Last updated 2026-07-23
TL;DR
Assisted living provides housing plus help with bathing, meds, and meals for people who don't need daily medical care. A nursing home (skilled nursing facility) provides licensed nursing care around the clock for people with serious medical or rehab needs. Medicare doesn't pay for assisted living room and board, and only covers short nursing home stays after a qualifying hospital stay.
What is assisted living, and what is an assisted living facility?
Assisted living is a residential option for people who need help with some daily tasks but don't need round-the-clock medical care. An assisted living facility is the actual building or licensed program where that happens: usually private or semi-private apartments, a shared dining room, common areas, and staff on-site to help with bathing, dressing, medication reminders, and getting around. The National Institute on Aging describes these communities as designed for people who need some assistance with daily activities but want to keep as much independence as possible [1]. Here's the part people miss: assisted living is not a federally defined category. There's no single national license. Each state sets its own name, rules, and bed caps for this kind of care, which is why you'll see the same basic model called a personal care home in one state, a residential care facility in another, and an adult foster care home somewhere else. If you're researching a specific state's rules, start with that state's own assisted living facility licensing page rather than assuming national standards apply. What ties all the versions together is the philosophy: help with activities of daily living (ADLs), not medical treatment. Staff aren't typically required to be nurses. Many facilities do have a nurse on staff or on call, but the core service is custodial support, not clinical care.
What is a nursing home?
A nursing home, also called a skilled nursing facility (SNF), is a licensed medical facility that provides 24-hour nursing care, physician oversight, and rehabilitation services like physical, occupational, and speech therapy. It's built for people recovering from surgery or a hospital stay, or for people whose ongoing medical needs (wound care, IV medication, feeding tubes, ventilator support) are too complex for a residential setting. Nursing homes that accept Medicare or Medicaid have to meet federal requirements, more than state ones. Those requirements live in 42 CFR Part 483, and one specific rule tells you how different this is from assisted living: a certified nursing facility must "use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week" . Assisted living has nothing close to that federal floor. Nursing homes also get graded publicly. CMS runs a Five-Star Quality Rating System through its Care Compare tool, scoring facilities on health inspections, staffing levels, and clinical quality measures [2]. There's no equivalent national rating system for assisted living, because there's no single national regulator behind it.
What is the difference between assisted living and a nursing home?
| Level of care | Help with ADLs, meds, meals | 24-hour skilled nursing, rehab | |
|---|---|---|---|
| Staffing | Aides, often no RN required 24/7 | RN required 8+ hrs/day, 7 days/week | |
| Regulation | State licensing only | State licensing + federal CMS certification | |
| Typical stay | Months to years | Short-term rehab (days to weeks) or long-term | |
| Medicare coverage | Generally none | Short stays, conditions apply [3] | |
| Medicaid coverage | Varies by state, usually services only | Mandatory benefit in all states [4] | |
| Public quality rating | No national system | CMS Five-Star via Care Compare [2] | Some facilities blur the line on purpose. "Enhanced" or "assisted living with nursing" tiers exist in several states, and memory care units inside assisted living campuses handle dementia care that in another state might require a nursing home. Always confirm with your state licensing agency what a specific license tier actually permits, because the label on the door doesn't guarantee the level of care inside. |
The short version: assisted living is residential support for people who are mostly independent. A nursing home is medical care for people who need a nurse nearby at all times. Everything else (cost, regulation, who pays, how long people stay) flows from that one distinction. | Factor | Assisted living | Nursing home (SNF) |
What is a group home, and how is it different from assisted living or a nursing home?
A group home is a small residential setting, often a regular single-family house, licensed to serve a limited number of people who need support but not hospital-level care. Group homes serve a much wider range of populations than assisted living alone: people with intellectual or developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, and small numbers of frail seniors under an adult foster care model. Under federal fair housing law, group homes for people with disabilities are treated as a residential use of property, not a business use, which is why zoning boards can't simply ban them from single-family neighborhoods. HUD's fair housing guidance addresses this directly for group living arrangements [5]. That protection is a big part of why group homes can operate in areas where a large assisted living facility never could. Size is the other defining feature. Many states cap small group homes and adult foster care homes at somewhere between 4 and 16 residents, while a licensed assisted living facility can run into the dozens or hundreds of beds. Exact caps and license names vary a lot, so confirm with your state licensing agency before assuming a number. If you're comparing the plural assisted living facilities model against a small group home model for your own project, bed count and population served are usually the two variables that decide which license category you actually fall under.
