If your are no longer able to care for an aging parent, spouse, or other relative, it may be time to consider a nursing facility. Unfortunately, most people don't learn about nursing facilities until there is a crisis. At a time of emotional turmoil, many families face the added stress of finding an appropriate facility and understanding how such services are provided and financed. It is important to plan ahead. It takes time to find the right facility. And, since the cost of nursing facility care is generally not covered by Medicare or private health insurance, it is important to consider how to pay for that care if it is needed.

When to Consider a Nursing Facility

Nursing facilities are for people who need nursing care 24 hours a day, 7 days a week. Some people are admitted to nursing facilities for a short period of rehabilitation or recuperation after a hospital stay, and then return home. In other cases, families look for a nursing facility when an elderly relative's illness reaches the point where he or she is no longer able to safely remain at home.

In making the decision to seek care from a nursing facility, it is important to discuss the issue thoroughly with the individual involved and his or her personal physician, preferably before the situation becomes an emergency. Families often feel guilty that they can no longer provide or arrange for all the care an elderly relative may need. It's important to remember that asking for help doesn't mean you've stopped caring.

Paying for Care

Most people think that Medicare, the nation's health insurance program for the elderly, covers the cost of care in a nursing facility, but in most cases it doesn't. Medicare beneficiaries are eligible for up to 100 days of nursing facility care, but only 20 of those days are fully covered by Medicare. Most private health insurance policies don't cover the cost of nursing facility care either.

Because of this lack of insurance coverage, most people pay for nursing facility care out of their income and savings, at least initially. Once their resources run out, they may qualify for Medicaid. To qualify for Medicaid, an individual must have no more than $2,000 in assets, excluding a house, car and personal belongings. In the case of a married couple, the assets are divided equally, with the at-home spouse allowed to keep up to a certain amount in assets and monthly income.

Because 24-hour care in a nursing facility is expensive - averaging $40,000 to $60,000 a year - it is critical that families consider how they will pay for such care. Private long term care insurance is now available that covers the cost of nursing facility care and other long term care services. In considering such policies, be sure that the level and type of coverage you need is provided by the policy, and that the premium is affordable.

Finding The Right Facility

Finding the right nursing facility is time-consuming, but very important. In some cases, the facility may become the individual's "home" for a significant period of time. Be prepared to spend as much time looking for a nursing facility as you would for any new housing situation, and involve the individual in the selection process if at all possible Visit a number of facilities, spend time talking with staff, residents and families, and observe the care being provided. Make sure the facility has any specialized services your relative needs, and is convenient for family and friends to visit. Use the following steps to guide you through the selection process:

1. Consider location and Types of Services Needed

  • Find out from his or her physician what kinds of services your relative will need.
  • Decide who will visit the individual most often, and identify those communities closest to the visiting friend or relative.
  • If it's important to your relative, find out whether his or her personal physician will be able to continue to provide care in the communities you select.

2. Identify Appropriate Facilities

  • Once you have selected the communities in which to look, identify facilities in those communities that provide the kinds of services your relative needs.
  • For help, contact the Massachusetts Senior Care Association toll-free at 1-800-CARE-FOR and ask for a copy of their Guide to Extended Care Facilities, which lists nursing facilities by community and provides information on services provided.
  • Select a reasonable number of facilities and make appointments with admissions staff for an informational meeting and tour of each facility.

