It usually starts in a hospital. A parent has fallen, had a stroke, or simply cannot go home safely. A discharge planner explains that a skilled nursing facility is the next step, hands over a list, and asks the family to choose — often within a day or two.
Before practicing law, Grover Peters spent fifteen years running healthcare organizations, including the departments that make these discharge decisions. This guide is written from both sides of that conversation.
Step 1: Find out how Medicare classified the stay
Medicare generally covers a skilled nursing stay only after a qualifying inpatient hospital stay of at least three days. Days spent under “observation status” do not count, even if your parent was in a hospital bed the entire time. Ask the hospital directly: Was my parent admitted as an inpatient, and on what date?
If Medicare coverage applies, it pays for up to 100 days of skilled nursing or rehabilitation in a benefit period — in full for the first 20 days, then with a substantial daily copay. It stops when your parent stops improving or no longer needs skilled care, which can happen well before day 100. Medicare Advantage plans have their own rules and often require prior authorization.
If you believe the hospital is discharging your parent too soon, or a facility says Medicare coverage is ending, you have the right to a fast appeal. The notices you receive explain how. Deadlines are short — often by noon the next day.
Step 2: Locate the paperwork
Find out whether your parent signed a durable power of attorney (for finances), a medical power of attorney, and a directive to physicians. If they did, the person named can act now. If they did not, and your parent still has capacity, signing them this week is the single most useful thing you can do. See our guide to powers of attorney.
If your parent no longer has capacity and nothing was signed, a court guardianship may eventually be needed. Talk to a lawyer before assuming so — sometimes less restrictive options exist.
Step 3: Choose the facility with long-term care in mind
The facility you pick for a short rehab stay often becomes the long-term home. Before choosing, ask:
- Does it accept Medicaid, and does it have Medicaid beds available? A facility that is private-pay only may require a move later.
- What is the private daily rate, and what is extra?
- What are its staffing levels and recent inspection results? Medicare's Care Compare website publishes star ratings and inspection reports.
Step 4: Read the admission agreement before signing
Admission packets are long and presented at a stressful moment. Two points deserve particular care:
- Sign as agent, not as guarantor. Federal rules prohibit facilities from requiring a third party to personally guarantee payment as a condition of admission. Sign as “agent” or “responsible party” only in the representative capacity, and read what that term means in the document.
- Arbitration clauses are generally optional and cannot be a condition of admission. You may decline.
Step 5: Start the money conversation now
If a long-term stay is likely, begin Medicaid planning immediately. Do not move money, retitle the house, or pay family members before getting advice — those steps can create a penalty period. Do gather:
- Five years of bank and investment statements.
- Income records: Social Security, pensions, annuities.
- Deeds, vehicle titles, life insurance policies and any prepaid funeral contracts.
- Health insurance and Medicare cards.
A checklist for this week
- Today
- Confirm inpatient versus observation status and the admission date.
- This week
- Locate or sign powers of attorney and a HIPAA release.
- Before admission
- Confirm the facility accepts Medicaid; read the admission agreement; decline arbitration if you prefer.
- First 30 days
- Gather financial records and speak with an elder law attorney about Medicaid before moving any assets.
Common questions
Am I personally responsible for my parent's nursing home bill?
Generally not, unless you personally agreed to pay. That is why it matters how you sign the admission agreement. Misusing a parent's funds as their agent is a different matter, so keep careful records.
My parent has dementia. Can they still sign a power of attorney?
Possibly. Capacity is specific to the task and can fluctuate. A diagnosis alone does not end it. An attorney can assess whether signing is appropriate and document it properly.
This guide is general information about Texas law as of September 2026, not legal advice for your situation. Laws and dollar figures change, and small facts change outcomes. Reading it does not create an attorney-client relationship. Grover C. Peters III is responsible for this content.