What does assisted living provide day to day?
Assisted living covers the practical stuff that starts to feel unmanageable when someone can't quite do it alone anymore. That typically includes help bathing, dressing, and using the bathroom; medication reminders or supervised self-administration; three meals a day plus snacks; housekeeping and laundry; transportation to appointments; and organized social or recreational activities. Most facilities also provide 24-hour staff availability for emergencies and an emergency call system in each unit, even if the person answering that call isn't a nurse. That's the detail people get wrong most often: staff presence around the clock is not the same thing as skilled nursing around the clock. What assisted living generally does not provide is ongoing medical treatment: IV therapy, wound care beyond basic first aid, ventilator management, or the kind of monitoring someone needs after major surgery. States set acuity limits (sometimes called "negotiated risk" or "level of care" rules) that determine when a resident's needs have outgrown what an assisted living license allows, at which point a move to a nursing home becomes a real conversation. If you're researching options for a specific person, the assisted living overview covers how those acuity thresholds typically get set.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or personal care portion of assisted living. Medicare.gov is direct about this in its long-term care guidance, stating that Medicare doesn't cover custodial care "if that's the only care you need" . Assisted living, by design, is mostly custodial care, so it falls outside what Medicare pays for in almost every case. Where Medicare does show up is on the nursing home side, and even then only under narrow conditions. Medicare Part A can cover a stay in a Medicare-certified skilled nursing facility after a qualifying inpatient hospital stay of at least three days. Coverage runs up to 100 days per benefit period: the first 20 days are covered in full, and days 21 through 100 require a daily coinsurance payment that changes every year (it was $204 per day in 2024), and it stops entirely after day 100 [3]. That coinsurance number resets annually, so check the current figure on Medicare.gov before budgeting around it. Medicaid works differently and matters more for long-term stays. Nursing facility care is a mandatory Medicaid benefit in every state for people who meet financial and medical eligibility [4]. Assisted living services (not room and board) can sometimes be covered through a state's Medicaid Home and Community Based Services (HCBS) waiver, but availability, waiting lists, and covered services vary a lot by state [6]. This funding gap, Medicaid reliably pays for nursing home care but only sometimes and only partially pays for assisted living, is one of the biggest reasons families end up choosing a nursing home even when a loved one's medical needs don't strictly require it.
How much does assisted living cost compared to a nursing home?
Nationally, assisted living runs cheaper than nursing home care, and a private nursing home room costs more than a shared one. Genworth's 2023 Cost of Care Survey put the national median monthly cost of assisted living at $5,350, a semi-private nursing home room at $8,669, and a private nursing home room at $9,733 [7]. Those are national medians, and real costs swing hard by state and even by metro area. Rural facilities in lower cost-of-living states can run well under those medians; some coastal metro areas run well above them. There's no shortcut around checking local pricing directly with facilities and your state's Medicaid agency, because national averages won't tell you what a specific county actually charges. One more cost wrinkle worth flagging: assisted living pricing structures vary. Some facilities charge one flat monthly rate; others charge a base rate plus add-on fees tied to a resident's specific care needs (a "levels of care" pricing model). Nursing homes are more likely to bill a flat daily or monthly rate that already reflects a higher baseline of included medical service.
How do you decide which one you or a family member actually needs?