3. Visit, Observe, and Ask Questions

  • Do residents appear well cared for? Are they dressed appropriately and well groomed? Ask to speak with residents and family members about their experiences with the facility.
  • Listen for the content and tone of the staff's conversations as they speak with residents. Do staff seem friendly and interested in the residents? Do they call residents by their appropriate names? Do they respond promptly to residents' requests?
  • Does the facility appear clean? Does it smell? Strong odors may indicate poor assistance with personal hygiene or other unsanitary conditions. Ask to see the shower and food preparation areas in particular.
  • Ask about the facility's hiring and staffing policies. How are prospective employees screened? What kind of training do new employees receive? What about ongoing training? What is the staff-to-resident ratio?
  • If you are considering a facility with a specialized Alzheimer's unit, ask if the unit meets the Alzheimer's Association's suggested guidelines for such units.
  • If your relative will be residing in a semi-private room, ask about the facility's policies regarding roommates. How are residents paired? What recourse is there if a roommate situation doesn't work out?
  • What is the facility's policy about personal items from home? To what extent can an individual bring items from home? What steps are taken by the facility to prevent theft of personal items?
  • What are the facility's visiting hours? Are there common rooms available for family visits in addition to the resident's own room?
  • Observe the facility at mealtime and sample the food. What is the quantity, quality and temperature of the food? Are there food choices? Are special diets available? are snacks and drinks available on the units?
  • What activities are offered? What is the nature of the activities, and how often are they offered? Ask to see a copy of the facility's activity calendar for the month.
  • Depending on the needs of the individual, inquire about the facility's rehabilitation program and ask to see the therapy area.
  • Ask about the cost of care as well as the availability of Medicare or Medicaid coverage.

4. Narrow Your Choices, Revisit, and Check Survey Performance

  • Narrow the choice to two or three facilities, and visit these facilities again.
  • Contact the Massachusetts Department of Public Health and ask for the survey performance tool for each of the facilities on your list. The tool measures a facility's performance in key quality areas. You can also request copies of the complete survey reports upon which the tool is based.
  • Question each facility about its performance. If performance is less than satisfactory in any area, ask what the facility has done to correct the problem.
  • Make your final choice and contact the admissions staff for placement advice.
  • Once you have made your selection, meet with the administrator and key staff to discuss any specific concerns you may have about your relative's care.
  • Once you relative has been admitted to the nursing facility, visit often and remain involved in his or her ongoing care.

Nursing Facility Services

Nursing facilities provide a wide range of services, from post hospital care to rehabilitative care to their more traditional role of providing long term care to the elderly and disabled. Among the services provided by nursing facilities are 24-hour nursing care; rehabilitative services, such as physical, occupational and speech therapy; and help with personal care such as dressing, eating, toileting, and bathing. In addition, a growing number of nursing facilities now provide specialized services for people with Alzheimer's disease. Many also provide respite care to enable families to take some time off in caring for an elderly relative.

Ensuring the Quality of Care

All nursing facilities that participate in the Medicare and Medicaid programs are inspected by the Massachusetts Department of Public Health at least once every 9-15 months to ensure that they meet state and federal quality standards. State inspectors look at everything from the adequacy of staffing to the general cleanliness of the facility to food preparation and the proper administration of medications. A copy of the most recent inspection report is available from each facility.

In addition, the Department of Public heath publishes consumer information about each Medicare and Medicaid certified nursing facility in the state based on the facility's performance in key quality areas. Contact the Department for more information about its survey performance tool.

Choosing the Right Nursing Facility for Someone You Love

Presented in cooperation with:

The Massachusetts Department of Public Health



Division of Health Care Quality
10 West Street
Boston, MA 02111
For nursing facility survey performance, call (800) 493-8333


2310 Washington Street, Suite 300
Newton Lower Falls, MA 02162
Publishes a Guide to Extended Care Facilities and a Guide to Assisted Living and Continuing Care Retirement Housing. Both are free.


One Ashburton Place, Fifth Floor
Boston, MA 02108
617.727.7750 Ombudsman
1.800.882.2003 Information & Referrals
1.800.992.2275 Elder Hotline with TTD
Provides volunteers who visit nursing facility residents on a regular basis to resolve complaints.


One Kendall Square, Building 200
Cambridge, MA 02139
(617) 494-5150
Alzheimer Helpline: (617) 494-5150, (800) 548-2111
Provides education, advocacy, and support to people with dementia and their families.


45 Bromfield Street
Boston, MA 02108
(617) 423-0718
Represents nonprofit elder housing, health care and supportive services providers.