August 28, 2026
4:10 am

Touring a Nursing Home: What to Ask and Look For

Ask for the bed-hold policy in writing before you ask about anything else, because that single document tells you what happens if your mother goes to the hospital for four days — and whether her room is still hers when she comes back. It is the question tours are not designed to prompt and the one families most regret not asking.

Almost every question worth asking on a nursing home tour is really a question about a clock. How many Medicare-covered days are left. How much notice before a discharge. How many hours before an appeal window closes. How many days a bed is held. How long since the last state survey. The marketing director will show you the dining room and the activity calendar; the deadlines are in documents you have to request.

So tour with the clocks in front of you. This page lays them out in the order they will actually hit your family, with the exact document or agency attached to each. Pine Lake Legacy provides education and a free policy review only; nothing here is legal or medical advice, and your Long-Term Care Ombudsman and your State Health Insurance Assistance Program counselor are free resources built for exactly these questions.

In This Article

Clock One: The Medicare Skilled Nursing Benefit — 100 Days, and Usually Far Fewer
Clock Two: The End-of-Coverage Appeal — Noon of the Day Before
Clock Three: Transfer and Discharge — 30 Days’ Notice, With Exceptions
Clock Four: The Bed-Hold Policy — Measured in Days, and It Costs Money
Clock Five: The Survey Cycle — And the Reports You Can Read Today
Clock Six: The Admission Agreement — Signed in Ten Minutes, Binding for Years
Frequently Asked Questions

Touring a Nursing Home: What to Ask and Look For

Clock One: The Medicare Skilled Nursing Benefit — 100 Days, and Usually Far Fewer

Under traditional Medicare, a skilled nursing facility stay is covered after a qualifying inpatient hospital stay of three consecutive days, not counting the day of discharge. Coverage runs up to 100 days per benefit period: days 1 through 20 with no coinsurance, days 21 through 100 with a daily coinsurance amount that the Centers for Medicare & Medicaid Services updates each January and that ran a little over $200 per day for 2025. Confirm the current figure at Medicare.gov or with a SHIP counselor.

Two things families misread. First, 100 days is a ceiling, not an entitlement — coverage continues only while a daily skilled need exists, and most stays end well before day 100. Second, observation status does not count toward the three-day qualifying stay, and Medicare Advantage plans handle the requirement differently, with some waiving it entirely.

Ask on the tour: “What is your average length of Medicare-covered stay?” and “Who on staff tells the family when Medicare days are ending, and how many days of warning do we get?”

Ask the plan, not the facility, if it is Medicare Advantage: whether the three-day rule is waived and whether this facility is in network. Read how long a private-pay runway actually lasts before you need the answer.

Clock Two: The End-of-Coverage Appeal — Noon of the Day Before

When a facility plans to end Medicare-covered services, it must deliver a Notice of Medicare Non-Coverage, generally at least two calendar days before coverage ends. That notice triggers a fast-track appeal to the Beneficiary and Family Centered Care Quality Improvement Organization for your region, and the request generally must be made no later than noon of the day before coverage is set to end.

This is the shortest and least forgiving clock in the whole process. Families miss it constantly because the notice arrives during a visit, gets folded into a bag, and is read three days later.

Ask on the tour: “Who hands the family the Notice of Medicare Non-Coverage, and do you also call?” A facility that has a named person and a phone call in its process is telling you something real about how it operates.

Do this at admission: give the facility a written designation of who receives notices, with a phone number and an email, and ask for it to go in the chart. Then put the regional quality improvement organization’s contact information in your phone before you need it. If the plan is Medicare Advantage, the plan’s own expedited appeal process layers on top; call the number on the card and use the word “expedited.”

Clock Three: Transfer and Discharge — 30 Days’ Notice, With Exceptions

In a Medicaid- or Medicare-certified nursing facility, the federal requirements for long-term care facilities in title 42 of the Code of Federal Regulations restrict when a resident may be transferred or discharged, require written notice of the reasons and of appeal rights, and generally require 30 days’ advance notice — with shorter notice permitted in specified urgent circumstances such as a health emergency.

The notice must tell the resident how to appeal to the state, and it must identify the Long-Term Care Ombudsman. That last requirement exists because ombudsman programs, established under the Older Americans Act, are the free advocates for residents, and they handle discharge disputes routinely.

Ask on the tour: “How many involuntary discharges have you issued in the past year, and for what reasons?” and “Do you accept residents who convert to Medicaid, and how many Medicaid-certified beds do you have?” The second question is the one that determines whether your family faces a move in eighteen months.

See what to do when a facility issues a discharge notice and what a long-term care ombudsman does before you sign anything.

The Clock	The Deadline	What to Ask For
Medicare skilled nursing benefit	Up to 100 days per benefit period; coinsurance from day 21	Average covered length of stay at this facility
End-of-coverage appeal	Generally by noon the day before coverage ends	Who delivers the Notice of Medicare Non-Coverage
Transfer or discharge notice	Generally 30 days, shorter in urgent cases	Number of involuntary discharges last year
Bed-hold policy	State-set number of paid days; often few or none	The written bed-hold policy and the daily private rate
Survey cycle	Roughly annual, plus complaint investigations	The survey book and the plan of correction
Admission agreement	Signed once, binding for the whole stay	A copy to read before admission day

Clock Three: Transfer and Discharge — 30 Days' Notice, With Exceptions

Clock Four: The Bed-Hold Policy — Measured in Days, and It Costs Money

If a resident is hospitalized or takes a therapeutic leave, whether the bed is held depends on state Medicaid policy and on the facility’s own policy. Federal rules require the facility to provide written notice of the state’s bed-hold policy — the number of days Medicaid will pay to hold a bed, if any — at admission and again at the time of a transfer. States vary widely, and a number pay for few or no bed-hold days.

