Moving a family member with dementia into a nursing home involves medical assessments, legal paperwork, financial planning, and often difficult conversations. The process typically takes several weeks to a few months, depending on how quickly you can line up documentation, secure a bed, and arrange payment. Here’s what to expect at each stage.
Determine the Right Type of Facility
Not all residential care is the same, and the distinction matters for someone with dementia. The two main options are skilled nursing facilities (nursing homes) and memory care units. They serve different needs, and choosing the wrong one can mean a disruptive second move later.
Skilled nursing facilities provide 24-hour medical supervision, including wound care, IV management, tube feedings, and therapies like physical and speech rehab. Every nursing home must be licensed by its state and regulated by the federal government. These are the right fit when your family member has significant medical needs on top of cognitive decline.
Memory care units are specifically designed for people with dementia and Alzheimer’s. Staff receive specialized training in cognitive impairment, and the environment is built around safety. Most memory care units are locked or secured to prevent wandering, which is critical if your family member has a history of leaving the house, getting lost, or being found in unsafe situations. Memory care also typically offers structured daily routines and sensory-friendly spaces that reduce confusion and agitation. If wandering, aggression, or severe disorientation are the primary concerns rather than complex medical needs, memory care is often the better match.
Recognize When It’s Time
The clearest indicators are safety risks and care needs that exceed what you can manage at home. For Medicaid-funded long-term care, the standard threshold is needing substantial help with at least two of six basic activities of daily living: bathing, dressing, eating, toileting, transferring (moving from bed to chair), and maintaining continence. A person can also qualify based on behavioral or cognitive issues alone if they require at least moderate supervision.
For dementia specifically, watch for patterns that signal danger. The VA’s patient safety criteria flag people as high-risk if they have a history of wandering or going missing, lack the cognitive ability to make relevant decisions, or are considered dangerous to themselves or others. Physical limitations that compound the risk, like poor balance combined with poor judgment, also raise the urgency. If you’re finding that your family member can’t safely be left alone for any stretch of the day, or if caregiving is causing you serious physical or mental health strain, the timing is right.
Get Legal Authority in Place
If your family member can no longer make decisions about their own care, you need legal documentation authorizing you to act on their behalf. The most common tool is a durable power of attorney for health care, which names a proxy (sometimes called an agent or surrogate) to make medical decisions when the person can’t. Ideally, this document was signed while your family member still had the capacity to do so.
If no power of attorney exists and your family member is already incapacitated, you’ll likely need to pursue legal guardianship through the courts. This process varies by state, takes weeks to months, and requires a judge to determine that the person lacks decision-making capacity. It’s significantly more expensive and time-consuming than a power of attorney, which is why planning ahead matters so much.
If neither document is in place, most states default to a hierarchy: spouse first, then parents if available, then adult children. But relying on state defaults can create problems, especially for unmarried partners, who may be excluded from decision-making entirely. Contact your state’s legal aid office or bar association to understand local rules.
Complete the Required Medical Screenings
Every applicant to a Medicaid-certified nursing facility must go through a federally mandated process called the Pre-Admission Screening and Resident Review, or PASRR. This happens in two stages.
The Level I screen is a preliminary assessment that checks whether the applicant might have a serious mental illness or intellectual disability. For someone with dementia, this screening helps determine whether a nursing facility is the most appropriate setting or whether community-based care would be better. If the Level I screen flags a concern, a more in-depth Level II evaluation follows. This deeper review results in a determination of need, a recommendation for the appropriate care setting, and a set of service recommendations that feed into the person’s care plan once they’re admitted.
Your family member’s doctor will also need to provide medical records, a current diagnosis, and documentation of their care needs. Most facilities require a physician’s order or referral confirming the need for the level of care they provide. Gather recent medical records, a medication list, and any cognitive assessments before you start touring facilities, because admissions coordinators will ask for them.