The honest answer is that it comes down to a level-of-care assessment, not personal preference. If someone needs help with two or three ADLs (bathing, dressing, toileting) but doesn't need daily skilled medical treatment, assisted living usually fits. If someone needs a feeding tube, IV medication, frequent wound care, or has a medical condition requiring constant nursing judgment, that points toward a nursing home. For anyone being considered for a Medicaid- or Medicare-certified nursing facility who has a serious mental illness or intellectual disability, federal law requires a Preadmission Screening and Resident Review (PASRR) before admission, specifically to confirm a nursing home is actually the appropriate setting and more than the most available one [8]. That screening exists because states have historically over-placed people with behavioral health needs into nursing homes when a lower-acuity, community-based setting would have served them better. Dementia adds a wrinkle to this decision. Many assisted living communities run dedicated memory care units for residents with Alzheimer's or related dementia, and those units can handle a fair amount of cognitive decline without a move to a nursing home, as long as the person's physical medical needs stay manageable. Once physical health complications stack on top of advanced dementia, though, a nursing home level of nursing coverage often becomes the safer call.
How do you start a group home?
Starting a group home is closer to opening a small, heavily regulated business than starting a facility from scratch, and the process runs through your state licensing agency from day one, not a national body. In broad strokes, the path looks like this: pick the population you'll serve (IDD, mental health, recovery, or adult foster care for seniors), confirm the specific license category and bed cap your state uses for that population, secure a property that meets zoning and fire/life-safety code, write your policy and procedure manual, build a staffing plan with required background checks and training hours, and submit your license application with the required fee and inspection. Zoning is where a lot of first-time operators get stuck. Group homes for people with disabilities are generally protected under federal fair housing law as a residential use, and cities can't use zoning to exclude them outright, but that doesn't mean every property qualifies automatically. Fire code, occupancy limits, parking, and spacing rules between similar facilities still apply and vary by jurisdiction, so confirm zoning requirements directly with your local planning department before signing a lease. Building this paperwork stack from scratch, application forms, sample policy manuals, staffing templates, self-inspection checklists, is where most of the real time gets burned, and it's exactly the gap our $299 State Group Home Licensing Kit is built to close: state-specific starting documents instead of a blank page. It doesn't replace your state's own application or guarantee approval; no one can promise that, and any state or vendor claiming otherwise should raise a flag.
What licensing and inspection differences should operators expect between the two models?
If you're choosing between opening an assisted living or group home versus a nursing home, understand you're choosing between two very different regulatory worlds. Assisted living and most group homes are licensed at the state level only. Nursing homes that want to bill Medicare or Medicaid need that state license plus federal certification, which means passing a CMS survey process, meeting the RN staffing requirement in 42 CFR 483.35 , employing a medical director, and submitting to the ongoing Five-Star inspection and rating system on Care Compare [2]. That federal layer is a real barrier to entry. It means more staffing costs, more required clinical positions, more paperwork, and a slower, more expensive path to opening. It's also why most people entering this field for the first time start with an assisted living or group home license rather than a nursing home: the capital, staffing, and clinical infrastructure requirements are dramatically lower. Inspections differ too. Assisted living and group home inspections typically focus on life safety code, staff training records, medication management logs, resident care plans, and background check compliance, run by your state licensing agency. Nursing home inspections add federal survey elements: clinical quality measures, staffing ratio verification, infection control protocols, and resident rights compliance under CMS rules. Either way, the inspection is not optional and not a formality; states can and do cite, fine, or shut down facilities that fail to meet their license conditions.
Frequently asked questions
What is assisted living?
Assisted living is residential care for people who need help with daily tasks like bathing, dressing, and medication reminders, but don't need 24-hour skilled nursing care. It's housing plus support, not a medical facility. Each state licenses and names this care category differently, so specific rules, staffing requirements, and bed caps vary by state.
What is a group home?
A group home is a small residential setting, often a house, licensed to serve a limited number of people needing support with daily living, commonly people with intellectual or developmental disabilities, mental health conditions, or substance use recovery needs. Bed caps and license names vary widely by state; confirm specifics with your state licensing agency.
What is an assisted living facility?
An assisted living facility is the licensed building or program where assisted living care happens: private or shared apartments, common dining and activity areas, and staff available to help residents with daily tasks and medication reminders. It's licensed and regulated at the state level, not by a single federal agency.
What is the difference between assisted living and a nursing home?
