The Nursing Home Placement Nightmare: What Families Need to Know

Anyone who thinks “nightmare” is too strong a word has clearly never tried to find a nursing home for a loved one. The nightmare emotions of anxiety and dread are all too real for families who realize their loved one is no longer safe at home; or when the cost of care becomes unsustainable. 

The High Cost of In-Home Care

In-home care is often the first option families turn to, but it quickly becomes overwhelming. Rates typically rangefrom $25–$45 per hour. Just six hours of care a day can add up to $4,500–$8,000 per month, an expense few families can manage for long.

Sleepless Nights for Caregivers 

Many of our clients arrive physically and emotionally drained after weeks or months of sleepless nights. Spouses, children, grandchildren take turns staying awake to: 

• Prevent a loved one from falling on the way to the bathroom

• Stop repeated medication attempts

• Calm someone who insists it’s time for work at 3 a.m.
  
• Keep a loved one from wandering outside

And the list goes on. Caregivers often go days with little or no rest, sacrificing their own health to keep someone safe and secure… An unfortunately unsustainable care model for all involved. 

The Hospital Isn’t a Safety Net

Even after families make the painful decision that nursing home care is needed, the nightmare doesn’t end… It’s only the beginning.  Many assume that bringing someone to the ER will trigger hospital placement, but that’s rarely the case. According to the Massachusetts Hospital Association, on any given day over 1,000 patients a day are stuck in hospitals because there aren’t enough nursing home or rehab beds. Unable to be discharged, this creates a devastating cascade and the the result is:

• Overcrowded ERs refusing new patients

• Families pressured to take loved ones back home

• Admitted patients waiting days or weeks for hospital beds

The reality is, patients who do require admission can spend days or even weeks in the glaring lights and chaos of the Emergency Room, awaiting hospital beds to become available. 

Why Nursing Home Beds Are Disappearing: 

The primary cause of this breakdown in the continuum of care is the loss of beds and the severe and worsening staffing shortage at skilled nursing and rehab facilities. 

• The New England region has lost 150 skilled nursing facilities since 2011.
• Other research has shown that there were only 7 new skilled nursing facilities opened in 2024, nationwide. 
• The US has lost more than 62,000 nursing home beds since 2020. 
• Immigration changes could force 2,000 direct care workers in Massachusetts out of their jobs.

These losses create a ripple effect, leaving families feeling trapped with fewer and fewer options.

Although anxiety is warranted, there are things you can do to prepare. If you have a loved one at risk of needing long term care, it is never too early to begin planning.  

1. Update Estate Planning Documents – The first step should be getting a comprehensive review of your loved ones estate plan with an Elder Law Attorney. This doesn’t mean just signing a Will.
   1. Secure Powers of Attorney and Health Care Proxies so trusted individuals can make decisions if they lose that capacity. 
   2. Naming Beneficiaries or having joint owners may be adequate in some cases, but in others consider trusts for asset protection in the face of rising care costs.
   3. Every situation is different – professional guidance is crucial.
2. Research Nursing Facilities Early – In conjunction with establishing a proper estate plan, I recommend identifying the nursing facilities in your area before such care is needed. Geographical proximity to those who will be visiting your loved one in a nursing facility is of paramount concern. You can crunch all the numbers in an attempt to find the best nursing home in the State, but if it is too far from those who will be visiting, then it is all for naught.
   1. Identify facilities near loved ones who will visit.
   2. Narrow your list to the top 2–3 options.
   3. Remember: families working with Elder Law Attorneys often get priority because staff know MassHealth (Medicaid) planning will be handled properly.
3. Understand Costs – Nursing facilities are being stretched to the limit, and it is often easier for admissions staff to simply say “we have a one year waiting list” rather than process every request for a placement. 
   1. Private-pay preference is real, but the average cost is $15,000/month.
   2. Nursing homes often give preference to individuals who have engaged with an Elder Law Attorney who they know will advise the family about their options for applying for Long Term Care MassHealth; this is the State’s Medicaid program, which pays for nursing home care.  
   3. With planning, families can often qualify for Long-Term Care MassHealth without spending down to their last dollar.

I would like to conclude with an optimistic note, although I don’t yet see any signs of substantial improvements in our long term care industry.  However, while the challenges in long-term care are significant and change may be slow, families are not powerless. The best defense is preparation; through research, planning, and professional guidance. By taking steps now to establish the right legal documents, explore care options, and understand financial strategies, you can ease much of the uncertainty and protect both your loved one and your family’s future.

No one can control the broader industry trends, but you can control how ready you are to meet them. With thoughtful planning and the right support, what feels like a nightmare today can become a more manageable journey tomorrow.

by Daniel J. Sullivan, Case Manager