Nursing Home Admission Checklist: Papers, Questions, What to Pack

For a nursing home admission, bring your parent's photo ID, Medicare, Medicaid and other insurance cards, copies of any power of attorney, health care proxy, advance directive or POLST, a current medication list, and the hospital discharge papers. Pack labeled clothing, glasses, hearing aids and dentures, and leave jewelry and original papers at home. Read the admission agreement before anyone signs: a nursing home that takes Medicare or Medicaid can't make you personally guarantee the bill or make arbitration a condition of admission. Then ask when the first care plan meeting is.

Below: what each paper is for, the agreement clauses worth crossing out, and the first two weeks, when the useful decisions get made.

The checklist at a glance

The documents, one group at a time

Identity and insurance

• Photo ID, plus the Social Security number written down (not the card)
• Medicare card, plus any Medicare Advantage, Part D or Medigap card
• Medicaid card or case number, if your parent already has Medicaid
• Long-term care insurance policy number and the claims phone number
• VA information, if your parent is a veteran

Bring front-and-back copies of every card. The business office will ask which plan pays first, and "the blue one" won't get you far.

Legal papers

• Financial power of attorney
• Health care proxy or health care power of attorney (the name varies by state)
• Living will or other advance directive, and any POLST
• Guardianship or conservatorship order, if a court appointed someone
• HIPAA authorization naming the family members staff can talk to

The facility files copies. Medicare's fact sheet on living in a nursing home tells residents to share advance directive wishes with staff so they can be followed. If you're not sure which document covers medical decisions and which covers money, see health care proxy vs. power of attorney. A POLST is a medical order signed by a clinician, not a form you fill out yourself, and it works differently by state; our POLST guide explains it. And if nurses won't discuss your parent with you, a HIPAA authorization is usually the missing piece.

Medical records

• A medication list with doses, times and the reason for each
• The hospital discharge summary and medication orders
• Recent test results and specialist notes
• Allergies, with what actually happens (rash, swelling, confusion)
• Any physical exam or tuberculosis screening the facility asks for

The facility will reconcile the medication list against the hospital's orders and the new doctor's, so it's worth getting right; our medication list guide covers the fields. Rules on a recent physical, TB screening or chest x-ray come from state rules and facility policy, so ask the admissions office what it needs and by when.

What to pack, what to label and what to leave home

Residents have a federal right to keep personal possessions, including furnishings and clothing, as space permits and as long as it doesn't infringe on other residents' rights, health or safety (42 CFR 483.10). Space is the real limit. A shared room usually means a bed, a nightstand, a chair and part of a closet.

Pack: about a week of easy-on clothes and a sweater, nonslip shoes they already wear, glasses, hearing aids with batteries or the charger, dentures with a case, a few photos, a familiar blanket, and any walker or cane they use now.

Label: anything that can get lost in the laundry or mixed up on a cart. Name labels in clothing, and a name on the glasses case, denture cup, hearing aid case, walker and charger. Ask whether the facility labels clothing itself; some do.

Leave at home: valuable jewelry, original legal papers, checkbooks, credit cards and more than a little cash. If your parent wants to keep wearing a wedding ring, decide together, knowing it could go missing.

The inventory, and your own photos

Many facilities list a new resident's belongings at admission, and some states require it. Nevada's rule for intermediate care facilities, for example, calls for an inventory at admission kept in the resident's record and permanent ownership marks on belongings, especially clothing. Ask for a copy of the list and check that hearing aids, dentures and glasses are on it with a description.

Then make your own: a phone photo of each small, expensive item, saved in one album. "Hearing aids" on a form doesn't help much when there are six pairs on the unit.

Federal rules also say the facility has to take reasonable care to protect residents' belongings from loss or theft, and the admission agreement can't ask your parent to sign away the facility's liability for lost property (more on the agreement below).

Spending money and the resident trust account

Facilities often offer a resident trust account for haircuts and outings. It's optional: the facility can't require residents to deposit money with it. If your parent does, the facility acts as a fiduciary, keeps a separate accounting and provides quarterly statements and statements on request. For a Medicaid resident, it also has to warn when the balance nears the limit that could affect eligibility.

Reading the admission agreement

The agreement usually arrives in a stack at the busiest moment of the day, so ask for it a day or two early. The Medicare fact sheet says residents "aren't required to agree to everything," and suggests crossing out a term you don't accept before signing, or having a lawyer review it.

For a nursing home that takes Medicare or Medicaid, 42 CFR 483.15 says the facility can't ask for or require any of these:

• A waiver of your parent's rights, including rights to Medicare or Medicaid
• A promise, spoken or written, that your parent isn't eligible for, or won't apply for, Medicare or Medicaid
• A waiver of the facility's liability for lost personal property
• A third party's guarantee of payment for admission or a continued stay
• For a Medicaid-eligible person, a gift, donation or extra payment as a condition of admission or staying

The guarantee point is the one that catches adult children. The facility can ask someone with legal access to your parent's money to agree to pay from that money, without personal liability. Look for "responsible party" or "guarantor" and sign as your parent's agent; the assisted living paperwork checklist covers the wording. For short-term rehab coverage, see our guide to Medicare's 3-day rule for skilled nursing.

