Tennessee Nursing Homes 2026, Costs, Quality, and How to Choose

Tennessee has roughly 304 licensed nursing homes as of the Health Facilities Commission's most recent annual inspection report. They range from top-quality nonprofit homes integrated with major health systems to chronically understaffed facilities with repeat serious deficiencies. For families making a placement decision, usually 24 to 72 hours after a parent has been hospitalized, the difference between those two extremes is enormous.

This guide covers what nursing home care actually costs in Tennessee in 2026, how Medicare and TennCare pay, how to read CMS Five-Star quality ratings, what the Tennessee Health Facilities Commission's inspection reports tell you, and the specific red flags and green flags to look for on a facility tour.

By Brevy Care Team · Last verified May 3, 2026

The Cost Reality

Tennessee nursing homes are expensive, but meaningfully less expensive than the national average. Statewide 2026 figures:

Two cost notes families regularly miss:

1. Nashville is the highest private-pay market in the state. Memphis runs slightly less in median terms, but private-room costs there can rival Nashville. Knoxville and Chattanooga are reliably the lowest among the four major metros.

2. TennCare reimburses about $294.87 per day, while private payers pay $300–$380 per day. That gap, roughly $30 to $85 per day, means private-pay residents effectively subsidize Medicaid residents in mixed-payer facilities. It's also why some facilities limit the share of beds available to Medicaid applicants. The cost of care does not change whether you pay through TennCare, the VA, long-term care insurance, or out of pocket; the price tag the facility quotes you, however, generally reflects the private-pay rate.

For the full Medicaid eligibility framework (Qualified Income Trust, Personal Needs Allowance, Minimum Monthly Maintenance Needs Allowance, Community Spouse Resource Allowance, the 5-year look-back, and the $294.87/day penalty divisor), see the Tennessee Medicaid Nursing Home Coverage guide.

Who Pays for a Nursing Home in Tennessee

Five funding sources cover Tennessee nursing facility stays. Most long-stay residents move through more than one over time.

Medicare (Short-Term, Post-Hospital Only)

Medicare Part A covers up to 100 days of skilled nursing facility care after a qualifying 3-day inpatient hospital admission. The structure:

• Days 1–20: Medicare pays 100%.
• Days 21–100: Member pays a daily coinsurance ($217/day in 2026).
• Day 101 and beyond: Medicare pays nothing.

Medicare pays only when the beneficiary has a skilled care need, skilled nursing, physical therapy, occupational therapy, speech therapy, and is showing measurable progress. It is post-acute rehab funding, not long-term custodial care funding. Most residents who need to stay long-term transition from Medicare to private pay or to TennCare.

A persistent source of confusion: a Medicare Advantage plan may set different cost-sharing or require prior authorization for SNF days, and some plans use "observation" status (Medicare Part B outpatient) rather than admitting through Part A, which can disqualify the patient from the post-hospital SNF benefit. Always ask the hospital case manager whether the parent is admitted as inpatient or being held for observation before counting on Medicare SNF coverage.

Private Pay

Direct payment from savings, investments, Social Security, pensions, and home-sale proceeds. Most families who start private-pay eventually spend down to TennCare after a few years; at $9,700–$10,500/month, even substantial assets deplete quickly.

Long-Term Care Insurance

Policies purchased before a care need arose. Benefits vary; typical individual policies pay $150–$350/day for a defined benefit period (commonly 3 to 5 years), and many policies have an elimination period of 90 days before benefits begin. Hybrid life-insurance/LTC policies are increasingly common.

Tennessee participates in the Long-Term Care Partnership Program, which protects assets equal to the LTC insurance benefits paid out from later Medicaid spend-down, a meaningful planning tool for middle-class families with a partnership-qualified policy.

TennCare CHOICES Group 1 (the primary long-term funding source)

TennCare's CHOICES Group 1 is the open-entitlement nursing facility benefit. Eligibility requires:

• Functional eligibility (NF Level of Care): A score of 9 or more points on the TennCare PAE Acuity Scale (transfer/mobility, eating, toileting, orientation, communication, medication self-administration, dementia behaviors, plus skilled-services items). The Pre-Admission Evaluation (PAE) is submitted by a physician, nurse practitioner, clinical nurse specialist, or PA; the AAAD or MCO Care Coordinator can submit on the applicant's behalf.
• Financial eligibility: Monthly income up to $2,982 (300% of the 2026 SSI Federal Benefit Rate), countable assets up to $2,000 individual / $3,000 couple, home equity exclusion up to $752,000, with CSRA up to $162,660 and MMNA between $2,643.75 and $4,066.50/month for the at-home spouse. Applicants over the income limit can establish a Qualified Income Trust (the TN equivalent of a Miller Trust).
• Patient liability: A Group 1 nursing facility resident keeps a Personal Needs Allowance (PNA) of $70/month plus deductions for Medicare premiums, MMNA for the community spouse, and certain other obligations; the remainder of monthly income is owed to the facility as patient liability.

