Start with Medicare eligibility, then compare quality data, services, staffing, location, and the experience you observe during a visit. CMS star ratings are a useful screening tool, but Medicare advises families to use them with other information rather than as the only deciding factor.
How to compare facilities step by step
- Confirm Medicare coverage eligibility. Ask the hospital, plan, and facility whether the stay meets current Medicare skilled nursing facility coverage rules and whether the facility is Medicare-certified.
- Build a local shortlist. Use the directory to identify nearby Medicare-certified facilities, because family access and transportation can materially affect the care experience.
- Compare CMS quality categories. Review the overall rating together with the separate health inspection, staffing, and quality-measure ratings.
- Confirm the required services. Ask whether the facility can provide the specific nursing, rehabilitation, medication, equipment, dietary, or specialty support in the discharge plan.
- Visit and ask the same questions. Tour each finalist when possible and use the same questions about staffing, communication, care planning, costs, and discharge support.
- Verify costs and bed availability. Before transfer, confirm current availability, Medicare or plan authorization, daily cost sharing, non-covered charges, and what happens if skilled coverage ends.
First confirm that Medicare can cover the stay
Original Medicare Part A covers skilled nursing facility care for a limited time when all eligibility conditions are met. Those conditions generally include Part A coverage and available benefit-period days, a qualifying inpatient hospital stay, entry into the SNF generally within 30 days, a clinician’s determination that daily skilled care is needed, and care in a Medicare-certified facility. Some Accountable Care Organizations and Medicare Advantage plans may waive the usual three-day inpatient-stay rule, so confirm the rule that applies to the patient before choosing a facility.
Medicare generally does not cover a long-term nursing-home stay when custodial care is the only care needed. Ask the hospital discharge team and the Medicare plan to explain in writing which part of the proposed stay is covered.
Use ratings as a screen, not a final answer
CMS publishes an overall one-to-five-star rating plus separate ratings for health inspections, staffing, and quality measures. Compare the component ratings instead of relying only on the overall number. CMS also cautions that ratings cannot capture every consideration, including specialized services and how easy it is for family members to visit.
- Review the health-inspection rating and recent inspection findings.
- Compare staffing and quality-measure ratings separately.
- Ask about specialty rehabilitation, dementia support, wound care, dialysis transportation, or other needs in the discharge plan.
- Consider distance from family and the hospital or clinicians coordinating follow-up care.
Questions to ask during every facility visit
- Is a Medicare-covered bed available on the expected transfer date?
- Who participates in care-plan meetings, and how are families updated after a change in condition?
- Which nurses and therapists are present on evenings and weekends?
- How quickly does therapy usually begin after admission?
- Can the facility provide every service, medication, and piece of equipment in the discharge plan?
- Which charges are not included in the Medicare-covered stay?
- What is the appeal and discharge process if skilled coverage is ending?
- Who should the family call with a concern after hours?
A simple comparison scorecard
For each finalist, record Medicare certification and plan network status, bed availability, travel time, the four CMS ratings, required services, observed cleanliness and staff responsiveness, therapy schedule, family communication, estimated patient cost, and any unresolved concern. Use the same fields for every facility so a strong first impression does not hide a practical gap.
Frequently asked questions
What should I compare when choosing a skilled nursing facility?
Compare Medicare eligibility and certification, bed availability, the overall and component CMS ratings, required nursing and rehabilitation services, staffing and communication, location, expected costs, and what you observe during a visit.
Does a five-star CMS rating mean a nursing home is the best choice?
No. CMS ratings are useful for screening and comparison, but CMS recommends using them with visits and other information. Specialty services, current availability, location, and the patient’s individual care needs also matter.
Does Medicare cover long-term nursing home care?
Medicare generally does not cover long-term custodial nursing-home care. Part A may cover short-term skilled nursing facility care when all eligibility conditions are met.