Assisted living vs nursing home: what's the difference?

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By Nursing Homes In Each State · Published October 31, 2026 · Last updated October 31, 2026

Levels of care

The biggest difference is how much medical and nursing care each one gives.

Assisted living is for people who can live fairly independently but need help with some daily activities, such as bathing, dressing, managing medicines or getting to meals. Staff are available around the clock for help and safety, but there may not be a nurse on site at all times. What a community is allowed to do, and for whom, depends on state rules and the community's own license.

Nursing homes provide 24-hour care, with licensed nurses on every shift, a registered nurse on site at least 8 hours a day, a physician overseeing each resident's care, and therapy on site. They care for people who need help with most daily activities, who have complex medical needs, or who are recovering from a hospital stay. Most also run short-term rehab.

Who pays

Medicare doesn't pay for long-term care in assisted living or in a nursing home. Medicare.gov says Medicare and most health insurance "don't pay for long-term care services," and the Congressional Research Service notes that Medicare doesn't cover long-term services in assisted living. The one exception is in nursing homes: Medicare Part A can cover a short skilled nursing stay, up to 100 days, after a qualifying hospital stay. See Does Medicare pay for nursing home care?

Medicaid is required to cover nursing home care for eligible adults 21 and older, in homes certified for Medicaid. For assisted living, it's different. Some states use Medicaid to pay for personal care and other services in assisted living, often through waiver programs with limited slots, but Medicaid doesn't pay for room and board there. Your state Medicaid office can tell you what is available.

Private payment covers most assisted living and much nursing home care, from savings, income, family help or long-term care insurance. Prices vary widely by area and by home, and CMS doesn't publish them, so ask each place for its current monthly or daily rate in writing, and what is and isn't included.

Regulation and inspections

Every nursing home that takes Medicare or Medicaid must meet federal requirements covering residents' rights, care planning, staffing, infection control and more. State inspectors check each home on CMS's behalf, usually about once a year and whenever a complaint comes in. The results are public, and CMS publishes star ratings, staffing levels and inspection findings for every certified home. That is the data on this site.

Assisted living works differently. The Congressional Research Service puts it simply: assisted living facilities "are licensed and regulated by states," and "the federal government has not set minimum ALF quality or staffing standards." Rules on staffing, training, what care can be given and how often communities are inspected differ from state to state. Some states post inspection reports online; others don't. To check an assisted living community, contact your state's licensing agency and ask for its most recent inspection results and any complaints.

Signs it may be time for a nursing home

This is a decision to make with the person's doctor and care team, but these are common reasons families start looking at nursing homes rather than assisted living:

• The person needs nursing care that can't be scheduled, such as frequent medication changes, wound care, oxygen, or a feeding tube.
• They need help from one or two people to get out of bed, move around or use the bathroom.
• Falls or hospital stays are becoming more frequent.
• An assisted living community says it can no longer meet their needs, which often happens as dementia or mobility problems progress.
• They need rehab after a hospital stay before they can safely go home or back to assisted living.

Many families try assisted living first and move to a nursing home later. Others use a short nursing home stay for rehab and then move to assisted living. If the move may become long-term and Medicaid could be needed later, choose a nursing home that is certified for Medicaid from the start.

How to check a nursing home

1. Start with the CMS record. Every certified home has star ratings for inspections, staffing and quality, explained in our star ratings guide.
2. Read the inspection findings, not just the stars, and check whether CMS lists the home as a Special Focus Facility or shows its abuse icon.
3. Compare staffing with the state median and look at staff turnover. Each home's page here shows both.
4. Visit more than once, including an evening or weekend, and talk with residents and families if you can.
5. Ask about payment: Medicare and Medicaid certification, the daily private rate, and what happens if savings run out.

You can compare up to four homes side by side or start from the state list below. For more on how these homes are certified, read What is a skilled nursing facility?

More guides

• Does Medicare pay for nursing home care?

  What Medicare covers in a nursing home in 2026, the 3-day hospital rule, what you pay on days 21 to 100, and where Medicaid comes in.

• What is a skilled nursing facility?

  What "skilled nursing facility" means, how it differs from a nursing home and rehab, who works there, and how CMS rates them.

• Nursing home star ratings, explained

  How CMS builds the overall star from inspections, staffing and quality measures, with the live national spread of ratings.

Last updated October 31, 2026. Figures about nursing homes on this page come from the CMS Provider Data Catalog, October 2026, and update when CMS releases new data. Rules and dollar amounts are from the government sources listed above and can change; check them before you rely on them. Not medical, legal or financial advice. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report an error.