CHOICES Group 1 is the funding mechanism that keeps the lights on for most long-term Tennessee nursing home residents. Most facilities that accept Medicaid have a substantial majority of their residents on TennCare. See the TennCare CHOICES guide for the full eligibility framework, and the TN Medicaid Nursing Home guide for the full LTC mechanics.

VA Benefits (for Eligible Veterans)

For service-connected veterans and some others, the VA covers nursing facility care through three pathways: VA Community Living Centers (operated directly by the VA), contract community nursing homes, and Tennessee State Veterans Homes. Tennessee operates five State Veterans Homes with a sixth under construction:

• Murfreesboro (140 beds, on the Alvin C. York VA Medical Center campus)
• Knoxville, the Ben Atchley Home (140 beds)
• Clarksville, the Brigadier General Wendell H. Gilbert Home (108 beds)
• Humboldt, the W.D. "Bill" Manning Home
• Cleveland

A sixth home is under construction at Arlington (West Tennessee). Eligibility generally requires honorable discharge, Tennessee residency, and a demonstrated need for skilled nursing or rehabilitation. Cost is offset by the federal VA per-diem payment for eligible veterans plus, for some, TennCare or Medicare. State Veterans Homes are persistently underutilized in Tennessee, many veteran families don't know they exist.

Regulatory Oversight

Tennessee nursing homes are regulated by overlapping state and federal authorities:

• Tennessee Health Facilities Commission (HFC), the state regulator, replacing the former TN Department of Health Board for Licensing Health Care Facilities (BLHCF) when LTC oversight migrated to HFC in mid-2024. Many third-party guides and even some hospital discharge materials still cite the old regulator. Rules are now codified at Chapter 0720-37 (formerly 1200-08-06).
• CMS (federal), for Medicare and Medicaid certification, the Five-Star Quality Rating System, and standard surveys at least every 15 months under 42 CFR §488.308. The HFC contracts with CMS as the State Survey Agency.
• The federal Nursing Home Reform Act of 1987 (42 USC §§1395i-3, 1396r; regulations at 42 CFR Part 483 Subpart B), setting the federal floor on resident rights and minimum standards.
• The Nursing Home Compassion, Accountability, Respect and Enforcement Reform Act of 2003 (Tenn. Code §68-11-810), which directs the HFC to publish an annual Nursing Home Inspection and Enforcement Activities Report to the Governor and General Assembly.
• Tenn. Code §68-11-901 et seq., Tennessee's resident-rights statutory umbrella.
• The Tennessee Adult Protection Act (Tenn. Code §71-6-101 et seq.), making suspected abuse, neglect, or exploitation of an adult mandatorily reportable for healthcare professionals to TN Adult Protective Services at 888-277-8366.

The HFC inspects every Tennessee nursing facility at least annually for state license purposes. Federal Medicare-certified facilities receive standard surveys at least every 15 months. Complaint-driven surveys may occur at any time. Inspection results are public.

Reading CMS Five-Star Ratings

CMS publishes Nursing Home Compare at medicare.gov/care-compare. Every Medicare-certified nursing home is rated on a 1-to-5-star scale across four domains plus an overall rating:

• Health Inspections. Based on the three most recent state inspections, weighted by recency and severity of deficiencies.
• Staffing. Nurse and aide hours per resident day, adjusted for resident acuity.
• Quality Measures. Outcomes such as pressure ulcers, falls, hospitalizations, and resident-reported metrics.
• Overall Rating. A weighted combination of the three.

Read the rating carefully. A 5-star Overall with a 2-star Health Inspection means quality measures look good but recent inspections found problems. A 2-star Overall facility usually means look elsewhere unless you know something the rating doesn't.

What Inspection Deficiencies Mean

CMS and HFC inspection reports categorize deficiencies by scope and severity on an A-through-L grid. Severity rises from no actual harm to immediate jeopardy; scope rises from isolated to widespread.