Figure Out How to Pay
Nursing home care is expensive. The national average for a semi-private room runs about $308 per day, which comes to roughly $112,000 per year. Private rooms cost more. Understanding your payment options early prevents financial crises down the road.
Medicare covers short-term skilled nursing stays (up to 100 days) following a qualifying hospital admission, but it does not pay for long-term custodial care, which is what most dementia patients need. Long-term care insurance, if your family member purchased a policy years ago, may cover a portion. But for most families, the path to sustained coverage eventually runs through Medicaid.
Medicaid will cover nursing home costs once your family member’s assets fall below the state’s eligibility threshold. The critical detail: Medicaid applies a five-year look-back period on asset transfers. If your family member gave away money, transferred property, or sold assets below fair market value during the five years before applying, Medicaid will impose a penalty period during which it won’t pay for care. This means financial planning needs to start well in advance. An elder law attorney can help you navigate asset protection strategies legally, structure spend-down plans, and protect a spouse’s assets through rules like the community spouse resource allowance.
Many families pay out of pocket initially while working through the Medicaid application process. Some facilities accept “Medicaid pending” status, meaning they’ll admit a resident while the application is being processed, but not all do. Ask about this upfront when evaluating facilities.
Choose and Evaluate a Facility
Start by identifying facilities in your area that have availability and accept your payment method. Your local Area Agency on Aging can provide referrals, and Medicare’s Care Compare tool (medicare.gov/care-compare) lets you search nursing homes by location and see inspection results, staffing levels, and quality ratings.
When touring, pay attention to how staff interact with current residents, not just how they interact with you. Ask about staff-to-resident ratios, turnover rates, and how they handle behavioral symptoms common in dementia like sundowning, repetitive questioning, and resistance to care. If wandering is a concern, ask directly whether the unit is locked, whether they use door alarms or tracking systems, and what their elopement prevention protocol looks like.
Other practical questions worth asking: What’s the process for communicating with families about changes in condition? How are medications managed? What does a typical day look like for residents? Can you bring familiar items from home? What happens if the resident’s needs increase beyond what the facility can handle?
Handle the Transition Day
Moving day is often the hardest part, emotionally, for both you and your family member. People with dementia may not understand why they’re leaving home, and explaining it in literal terms can increase agitation and resistance.
Many dementia care specialists recommend a communication approach sometimes called “therapeutic fibbing,” where you simplify or gently reshape the situation rather than giving a full, accurate explanation that the person can’t process. This might mean being vague about details (“We’re going to a place where people will help you during the day”), changing the framing (“The doctor wants you to stay here for a little while”), or redirecting attention away from the move itself. The key is that your tone, body language, and facial expressions need to match whatever you’re saying. People with dementia are often highly sensitive to nonverbal cues, and a mismatch between your words and your anxiety will register even if the words themselves don’t.
Bring familiar items: a favorite blanket, family photos, a clock they’re used to seeing. Keep the goodbye brief. Lingering tends to increase distress for the resident. Many facilities recommend that families stay away for the first few days to give staff time to establish new routines and let the resident begin adjusting without the emotional trigger of repeated goodbyes.
What to Expect After Admission
Adjustment periods vary widely. Some people with dementia settle into a new routine within days, especially if the environment is calm and structured. Others may take weeks, showing increased confusion, agitation, or withdrawal before stabilizing. This is normal and doesn’t necessarily mean you made the wrong choice.
Stay in regular contact with the care team during the first month. Ask for updates on eating, sleeping, behavior, and engagement in activities. Once the initial adjustment passes, establish a visiting schedule that works for both you and your family member. Consistent, shorter visits tend to be more beneficial than infrequent, long ones.
After admission, the facility will develop an individualized care plan based on the PASRR evaluation, the physician’s orders, and their own assessments. You have the right to participate in care planning meetings and to request changes if something isn’t working. If your family member’s needs change significantly, the facility should reassess and adjust the plan accordingly.