Guide
Nursing Home vs Assisted Living: What’s the Difference?
Published Feb 18, 2026
TL;DR
Nursing homes provide 24/7 skilled medical care for people with serious health conditions. Assisted living helps mostly independent seniors with daily activities like bathing, dressing, and medication management. Nursing homes cost roughly twice as much (~$8,000/month vs ~$4,500/month) and are federally regulated, while assisted living is regulated at the state level.
What Is a Nursing Home?
A nursing home (also called a skilled nursing facility or SNF) provides round-the-clock medical care and supervision for people who cannot care for themselves due to chronic illness, disability, or recovery from surgery or injury.
Nursing homes are staffed with registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). Federal law requires at least one RN on-site 24 hours a day and a physician available for medical direction. Residents receive help with all activities of daily living (ADLs) plus skilled medical services such as wound care, IV therapy, physical therapy, and medication administration.
Every nursing home that accepts Medicare or Medicaid is inspected by CMS and must meet federal quality and safety standards. CareGrader grades every one of these facilities from A to F using this government inspection data.
What Is Assisted Living?
Assisted living facilities provide housing, meals, and help with activities of daily living (ADLs) for seniors who are mostly independent but need some regular assistance. ADLs include bathing, dressing, grooming, toileting, eating, and mobility.
Assisted living typically offers a more residential, apartment-style environment. Staff are trained caregivers rather than licensed nurses, though many facilities have a nurse on-call or available during business hours. Residents manage their own medications with reminders, enjoy communal dining, and participate in social activities.
Unlike nursing homes, assisted living facilities are regulated entirely at the state level. There are no federal standards, and the definition of “assisted living” varies from state to state. This means quality and services can vary significantly depending on where the facility is located.
Who Is Each Option Best For?
Nursing Home
- Requires daily skilled medical care (wound care, IV therapy, ventilator)
- Recovering from surgery, stroke, or hip fracture (short-stay rehab)
- Advanced dementia requiring medical intervention
- Multiple chronic conditions needing 24/7 monitoring
- Cannot perform most ADLs without hands-on nursing assistance
Assisted Living
- Mostly independent but needs help with 1-3 ADLs
- Needs medication reminders but not clinical administration
- Wants a social environment with meals and activities
- Mild cognitive impairment or early-stage dementia
- No longer safe living alone (fall risk, forgetfulness)
Not sure which level of care is needed? Take our care assessment to get a personalized recommendation.
Side-by-Side Comparison
| Category | Nursing Home | Assisted Living |
|---|---|---|
| Level of Care | 24/7 skilled medical care from RNs, LPNs, and CNAs | Help with daily activities (bathing, dressing, meals, medication reminders) |
| Staffing | Licensed RN on-site 24/7; physician oversight required | Trained caregivers; nurse on-call or visiting; no 24/7 RN mandate |
| Typical Resident | Chronic conditions, post-surgical rehab, dementia requiring medical intervention | Mostly independent but needs help with some ADLs |
| Monthly Cost (Median) | $8,000 - $9,500 (semi-private room) | $4,500 - $5,000 |
| Medicare Coverage | Up to 100 days post-hospitalization for skilled nursing | Generally not covered |
| Medicaid Coverage | Covered in all states for eligible residents | Varies by state; limited waiver programs |
| Regulation | Federal CMS standards + state licensing | State-level only; no federal standards |
| Inspection Data | CMS publishes inspections, staffing, quality measures, and penalties | State-dependent; often not publicly available |
| Setting | Clinical/institutional; shared or private rooms | Residential; private apartments or suites |
| Average Length of Stay | ~835 days (long-term); 22 days (short-stay rehab) | ~22 months |
Cost Comparison
Cost is often the most immediate concern for families. The difference is significant:
Nursing Home (semi-private)
~$8,000
per month (national median)
Assisted Living
~$4,500
per month (national median)
These are national medians. Costs vary dramatically by state and metro area. A private room in a nursing home in New York or Connecticut can exceed $14,000/month, while the same room in Louisiana or Oklahoma may cost under $6,000/month.
Assisted living costs can also increase significantly if a resident needs memory care (add $1,000-$3,000/month) or additional personal care hours. Always ask about the base rate versus the all-in cost.