• A–C: Minimal to no harm; isolated to widespread.
• D–F: Actual harm that was not serious.
• G–I: Actual harm or substandard quality of care.
• J–L: Immediate jeopardy to resident health or safety.

Any G-or-above finding in the last year is a red flag. Two or more G-or-above findings in two years is a serious red flag. Per the HFC's most recent annual report, approximately 88 of Tennessee's 304 nursing homes had at least one G-or-above deficiency in the reporting window, about 29 percent. That figure is one of the strongest reasons to read the inspection report before touring, not just after.

You can pull the official Statement of Deficiencies (CMS-2567) from Nursing Home Compare for any Medicare-certified facility. The HFC facility lookup at internet.health.tn.gov/facilitylistings returns license number, bed count, and date of most recent survey for every TN-licensed facility; the full state survey reports can be requested from the facility or the HFC under public records.

Choosing a Facility: The Tour

Tours are the strongest signal of facility quality. Schedule tours at multiple facilities, visit at different times of day (mid-morning is common; visit at 4 PM and on a weekend if you can), and bring a family member or trusted friend. The right tour is roughly two hours and includes both a structured walk-through and quiet observation.

Before the Tour

• Pull the CMS Five-Star rating from medicare.gov/care-compare.
• Pull the most recent CMS Statement of Deficiencies (CMS-2567).
• Look up the facility on the HFC database at internet.health.tn.gov/facilitylistings for license, bed count, and most-recent-survey date.
• Read online reviews skeptically, they tend to overrepresent both highly satisfied and highly aggrieved families. Treat them as anecdote, not evidence.
• Call the Tennessee Long-Term Care Ombudsman at 877-236-0013 and ask whether the facility has had recent complaint patterns.

During the Tour

Sensory checks.

• Is there a consistent odor of urine in resident hallways? One bad day happens; a pervasive smell signals understaffing and hygiene gaps.
• Is the lighting adequate, and are common areas welcoming and clean?
• Are call lights visible and being answered promptly (within roughly 5 minutes)?

Staff interaction.

• Do staff greet residents by name?
• Are residents being attended to, or left alone in hallways?
• Is the activities program active, actual people participating, not just a calendar on the wall?
• Ask the tour guide directly: "What is the ratio of nursing assistants to residents on the day shift, evening shift, and overnight?"

Resident signals.

• Do residents look clean, well-groomed, appropriately dressed?
• Do residents seem engaged with each other and with staff?
• Are residents positioned properly in wheelchairs (not slumped, not restrained)?

Facility questions to ask the administrator and director of nursing.

• How long has the director of nursing been in this role? How long has the administrator?
• What is the annual staff turnover rate? (Aim for under 50% nurse-aide turnover; over 70% is concerning. Industry benchmarks place median nursing-home aide turnover above 100% nationally, so a facility reporting much lower is unusually stable.)
• How does the facility handle a resident's decline, hospital transfers, hospice integration, end-of-life conversations?
• What happens when a resident runs out of funds and converts to Medicaid? The correct answer is "nothing changes." Federal law (42 CFR §483.15(c)) prohibits discharging a resident for converting from private pay to Medicaid. Any equivocation is a serious red flag.
• May I see the most recent resident and family satisfaction survey results?
• May I see the most recent CMS Statement of Deficiencies and the facility's plan of correction?

Red Flags

• Frequent ownership changes in the last 5 years.
• New administrator or director of nursing in the last 6 months.
• History of G-or-above deficiencies, especially in the last 12 months.
• Staff turnover above 70% annually.
• Heavy use of agency / temporary staff.
• Pressure to sign move-in paperwork before reading it.
• Insistence that you private-pay for a fixed period before applying for Medicaid.
• Dismissiveness about specific dietary, religious, or care preferences.
• Refusal to share the most recent CMS-2567.

Green Flags

• Long-tenured staff, especially at the DON and administrator levels.
• Low nurse-aide turnover.
• Recent inspection with minimal or no serious deficiencies.
• Active, visible, engaged activities program (residents in groups, not parked).
• Ombudsman has a good working relationship with facility leadership.
• Residents who greet visitors or interact in common areas.
• Staff who knock before entering resident rooms.
• Transparent willingness to walk through the deficiency report with you.

