From Skilled Nursing to Board and Care When Medicare Coverage Ends

The call often comes on a weekday afternoon: the skilled nursing facility says Medicare coverage for your parent’s rehab is ending, and they need a discharge plan in a few days. For many San Diego families, the right next step is a move from the nursing home to board and care, a small licensed home where a parent gets daily help and supervision without the medical intensity of a skilled nursing facility (SNF).

This guide focuses on the logistics of that transition: what the coverage notice means, how to line up a board and care home quickly, which documents and orders to gather, how to handle medications, equipment and transportation, and what the first week should look like. For the coverage rules themselves, see our explainer on the Medicare 100-day skilled nursing rule.

When Does a Move From Nursing Home to Board and Care Make Sense?

A move from nursing home to board and care makes sense when a parent no longer needs daily skilled nursing or therapy but still cannot live safely alone. If care has become mostly help with bathing, dressing, toileting, transfers and medications, a licensed 6-bed board and care home can usually provide it in a calmer, more personal setting.

Signs the timing is right:

• Therapy has ended or your parent has plateaued
• Medical condition is stable, with no IV medications or complex wounds
• Your parent needs help with daily activities and supervision, especially at night
• Going home alone, or with a frail spouse, is not safe
• The SNF has issued a Notice of Medicare Non-Coverage

A board and care home is a residential care facility for the elderly (RCFE) licensed by the California Department of Social Services. Most in San Diego are single-story homes for up to 6 residents, the kind of senior care home families often call an elder care home or home for elderly adults. If you are still weighing whether your parent needs a SNF at all, our comparison of board and care vs. nursing home care covers that decision.

What Does the Notice of Medicare Non-Coverage Mean?

A Notice of Medicare Non-Coverage (NOMNC) tells you that Medicare-covered skilled services at the SNF are ending. According to Medicare.gov, you should receive it at least 2 days before covered services end. It is not an eviction notice, but it is your signal to finalize where your parent will go next.

What to do when you receive it:

• Read the end date carefully. After that date, your parent may be responsible for the cost of staying in the SNF.
• Decide whether to appeal. If you believe your parent still needs skilled care, you can request a fast appeal from the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) listed on the notice. Medicare.gov says to request it by noon the day before the termination date.
• Start placement right away even if you appeal. If the appeal is denied, you will need a plan within days.
• Ask for a care conference. Meet with the SNF social worker, nurse and therapist to understand current needs and discharge recommendations.

If your parent is on a Medicare Advantage plan, the process is similar but may involve the plan’s own notices. The SNF social worker can tell you which applies.

How Quickly Can You Find a Board and Care Home?

A move from a nursing home to board and care can often happen within a few days to two weeks, depending on bed availability, how fast paperwork comes together, and how specific your parent’s needs are. Starting the search when rehab begins, rather than when the notice arrives, gives you the most choices.

How to speed things up:

• Start early. As soon as your parent enters rehab, ask the team about the expected length of stay and begin touring homes.
• Narrow the area. Choose two or three neighborhoods near family or your parent’s doctors. Our San Diego County service areas page lists local guides.
• Prepare a one-page summary. Diagnoses, mobility, transfer needs, continence, cognition, diet, medications and any behaviors. Homes decide faster when the picture is clear.
• Tour in person. Visit at least two homes. Our list of board and care tour red flags helps you spot problems quickly.
• Check the license. Use the CDSS Care Facility Search and our guide to reading RCFE inspection reports.
• Let the home assess your parent. Many board and care operators will visit the SNF to meet your parent and review records before accepting them.

For example, a family in Escondido whose mother is finishing hip fracture rehab at a nearby SNF might tour three homes in the second week of rehab, choose one close to her son’s house, and have the home’s administrator visit her at the SNF. When the coverage notice arrives, the bed and paperwork are nearly ready. This is an illustration of good timing, not a specific client story.

What Paperwork Is Needed to Move From a SNF to an RCFE?

California requires the same admission paperwork for someone coming from a nursing home as for any new RCFE resident: a physician’s report, TB screening, a pre-admission appraisal, an admission agreement and identifying and emergency information. The SNF’s records make this easier, but someone has to gather them.

Documents to collect before discharge:

• Physician’s report (LIC 602A). Ask the SNF attending physician or your parent’s primary care doctor to complete it. Our guide to the LIC 602A physician’s report explains the form.
• TB screening results. Most SNFs have recent results on file. See TB test requirements for assisted living in California.
• Discharge summary and recent notes. Diagnoses, therapy progress, precautions and recent vital signs.
• Medication administration record (MAR). The current list of medications, doses and times, including any recently changed.
• Skin and wound assessment. Important because certain pressure injuries are prohibited in RCFEs under Title 22, Section 87615.
• POLST and advance directive. Copies for the home and for emergency responders.
• Insurance cards and legal documents. Medicare, supplemental or Medi-Cal cards, and health care power of attorney.

The board and care home will complete its own pre-admission appraisal. Our article on the RCFE pre-admission appraisal explains what the home evaluates.

How Should Medications Be Handled During the Transition?

Medications are the most common source of problems when moving from a nursing home to board and care. Ask the SNF for a reconciled medication list and new prescriptions for every drug, arrange pharmacy delivery to the board and care home before move-in day, and make sure the first doses at the new home are covered.

Steps that prevent gaps:

• Get prescriptions written before discharge. SNF medications usually come from the SNF’s own pharmacy and do not travel with your parent.
• Ask which pharmacy the home uses. Many board and care homes work with pharmacies that deliver medications in sealed blister packs.
• Reconcile the list. Compare the SNF list with your parent’s pre-hospital medications. Ask the doctor about anything that was stopped, started or changed.
• Cover the first day. Confirm that medications will arrive before the first dose time, or bring a short supply in labeled containers if the SNF allows it.
• Clarify “as needed” medications. California RCFEs need clear physician instructions for PRN medications. Ask the doctor to write exactly when and how they should be used.

