary care physician and the facilities are crucial in determining the best route for your loved one.  

Step 4: Start Medicaid Application if Needed 

The application process will suss out for you if Medicaid is needed. Nursing home Medicaid is different from any Medicaid assistance your loved one may have in the community. The facility may have a Medicaid coordinator or liaison to work with, and if not, your county local office may have representatives that can assist with applications.  

Medicaid applications are lengthy and as mentioned above, will require an in-depth five-year financial review or “lookback” in most cases. This means they will inspect your finances for the past five years, and ask questions or explanations about any large sums of money you have received.

Here is a list of some of the paperwork needed for the Medicaid Application below. Make sure to double-check with your Medicare liaison if you require further documentation.

  • Birth certificate (resident and spouse)
  • Marriage certificate
  • Military paperwork if applicable
  • Property documents, including closing papers, deed, etc. 
  • Bank statements, the past five years for each account
  • Life insurance policies 

Some nursing homes will accept new admissions while their applications are in process while others require Medicaid to be started as of their admission date or prior to. This on a facility by facility basis and is a question that admission representatives can answer for you. 

Step 5: Meet with Facility Staff to Complete Admission Agreement 

If the facility accepts the particular nursing needs and financial standing of the potential applicant, the next step is completing an admission agreement. Depending on the facility, you may meet with an admissions representative, a social worker, or someone else to complete this paperwork. 

This admission agreement is an agreement between the facility and resident that discusses several important things including but not limited to: 

  • The Facility: The paperwork will discuss the legal certificates that are required for a nursing home, and what its limitations are regarding the level of care.
  • The Resident: Sections in the agreement will explain what is expected of a resident, as well as their rights and responsibilities within the facility. This might include things like a non-smoking policy.
  • Finances: At this point, you will have an idea of what room and board will cost, but this agreement will spell out what you are paying for in terms of care, room and board, and other things. For example, one room, as well as food and nursing care may be $200/day. 
  • Personal Needs Account: Nursing Home residents who receive Medicaid assistance are allowed to keep a certain amount of money for personal use per month. This varies from state to state but can be put into a personal account managed by the facility. This is covered in the paperwork.

The admission agreement can be signed by the resident and/or their representative. Make sure to ask for copies of all signed papers.

Step 6: Moving Day

The next step is to prepare for move-in day. Rooms at a nursing home may be a big adjustment for anyone moving in, as residents are often asked to part ways with a good number of home furnishings and other things they hold close.

The move-in part of admission can be made easier by touring at the start of the process. If you can, measure the size of the room and take pictures of the other amenities provided so you have a sense of what to expect.

However, there are some things that cannot be measured in pictures or by visiting. Some of those changes may include sharing a room, sharing a bathroom, and some louder residents. 

There is no doubt it is a huge adjustment and creating a homey space for your loved one makes the transition easier. It is recommended to not bring anything too valuable, as some residents with dementia may misplace or walk off with expensive items, not to mention the opportunity to have these items stolen.

It’s Never Too Soon To Prepare 

Having a conversation about nursing home care before the time comes may be a good idea for everyone. That way, everyone has the ability to mull over options and not be forced to make a rushed decision. Like other long-term care decisions, they have long-lasting impacts and influence the way we transition into end-of-life care.

Being prepared starts off with end-of-life planning, so consider diving into the Cake platform to help you answer any questions you may not have considered.

If you're looking for more on long-term care, read our guides on questions to ask a nursing home and respite care.

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