Assisted living is for people who need help with daily tasks like bathing, dressing and medications but don't need round-the-clock medical care. A nursing home provides 24-hour nursing care and supervision for people with serious health needs, and it costs much more. The right choice depends mostly on how much medical care your parent needs each day, not on age or diagnosis.
The short version
- Assisted living: a private apartment or room, meals, help with personal care and medications, activities and 24-hour supervision. Licensed by the state. Usually paid privately. National median: $6,200 a month in 2025.
- Nursing home: 24-hour nursing care, three meals a day, help with daily activities, and rehab such as physical, occupational and speech therapy. Federally certified and inspected if it takes Medicare or Medicaid. Often paid by Medicaid for long stays. National median: about $9,581 a month for a shared room in 2025.
Cost figures here come from the CareScout Cost of Care Survey for 2025. Prices vary a lot by state, so treat national numbers as a rough guide.
Level of care
The National Institute on Aging (NIA) describes assisted living as being "for people who need help with daily care, but not as much help as a nursing home provides." Residents usually have their own apartment or room and share common areas like a dining room. Services can include up to three meals a day, personal care, help with medications, housekeeping, laundry, 24-hour supervision and social activities. Most communities offer several levels of care, and residents pay more as they need more help.
Nursing homes, also called skilled nursing facilities, provide a much wider range of health and personal care. NIA lists nursing care, 24-hour supervision, three meals a day, help with daily activities, and rehabilitation services. Some residents stay a few weeks to recover after a hospital stay; others live there long term because they need ongoing nursing care.
Staffing
This is one of the clearest differences.
Nursing homes
Nursing homes that take Medicare or Medicaid must meet federal staffing rules. Under 42 CFR 483.35, a facility must have sufficient nursing staff on a 24-hour basis, use a registered nurse for at least 8 consecutive hours a day, 7 days a week, have a full-time registered nurse as director of nursing, and designate a licensed nurse as charge nurse on every shift. Some of these rules can be waived in limited cases.
Assisted living
There is no single national staffing standard for assisted living. Each state writes its own rules. A federal review of state regulations (the 2015 Compendium of Residential Care and Assisted Living Regulations, from the U.S. Department of Health and Human Services) found that 40 states required training for direct care workers, with required hours ranging from 1 to 80. Whether a nurse is on site varies from one community to the next, so ask each one exactly who is in the building overnight and when a nurse is available.
Licensing, inspections and oversight
Assisted living is regulated by states
The same HHS compendium states that residential care settings, including assisted living, "are licensed and regulated at the state level." Every state has at least one type, but the names and rules differ. California, for example, licenses Residential Care Facilities for the Elderly. That means what a community can and cannot do, from medication help to dementia care, depends on your parent's state.
Nursing homes are federally certified
To receive Medicare or Medicaid payment, a nursing home must comply with federal requirements in 42 CFR Part 483. According to CMS, a state surveyor must complete a standard health survey, a Life Safety Code survey and an emergency preparedness survey for certification, and these surveys are unannounced. CMS rates nursing homes from one to five stars on health inspections, staffing and quality measures, and publishes the ratings on Medicare's Care Compare site. CMS also cautions that ratings should be used alongside a visit and other sources.
Every nursing home page on Pairlo links to its CMS inspection record, so you can see fines and inspection findings before you visit.
Resident protections differ
Federal rules give nursing home residents specific protections. Assisted living protections come from state law and vary. In Maryland, for example, the court-sponsored People's Law Library notes that assisted living residents don't have the same involuntary-discharge protections as nursing home residents, though the community must generally give at least 30 days' written notice before an involuntary discharge. In every state, the free long-term care ombudsman program advocates for residents of nursing homes, assisted living and board and care homes.
Cost and who pays
What it costs
Here are the 2025 national medians from the CareScout survey:
- Assisted living: $6,200 a month ($74,400 a year), private one-bedroom
- Nursing home, semi-private room: $315 a day, about $9,581 a month
- Nursing home, private room: $355 a day, about $10,798 a month
State differences are large. Assisted living ran from about $4,369 a month in Mississippi to about $12,096 in Hawaii. A shared nursing home room ran from about $5,627 a month in Texas to about $27,831 in Alaska.
Assisted living bills also climb as care needs grow, since communities typically charge more for higher levels of care. For a parent with rising needs, the gap between assisted living and a nursing home can narrow over time.
Who pays
- Medicare does not pay for assisted living or long-term custodial care. It covers up to 100 days in a skilled nursing facility per benefit period after a qualifying inpatient hospital stay of at least 3 days, if your parent needs daily skilled care. In 2026, days 1 to 20 cost $0 after the Part A deductible, and days 21 to 100 cost $217 a day.
- Medicaid must cover nursing home care for eligible adults 21 and older, and states cannot put it on a waiting list. KFF reports over 60% of nursing home residents had Medicaid as their primary payer as of July 2024. For assisted living, Medicaid coverage depends on the state and often comes through waiver programs that may cover services but not room and board.
- Private funds and long-term care insurance pay for most assisted living. NIA notes most residents pay the full cost themselves, and some long-term care insurance policies cover part of it.
Our guide on whether Medicare pays for assisted living goes through each option, including veterans benefits.
How to tell which one your parent needs
Start with what a typical day looks like. Assisted living may fit if your parent:
- Needs help with a few daily tasks, like bathing, dressing or managing pills
- Can move around on their own or with a walker, or needs only light help with transfers
- Is lonely, isn't eating well, or can't keep up with a house
- Has a stable health condition that doesn't need a nurse's attention each day
A nursing home may be the better fit if your parent:
- Needs daily skilled nursing, such as wound care, IV medications or frequent monitoring
- Needs two people or a lift to get out of bed
- Has complex medical conditions that change quickly
- Is recovering from a hospital stay and needs daily rehab (often a short-term stay)
Talk to your parent's doctor, and ask the hospital discharge planner if there has been a recent stay. Assisted living communities assess new residents too. Ask whether your parent's needs fit what the community is licensed to provide. If your parent is likely to need more care soon, ask a community what happens when needs grow: some can add services, others will require a move.
The in-between options
Memory care
Memory care is care designed for people with Alzheimer's or other dementia, often in a separate unit of an assisted living community or nursing home. NIA notes that some facilities offer special programs for people with dementia, and the HHS compendium found just over half of residential care settings with 50 or more units had a dementia care program or unit (2012 data). Expect to pay more: California advocacy group CANHR notes that higher rates are common for dementia care. Ask how staff are trained and how the unit keeps residents safe.
Board and care homes
NIA describes board and care homes (also called residential care facilities or group homes) as small private facilities, usually with 20 or fewer residents. They provide personal care and meals with staff available around the clock, but usually not nursing or medical care. For a parent who does better in a quiet, home-like setting, they can be a good middle ground. Residents generally pay out of pocket, and Medicaid may cover part of the cost in some states.
Continuing care retirement communities
These campuses offer independent living, assisted living and skilled nursing in one place, so residents can move between levels as needs change. NIA notes most charge a one-time entrance fee, which can be expensive, plus a monthly fee.
Practical next steps
- Write down your parent's daily needs. List what they need help with, how often, and any medical care. Share it with their doctor.
- Shortlist both types. Search communities and nursing homes near your parent, or browse by state. For nursing homes, look at the CMS star ratings and inspection history.
- Visit at least two of each type if you are unsure. Bring our touring checklist and ask who is on site at night.
- Get the paperwork ready. Admission moves fast after a hospital stay. Our documents checklist covers what you will need.
- Get help on the ground. If you live far away, an aging life care manager can assess your parent and recommend the right level of care. Find a care manager near your parent.