The Tennessee Long-Term Care Ombudsman

Every state has a federally required Long-Term Care Ombudsman program under the Older Americans Act (§§711–712). Tennessee's program is housed at the Department of Disability and Aging (DDA) and is programmatically independent, it cannot be directed by the facility or by TennCare.

• State Long-Term Care Ombudsman: Teresa Teeple
• Statewide complaint line: 877-236-0013
• Local district structure: Nine district programs covering all 95 counties through the Area Agencies on Aging and Disability (AAADs)

The ombudsman is independent, free, and confidential. They are an advocate for the resident's wishes, not the family's wishes, not the facility's policies. They can help with:

• Disputes about care, services, or billing
• Complaints about staff conduct
• Concerns about quality or safety
• Involuntary discharge situations
• Resident-rights violations

In FFY 2023 (the most recent published annual report), Tennessee's ombudsman program received 4,582 complaints, a record high, and made 4,492 facility visits with roughly 17.5 FTE district ombudsmen statewide and 63 volunteer ombudsmen contributing 1,661 hours. The Institute of Medicine's recommendation for Tennessee's facility population is closer to 30 FTE; TN is the only state in its region without dedicated state funding for the program. The ratio works out to roughly 3,356 LTC beds per FTE ombudsman, the worst in the region. Use the program; advocate for it being better resourced when you can.

The ombudsman has jurisdiction over nursing homes, assisted-care living facilities, residential homes for the aged, and adult care homes, about 700 facilities and 60,000 licensed beds across the state. Most Tennessee families don't know the ombudsman exists. They should. Call before there is a crisis.

Memory Care Within Nursing Homes

Some Tennessee nursing homes operate secured Alzheimer's care units under historic standards at Tenn. Comp. R. & Regs. 0720-18-.07 (carried forward under the HFC). Features typically include:

• Locked or alarmed doors to prevent wandering (with required egress procedures)
• Staff specifically trained in dementia care, with annual in-service training documented
• Lower staff-to-resident ratios in the secured unit
• Sensory-friendly environment design
• Annual reporting to HFC covering interdisciplinary team review, deaths, hospitalizations, incidents, staffing patterns, and group activities
• Required interdisciplinary team membership: physician with dementia experience, social worker, registered nurse, and family member or patient advocate

A secured memory care unit is a special-services unit within a nursing facility license, not a separate license. The cost is generally the same as standard nursing home care because the resident's primary need is skilled nursing with memory support. For dementia care outside a nursing facility setting (memory care within an assisted living building, for example), see the upcoming Tennessee Memory Care guide and the Tennessee Assisted Living guide.

Transitioning Out: Money Follows the Person

Placement in a nursing facility is not always permanent. Tennessee runs the federal Money Follows the Person (MFP) demonstration, federally funded through September 30, 2027. TN's implementation is unusually strong: rather than running MFP as a separate program with its own paperwork (the model in many other states), TennCare integrates MFP enrollment directly with CHOICES, eligible residents enroll in both simultaneously, ensuring continuous HCBS coverage after the 365-day federal MFP participation period ends.

To qualify, the resident must:

1. Have lived in a qualified institution (nursing facility, ICF/IID, or regional mental health institute) for at least 60 days.
2. Have care needs that can be safely met in the community.
3. Be Medicaid-eligible (or eligible at the point of transition).

A Transition Coordinator, typically the MCO Care Coordinator (an RN or social worker), develops the transition plan, conducts an in-home safety evaluation, and makes quarterly face-to-face visits post-transition. Historical KFF data showed Tennessee transitions averaged 31 days from initiation to relocation, well below the 3.5-month national average, with reinstitutionalization rates around 10%. In 2025, TennCare added a $50 million HCBS provider capacity investment over 5 years to expand the community service workforce.

If your loved one was placed in a nursing facility under crisis conditions and now wants to come home, ask the MCO Care Coordinator about MFP and CHOICES. The path exists; it is materially underused.

