Last updated 2026-07-26
TL;DR
Assisted living and residential care homes serve people who need help with daily living but not daily medical care. Nursing homes serve people who need skilled nursing or rehab. Medicare does not pay for room and board at any of them long-term; it only covers short skilled nursing stays. Medicaid can cover nursing home care in every state and assisted living/residential care in most states through waivers.
What is assisted living?
Assisted living is licensed housing for people who need help with daily activities like bathing, dressing, medication reminders, and meals, but who don't need round-the-clock nursing care. Most assisted living communities look like apartment buildings or campuses with private or semi-private units, a dining hall, and staff on site 24 hours a day, though not necessarily nurses. Every state licenses assisted living differently and often under a different name. Some states call it "assisted living facility," others use "residential care facility for the elderly," "personal care home," or "adult foster care." The Centers for Medicare & Medicaid Services notes that assisted living is regulated at the state level, not federally, which is why the rules and even the terminology shift when you cross a state line [1]. Staffing ratios, medication administration rules, and move-out ("discharge") criteria vary a lot by state. If you're comparing two communities in different states, don't assume the license means the same thing. Always confirm the exact scope of care allowed with your state's licensing agency before signing anything.
What is a group home?
A group home is a licensed residential setting, usually a single-family style house, that serves a small number of residents, often somewhere between four and sixteen depending on the state, who need support with daily living, behavioral health care, or a disability-related service. Group homes serve very different populations depending on the license type: intellectual and developmental disabilities (IDD), mental health/behavioral health, substance use recovery, or elderly adult foster care. Unlike a big assisted living campus, a group home usually has a home-like feel with a shared kitchen, common living room, and staff who work shifts rather than nurses on a medical unit. Licensing typically comes from a state's department of health, department of social services, or a disability-specific agency, and the application usually covers staffing plans, a policy and procedure manual, background checks, fire and life-safety inspection, and zoning compliance. If you're planning to open one, start with your state's specific application packet rather than a generic checklist, since fee amounts, staff-to-resident ratios, and required trainings differ by state and by population served. For a walkthrough of typical requirements, see assisted living facility licensing basics, which cover a lot of the same paperwork categories (background checks, fire inspection, policy manuals) that most residential license types share.
What is an assisted living facility (and how is it different from "assisted living")?
"Assisted living facility" and "assisted living" usually mean the same thing in casual conversation, but the word "facility" is often the literal legal term a state uses in its statute or regulation. For example, Florida licenses "assisted living facilities" under Chapter 429 of its statutes, with the Agency for Health Care Administration handling licensure [2]. California instead uses "Residential Care Facilities for the Elderly" (RCFE) under its Health and Safety Code, licensed by the Department of Social Services [3]. So when you're comparing options, check what your state actually calls the license type, because the marketing name on the building's sign ('The Something at Somewhere') tells you nothing about what's actually licensed inside. Ask to see the facility's license and confirm its category directly with the state licensing agency. That single step catches a surprising number of mismatches between what a place advertises and what it's actually approved to do. A facility licensed only for lower-acuity assisted living, for instance, may not legally be allowed to keep a resident who needs two-person transfer assistance or has advanced dementia with exit-seeking behavior. Ask directly: what's the highest level of care this specific license allows, and what triggers a required move-out?
What does assisted living provide?
| Help with bathing/dressing | Yes | Yes | |
|---|---|---|---|
| Medication reminders | Yes | Yes, administered by nursing staff | |
| Skilled nursing (wound care, IV, injections) | Usually not, or limited | Yes | |
| Physical/occupational therapy | Rarely on-site | Yes, often daily | |
| 24-hour licensed nurse on site | Not required in most states | Required | |
| Typical setting | