Last updated 2026-07-23
TL;DR
Assisted living and nursing homes both offer housing and support for older adults, but they aren't interchangeable. Assisted living covers help with daily tasks like bathing and meals in a home-like setting; nursing homes provide 24-hour skilled nursing care for people with serious medical needs. Medicare doesn't pay for either as long-term room and board, though it may cover short-term rehab. Use the Eldercare Locator or Medicare Care Compare to find licensed options near you.
What is assisted living?
Assisted living is housing for adults, usually seniors, who need help with everyday tasks but don't need round-the-clock medical care. Residents typically have their own room or small apartment, eat meals in a shared dining room, and get help from staff with things like bathing, dressing, and taking medication on schedule. Think of it as a middle step between living alone and a nursing home. There's no single federal definition of assisted living. It's licensed and regulated at the state level, and the rules (and even the name) differ a lot from state to state. Some states call it "assisted living," others use "personal care home," "residential care facility," or "community-based residential facility." The National Center for Assisted Living notes that assisted living communities operate under state-specific licensing and regulatory frameworks rather than one national standard. That's exactly why searches for "assisted living nursing homes near me" get confusing results. Google is trying to answer two different questions at once: what kind of care does my family member actually need, and which licensed places nearby provide it. If you're an operator instead of a family member, this distinction matters even more, because it decides which license category you apply for. For a state-by-state look at how licensing categories are defined, see our guide to assisted living.
What is an assisted living facility?
An assisted living facility (often shortened to ALF) is the physical building and licensed program where assisted living happens. It's usually a residential-style building with private or semi-private rooms, common areas, a dining room, and staff on site 24 hours a day for supervision and help, though not necessarily a nurse around the clock. The National Institute on Aging describes assisted living as providing help with daily activities such as bathing, dressing, and managing medications, along with meals, housekeeping, and social activities, all within a home-like setting [1]. Some ALFs are large campuses with 100-plus beds. Others are small houses licensed for six to ten residents that look just like the house next door. Both fall under "assisted living" in most state statutes, though the paperwork, staffing ratios, and inspection frequency can differ by size. If you're comparing specific facilities, it helps to know what license category they hold and what level of care that license actually permits. Some states cap the level of nursing care an ALF can provide before a resident has to move to a higher level of care. Our breakdown of assisted living facility licensing requirements and our state list of assisted living facilities categories walk through how states draw that line.
What is a group home?
A group home is a small, licensed residential setting where a limited number of people, often 4 to 10, live together and receive support from paid staff. Group homes serve a range of populations: seniors who need assisted-living-level care, adults with intellectual or developmental disabilities, people recovering from mental illness, and people in addiction recovery. The defining feature isn't the population, it's the scale. Group homes are smaller and more residential than institutional facilities. Staffing is usually built around shifts rather than a large clinical team, and the home often looks like an ordinary single-family house from the street. That's part of why zoning fights over group homes happen so often; neighbors frequently don't realize a home is licensed until there's a state inspection car in the driveway. Medicaid can help pay for services delivered inside a group home for people who qualify, largely through Home and Community-Based Services (HCBS) authority, though it generally doesn't pay for the room and board itself [2]. If you're weighing a group home license against a larger assisted living license, our guide to facility assisted living models compares the two paths side by side.
What's the difference between assisted living and a nursing home?
| Medical staffing | Aides, medication techs; nurse on call in many states | Licensed nurses on site 24/7 | |
|---|---|---|---|
| Typical resident need | Help with bathing, dressing, meals, medication reminders | Wound care, IV therapy, rehab, dementia care requiring supervision | |
| Federal oversight | State licensed, no single federal standard | Federally certified under CMS Conditions of Participation for Medicare/Medicaid | |
| Medicare coverage | Not covered as long-term care [3] | Short-term skilled stays may be covered after a qualifying hospital stay | |
| Typical setting | Apartment-style or small residential home | Hospital-like rooms, higher staff-to-resident ratio | The National Institute on Aging frames nursing homes as the option for people who "need a lot of care" that can't safely be delivered at home or in a lower-care setting [4]. If a resident's needs grow past what an assisted living license allows, most states require a move-out or a step up to a higher license category. That threshold, and the exact wording of it, varies by state, so confirm the specific criteria with your state licensing agency before assuming a facility can keep a resident long term. |
The short version: assisted living helps with daily living tasks in a home-like setting, while a nursing home provides 24-hour skilled nursing care for people with serious medical needs, recovery from surgery, or advanced chronic illness. Nursing homes (also called skilled nursing facilities) are staffed with licensed nurses around the clock and are certified by CMS if they accept Medicare or Medicaid. Assisted living communities are not required to have a nurse on site at all times, and staff are generally not performing skilled medical procedures. | Feature | Assisted living | Nursing home |
What does assisted living actually provide day to day?
Assisted living typically provides help with what clinicians call "activities of daily living": bathing, dressing, toileting, mobility, and eating. Beyond that personal care, most communities include three meals a day, housekeeping and laundry, medication management or reminders, transportation to appointments, and organized social or recreational activities [1]. Staff are present 24 hours a day for supervision and emergency response, but that's different from skilled nursing care. Most states require a call system in every room and a written plan for how staff respond to falls or medical emergencies. Some states allow limited nursing tasks, like insulin administration or wound care, under specific licensing add-ons; others don't allow any of that under a base assisted living license. What a facility provides on paper and what it actually delivers day to day can differ. That's the whole reason state inspection reports exist. Before choosing a facility for a family member, or before deciding what services to build into your own license application as an operator, pull the last two years of inspection history from the state licensing agency. Repeated citations for missed medication passes or short staffing tell you more than any brochure will.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of living in an assisted living facility, and it doesn't pay for custodial care, meaning help with bathing, dressing, or supervision, when that's the only kind of care a person needs. Medicare.gov states plainly that Medicare doesn't cover long-term care, also called custodial care, "if that's the only care you need" [3]. What Medicare will cover, even for someone living in assisted living, is medically necessary care delivered separately: doctor visits, physical therapy, durable medical equipment, home health services ordered by a physician, or hospice care. None of that pays the monthly rent or care fee the facility itself charges. Medicaid is a different story, though it's still limited. Medicaid doesn't pay for room and board in assisted living either, but many states use Home and Community-Based Services waivers or state plan options to cover the personal care and supportive services delivered inside an assisted living setting for people who financially and medically qualify [2]. Coverage rules, waiver names, and waiting lists differ by state, so a family (or an operator planning to accept Medicaid residents) needs to check directly with the state Medicaid agency rather than assume national rules apply.
How do I find assisted living or nursing homes near me?
Start with two federal tools built for exactly this search. The Eldercare Locator, a public service supported by the Administration for Community Living, connects callers to local Area Agencies on Aging and licensed facility information by phone at 1-800-677-1116 or online. For nursing homes specifically, Medicare's Care Compare tool lets you search by ZIP code and see each facility's staffing levels, health inspection results, and quality ratings side by side. For assisted living, skip straight to your state licensing agency's public facility search, since that's the only place that reflects current license status and recent violations. Nearly every state health or social services department publishes a searchable database; the exact agency name (Department of Health, Department of Social Services, Office of Aging) varies, so confirm which one holds licensing authority in your state before trusting a third-party review site. Once you have a shortlist, call the Long-Term Care Ombudsman program in that state. Ombudsmen visit facilities regularly, handle complaints, and can tell you things an inspection report won't, like whether a facility is currently short-staffed or has high resident turnover. If you're researching senior-specific options close to home, our guide to senior assisted living facilities near me walks through how to read a state's public facility database.
How much does assisted living cost compared to a nursing home?
| Home health aide | $5,148 | |
|---|---|---|
| Assisted living facility | $4,500 | |
| Nursing home, semi-private room | $7,908 | |
| Nursing home, private room | $9,034 | Source: Genworth Cost of Care Survey, 2021 These are national medians from 2021, not current local prices; costs have risen since, and a rural county's rates can look nothing like a coastal metro's. Treat these numbers as a rough anchor for comparing care types against each other, not as a quote for any specific facility. If you're an operator building a rate sheet, pull current private-pay and Medicaid reimbursement rates for your specific county rather than relying on a national average. |
Assisted living generally costs less per month than a nursing home, but both run well into the thousands, and figures swing hard by region. Genworth's 2021 Cost of Care Survey, still the most widely cited national benchmark, put the median monthly cost of assisted living at $4,500, a semi-private nursing home room at $7,908, and a private nursing home room at $9,034. | Care type | Median monthly cost (national, 2021) |
How do I start a group home?
Starting a group home is a licensing project before it's a business project. The order matters: figure out which population you'll serve and which license category fits (assisted living, adult family care, IDD residential, mental health group home, or recovery residence), because that decision drives everything downstream, from staffing ratios to the physical building code. A rough sequence most states follow, though the agency names and exact steps vary: 1. Contact your state's licensing agency (often Department of Health, Department of Social Services, or a disability services office) to get the current application packet and fee schedule. 2. Confirm zoning for the property with your local planning department; residential zoning doesn't automatically permit a group home use. 3. Write your policy and procedures manual: admissions criteria, medication management, emergency response, grievance process, staff training plan. 4. Build a staffing plan that meets your state's minimum ratios and background check requirements. 5. Pass the pre-licensing inspection, which usually covers fire safety, health and sanitation, and physical plant requirements. 6. Submit the license application with required attachments and fees, then wait for the state's review period. Because every state writes its own rules, fee amounts, and forms, this is the part where a lot of first-time operators lose weeks re-submitting incomplete paperwork. That's the exact gap our $299 State Group Home Licensing Kit is built to close: state-specific application checklists, a policy manual template, and a staffing plan builder, so you're not guessing at what your state's application actually wants. You can start building yours at /licensing-kit-builder.
What licensing, staffing, and inspection requirements should I expect?
Every state requires some version of the same core pieces: a criminal background check for owners and staff, minimum staff-to-resident ratios (often stricter overnight than during the day), a set number of initial and ongoing training hours, and a physical building that passes fire marshal and health department review before a license is issued. What differs, sometimes a lot, is the specifics: exact ratio numbers, whether CPR certification is required before hire or within a grace period, how many hours of dementia-specific training staff need, and how often the state re-inspects (annually in many states, though some do it every two years or on a complaint basis). None of those numbers are safe to guess. Confirm the current ratios, training hour requirements, and inspection cycle with your state licensing agency directly, since these rules get updated through state legislative sessions and administrative rule changes more often than people expect. Once licensed, expect unannounced inspections. Inspectors typically check medication administration records, staff training files, fire drill logs, and resident care plans against what they observe in person. Facilities that keep clean, current documentation tend to have shorter, less stressful inspection days than ones scrambling to reconstruct records on the spot.
Frequently asked questions
What is assisted living?
Assisted living is a state-licensed residential option for adults who need help with daily tasks like bathing, dressing, and medication reminders but don't need 24-hour skilled nursing care. It combines housing, meals, and personal care support in a home-like setting. There's no single federal definition; each state sets its own licensing rules and terminology for assisted living [3].
What is a group home?
A group home is a small, licensed residential setting, usually housing 4 to 10 people, where paid staff provide support around the clock. Group homes serve seniors, adults with intellectual or developmental disabilities, people with mental illness, or people in addiction recovery, depending on the license type. They're generally smaller and more house-like than institutional facilities.
What is an assisted living facility?
An assisted living facility is the licensed building and program where assisted living care is delivered. It typically has private or semi-private rooms, a shared dining room, common areas, and staff on site 24 hours a day for supervision and personal care help, though not necessarily a nurse around the clock [4].
What is the difference between assisted living and a nursing home?
Assisted living helps with daily living tasks in a home-like setting with staff on hand but not around-the-clock nurses. A nursing home provides 24-hour skilled nursing care, certified by CMS, for people with serious medical needs, post-surgical recovery, or advanced chronic illness that can't be safely managed elsewhere [9].
What does assisted living provide?
Assisted living typically provides meals, housekeeping, medication management, help with bathing and dressing, transportation to appointments, social activities, and 24-hour staff supervision. It does not typically include skilled nursing procedures like IV therapy or wound care unless the state license specifically allows added services [4].
How do I start a group home?
Pick the population you'll serve and the matching state license category, confirm the property is zoned for a group home use, write a policy and procedures manual, build a compliant staffing plan, pass the pre-licensing fire and health inspection, then submit your application to the state licensing agency. Exact steps, fees, and forms vary by state.
Does Medicare cover assisted living facilities?
No. Medicare does not pay for the room, board, or custodial care costs of assisted living. Medicare.gov states it doesn't cover long-term care "if that's the only care you need" [1]. Medicare may still cover separate medically necessary services, like doctor visits or home health, delivered to someone living in assisted living.
Does Medicaid pay for assisted living?
Medicaid generally doesn't cover room and board in assisted living, but many states use Home and Community-Based Services waivers to cover personal care and support services delivered inside assisted living for people who qualify financially and medically [2]. Coverage varies by state, so check directly with the state Medicaid agency.
How do I find assisted living or nursing homes near me?
Call the Eldercare Locator at 1-800-677-1116 or use its website to connect with local aging services [7]. For nursing homes, use Medicare's Care Compare tool to search by ZIP code and compare staffing and inspection ratings [8]. For assisted living, check your state licensing agency's public facility database for current license status.
What's the difference between a group home and an assisted living facility?
The main differences are size and population focus. Group homes are usually smaller (often 4 to 10 residents) and can serve seniors, people with developmental disabilities, mental illness, or recovery needs. Assisted living facilities skew toward seniors and range from small homes to large campuses with 100-plus residents, all under a state-specific license.
How much does assisted living cost compared to a nursing home?
Nationally, Genworth's 2021 Cost of Care Survey put median assisted living at $4,500 a month, a semi-private nursing home room at $7,908, and a private nursing home room at $9,034 [6]. Costs vary widely by state and region and have risen since 2021, so treat these as a rough national comparison, not a local quote.
Do group homes require a nursing license to operate?
No, most group homes operate under a residential or personal care license rather than a nursing or medical facility license. Staff typically provide personal care and supervision, not skilled nursing procedures. States that allow limited nursing tasks inside a group home, like medication administration, usually require specific staff training or an add-on endorsement to the base license.
How long does it take to get a group home license approved?
Timelines vary a lot by state and by how complete the application is when submitted; some states review straightforward applications in a matter of weeks, while others with backlogs or required multiple inspections can take several months. There's no guaranteed or fast-tracked timeline, so confirm the current review period directly with your state licensing agency.
Sources
- Medicare.gov, Long-Term Care coverage page: Medicare doesn't cover long-term custodial care if that's the only care a person needs
- Medicaid.gov, Long Term Services & Supports: Medicaid HCBS waivers can cover services in assisted living/group home settings, not room and board
- National Institute on Aging, NIH: Assisted living provides help with daily activities, meals, housekeeping, and social activities
- National Institute on Aging, NIH: Nursing homes are for people who need a high level of ongoing medical or nursing care
- National Conference of State Legislatures: Assisted living facilities are regulated at the state level, with licensing, staffing, and inspection requirements varying by state.
- Medicaid.gov: Medicaid Home and Community-Based Services (HCBS) waivers can help cover some costs of assisted living for eligible individuals.
- U.S. Small Business Administration: Starting a group home requires market research and business planning steps similar to other regulated care businesses.