Financial Questions to Ask a Nursing Home
Questions for a tour or an admissions call: what the base monthly rate covers, which charges sit outside it, how much rates have risen, which payers the home accepts, what happens when private funds run out, and what the admissions agreement asks a family member to sign.
The questions
Open any question for the note
What is the base monthly rate here, and what does it cover?
Why ask it
Start with one number and what it buys, because homes quote in different ways. Some include everything; others quote a room rate and add care charges on top. If the answer comes back as a range rather than a figure, ask what puts a resident at the top of that range.
Is that rate the same for every resident, or does it rise with the level of care someone needs?
Why ask it
Two pricing models are common: one all-inclusive rate, or a room rate plus tiered care charges. The second can grow substantially over a few years without the home changing its published prices at all. Ask to see the tier table rather than a description of it.
Who assesses the level of care, and how often is that reassessment done?
Why ask it
The organization that bills for care usually also decides how much care is needed, so ask what evidence an assessment rests on and whether the family is shown it. A home that reassesses on a set schedule and explains each change is easier to budget for than one that adjusts a bill without notice.
If a resident moves up a level of care, how much does the monthly bill change?
Why ask it
Ask for the figure in dollars rather than a percentage, and ask for the level above that one too. Needs generally increase over time, so the cost of the next two tiers is closer to the real cost of the placement than today's quote is.
Which day-to-day items do families end up paying for separately, and what do those usually come to in a month?
Why ask it
Laundry, haircuts, incontinence supplies, transport to appointments and television service are often outside the base rate. Staff who deal with families daily can usually give a realistic monthly figure. A flat claim that there is nothing extra is worth testing against a real invoice.
How are medications and medical supplies billed?
Why ask it
Some homes include them, others use a contracted pharmacy that bills the resident directly, and for someone on several prescriptions the difference is large. Ask whether an existing pharmacy or drug plan can be kept, because being moved to a contracted supplier can change what is paid at the counter.
Is there a deposit, community fee or entrance fee, and is any of it refundable?
Why ask it
Ask which circumstances return the money and how quickly: a resident who dies in the first month, a family that changes its mind in week two, a placement that ends because the home cannot meet the need. Take the refund terms from the agreement, not from the conversation.
When did rates last go up, by how much, and how much notice do residents get?
Why ask it
Past increases are the only concrete guide to future ones, and most administrators will answer when asked plainly. What you want is a date, a figure, and the notice period written into the contract. A home that cannot say when it last raised rates is either newly managed or not being straightforward.
What would Medicare pay for here, and for how long?
Why ask it
Medicare covers a limited period of skilled nursing care following a qualifying hospital stay. It is not a payer for indefinite residence. Ask which of the home's beds are skilled nursing and which are long-term, and what happens on the day that coverage ends.
If there is a long-term care insurance policy, who handles the claim?
Why ask it
These policies pay only once their conditions are met, and the paperwork repeats monthly. A billing office that files claims directly saves a family a great deal of chasing. Ask whether they have billed this particular insurer before and how long payment usually takes to start.
Do you accept Medicaid, and how many of your beds are certified for it?
Why ask it
Accepting Medicaid and having a certified bed available are different things. A home may take the program in principle and have nowhere to put a resident whose savings have gone. Ask how many certified beds there are and how often one is free.
If a resident's savings run out, would they have to change rooms or leave?
Why ask it
Ask this while you still have a choice of homes. Some will move a resident from a private to a shared room, some will transfer them to another facility, and some keep people where they are. Ask for the policy in writing, because this decision arrives at the worst possible moment.
Would your staff help with a Medicaid application, or does the family arrange that?
Why ask it
The application asks for years of financial records and the rules differ by state. Someone in the building who does this regularly is a real practical advantage. If the answer is that families handle it themselves, budget for an elder law attorney or a benefits counselor.
Does the admissions agreement name a financially responsible party, and what does that person agree to?
Why ask it
Signature lines described as routine can commit a family member to paying from their own funds, or to managing the resident's money in a particular way. Ask which pages carry that obligation and what the home would do if a bill went unpaid.
Can I take the agreement away and have someone go through it before I sign?
Why ask it
A reasonable home says yes without hesitation. Pressure to sign during the tour, or on the afternoon of a hospital discharge, is the clearest warning sign in this process. Ask separately whether the agreement contains an arbitration clause and whether admission depends on accepting it.
If a resident goes into hospital, do you charge to hold the bed, and for how many days?