Our guide to pharmacy and prescriptions in board and care homes explains who orders, pays for and gives medications.

What Equipment and Services Should Be Arranged?

Before discharge, ask the SNF team to order the equipment and follow-up services your parent will need at the board and care home. That usually means durable medical equipment such as a walker, wheelchair or hospital bed, home health nursing or therapy if ordered, and a doctor who will follow your parent after the move.

Checklist:

• Durable medical equipment. Walker, wheelchair, shower chair, bedside commode or hospital bed. Ask the SNF to order it with delivery to the board and care address. Medicare Part B covers many items with a doctor’s order.
• Home health referral. If your parent still benefits from intermittent nursing or therapy, a doctor can order Medicare home health to visit the board and care home. Our home health care guide explains the rules.
• Primary care follow-up. Schedule an appointment within a week or two, or connect with a physician or nurse practitioner who makes house calls to board and care homes.
• Specialists. Note any follow-up with orthopedics, cardiology or wound care.
• Hospice, if appropriate. If your parent is declining, ask whether a hospice evaluation makes sense before or after the move. Our San Diego hospice page explains the benefit.

How Do You Pay for Board and Care After Medicare Ends?

Medicare does not pay for room, board or personal care in a board and care home. Most families pay privately, at about $5,500 to $9,500 per month for board and care homes in San Diego in 2026. Medi-Cal’s Assisted Living Waiver, VA pension benefits and long-term care insurance can help some families.

Payment sources to check:

• Private funds. Savings, Social Security, pensions, investments or proceeds from selling or renting a home.
• Long-term care insurance. Many policies cover licensed RCFEs. Call the insurer early, because claims take time.
• VA Aid and Attendance. Wartime veterans and surviving spouses who need help with daily activities may qualify.
• Medi-Cal Assisted Living Waiver. Available in San Diego County for eligible Medi-Cal members, with limited slots. Our guide to the Assisted Living Waiver in San Diego explains eligibility.

If your parent is on long-term Medi-Cal in the SNF and cannot afford board and care, our article on Medi-Cal nursing home vs. board and care lays out the realistic options.

How Do You Plan Move Day and the First Week?

A smooth move day starts with a confirmed discharge time, transportation that fits your parent’s mobility, medications and equipment already at the new home, and a family member present for the arrival. The first week is about settling in, watching closely for problems, and communicating often with the home.

Move-day checklist:

• Transportation. A car works for many residents. A wheelchair van or non-emergency medical transport may be needed for others. Book it early.
• Timing. Aim for a late-morning or early-afternoon arrival so staff can settle your parent before evening.
• Belongings. Labeled clothing, glasses, hearing aids, dentures, photos and a familiar blanket.
• Paperwork in hand. Discharge summary, medication list, prescriptions and POLST.

In the first week, expect some fatigue or confusion as your parent adjusts. Visit regularly but briefly, share preferences with caregivers, and ask the home to call you with any change. Our guide to the first 30 days after moving into a board and care home covers what to expect.

How Elder Answers Helps With SNF Discharges

A nursing home discharge leaves little time to find, tour and vet a residential senior care home. Elder Answers has helped San Diego families for well over a decade, and our advisors personally visit the homes we recommend and know which have openings this week.

Our help is free to families, because homes pay us after move-in, and your rate does not change. We share information only with the homes you choose, and moves can often happen within a few days when discharge is close. Contact Elder Answers to plan a move from a nursing home to board and care, or start with our board and care homes in San Diego page.

Frequently Asked Questions About Moving From a Nursing Home to Board and Care

How much notice do we get before Medicare coverage ends in a SNF?

According to Medicare.gov, you should receive a Notice of Medicare Non-Coverage at least 2 days before covered services end. That is a short window, so start looking at board and care homes as soon as rehab begins rather than waiting for the notice.

Can we appeal the end of Medicare coverage?

Yes. You can request a fast appeal from the BFCC-QIO listed on the notice. Medicare.gov says to request it by noon the day before the termination date. Keep planning the move while the appeal is reviewed, because a denial can leave only days to arrange care.

Can a board and care home accept someone directly from a nursing home?

Yes. Board and care homes regularly admit residents from skilled nursing facilities, as long as the resident does not have a condition California prohibits in RCFEs. Many homes will visit your parent at the SNF to assess them before move-in.

Who completes the physician’s report for the board and care home?

Usually the SNF’s attending physician or your parent’s primary care doctor completes the LIC 602A physician’s report. Ask for it early in the discharge process, since it is required before the home can admit your parent.

Will my parent’s medications come from the nursing home?

Usually not. SNF medications typically come from the facility’s own pharmacy. Get new prescriptions written before discharge and arrange delivery to the board and care home so no doses are missed on move-in day.

Can home health continue after the move?

Yes, if a doctor orders it and your parent qualifies under Medicare’s home health rules. A home health agency can send nurses and therapists to the board and care home, which counts as your parent’s residence.

What if my parent’s needs are too high for board and care?

If your parent has a prohibited condition, such as a stage 3 or 4 pressure injury or a feeding tube, or needs daily skilled nursing, a board and care home cannot accept them. Staying in the SNF, or hospice in a home with a hospice waiver, may be the better path.

How long does the move from a nursing home to board and care take?

When paperwork and a bed are ready, the move itself takes a few hours. The planning can take a few days to two weeks. Starting early in the rehab stay gives you more choices and a calmer transition.