My Mom (88) lives in a home she owns. Her only asset is her home. Must she sell?

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She can no longer live alone. Or can a lien be placed on it by the living facility?

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…and pay for the emergency tree service($$) when the ancient pecan tree at your parents homestead comes down across the neighbors yard.

Jeanne has given spot-on suggestions.

The NH is not at all interested in placing a lien on her home. NH is just not in the real estate business. But what they want & fully expect is to to be paid for their services. For about 70% of the elderly who need a NH, they apply for Medicaid. Really even with mid-6 figures in assets - at 5K - 15K a month for NH care - their $$ will run out. If they live long enough, unless they are generationally wealthy, they will just flat run out of $$ and apply for Medicaid.

Medicaid in most states allows for the homeowner to have the homestead property as an exempt asset. As Jeanne said, there will be no money to maintain it. Under Medicaid rules, they must do a co-pay or their "SOC" (share of cost) of all their monthly income to the NH. They are allowed to keep a small ($ 35 - 90 a mo) personal needs allowance. But it is only enough to pay for beauty shop, some clothing replacement, phone or cable costs. There will be none - nada - zilch to pay for anything on the exempt home for the rest of the elders lifetime. If family can afford and has the sense of humor to essentially have & maintain the home for whatever the rest of the parents life AND there is something about the situation that will meet the requirements for a MERP exemption, then keeping the home can make sense. But most families decide to sell the parents home.

If you do this, really imho, you need to do it asap so that you have the proceeds from the sale to private pay for the NH from the outset (allows you to perhaps get into a better facility that will take future Medicaid residents based on 1 - 2 years of living there); also enables you to buy a NCV funeral & burial policy; pay for services that will not be covered by Medicaid (like dental care, eyeglasses, better hearing aids). Whatever you do, if you sell the house, all the proceeds from the house sale must be used for their care & their needs. The sale will be recorded by the local tax assessor & then dovetailed into the state records. So Medicaid will find out to the penny the funds paid on the home. If you need to pay for things on the property to make it sellable, you really need to have some sort of document on the costs which you enter into the Realtor / act of sale agreement so that you can be reimbursed from the proceeds. Otherwise the state will look at it as a gifting transfer and can do a transfer penalty on the amount before Medicaid will pay. It all is a lot to consider, so take your time and do things that work best for all in the long run. Good luck.
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I take it she is planning on moving into a care center of some kind. If she doesn't sell the house, what will happen to it? Who will pay the taxes, insurance, maintain the property, rake, shovel, etc.?

Do you have an approximate idea of the value of the house? If she sold it, after all the costs of selling are deducted, how long would that money last in the care center? For example, if she clears $120,000 on the sale and the center costs $6,000 a month, it would pay for 20 months. Of course, her monthly income would make a difference, too. If she has $1,000 available each month to pay toward the care center, then the house money would last a full 2 years.

What will happen when the money runs out? If the house money would last 2 years and she lives 7 years, then what?

For many people the answer is to apply for Medicaid. Medicaid does not require the house to be sold, but she would have no money available to maintain it. Also the state would have a right to the proceeds to repay their expenses after her death.

I think if you provide a few more details about your Mom's situation, you will get more specific responses.
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