Guides › Care guide
The two are regulated by different governments, paid for by different money, and staffed at completely different levels. Choosing the wrong one is the most common and most expensive mistake families make.
| Assisted living | Nursing home (skilled nursing) | |
|---|---|---|
| Who it's for | Needs help with daily activities — bathing, dressing, medication reminders — but is medically stable | Needs skilled nursing or rehabilitation: wound care, IV therapy, post-surgical recovery, complex conditions |
| Nursing on site | Varies by state and facility; often no 24-hour licensed nurse | Licensed nursing 24 hours a day, RN coverage required |
| Regulated by | State licensing agencies only — no federal standard | Federal (CMS) plus the state, with standardized inspections |
| Public ratings | None. Records vary by state | Five-star ratings, inspection records, staffing data, all public |
| Typically paid by | Private funds; Medicaid waivers may cover services, not room and board | Medicare (short-term rehab only), Medicaid (long-term), private funds |
| Facilities in the US | About 30,600 | 14,693 Medicare/Medicaid-certified |
Ask what happens at 3 a.m. If the answer requires a licensed nurse — a catheter, oxygen management, a wound that needs assessment, unpredictable medical instability — that is skilled nursing. If the answer is help getting to the bathroom, reminders, and someone noticing if something is wrong, assisted living can do that, and does it in a far less institutional setting.
Memory care is a third category, usually a secured unit inside either type, priced above the base rate. A dementia diagnosis alone does not require a nursing home; behavior and medical complexity do.
Because nursing homes are federally regulated, you can read every inspection citation, every fine, staffing levels from payroll data, and who owns the company — all before your first visit. For assisted living, the same questions are answerable only in states that publish good records: Florida publishes complaints, sanctions, fines, and severity-classified deficiencies; Texas and Virginia publish inspection findings per facility; several states publish almost nothing.
This is not a reason to avoid assisted living. It is a reason to do more of your own checking: start with your state's records, and ask the facility directly for its most recent inspection report — a facility that hesitates has told you something.
Needs change, and many families end up in both within a couple of years — often through a hospital stay that triggers Medicare-covered rehab in a skilled nursing facility. Two things worth knowing in advance: many assisted living communities cannot keep a resident whose needs exceed their license category, and a rehab stay is a chance to evaluate a nursing home from the inside before any long-term decision.
Before either move, check the specific building: nursing home records by state · assisted living records.
Substantially, usually roughly half. Assisted living is room, board, and personal care; a nursing home is 24-hour licensed clinical care, and the staffing cost drives the difference. Actual prices vary widely by state and by level of care needed.
No. Medicare does not pay for room and board in assisted living. It covers short-term skilled nursing care after a qualifying hospital stay, which is a different service in a different kind of facility.
Often yes, especially in a dedicated memory care unit. The deciding factors are medical complexity, wandering and exit-seeking behavior, and whether the facility's state license permits that level of care.
Neither category is safer as a category — individual facilities vary far more than the two types do. The difference is that you can verify a nursing home's record in detail before choosing, and in most states you can verify far less about an assisted living facility.
Records for 14,693 nursing homes and 5,584 assisted living facilities: search by name or city · browse by state · by ownership group.
This guide is general information from public sources, not medical, legal, or financial advice. Program rules and dollar figures change annually and vary by state — verify with Medicare.gov, your state Medicaid agency, or a certified elder law attorney before acting.