Assisted living provides help with daily activities in a residential setting, without required around-the-clock nursing staff. A nursing home provides licensed 24-hour skilled nursing care, physician oversight, and rehab services, and must meet federal certification rules if it accepts Medicare or Medicaid. Cost, staffing, and regulation all differ sharply between the two.
Does Medicare cover assisted living facilities?
No, Medicare does not cover the room, board, or custodial care costs of assisted living. Medicare Part A only covers a limited nursing home (skilled nursing facility) stay after a qualifying hospital stay, up to 100 days per benefit period, with coinsurance kicking in after day 20. Check Medicare.gov for the current coinsurance amount, since it changes yearly.
What does assisted living provide?
Assisted living typically provides help with bathing, dressing, and toileting; medication reminders; three daily meals; housekeeping and laundry; transportation; social activities; and 24-hour staff availability with emergency call systems. It does not provide ongoing skilled medical treatment like IV therapy or complex wound care.
How do I start a group home?
Pick the population you'll serve, confirm the exact license category and bed cap your state licensing agency requires for that population, secure a compliant property, build staffing and policy plans, complete required training and background checks, and submit your license application with the required inspection and fee. Timelines and requirements vary a lot by state.
Does Medicaid pay for assisted living or nursing homes?
Nursing facility care is a mandatory Medicaid benefit in every state for people who meet eligibility rules. Assisted living services (not room and board) may be covered through a state's Medicaid Home and Community Based Services waiver, but availability and waiting lists vary widely by state, so this needs direct confirmation with your state Medicaid agency.
Which costs more, assisted living or a nursing home?
Nursing homes cost more nationally. Genworth's 2023 Cost of Care Survey found a national median monthly cost of $5,350 for assisted living, $8,669 for a semi-private nursing home room, and $9,733 for a private nursing home room. Actual local costs vary significantly by state and metro area.
Can a nursing home resident move to assisted living?
Yes, if their medical needs decrease enough that they no longer require 24-hour skilled nursing care, a resident can transition to assisted living. This move typically requires a new level-of-care assessment and, for Medicaid-certified residents with mental illness or intellectual disability, may involve PASRR review before any nursing facility placement or transfer decision.
Is a group home the same thing as assisted living?
Not exactly. Group homes often serve smaller populations (IDD, mental health, recovery) and cap far fewer residents than a typical licensed assisted living facility, though states differ in how they classify small group and adult foster care homes. In some states a small group home is licensed under the same broad assisted living statute; in others it's a separate category entirely.
What is PASRR and why does it matter for nursing home placement?
Preadmission Screening and Resident Review (PASRR) is a federally required screening for anyone being considered for a Medicaid-certified nursing facility who may have a serious mental illness or intellectual disability. It confirms the nursing home is the appropriate setting rather than a lower-acuity, community-based option, and applies before admission and periodically afterward.
Sources
- National Institute on Aging, "Residential Care Facilities, Assisted Living, and Nursing Homes": Definition and purpose of assisted living communities
- Medicare.gov, "Skilled Nursing Facility (SNF) Care": Medicare Part A coverage rules and 100-day benefit period for SNF stays
- Medicaid.gov, "Home & Community Based Services": Medicaid HCBS waivers may cover assisted living services, coverage varies by state
- Medicaid.gov, "Nursing Facilities": Nursing facility care is a mandatory Medicaid benefit in all states
- CDC National Center for Health Statistics, National Post-acute and Long-term Care Study (NPALS): National data on long-term care providers including residential care and nursing homes
- HUD, Office of Fair Housing and Equal Opportunity: Group homes for people with disabilities are protected as residential use under fair housing law
- Genworth, Cost of Care Survey 2023: National median monthly costs for assisted living and nursing home care
- Medicaid.gov, Institutional Long-Term Care / PASRR: Preadmission Screening and Resident Review requirement before nursing facility admission
- Electronic Code of Federal Regulations, 42 CFR Part 483: Federal requirement for RN coverage at least 8 hours a day, 7 days a week in certified nursing facilities
- Medicare.gov, "Long-term care": Medicare does not cover custodial care if that is the only care needed