Nursing Home Checklist
Last updated: April 4, 2013
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home staff member will assist a family through the admittance
process, but it helps to be prepared. If your loved one is
currently in the hospital, the first five items on this nursing
home checklist will be taken care of by hospital staff. Otherwise,
make an appointment with the primary care physician to discuss the
following items to help prepare for the move to a nursing
- Physician's order for admission to a skilled nursing
facility - A doctor needs to confirm that a patient
needs to enter a nursing home for care. This order is similar to
writing out a prescription.
- Physician's order for medications and treatment
- Your loved one will have a new physician and
caregivers at the nursing home. To care for him or her, they will
need orders from a primary care physician or hospital staff.
- History and physical - The nursing
home's attending physician needs up-to-date information on your
loved one. The primary care physician should perform a physical and
write up a current medical history.
- State-required form - Every state has a
required form-which goes by different titles-that certifies a
patient meets state nursing home criteria. This means his medical
needs can be fulfilled at a skilled nursing facility. Either the
hospital or the primary care physician will fill out and sign this
form. It can be obtained at any nursing home in the state where
they will be receiving. (The hospital should also already have the
form.) Because financial assistance is only granted if the patient
meets state criteria for nursing home care, this form meets the
first requirement for funding, before monetary need is ascertained.
- Negative tuberculosis (TB) test or chest X-Ray, per
policy - TB is an airborne communicable disease.
Nursing homes need to make sure their residents do not have or
carry this disease.
- Completed admissions paperwork at the time of admission
to the community - Usually, paperwork can be filled
out prior to or on the day of admission. Although nursing homes
have different rules, most often these forms are filled out at the
facility with a staff member. The patient (or agent) will sign her
name several times after learning pertinent information. Because
nursing homes are regulated by state and federal laws, the
community needs written proof that the patient learned this
information. Part of the paperwork gives the patient's consent to
be treated. As part of the application process your loved one may
need to bring his or her social security card.
- Completed financial obligations to the community at the
time of admission to the community - This step
ensures that each patient has the means to pay for care. The
patient or her family needs to disclose financial information
(along with corroborating paperwork), including, but not limited
to, answers to the following questions:
Is the patient currently enrolled in
Medicare (Part A or B) or Medicaid or plan to apply? Does he
have supplemental insurance?
Does the patient receive Veterans Benefits, Railroad Retirement,
SSI funds, or a private or government pension?
What are the patient's assets, including cash, checking and
savings accounts, stocks, bonds, CDs, trust funds, and real estate
Does the patient have any paid-up life insurance policies or
paid-up burial insurance or long-term care insurance?
Has the patient transferred assets in the last 3-5 years?
What is the patient's current living situation (rental housing,
own a home)? What is the amount of the monthly rental or mortgage
has an obligation to determine if incoming residents meet
the criteria for any state or federal funding. This process is
similar in nature to a person divulging financial information to
get a mortgage; the nursing home is, in effect, the patient's new
Source: Information in this nursing home checklist provided
courtesy of Stephanie Blakeney at Golden Living
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