What Happens During the First 24 Hours in a Nursing Home?

The first 24 hours in a nursing home are mostly about making the handoff safe. Staff need to confirm immediate orders, medications, diet, mobility, fall risk, skin and toileting needs, communication preferences, equipment, and who should be contacted when something changes. The resident also needs time to learn the room, routines, call system, staff, and basic schedule.

Families do not need to solve every long-term care question on move-in day. The priority is to make sure the resident can get through the first night safely and that unresolved items have a named person responsible for follow-up.

Before arrival: confirm the nursing home has what it needs

Whenever possible, confirm that the receiving facility has the current information before transportation begins. This is especially important after a hospital or rehab transfer.

Useful records can include:

• current medication list and medication orders;
• allergies;
• diagnoses and recent hospital information;
• diet and swallowing instructions;
• mobility and transfer status;
• wound or skin-care orders;
• oxygen or equipment needs;
• therapy recommendations;
• advance directives when applicable;
• emergency contacts; and
• insurance and payer information.

For a document-focused list, see Nursing Home Admission Checklist: Documents, Assessments & Signatures.

At admission: confirm the immediate orders

CMS guidance requires the facility to have physician orders for the resident’s immediate care at admission. Families should not assume that a medication list in a discharge packet automatically means every order has been entered correctly at the nursing home.

Ask:

• Who reviewed the admission orders?
• Have medication orders been reconciled?
• Are there any medications the facility is still waiting to receive?
• Are diet and swallowing instructions entered?
• Are oxygen, wound, catheter, glucose-monitoring, or other orders active?
• Are there follow-up appointments or labs that need to be scheduled?

If something is unclear, ask who is contacting the hospital, physician, pharmacy, or other sending provider.

Show staff how the resident actually moves

A written note that says “assist with transfers” may not be enough. Tell staff whether the resident:

• walks independently;
• uses a cane or walker;
• needs one-person assistance;
• needs two-person assistance;
• uses a sit-to-stand or mechanical lift;
• needs help repositioning in bed; or
• has recent fall restrictions.

Also point out what makes transfers easier or harder. A resident who looks steady at noon may need much more help at 2 a.m. when tired or confused.

Identify the highest-risk first-night issues

The first day is a good time to be explicit about problems that can lead to an early fall, missed treatment, distress, or hospital return.

Make sure staff know about:

• recent falls;
• wandering or exit-seeking;
• delirium or sudden confusion;
• hearing or vision limitations;
• pain that may be hard to communicate;
• skin breakdown or pressure-injury risk;
• swallowing difficulty;
• incontinence or frequent nighttime toileting;
• sleep habits;
• behavior or trauma triggers;
• seizures;
• diabetes or hypoglycemia risk; and
• oxygen or breathing concerns.

CMS requires a baseline care plan within 48 hours

For Medicare- and Medicaid-certified nursing homes, CMS requires a baseline care plan to be developed and implemented within 48 hours of admission. The purpose is to provide enough immediate, person-centered information to keep the resident safe while the full assessment and comprehensive care plan are being developed.

The baseline plan must address key information such as initial goals, physician orders, dietary orders, therapy services, social services, and other immediate care needs.

CMS also requires the resident and representative, when applicable, to receive a summary of that baseline care plan.

Official source: CMS State Operations Manual, Appendix PP.

Ask what the first-night routine will look like

The first night can be confusing even for someone without dementia. Ask:

• What time are medications usually given?
• Who helps with toileting?
• How does the resident call for help?
• How often are overnight checks performed?
• What time are meals?
• Where is the dining room?
• What happens if the resident wakes up confused?
• Who is the nurse on the unit tonight?

If the resident has dementia, consider a familiar blanket, family photos, clock, calendar, or other approved item that makes the room easier to recognize.

Confirm the call system is actually reachable

Do not just verify that a call button exists. Make sure the resident can reach and use it from the bed and bathroom.

If the person has limited hand strength, poor vision, cognitive impairment, or hearing loss, ask whether another method is needed.

Make sure eating and drinking are safe

Confirm the resident’s diet, food texture, fluid consistency, allergies, and feeding assistance needs.