Avoiding Placement in the First Place

For families trying to avoid nursing facility placement entirely, Tennessee has several community alternatives that can make staying at home viable:

• CHOICES Group 2, TennCare's HCBS at home, including personal care, attendant care, home modifications, respite, adult day, home-delivered meals, and personal emergency response systems. Group 2 is enrollment-capped (~12,500 historical slots) with a waitlist; "At Risk" Group 3 is a lower-acuity preventive bridge.
• Paid family caregivers via the agency route, under Public Chapter 182 (the Freedom for Family Caregiving Act of 2025, fully effective July 1, 2025), TennCare-contracted home care agencies can hire a relative, including spouses and parents of minor children, as a W-2 Direct Support Worker. The act prohibits TennCare and DDA from blocking the hire on six specific bases (family relationship, shared residence, recipient age, parental or spousal status, which TennCare program the recipient is enrolled in, or the relative's other unrelated caregiver employment). Consumer Direction rules are unchanged, so spouses, conservators, and powers of attorney remain ineligible under that route. See the Tennessee paid family caregiver guide for the full framework.
• Assisted living with VA Aid & Attendance, a wartime veteran or surviving spouse may receive an Aid & Attendance pension that helps fund AL services. See the Tennessee Assisted Living guide.
• Private-duty home care paid from LTC insurance or savings.
• PACE (Programs of All-inclusive Care for the Elderly), Tennessee has exactly one PACE site as of 2026: Ascension Living Alexian PACE at 425 Cumberland Street, Chattanooga, serving Hamilton County only. Adults 55+ who meet nursing facility level of care and live in the service area receive integrated Medicare + Medicaid coverage with all care coordinated by an 11-discipline interdisciplinary team, no premiums, copays, or cost sharing if Medicaid-eligible. 2024 SB 459 / HB 416 attempted statewide expansion but did not pass as a standalone public chapter. Outside Hamilton County, PACE is not currently available in Tennessee.

For the full set of community-based alternatives, see the Tennessee caregiver programs hub.

Common Misconceptions

"Medicare will pay for my mom's nursing home indefinitely." It will not. Medicare's SNF benefit caps at 100 days, requires a qualifying 3-day inpatient hospital admission, and stops the moment skilled need or measurable progress ends. Long-term nursing home care is funded by TennCare, private pay, LTC insurance, or VA benefits, not Medicare.

"All Tennessee nursing homes are basically the same." They are not. The CMS Five-Star ratings, HFC inspection reports, and ombudsman complaint patterns document significant variation. The gap between a top-tier and a bottom-tier Tennessee nursing home is real, measurable, and worth driving an extra 30 minutes to access.

"Once on Medicaid, the facility can evict us." Federal law (42 CFR §483.15(c)) prohibits a nursing home from discharging a resident solely because they convert from private pay to Medicaid. Any facility that threatens this is in violation of federal law; report immediately to the Tennessee Long-Term Care Ombudsman at 877-236-0013 and to the HFC complaint line at 877-287-0010.

"The facility will tell me what I need to know." Facilities are sales organizations during the move-in process. The CMS Five-Star rating, the HFC inspection report, the ombudsman conversation, and direct observation of residents are stronger signals than the marketing tour.

"Online reviews tell me what the facility is really like." Online reviews are a weak signal. A mix of five-star raves and one-star horror stories often reflects selection bias rather than typical experience. Inspections and ombudsman conversations are better.

"The estate will lose the home to TennCare." TennCare estate recovery is real but is probate-only in Tennessee, the state does not file lifetime liens (no TEFRA liens), recoveries under $10,000 are released automatically, and surviving-spouse, minor-child, and disabled-child exemptions are mandatory. Hardship waivers exist for sibling and adult-child caregivers who lived in and provided care in the home. The full mechanics are in the Tennessee Medicaid Nursing Home guide.

Related Terms

• Nursing Facility Level of Care (NFLOC): The clinical eligibility test for TennCare nursing home coverage; assessed via the TN PAE Acuity Scale, 9+ points required.
• Activities of Daily Living (ADLs): The functional measures (bathing, dressing, toileting, transferring, eating, continence) that drive much of the PAE score.
• HCBS Waiver: TennCare CHOICES Groups 2 and 3 are the primary HCBS alternatives to nursing facility placement.

Learn More

• Tennessee Medicaid Nursing Home Coverage
• TennCare CHOICES
• Tennessee Medicaid Programs
• How to Apply for TennCare
• Tennessee Assisted Living
• Tennessee Caregiver Programs
• How to Get Paid as a Family Caregiver in Tennessee

Find personalized help choosing a Tennessee nursing home at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Facility quality, costs, and regulatory status change. Always verify current details with the facility directly, the CMS Five-Star rating, the HFC inspection report, and the Tennessee Long-Term Care Ombudsman. Brevy is not a law firm, financial advisor, or healthcare provider.