Skilled nursing and nursing homes

Your next 3 actions

1. List the care that must be available every day and night. Include transfers, toileting, wounds, feeding, behaviors, oxygen, and medication complexity.
2. Compare the actual facilities and units. Check Medicare Care Compare and Washington licensing records, then visit at different times if possible.
3. Get admission and payment terms in writing. Ask what is included, what costs extra, which payers are accepted, and what happens if needs or payment source change.

When it may fit

A nursing home provides 24-hour nursing and personal care. It may fit when needs exceed what can be safely arranged at home or in assisted living. It offers the most on-site clinical support among common long-term residential options, but residents have less privacy and control than at home.

Alternatives include home with paid and unpaid support, an adult family home, assisted living, or memory care. Compare the full care plan, overnight coverage, backup staffing, accessibility, and total cost—not the label.

Questions to ask

• Can you meet every item on the current assessment, including two-person transfers or behavioral needs?
• How many direct-care staff are assigned on days, evenings, nights, and weekends?
• How often do agency staff fill shifts? Who is the medical provider after hours?
• How do you prevent pressure injuries, falls, medication errors, and avoidable hospital trips?
• Can residents choose waking, bathing, meals, and activities?
• What complaints, enforcement actions, or substantiated findings are recent?
• What can trigger transfer or discharge? Is a bed held during hospitalization?
• Is the facility certified for Medicare, Medicaid, both, or neither?

Common failures

• Confusing short-term Medicare rehabilitation with long-term nursing-home payment.
• Relying on a polished lobby rather than staffing, resident experience, and inspection history.
• Signing as a personal guarantor without understanding the document.
• Assuming a Medicaid bed will be available later.
• Waiting to contact the Long-Term Care Ombuds until a conflict becomes severe.

Costs and payment basics

Long-term nursing-home care is commonly private pay or Medicaid for people who meet financial and functional eligibility rules. Medicare covers qualifying skilled care for a limited period, not indefinite custodial residence. Long-term-care insurance and veterans benefits may help some people. Ask DSHS for an eligibility screening before assets are exhausted, and keep copies of contracts and notices.

King County help

• Community Living Connections: Call 844-348-5464 for free, unbiased help finding local aging, disability, caregiver, and long-term-care services. Start at https://communitylivingconnections.org/.
• Aging and Disability Services: Seattle–King County’s Area Agency on Aging explains local programs at https://www.seattle.gov/human-services/services-and-programs/aging-and-disability.
• Washington 211: Dial 211 or search https://wa211.org/ for food, housing, transportation, and other practical help.
• Long-Term Care Ombuds: For concerns about a nursing home, assisted living facility, or adult family home, contact https://www.waombudsman.org/.

Sources

• Medicare, Care Compare: https://www.medicare.gov/care-compare/
• Medicare, Skilled nursing facility care: https://www.medicare.gov/coverage/skilled-nursing-facility-care
• Washington DSHS, Long-Term Care Services & Information: https://www.dshs.wa.gov/altsa/long-term-care-services-information
• Washington DSHS, Nursing Home Locator: https://fortress.wa.gov/dshs/adsaapps/lookup/BHAdvLookup.aspx
• Washington State Long-Term Care Ombuds: https://www.waombudsman.org/

Reviewed 2026-08-23.