Guide
Hospital discharge to a nursing home: what to do
Updated October 15, 2026 · Reviewed against official sources
The hospital tells you that your mom or dad will be discharged tomorrow, and you feel they're not ready to go home yet. It's one of the most stressful situations a family can face. The good news is that the hospital has a team whose job is to prepare for the discharge, and you have clear rights. This guide helps you take the steps in order. If the discharge is today or tomorrow and you need help right away, go to our urgent discharge page.
Step 1: ask whether they're an inpatient or under observation
Even if your loved one has spent several nights in the hospital, they may be registered as an outpatient under observation. That paperwork difference has important consequences:
- Original Medicare pays for a stay in a skilled nursing facility (SNF) only after an inpatient hospital stay of at least 3 days in a row.
- Days under observation don't count toward those 3 days. Neither do the hours in the emergency room before being admitted, or the day of discharge.
Ask the doctor or the social worker directly: "Is my loved one an inpatient or under observation? Since what date?" If they were under observation for more than 24 hours, the hospital must give them a written notice called the Medicare Outpatient Observation Notice (MOON), which explains their situation.
Exceptions to the 3-day rule
- Medicare Advantage: many plans don't require the 3 days, but each plan has its own rules, approvals and network of facilities. Call the number on the plan card.
- CMS's TEAM model (2026 to 2030): in Original Medicare, CMS removed the 3-day requirement for certain surgeries (leg joint replacement, hip or femur fracture treated with surgery, spinal fusion, coronary bypass and major bowel surgery), only at hospitals that take part in the TEAM model. Ask the hospital whether it takes part and whether your loved one's case falls under that program.
If their status was changed from inpatient to observation
Since February 14, 2025, people with Original Medicare whose status is changed from inpatient to observation while they're still in the hospital can ask for a fast appeal. The hospital must give them the Medicare Change of Status Notice (form CMS-10868) no later than 4 hours before discharge, with instructions on how to appeal. This right comes from the court case Alexander v. Azar and does not apply to Medicare Advantage.
For past stays, there was also a retroactive appeal, but the general deadline to request it ended on January 2, 2026. Late requests are accepted only if there is good cause. If you think your case may qualify, check with your state's SHIP.
Step 2: understand what Medicare covers for rehab
If the 3-day rule is met and your loved one needs therapy or skilled nursing care every day, Original Medicare pays for up to 100 days per benefit period in an SNF. In 2026, the person pays:
| Days in the SNF | What the person pays |
|---|---|
| 1 to 20 | $0 |
| 21 to 100 | $217 per day |
| Day 101 and after | All costs |
A Medigap (Medicare Supplement Insurance) policy or Medicaid may cover part of the coinsurance for days 21 to 100. Keep in mind that coverage can end before day 100 if your loved one no longer needs skilled care, for example, if they're no longer making progress in therapy and only need help bathing and dressing. Medicare doesn't pay for that custodial care. Find more details in our guide on what Medicare covers.
Step 3: ask for the discharge plan in writing
The hospital has a discharge planning team, usually a social worker or a nurse case manager. Their job is to help you, so feel free to ask them for:
- The discharge plan in writing, in Spanish if you need it. You have the right to a free interpreter.
- The list of skilled nursing facilities or home health agencies available in your area.
- The medication list, with any changes and the doses.
- Follow-up appointments with the doctor.
- Orders for medical equipment (walker, wheelchair, hospital bed).
If this is your first time dealing with this team, our guide to the hospital social worker explains what they do and what to ask them.
You choose the facility. The hospital gives you a list, but it can't force you to accept a particular place. To compare with peace of mind, check each facility's star ratings and inspection reports in our directory or search for places near you. Remember that a report is a snapshot of one moment: if something catches your eye, ask the facility what has changed since then. Also read how to read Medicare star ratings.
Step 4: if the discharge seems too soon, appeal
If your loved one is an inpatient with Original Medicare, the hospital must give them the notice An Important Message from Medicare About Your Rights (IM). That notice explains how to appeal.
How it works:
- Call your state's BFCC-QIO (the independent organization that reviews these appeals). The phone number is on the IM notice.
- Call before leaving the hospital, no later than the planned discharge date.
- While the QIO reviews the case, your loved one can usually stay in the hospital without paying for those extra days.
- The QIO reviews the medical records and gives you a quick answer.
