Assisted living is housing with help: a private apartment or room, meals, and help with daily tasks such as bathing, dressing and medications. A nursing home is a health care setting with licensed nurses on duty around the clock, for people who need medical care or close supervision every day.
Medicare pays for neither as long-term care. Medicaid pays for nursing homes for people who qualify, and only for some care services in assisted living, depending on the state.
Side by side
| Assisted living | Nursing home | |
|---|---|---|
| Who it is for | People who need help with daily care, but not as much as a nursing home provides (National Institute on Aging) | People who need nursing care and 24-hour supervision, or rehabilitation after a hospital stay |
| Living space | Usually a private apartment or room, with shared common areas | Usually a shared or private room in a clinical setting |
| Typical services | Up to three meals a day, personal care, help with medications, housekeeping, laundry, 24-hour supervision and security, activities | Nursing care, 24-hour supervision, three meals a day, help with everyday activities, physical, occupational and speech therapy |
| Medical staff | Varies by state and by community. Many do not have a nurse on site at all hours | Licensed nurses on duty; care is planned and supervised by health professionals |
| Who sets the rules | Each state licenses and inspects assisted living. Rules, and even the name of the license, vary by state | The state licenses nursing homes. Homes that take Medicare or Medicaid must also meet federal requirements and are inspected by a state survey agency |
| Where to check quality | The state licensing agency's inspection reports | Medicare's Care Compare (star ratings, staffing, inspections) and the state survey agency |
| Medicare | Does not pay (Medicare.gov) | Does not pay for long-term stays. Can cover up to 100 days of skilled nursing care after a qualifying hospital stay (Medicare.gov) |
| Medicaid | May pay for some care services (not room and board), depending on the state and eligibility | Pays for eligible people in a Medicaid-certified nursing facility (Medicaid.gov) |
| Relative cost | Less expensive than a nursing home, more than living independently (National Institute on Aging) | Generally the most expensive setting |
The question that decides it: what care is needed every day?
Families often compare the buildings. The more useful comparison is the care. Write down what your parent needs help with on a normal day and at night, then compare that list with what each place is licensed and staffed to do.
- Help with daily tasks (bathing, dressing, getting to meals, reminders to take medicines): this is the core of assisted living.
- Nursing tasks every day (wound care, injections, tube feeding, managing several unstable conditions) or help from two people to move: this is usually beyond what assisted living may provide under its state license.
- Wandering, getting lost or unsafe at night because of dementia: look at memory care units, which can be part of assisted living or of a nursing home.
- Recovering after a hospital stay (for example, rehabilitation after a fall): a short stay in a skilled nursing facility is common, and Medicare may cover it if the conditions are met.
The doctor, the hospital discharge planner and the facility's own admission assessment will all weigh in. Ask each one what level of care they think is needed and why.
Who pays, in more detail
Medicare
Medicare does not pay for long-term care, also called custodial care, in any setting. That includes assisted living and long-term stays in a nursing home (Medicare.gov). What Medicare Part A can cover is a limited stay in a skilled nursing facility after an inpatient hospital stay of at least 3 days in a row, when daily skilled care is needed. In 2026, days 1–20 cost $0 after the Part A deductible, and days 21–100 cost $217 a day (Medicare.gov). See Does Medicare pay for a nursing home? for the full rules and a calculator.
Medicaid
Medicaid pays for nursing home care for people who meet its income and asset rules, in a home that the state survey agency has certified as a Medicaid nursing facility. Many people move to Medicaid after paying privately for a while, and often they do not have to change nursing homes when that happens (Medicaid.gov).
For assisted living, Medicaid does not pay rent or meals. Many states use home- and community-based services (HCBS) programs, often called waivers, to pay for some of the care services instead (Medicaid.gov). Each state decides whether it does this, who qualifies and how many places are available.
Paying privately
Most people pay for assisted living themselves, and many pay for at least part of a nursing home stay. Some long-term care insurance policies cover part of the cost (National Institute on Aging). Veterans and surviving spouses may be able to get help through VA programs.
How to check a specific place
- Nursing home: look it up on Care Compare for its star ratings, staffing and inspection results. Read the inspection report itself, not just the stars.
- Assisted living: ask for the state license number and find the inspection reports on the state licensing agency's website.
- Both: visit more than once, at different times of day, including a meal. Ask for the contract and the list of reasons a resident can be asked to leave.
- Your local Area Agency on Aging, which you can find through the Eldercare Locator, can tell you about local options and the long-term care ombudsman, who helps residents with complaints.
Costs vary a lot by state and by the level of care. We do not publish a price we cannot source. Ask each place for its full price list, including what raises the monthly rate as care needs grow.
Common questions
Is a nursing home the same as a skilled nursing facility?
The terms overlap. The National Institute on Aging uses "nursing home" and "skilled nursing facility" for the same kind of place. Medicare uses "skilled nursing facility" (SNF) for short-term skilled care it covers after a hospital stay. Medicaid uses "nursing facility" for long-term care in a home it has certified. Many buildings are certified for both.
Can someone with dementia live in assisted living?
Often, yes, especially in the earlier stages. Some assisted living communities have a separate memory care unit. What a community may accept depends on its state license and its own policies, so ask for the move-out criteria in writing before signing.
Does Medicaid pay for assisted living?
Not for room and board. In many states a Medicaid home- and community-based services (HCBS) program can pay for some of the care services in assisted living, for people who qualify. Eligibility and waiting lists differ by state.
Who inspects assisted living?
The state. There is no federal license for assisted living, so the agency, the name of the license and the inspection reports differ from state to state. Ask the community for its license number and look it up on the state agency website.
Related guides
Sources
- Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care, National Institute on Aging (NIH). Checked November 7, 2026.
- Long-term care, Medicare.gov. Checked November 7, 2026.
- Skilled nursing facility care, Medicare.gov. Checked November 7, 2026.
- Nursing Facilities, Medicaid.gov. Checked November 7, 2026.
- Home & Community-Based Services, Medicaid.gov. Checked November 7, 2026.
- Care Compare, Medicare.gov. Checked November 7, 2026.
- State Survey Agency contact information, CMS. Checked November 7, 2026.
- Eldercare Locator, U.S. Administration for Community Living. Checked November 7, 2026.
This guide explains general rules. It is not medical, legal or financial advice for your situation. Program rules and amounts change, usually each January (Medicare and Medicaid) and each October (VA). Confirm details with the agency or a qualified professional before you decide. See our editorial policy.