If the person recently came from the hospital with a swallowing recommendation, ask whether the facility received it and how meals will be prepared until the full assessment is complete.

Check the room for immediate practical problems

Before leaving, look at:

• bed height;
• walker or wheelchair access;
• path to the bathroom;
• night lighting;
• call-button placement;
• glasses and hearing-aid storage;
• phone or charger access;
• oxygen or medical-equipment placement; and
• whether important personal items are labeled.

You do not need to decorate the entire room on day one. Safety and orientation come first.

Inventory important belongings

Label frequently misplaced items such as clothing, eyeglasses, hearing aids, dentures, chargers, walkers, and wheelchairs when appropriate.

If the resident brings valuables, ask how the facility documents or secures them. Photographing important items can make later identification easier.

For a move-in packing guide, see What to Pack for a Nursing Home Move. If an item later goes missing, see Lost Belongings in a Nursing Home.

Give staff the resident’s preferences, not only diagnoses

Person-centered care starts with what matters to the resident. A short list of useful preferences can be more valuable on day one than a long biography nobody has time to read.

Share things such as:

• preferred name;
• usual wake and sleep times;
• how the resident likes to be approached for personal care;
• important religious or cultural practices;
• favorite foods and activities;
• hearing or communication strategies;
• what causes anxiety;
• what usually calms the person; and
• who the resident wants involved in decisions.

NHP’s resident-preferences guide can help families organize that information.

Find out who the family’s point of contact is

Families often leave move-in day with several phone numbers but no idea who owns the next question.

Ask for:

• unit phone number;
• charge nurse or nursing contact;
• social worker or care coordinator;
• billing/business-office contact;
• therapy contact if relevant; and
• who should receive non-urgent family questions.

For a more detailed strategy, see How to Ask for a Consistent Nursing-Home Point of Contact.

Do not try to complete the entire care plan in the first hour

Admission day can involve transportation delays, pharmacy questions, paperwork, fatigue, and emotional stress. It is reasonable to focus first on immediate safety and care.

The nursing home’s full assessment and comprehensive care-planning process continues after admission. Families should ask when they can contribute to the formal assessment and care-plan discussion.

See What Families Should Know About the First Nursing-Home Care Assessment.

Know what requires same-day escalation

Do not wait for the first care conference if the resident:

• does not receive an essential medication;
• has the wrong diet or swallowing plan;
• does not have ordered oxygen or equipment;
• cannot safely transfer or reach the bathroom;
• has severe uncontrolled pain;
• falls;
• becomes suddenly much more confused or difficult to wake;
• has breathing trouble or another medical emergency; or
• is missing an essential treatment that was part of the transfer plan.

Raise the issue with the nurse or appropriate clinical leader immediately. Emergency symptoms require appropriate urgent care.

If arrival happens after the admissions office closes

Evening or weekend arrivals can create extra handoff risk because fewer administrative staff may be available.

If that applies, use Your Parent Arrives After the Admissions Office Closes: A Nursing Home Handoff Plan.

A first-24-hours checklist

• Admission orders received and reviewed.
• Medication list reconciled.
• Diet and swallowing instructions confirmed.
• Mobility and transfer method confirmed.
• Fall, skin, wandering, and other immediate risks communicated.
• Call system reachable and understood.
• Bathroom and equipment setup safe.
• Important belongings labeled or inventoried.
• Resident preferences shared.
• Family point of contact identified.
• Unresolved issues assigned to a named staff member.
• Family knows when the baseline/initial care-planning discussion will occur.

Compare care options

If the first day reveals that the nursing home cannot safely meet the resident’s needs, address the problem promptly with the care team. If another setting may be needed, browse nursing homes and senior-care communities or use the Nursing Home Placement Care Finder.

Authoritative sources

• CMS State Operations Manual, Appendix PP — Baseline Care Plans
• CMS — Residents’ Rights & Quality of Care

Reviewed October 24, 2026. General U.S. educational information only. Individual admission procedures, clinical needs, state rules, payer requirements, and facility practices can differ.