Why ask it
Bed-hold terms settle two things: what you pay for an empty room, and whether the same room is there on return. Ask what happens once the hold period ends, and who tells the family that the limit is approaching.
What are the terms if we give notice, and on what grounds could you discharge someone?
Why ask it
Ask about the notice period, whether prepaid days are refunded, and what becomes of the deposit. Ask about discharge separately, because non-payment and a change in clinical need are handled under different rules and different timelines.
How does billing work month to month, and who do I call about a charge I do not recognize?
Why ask it
You want a name and a direct number rather than a general line. Ask whether invoices itemize care charges and extras separately, because a single lump sum makes it impossible to see the month a level of care quietly changed.
Could I see a sample invoice with the personal details removed?
Why ask it
One real invoice tells you more than an hour of discussion, because it shows what actually appears as a line item and how much of the bill sits outside the quoted rate. A refusal, when details could easily be redacted, is worth noticing.
What do families most often misjudge about the cost of being here?
Why ask it
Administrators watch the same errors repeatedly, and this lets them say so without criticizing anyone. Answers tend to be concrete: underestimating how quickly care levels rise, or planning on a number of years of private funds that turns out to be shorter.
Working out what a placement will actually cost
Practical guidance for the conversation itself
Getting a number you can rely on
Ask for the quote as a document
A spoken rate on a tour is not something you can compare or hold anyone to. Ask for the full fee schedule, every care level, and the list of separately billed items. Homes that price by tier usually have this on paper already.
Compare like with like
One home's all-inclusive rate can look higher than another's room rate and still cost less by the second year. Rebuild each quote the same way: room, care at the level the person needs now, and the extras a resident actually uses.
Price the third year, not the first
Most residents need more help over time, and rates rise on top of that. Take today's quote, apply the next care tier, and add the increases the home has made over the past few years. That figure is the one to test the funds against.
Who pays for what
Long-term care is usually paid from a mix of sources, and admissions staff often assume a family already knows the distinctions. It helps to be explicit about which source is expected to cover which period.
- Private funds: savings, pension income, the proceeds of a house sale. This pays for most long-term stays and runs down over time.
- Medicare: covers a limited period of skilled nursing care after a qualifying hospital stay. Coverage can end while a resident still needs care, and it does not fund indefinite residence.
- Medicaid: the main public payer for long-term custodial care. Income and asset rules differ by state, and transfers of assets are subject to a look-back period. Check the rules of the state where the resident lives.
- Long-term care insurance: pays a daily or monthly benefit once the policy's conditions are met, usually after a waiting period. Read the policy rather than relying on the figure you remember.
- Veterans' benefits: may apply for some residents and are assessed separately from the above. Ask whether the home has residents using them and who files the paperwork.
Before anyone signs
- 1Get the complete fee schedule and the list of separately billed items in writing.
- 2Read the admissions agreement away from the building, and ask about any clause you cannot restate in your own words.
- 3Identify exactly who is being asked to sign as a responsible party, and what that commits them to personally.
- 4Ask whether an arbitration clause is included and whether admission depends on accepting it.
- 5Check the refund terms for the deposit and for any prepaid days.
- 6Ask for the home's most recent state inspection report. Cost and care quality are not separate questions.
Where families get caught out
Deciding during a hospital discharge
Discharge planning runs on short timescales, and the paperwork often arrives on the day. Where there is any warning, tour and read agreements before there is urgency. Where there is not, ask about a short-term placement rather than signing terms nobody has read.
Budgeting from the quoted rate
The quoted rate is usually the lowest the home charges. Build the budget from a middle care level and include the items billed separately, then check whether the funds still last as long as you assumed.
Expecting Medicare to keep paying
Skilled nursing coverage ends on a date, and the switch to private pay can arrive with little notice. Ask at the start who informs the family, how much warning is given, and what the daily rate becomes.
Leaving Medicaid questions until the money is nearly gone
Eligibility rules include a look-back on transfers of assets, so rearranging finances late can create a penalty period with no funds left to cover it. Advice is more useful well before savings are low.
Keeping no record of what was said
Tours involve several people over several weeks. Write down who said what about rates, bed holds and Medicaid, with dates. If an answer matters to the decision, ask for it by email.
What this page is not
These are questions to ask, not answers. Costs, public program rules, eligibility tests and contract terms vary by state and by the facts of a particular case, and nothing here is legal, tax or financial advice. An elder law attorney can review an admissions agreement and advise on Medicaid, and a benefits counselor can help with an insurance or veterans' claim.