Nursing home vs. assisted living: care, cost and who pays
Key takeaways
- A nursing home provides 24-hour nursing care and is inspected under federal rules. Assisted living provides housing, meals and help with daily tasks, and is licensed by each state.
- The 2025 national median cost is $6,200 a month for assisted living and $9,581 a month for a semi-private nursing home room.
- Medicare does not pay for long-term stays in either. Medicaid covers nursing home care in every state; help with assisted living depends on the state.
- Federal star ratings and inspection records exist for nursing homes, not for assisted living.
The two are often mentioned together, but they are different kinds of places. A nursing home is a health care facility with nurses on duty day and night. Assisted living is a place to live, with staff who help with meals, medicines and daily tasks.
How do they compare?
| Topic | Nursing home | Assisted living |
|---|---|---|
| Care | Nursing care 24 hours a day, therapy, help with all daily activities | Housing, meals, help with daily activities and medicines; limited nursing |
| Who it suits | People who need a nurse's care every day or help from staff for most activities | People who are mostly independent but need some daily help |
| Who regulates it | Federal rules for homes certified by Medicare or Medicaid, plus state licensing | Each state, under its own rules and names |
| Public record | CMS star ratings, staffing hours, inspection results and fines | No federal ratings; what is public depends on the state |
| Median cost, 2025 | $9,581 a month, semi-private room | $6,200 a month |
| Medicare | Short-term skilled care only, up to 100 days | Does not pay for room and board |
| Medicaid | Covers nursing home care in every state for people who qualify | Depends on the state |
Costs are national medians from the CareScout Cost of Care Survey, 2025. Prices vary widely by state and by the care a person needs.
Which level of care fits?
The question is how much nursing care a person needs, not how old they are. A doctor, a hospital discharge planner or your state's Medicaid assessment can tell you which level of care is appropriate. In general:
- Assisted living is designed for people who can move around with little help and need support with things like meals, bathing, housekeeping and remembering medicines.
- A nursing home is designed for people who need daily care from licensed nurses, such as wound care, injections, tube feeding or close monitoring, or who need staff to help them with most daily activities.
Where does memory care fit?
Rules for memory care are set by each state. A memory care unit usually operates under an assisted living license or a nursing home license, sometimes with extra state requirements. The Alzheimer's Association describes special care units as settings where people living with dementia are grouped on a floor or unit within a larger residential care building. Ask any memory care unit which license it operates under, because that decides the rules it follows and who can pay.
What about a community that has both?
A continuing care retirement community offers independent living, assisted living and a nursing home on one campus, so a resident can move between levels of care. CMS flags nursing homes that are part of one, and this site shows that flag on the home's page.
Why does this site list only nursing homes?
Because the federal government publishes facility-level data for nursing homes but not for assisted living. Assisted living is licensed by the states, each with its own rules and its own level of public reporting, so there is no national record to show.
Next: what Medicare covers and how Medicaid pays for a nursing home.