Most families start looking for a nursing home from a hospital hallway. A parent has fallen, had surgery or a stroke, and a discharge planner says they can't go home yet. You're handed a list of names and asked to pick one, sometimes within a day. Knowing how to choose a nursing home under that kind of pressure comes down to a handful of questions most people don't think to ask. Here's how our advisors walk Oregon families through it: what star ratings leave out, who actually pays, and what to check before you say yes.
First, Decide What Kind of Nursing Home Stay This Is
"Nursing home" covers two very different situations. One is short-term rehab, also called skilled nursing: a few weeks of therapy and nursing care after a hospital stay, with the goal of getting someone home or to a lower level of care. The other is long-term care, for someone who needs nursing help around the clock with no end date.
That difference changes which buildings make sense and who pays. If you're still not sure whether your parent needs a nursing home or could do well in assisted living, start with our guide to assisted living vs. nursing home care.
Who Pays for a Nursing Home (It's Usually Not Who Families Think)
Our founder Chantelle says the assumption comes up "90% of the time": Mom can't go home and care for herself, so her health insurance should cover the nursing home. It usually doesn't, at least not for long.
Original Medicare covers short-term skilled nursing after a qualifying hospital stay of at least three days as an admitted inpatient. Days spent "under observation" don't count, so ask the hospital which status your parent has. Medicare pays in full for the first 20 days. For days 21 through 100, there's a daily coinsurance of $217 in 2026, according to CMS. After day 100, Medicare stops paying, and it never covers long-term custodial care.
Medicare Advantage plans follow their own rules and networks. Only certain buildings will take a given plan.
Long-term care is paid privately, through long-term care insurance, or through Oregon Medicaid once someone qualifies financially.
And it isn't cheap. CareScout's 2025 survey puts the median cost of a semi-private nursing home room in Oregon at about $201,000 a year, roughly $16,700 a month, with private rooms higher still (CareScout via Business Wire). If Medicaid will be part of the picture, confirm before move-in that the building accepts it and has a Medicaid bed available. More on that in our paying for care guide.
Star Ratings Are a Starting Point, Not an Answer
Medicare's Care Compare tool rates every certified nursing home from one to five stars based on health inspections, staffing and quality measures. It's worth a look, and so are the full inspection reports behind the score.
But a rating can't tell you whether a building fits your parent. One of our advisors, who has spent 27 years in this industry, put it bluntly when a discharge planner recommended a rehab building because it had four stars: "That's only paper." In that case the bigger issue was insurance. The patient's plan was accepted at only a few buildings in town, and the four-star option wasn't one of them.
Use the stars to rule out obvious problems, then look at what a rating can't measure.
Match the Building to Your Parent's Actual Needs
Every nursing home has strengths and blind spots. Some have excellent therapy teams. Some are better with wound care, dementia, or residents who need a mechanical lift to transfer. So the right question isn't "Which one is best?" It's "Which one is best at what Dad needs?"
Details that seem minor can change the whole list. One woman we were helping mentioned, almost in passing, that she'd developed wounds on both legs. That one detail changes which buildings can safely take her, and it's exactly the kind of thing that gets missed when families pick from a list.
It works the other way, too. Our team once chose a building that wasn't strong overall because its physical therapist was exceptional, and that was exactly what the client needed. We were comfortable with it only because she was sharp and could speak up for herself. We wouldn't place someone there who couldn't advocate for their own care.
Before you tour, write down your parent's real needs: mobility and transfers, wounds, diabetes care, oxygen, memory changes, behaviors, diet, and therapy goals. Bring that list everywhere. A free care assessment can help you build it.
Questions to Ask a Nursing Home Before You Say Yes
Oregon sets minimum staffing for nursing homes: at least one nursing assistant for every 7 residents on day shift, every 9.5 on evening shift, and every 17 overnight (OAR 411-086-0100). The rule itself says those minimums don't automatically mean staffing is sufficient, so ask what the building actually runs.
What we'd ask on any tour:
How many nursing assistants and nurses are on each shift, including nights and weekends?
How long have the administrator and director of nursing been here?
Can you meet my parent's specific needs, like wound care, two-person transfers or a lift, and diabetic care?
How many days a week is therapy offered, and for how long each session?
Do you accept my parent's insurance plan? Do you accept Medicaid, and is a Medicaid bed available?
Who's my point of contact, and how will you update me about changes in condition?
What does discharge planning look like, and when does it start?
Then use your senses. Notice how the building smells, how quickly call lights get answered, and whether residents look clean and dressed for the day. If you can, visit twice, once at a mealtime. Our senior living checklists include one built for skilled nursing tours.
Don't Let Price or a Deadline Make the Decision for You
Discharge timelines are real, and the pressure is real. But the cheapest bed or the first open bed isn't always the safe one. Chantelle has seen families pick a building on price alone, and her take is simple: saving money doesn't protect your loved one if the care isn't there.
If the hospital is rushing you, ask for the full list of options, ask about insurance first, and call for help. That's exactly when an advisor earns their keep.
Frequently Asked Questions
Does Medicare pay for a nursing home?
Only for short-term skilled nursing after a qualifying hospital stay, up to 100 days per benefit period, with a daily coinsurance after day 20. Medicare doesn't pay for long-term custodial care in a nursing home.
What are red flags in a nursing home?
Strong odors, call lights that go unanswered, residents who look unkempt, frequent leadership turnover, and staff who can't give you straight answers about staffing or your parent's needs. Repeated serious findings in inspection reports are also worth a closer look.
How fast can someone get into a nursing home?
From a hospital, it can happen in a day or two if a building has an open bed, accepts the insurance, and can meet the care needs. From home, expect it to take longer while the building reviews records and assesses care needs.
How do I check a nursing home's inspection history in Oregon?
Medicare's Care Compare shows star ratings and federal inspection results. The Oregon Department of Human Services licenses and inspects Oregon nursing homes every year and offers license verification on its site.
Is a nursing home the same as skilled nursing?
Mostly, yes. Most nursing homes provide both short-term skilled nursing (rehab) and long-term care in the same building, though some focus more on one than the other.
You Don't Have to Choose a Nursing Home Alone
The short version: figure out whether this is rehab or long-term care, get clear on who's paying before you fall in love with a building, and match the nursing home to your parent's specific needs rather than its star rating. Our state-certified advisors know Oregon's skilled nursing communities firsthand, and our help is always free to families. If you're facing a discharge deadline or just starting to plan, learn more about nursing home placement or talk with an advisor.