Appealing isn't fighting with the hospital: it's a normal step that gets you an independent second opinion. If your loved one is already in an SNF or getting home health care and is told that Medicare will stop paying, there's also a fast appeal through the QIO. With Medicare Advantage the process is similar; check the notice your plan gives you.
Get free help from your state's SHIP (unbiased Medicare counseling) at shiphelp.org, or call 1-800-MEDICARE (1-800-633-4227) and ask for help in Spanish if you need it.
Checklist for the first 48 hours
- Ask whether your loved one is an inpatient or under observation, and since what day.
- Ask for the discharge plan in writing and the list of medicines.
- Ask for whichever notice applies (IM, MOON or the change of status notice) and keep it.
- If they have Medicare Advantage, call the plan to find out which facilities it accepts and whether you need authorization.
- Make a short list of 2 or 3 facilities and call to ask whether they have a bed available.
- Check star ratings and inspections with our compare tool and use the visit checklist if you can visit.
- Ask each facility whether they have staff who speak Spanish.
- Bring the Medicare, Medicaid and any other health insurance cards, an ID and the medication list.
- If your loved one can't make decisions, look for their power of attorney or advance directive. If they don't have them, read power of attorney and advance directives.
- If they're likely to stay long term, start looking into Medicaid as soon as possible.
If they will stay long term
Many people go into a nursing home for rehab and then can't go back home. When Medicare stops paying, the cost falls to the person and their family, unless they qualify for Medicaid. That's why it's a good idea to apply for Medicaid early. Also, under federal law P.L. 119-21, for applications made on or after January 1, 2027, retroactive Medicaid coverage for older adults drops from 3 months to 2 months before the month of application. Some states already had shorter periods, so ask your state's Medicaid office. Read Does Medicaid pay for a nursing home? and, to prepare for the first few weeks, our guide to the care plan meeting.
If they go back home
Original Medicare can pay for home health care (nursing or therapy visits) if your loved one is homebound and a doctor orders it. What Medicare doesn't pay for is personal care (bathing, dressing, eating) when that's the only care needed. Find certified agencies in our home health agencies directory, plan the rest with our guide to home care for seniors and, if you'll be the main caregiver, look at help for family caregivers. To get the home ready, see how to adapt a home for an older adult.
Frequently asked questions
Can the hospital discharge my loved one without a place to go?
The hospital must make a safe discharge plan and explain it to you. If you don't agree with the date, ask to talk with the social worker and, if you still disagree, use the fast appeal through the QIO before leaving.
How long does the QIO take to decide?
It's a fast process, designed to be resolved within a few days while your loved one is still in the hospital. The IM notice explains the exact timelines for your case.
Can I choose a facility that isn't on the hospital's list?
Yes. The list is there to help, not a requirement. Make sure the facility has a bed, accepts your health insurance and can give the care your loved one needs.
Rules can vary by state and by plan. This guide is for information only and is not legal or medical advice.
Sources
- Medicare.gov, Skilled nursing facility care (accessed October 15, 2026)
- CMS, 2026 Medicare Parts A & B Premiums and Deductibles (accessed October 15, 2026)
- CMS, Hospital Appeals: Change of Inpatient Status (Alexander v. Azar) (accessed October 15, 2026)
- Medicare.gov, Appeal when a hospital changes your status from inpatient to outpatient getting observation services (accessed October 15, 2026)
- CMS, MM13846: Medicare Change of Status Notice Instructions (accessed October 15, 2026)
- Federal Register, Medicare Program: Appeal Rights for Certain Changes in Patient Status (accessed October 15, 2026)
- CMS, Skilled Nursing Facility 3-Day Rule Billing (accessed October 15, 2026)
- CMS, MM14098: TEAM and the 3-day rule waiver (accessed October 15, 2026)
- Medicaid.gov, November 18, 2025 informational bulletin on P.L. 119-21 (accessed October 15, 2026)
- SHIP, free Medicare counseling (accessed October 15, 2026)
- Medicare.gov, Home health services (accessed October 15, 2026)
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Hospital social worker
What a hospital social worker or discharge planner does, what you can ask for, your right to choose the facility, and how to prepare for the meeting.
What does Medicare cover?
Medicare pays for up to 100 days of rehab after a 3-day inpatient stay, not long-term nursing home care. 2026 costs, home health and hospice.
Choosing a place for care
How to choose a nursing home: assess the need, check the license, star ratings and inspections, visit, what to ask and how to read the contract.
Rehab after the hospital
How to choose a skilled nursing rehab center, what happens in the first days, when Medicare stops paying, how to appeal and what comes next.
