When to Move From Assisted Living to a Nursing Home

Signs It’s Time to Move From Assisted Living to a Nursing Home

When your aging loved one initially entered assisted living, they may have needed help with activities of daily life (ADLs). Along with supplying daily support, assisted living facilities often open social doors. You may feel gratified to see your loved one enjoying new friendships and activities and feeling less lonely.

Assisted living facilities typically offer three levels of care, so people can live there comfortably for years even if their needs escalate or change. The third, most intensive level of care varies from community to community. In general, it’s earmarked by needs that exceed the facility’s mandate to safely and efficiently fulfill them. How do you know if that final care level is no longer enough?

The following signs may indicate that it’s time to consider a nursing home for your loved one:

• They required emergency room care or hospitalizations multiple times over the past month or months.
• Their mobility has decreased, and they’re unable to transport themselves easily out of bed, in the bathroom, or around the facility.
• They need support with more complex daily medication administration, such as diabetes injections, or with medical equipment, such as oxygen tanks or catheters.
• They need help feeding themselves.
• They’re experiencing worsening dementia or other signs of Alzheimer’s disease.
• A new or existing health condition requires frequent medical support, such as access to nearby dialysis, medication alterations, or rehabilitative care.
• Your loved one has had many falls or other types of accidents.
• They no longer participate in or enjoy the social activities provided by the facility.
• They have become bedridden.
• They need 24-hour medical support or supervision.

Making the Transition From Assisted Living to a Nursing Home

Once you’ve decided a nursing home is best for your loved one, it’s time to make the transition. How do you do that? We’ll get into the details below.

Ask for Input and Do Some Research

Whether you’re making the decision solo or with a large (and probably opinionated) cadre of family members, consider getting input from your loved one’s physicians about their needs. Not all nursing homes are the same. Some offer specialized care for degenerative brain diseases, such as Alzheimer’s. Others are geared toward short-term rehabilitation or long-term care.

Getting input from a medical professional can help take some of the emotion out of the decision and provide clarity about next steps. The Administration of Community Living Administration on Aging may also be a good resource for finding local nursing homes. You can also consult our comprehensive senior living directory to compare and learn more about nursing homes in your area.

Check Your State’s Requirements

Once the decision is made, you’ll need to meet your state’s requirements for nursing home placement. The facility you’ve chosen will most likely help you with forms and logistics. If possible, schedule a visit with one of the facility’s social workers to get clarity around the process and get the ball rolling.

Nursing homes are required by state and federal law to generate and adhere to an admission policy that prohibits discrimination against potential residents.2 Nursing homes are not obligated, however, to accept every applicant. Even if your loved one is accepted, there may be time constraints on room availability or a waiting list for non-emergency applications. Space is often made available quickly, however, for people being admitted straight from a hospital or urgent care.

State requirements vary to some degree, but to ensure you’re dotting every i and crossing every t, make sure to have the following on hand:

• Medical assessment form or doctor’s order, indicating the need for nursing home care
• Medication and treatment orders
• Proof of vaccination, including the COVID-19 and flu vaccines
• Tuberculosis test
• Health insurance coverage information, including long-term care, Medicare, or Medicaid coverage
• A signed admissions agreement between your loved one or their legal representative and the nursing home that makes clear the conditions for admission, including financial arrangements, legal responsibilities of both parties and level of care to be administered

It’s Not Just Paperwork

Moving from an assisted living facility to a nursing home may be downright traumatic for your loved one. They will be saying goodbye to friends, neighbors, and the staff they’ve come to rely on. They will also be losing a level of independence that, although no longer appropriate, may be important to them.

Their surroundings will also change significantly. They may be giving up an apartment or a private room for a shared room. In many instances, their furniture and most of their belongings will be left behind.

None of that is easy on them — or on you. Determining how best to help them through the transition may take a team effort. You know your loved one best, but it may be helpful to enlist the support of a social worker or therapist to work with them on understanding and accepting what is happening and why.

In addition to taking care of them, it’s important to take care of yourself. Identify your allies and seek support, even just for an occasional hug. Remember that the decision is not being made lightly and that it’s in your loved one’s best interests. Try to get the care and support you need during the process, and always remember to be kind to yourself.

Assisted Living vs. Nursing Home Costs

As you transition from assisted living to a nursing home, it’s critical to understand how costs and insurance coverage compare for the two types of care.

Assisted Living Costs

Assisted living costs vary by state and can range from $45,000 to over $90,000 annually, depending on the level of care required and add-on services. The costs will largely be paid out of pocket. According to the National Council on Aging, Original Medicare (Parts A and B), Medicare Advantage (Part C), and Medicaid do not foot the bill for assisted living facilities. The plans will, however, cover medically necessary services provided within or outside the facility, such as cancer screenings and vaccinations.5 Eligible veterans may be able to have more expenses covered through the VA, but they may also be required to choose VA-approved and VA-managed facilities.6

Nursing Home Costs

Nursing home costs are typically higher than assisted living facilities. Data from Genworth Financial, an international insurance holding company, found that in 2024 a semiprivate nursing home room has an estimated median cost of $8,929 per month, and a private room costs around $10,025.7 Rates typically go up around 2 percent annually, unless you have a contract locking them in. Like assisted living facility costs, they vary by state.

Medicare doesn’t cover custodial care, such as support with activities of daily living. It will provide coverage for short-term nursing home stays of up to 100 days, provided your loved one has medical needs, such as surgical follow-up care.8

Original Medicare doesn’t pay for long-term stays in nursing homes. It does, however, pay a portion of the cost for the individual’s doctor’s appointments, medical supplies, and hospitalizations while they’re in residence.9 Medicare Advantage plans are required to cover at least as much as Original Medicare does. If your loved one has a Part C plan, they may get coverage for more of the services provided in a nursing home, but it's unlikely that the plan will cover the cost of the residence itself.

If your loved one has long-term care insurance, you may be able to use it to pay for a nursing home. Check the plan to determine what it covers and what your out-of-pocket costs will be. You may also be able to use your loved one’s life insurance policy to pay for care if they have one.

Medicaid covers the costs of nursing home care, but not every nursing home accepts Medicaid. No matter what your loved one’s financial situation has been in the past, they may now be eligible for Medicaid.9 Medicaid is funded through both the federal government and state governments. Each state administers the program for its residents, so the financial and medical requirements for nursing home coverage vary from state to state. You can find out more by contacting the Medicaid office in your loved one’s state of residence.