Arbitration is a separate choice. Under 42 CFR 483.70, the facility can't require a binding arbitration agreement for admission or continued care, has to tell you explicitly that signing is optional, and the agreement itself must give your parent (or whoever signed for them) 30 calendar days to cancel it. So you can leave it unsigned. If it got signed in the rush, put the 30-day deadline on the calendar.

Extra charges. The agreement should say what the basic rate covers and what's billed separately. The facility has to tell residents about extra charges at admission and periodically, and for a Medicaid-eligible resident, list in writing what Medicaid covers and what costs extra.

When to start the Medicaid application

If your parent will pay privately at first, ask before admission whether the facility accepts Medicaid and whether your parent can keep the same room after switching. Then think about timing:

1. Gathering records takes weeks. Justice in Aging notes that long-term care applications commonly need five or more years of bank and investment records, plus property and insurance papers.
2. Coverage can reach back, but less of it soon. Medicaid has generally covered up to three months before the application month for people who were eligible in those months (42 CFR 435.915). Justice in Aging reports that the 2025 budget law cuts that to two months for most applicants, including people 65 and older and people with disabilities, for applications made in January 2027 or later. (Adults covered through Medicaid expansion get one month.)
3. A stalled application can count as nonpayment. Federal discharge rules say nonpayment includes not submitting the paperwork Medicaid or another payer needs.

Asset rules and look-back periods are set state by state, so talk with an elder law attorney or the state Medicaid office. The records themselves are where you can get ahead now; our list of important documents for aging parents shows where they usually hide.

The first two weeks: care plans and the meeting

The federal timeline, from 42 CFR 483.21 and 42 CFR 483.20:

Ask for the baseline care plan summary by name if nobody hands it over by day three. A wrong diet or a missing medication is easiest to fix early.

Residents have the right to take part in care planning, name who should be included, request meetings and revisions, and see the plan (42 CFR 483.10). Tell the social worker who to invite and ask whether you can call in. Bring:

• Your parent's goals in their own words ("walk to the dining room")
• Their routine: waking, bathing, meals, foods they won't eat
• What calms them and what upsets them, especially with memory loss
• Questions about any new medication, including anything sedating

The bed-hold policy

Before a hospital transfer or therapeutic leave, the facility has to give written information about the state's bed-hold policy, if any, and its own policy on residents returning, and give notice of the bed-hold period again at transfer (42 CFR 483.15). If a hospital stay outlasts the bed-hold, a resident who still needs the care and is eligible for Medicare skilled nursing or Medicaid nursing facility services goes back to their old room if available, or the first open semi-private bed.

Note at admission how many days the bed-hold covers and whether it costs anything, and keep that where a sibling can find it at 2 a.m.

Rights and the ombudsman

The facility must explain residents' rights orally and in writing at or before admission. Three that come up early: your parent can see their records within 24 hours of asking (excluding weekends and holidays) and get copies within 2 working days; they can choose their own attending physician; and each facility has a grievance official whose answer to a complaint must be in writing.

Every state has a free long-term care ombudsman program. Per the Medicare fact sheet, ombudsmen help resolve problems with the facility, including money disputes, and can tell you how many complaints a facility has had and whether they were resolved. Find your local office through the Consumer Voice locator, which the fact sheet points to, or the Eldercare Locator at 1-800-677-1116.

Questions to ask before admission day

• What paperwork, physical or TB screening do you need, and by when?
• Can we see the admission agreement early? Is arbitration optional and separate?
• Do you accept Medicaid, and can my parent keep the same room after switching?
• Do you label clothing, and who does the belongings inventory?
• How do you keep track of hearing aids, dentures and glasses?
• What is the bed-hold policy, and does holding the bed cost anything?
• When is the first care plan meeting, and who is my main contact?

Frequently asked questions

What documents are needed for nursing home admission?

Usually photo ID, Medicare, Medicaid and other insurance cards, copies of any power of attorney, health care proxy, advance directive or POLST, a medication list, and the hospital discharge summary or recent records. Many facilities also ask for a recent physical or TB screening.

Do I have to sign as the responsible party?

No. A nursing home that takes Medicare or Medicaid can't require a third party to guarantee payment. It can ask someone with legal access to your parent's money to pay from that money. Sign as your parent's agent, not as a guarantor.

When is the first care plan meeting?

Federal rules set deadlines for the plans, not a date for the meeting. The baseline care plan is due within 48 hours. The comprehensive care plan follows within 7 days of the comprehensive assessment, which is due within 14 days, so the full plan should exist within about three weeks. Ask the social worker at admission when the first meeting will be.

The folder that goes with them

Most of admission day comes down to having the right papers in one place and knowing which are copies. You can pull that together yourself from this checklist, one folder at a time. Or Emergency Binder Now can do the organizing from about 25 minutes of guided questions, producing a printable binder with a one-page Emergency Information Sheet, your parent's medications and doctors, and pages showing which legal documents exist and where each is kept, plus a list of what's still missing. If you want to know what you'd get, see a sample binder.

This article is general information, not legal, medical or financial advice. Federal rules apply to nursing homes that take Medicare or Medicaid; state rules on inventories, health screening, bed-holds and Medicaid eligibility vary. For your parent's situation, talk with the facility, your local long-term care ombudsman, your state Medicaid office or an elder law attorney.