Someone you love just went into a nursing home, or is about to. The facility needs decisions, the hospital is discharging, and nobody has explained what any of it costs or who pays.

Here is what to do in the next seven days — and, just as importantly, what not to do.

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Day 1–2: Find out what kind of stay this is

Ask whether they are admitted or under observation

If your loved one is still in the hospital, ask directly: “Is she admitted as an inpatient, or is she under observation?” Under Original Medicare, skilled nursing coverage requires a qualifying inpatient stay of at least three consecutive days. Time under observation does not count, even if they slept in a hospital bed for three nights.

Ask early, ask again before discharge, and write down who told you what and when.

Find out which Medicare they have

Original Medicare with a supplement, or a Medicare Advantage plan? It changes who decides how long the stay lasts. With an Advantage plan, the plan authorizes the stay and reviews it continuously — your conversations will be with the plan, not with Medicare. Get the plan name and member number in hand now.

What Medicare actually pays — and for how long →

Day 2–3: Get the real numbers

Ask the facility for its private-pay daily rate, in writing

Missouri’s statewide average is $8,235 a month — $98,820 a year — but your facility has its own number. Ask what it is, ask what is included, and ask what happens when Medicare coverage ends.

Ask when Medicare days are expected to run out

Ask the facility’s social worker or business office directly. This is the date your family is actually planning around, and it usually arrives sooner than anyone expects.

Look for long-term care insurance

Check the filing cabinet, the safe deposit box, and old bank statements for premium payments. Most families do not have a policy. The ones who do often have forgotten it exists.

Day 3–4: Find the power of attorney

This is the single most important document in the process, and it determines how many options your family has.

Somebody must have legal authority to move money and property. If your mother signed a financial power of attorney while she was well, the person she named can generally act. If she never signed one and can no longer understand and sign documents, no family member — not a spouse, not a child — automatically has that authority.

Put your hands on the actual document, not a memory of it. Then have someone read it: not every power of attorney contains the gifting and trust powers this kind of planning requires, and that difference matters enormously.

If there is no power of attorney and signing is no longer possible, it is harder but not necessarily over — Missouri courts can appoint a conservator with authority to act. Say so early, because that route takes time.

Day 4–6: Gather the paperwork

Missouri verifies five years of financial history, and gathering it takes longer than anyone expects. Starting now saves weeks later, whether or not you ever hire an attorney.

At minimum, start pulling together: identification and Social Security cards, four months of statements for every account, retirement and investment statements, the Social Security benefits letter for the current year, deeds for any real estate, vehicle titles, life insurance policies showing cash value, and any prepaid funeral paperwork.

The full document checklist — free to print →

Day 5–7: Understand what is actually protectable

Two things families almost never know, and both change the math:

If there is a spouse still at home

Missouri performs a Division of Assets. The spouse who stays home may keep up to $162,660 in countable assets — not the $6,220.50 limit that applies to a single person — plus a guaranteed monthly income floor of $2,705, funded by redirecting income from the spouse in the facility.

It is usually not too late

Most families believe the door closed at admission. It did not. Crisis planning exists specifically for families whose loved one is already in a facility. What cannot be recovered is money already spent while the family waited — roughly $274 a day.

Why “too late” is usually wrong →

What not to do this week

• Do not deed the house to the children. It creates a penalty, exposes the property to their creditors and divorces, and usually costs the family a substantial tax advantage.
• Do not start spending down on purpose because someone told you that you have to. Spending down is often the most expensive route to the same destination.
• Do not add anyone’s name to an account or a deed. Missouri treats it as a transfer.
• Do not sell the farm or the house to pay the bill until someone has looked at whether it was countable in the first place.
• Do not assume you have missed your chance. That belief costs families more money than any other.

One more thing

You are doing this in the middle of the hardest few weeks your family has had. Nobody stands at an altar saying “I do” imagining the day they will have to move their husband into a facility, and no adult child pictures making these calls on their lunch break.

If it helps to hand part of it to someone else, that is what we do. And if your family does not need us, we will tell you that too.

Are we a fit? Nine questions, about ninety seconds

Or just call: (573) 334-5125

This guide is general information about Missouri Medicaid and nursing home care, not legal advice, and reading it does not make you a client of the Law Office of Mark McMullin. Figures are 2026 Missouri amounts and change several times a year. Every family’s situation is different — please speak with an elder law attorney before making decisions about care or assets.