Nursing Home in Tennessee
Quality Reality Check
Navigating nursing home options for your loved one in Tennessee can feel overwhelming, especially when considering quality. Tennessee has 303 facilities with 34,676 beds. Unfortunately, a significant portion of these facilities are rated poorly. About 38.9% of Tennessee nursing homes receive a 1-star or 2-star rating from the Centers for Medicare & Medicaid Services (CMS), indicating quality much below average. This percentage is close to the national average where more than one-third of nursing homes have low ratings. In fact, Tennessee nursing homes have been ranked among the worst in the nation, with nearly one-third receiving the lowest possible rating. The average rating for Tennessee facilities is 3.0 out of 5 stars, which highlights the need for careful research. A critical area to watch out for is staffing; over 41% of Tennessee nursing homes have received the lowest score for adequate staffing, a key factor in preventing neglect. The average Registered Nurse (RN) hours per resident per day is 0.61, which can translate to less individualized attention than you might hope for. When evaluating facilities, be vigilant for signs of chronic understaffing, poor infection control, and a history of serious deficiencies, as these are common issues in lower-rated Tennessee homes.
Will TennCare Cover It?
TennCare, Tennessee's Medicaid program, can cover nursing home care for eligible residents. To qualify, your loved one must be 65 or older, blind, or disabled, and meet specific financial and medical criteria. Medically, they must require a "Nursing Facility Level of Care," which is determined through a Pre-Admission Evaluation (PAE) where a score of at least 9 out of 26 points is typically needed. Financially, a single applicant in 2026 can have no more than $2,000 in countable assets and a monthly income up to $2,982. For married couples where both are applying, the combined asset limit is $4,000 and the income limit is $5,964 per month. If only one spouse is applying, the applicant spouse still has a $2,000 asset limit, but the non-applicant spouse can keep up to $162,660 in assets under the Community Spouse Resource Allowance. Certain assets like a primary home, one vehicle, and prepaid funeral arrangements are typically exempt. If your parent has assets exceeding these limits, a "spend-down" process is required to legally reduce countable assets. This means using excess funds on approved items that benefit your parent or their spouse, such as home improvements, new appliances, or medical devices, rather than simply giving money away, which can trigger a 5-year penalty period. To apply for TennCare CHOICES, you'll need to submit a detailed application with supporting documents online via TennCareConnect.TN.gov, by phone at 855-259-0701, or through a paper application. Be prepared for the application to take up to 90 days to process, and promptly respond to any requests for additional information. Seeking guidance from your local Area Agency on Aging and Disability (AAAD) or an elder law attorney can be incredibly helpful.
Finding the Right Facility
When searching for a nursing home in Tennessee, Medicare's Care Compare tool is an essential resource. This website allows you to compare facilities based on their overall 1-to-5 star ratings, which are compiled from health inspections, staffing levels, and quality measures. While this tool is a great starting point, remember to use it in conjunction with facility visits and other information. Detailed information regarding regional nursing home availability isn't consistently provided, but it's important to note that many Tennessee facilities struggle with staffing shortages, which can impact care delivery. When reviewing an inspection report, often called a CMS-2567, look for "deficiencies," which are violations of state or federal rules. Inspectors examine areas like quality of care, resident rights, infection control, and the physical environment. Pay close attention to the scope and severity of any deficiencies, especially those categorized as Level 4, indicating "immediate jeopardy to resident health or safety". Specifically, watch for issues related to accident hazards, inadequate supervision, insufficient nurse competency, and failures to protect residents from abuse. Also, check the date of the most recent inspection; standard inspections should occur every 9 to 15 months. Resources like ProPublica also highlight homes with serious deficiencies and payment suspensions, which are strong warning signs.
Last updated: March 2026. Sources: CMS Nursing Home Compare, BLS, Genworth 2024.