Where Medicaid does not pay, families are offered the option of paying privately to hold the bed, at the facility’s private rate. Where nobody pays, federal rules generally give the resident a right to return to the next available bed of the same type.

Ask on the tour, in writing: “What is your bed-hold policy, what does the state pay, what would we pay per day, and what is the readmission right if we do not hold it?” Read what a bed-hold policy is so you can tell a real answer from a vague one.

The cost frame: nursing facility care ran roughly $8,000 to $10,500 per month in 2024 and 2025 cost-of-care surveys for semi-private and private rooms nationally, with wide regional spread. A private bed-hold day is generally quoted off the daily private rate.

Clock Five: The Survey Cycle — And the Reports You Can Read Today

Certified facilities are surveyed by the state survey agency on a recurring cycle, generally about once a year with the standard survey interval capped by federal requirements, plus complaint investigations that can happen any time. The results are public.

Two sources, both free and both worth using before you set foot in the building. The Medicare Care Compare tool publishes overall and component star ratings, including a staffing measure derived from the Payroll-Based Journal payroll data facilities are required to submit, and health inspection results. And federal requirements direct facilities to make the results of the most recent survey available for examination in a place readily accessible to residents — meaning you can ask to see the survey book on the tour.

Ask on the tour: “May I see the most recent survey results and the plan of correction?” A facility that hesitates has told you something. Read how to read a facility cited by state inspectors before you interpret what you find, because a single citation says less than a pattern does.

Ask about staffing directly: the number that predicts experience is nurse and aide hours per resident day, and how many agency staff are used. See what nursing home staffing ratios mean.

Clock Six: The Admission Agreement — Signed in Ten Minutes, Binding for Years

The admission agreement is the document with the longest tail and the least attention. Read it before admission day, not on it.

Look for four provisions. Responsible party language: federal requirements prohibit a certified facility from requiring a third-party guarantee of payment as a condition of admission, but agreements sometimes still contain language that reads that way — never sign as a personal guarantor. Arbitration: agreements frequently include arbitration clauses, and federal rules restrict conditioning admission on signing one; you can generally decline. Rate increases and level-of-care charges: ask how often rates changed in the last three years. Medicaid conversion: what happens when private funds are exhausted.

See what is inside a nursing home admission agreement and take it to an elder law attorney if six figures of private pay are in view.

On the life insurance question, because it comes up in every admissions office: a permanent policy’s cash surrender value is generally a countable resource for Medicaid while the death benefit is not, and most states exclude a small amount of face value under a burial exclusion. Request an in-force illustration from the carrier now — it is free and takes two to four weeks. Do not surrender anything in a hurry; surrender value is generally the lowest number a contract can produce. And selling is the wrong answer when the face amount is under roughly $100,000, when the policy already sits inside a burial exclusion, when the insured is in good health, or when a surviving spouse still needs the death benefit. If you want a free, no-obligation read on a specific policy, send the cover page or call (732) 978-9575. For eligibility questions, use your state Medicaid agency and your own elder law attorney.

Frequently Asked Questions

What is the single most important document to request on a tour?

The written bed-hold policy, alongside the admission agreement. It tells you what happens if the resident is hospitalized: how many days the state Medicaid program pays to hold the bed, what you would pay privately per day, and what the readmission right is if nobody holds it. Federal rules require the facility to give this notice at admission and at transfer.

How many days will Medicare pay for the nursing home?

Up to 100 days per benefit period under traditional Medicare after a qualifying three consecutive day inpatient hospital stay, with no coinsurance for days 1 through 20 and a daily coinsurance for days 21 through 100 that CMS updates every January. Coverage lasts only while a daily skilled need exists, so most stays end well short of 100 days.

They say Medicare coverage ends Friday. Can we appeal?

Yes, and fast. The Notice of Medicare Non-Coverage must generally be delivered at least two calendar days before coverage ends, and the fast-track appeal to your regional Beneficiary and Family Centered Care Quality Improvement Organization generally must be requested by noon of the day before coverage ends. Write down the date and time you received the notice and the time you called.

Can I see the inspection results before I decide?

Yes, from two sources. Medicare’s Care Compare publishes star ratings, health inspection results and a staffing measure built from Payroll-Based Journal data facilities must submit. Federal requirements also direct facilities to make the most recent survey results available for examination on site, so you can ask to see the survey book and the plan of correction during your tour.

Should I sign the admission agreement as the responsible party?

Do not sign as a personal guarantor of payment. Federal requirements prohibit a certified facility from requiring a third-party guarantee of payment as a condition of admission, though agreements sometimes contain language that reads that way. Sign only in a representative capacity if you hold authority, and have an elder law attorney read the agreement if substantial private pay is ahead.

Will a life insurance policy affect the Medicaid application later?

Cash surrender value is generally a countable resource while the death benefit is not, and most states exclude a small amount of face value under a burial exclusion. Term insurance usually has no cash value and is not counted. Request an in-force illustration now so you know the exact figure, and confirm treatment with your state Medicaid agency.

Find out what your policy is worth — free, confidential, no obligation.

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