Medicare & Medicaid Coverage
Medicare
Medicare covers skilled nursing facility (nursing home) stays for up to 100 days following a qualifying 3-day hospital stay. Days 1-20 are fully covered. Days 21-100 require a daily copay ($204.50 in 2025). After day 100, Medicare coverage ends entirely. Medicare does not cover long-term custodial care in a nursing home and does not cover assisted living at all.
Medicaid
Medicaid is the primary payer for long-term nursing home care in America, covering roughly 60% of all nursing home residents. Eligibility is based on income and asset limits, which vary by state. All states are required to cover nursing home care for Medicaid-eligible individuals.
For assisted living, Medicaid coverage is limited and inconsistent. Some states offer Home and Community-Based Services (HCBS) waiver programs that can help pay for assisted living, but these programs often have long waiting lists and strict eligibility requirements.
Regulation & Transparency
One of the most important differences between nursing homes and assisted living is how they are regulated and how much data is publicly available.
Nursing homes that accept Medicare or Medicaid must meet federal standards set by CMS. They undergo regular unannounced inspections, submit verified staffing data through the Payroll-Based Journal (PBJ) system, and report quality measures. All of this data is publicly available, which is what makes tools like CareGrader possible.
Assisted living facilities are regulated at the state level only. There are no federal standards, no standardized inspections, and no national database of quality data. Some states have robust licensing and inspection programs; others have minimal oversight. This makes it significantly harder for families to compare assisted living facilities objectively.
How to Decide Which You Need
The decision comes down to one core question: does your loved one need skilled medical care on a daily basis?
- Assess the care needs. List what your loved one needs help with. If the list includes clinical tasks (wound care, injections, catheter management, physical therapy), a nursing home is likely necessary. Use our care assessment tool for a structured evaluation.
- Consider the trajectory. Is the condition stable, improving, or declining? Someone recovering from a hip replacement may need short-term nursing home rehab before transitioning to assisted living or home. Someone with progressive dementia may need to plan for a nursing home in the near future.
- Evaluate the finances. Determine what you can afford out-of-pocket, what insurance covers, and whether Medicaid is an option. Estimate costs and check Medicaid eligibility.
- Visit facilities in person. Data tells you a lot, but nothing replaces walking through a facility, talking to staff, and observing how residents are treated.
- Check the data. For nursing homes, review the facility’s CareGrader grade, inspection history, staffing levels, and quality measures before making a decision.
Frequently Asked Questions
Can someone transition from assisted living to a nursing home?
Yes, this is one of the most common transitions in senior care. As a resident's medical needs increase -- for example, after a stroke, a fall resulting in a hip fracture, or advancing dementia -- they may require 24/7 skilled nursing that assisted living cannot provide. Many families start with assisted living and move to a nursing home when the level of care needed exceeds what assisted living staff can deliver.
Does Medicare pay for assisted living?
No. Medicare does not cover assisted living costs. Medicare only covers skilled nursing facility stays for up to 100 days following a qualifying hospital stay of at least 3 days. Assisted living is typically paid out-of-pocket, through long-term care insurance, or in some states through Medicaid waiver programs. Use our Medicaid eligibility tool to check if your state offers assisted living coverage.
How do I know if my parent needs a nursing home or assisted living?
The key question is whether your parent needs skilled medical care on a daily basis. If they require wound care, IV therapy, ventilator management, or round-the-clock monitoring of a serious medical condition, a nursing home is appropriate. If they are mostly independent but struggle with daily tasks like bathing, dressing, managing medications, or cooking, assisted living is likely sufficient. Our care assessment tool can help you evaluate the right level of care.
Why are nursing homes so much more expensive than assisted living?
Nursing homes are more expensive primarily because of staffing requirements. Federal regulations require a licensed RN on-site 24 hours a day, plus additional LPN and CNA staff. Nursing homes also provide medical equipment, rehabilitation services, and manage complex clinical needs. The higher staff-to-resident ratio and medical infrastructure drive costs significantly above assisted living, where staff are trained caregivers rather than licensed nurses.
Are nursing home grades available for assisted living facilities?
CareGrader grades are currently available for Medicare/Medicaid-certified nursing homes because these facilities are required to report data to CMS. Assisted living facilities are regulated at the state level, and most states do not publish comparable inspection, staffing, or quality data. This is one reason why choosing an assisted living facility can be harder -- there is less public data to evaluate quality.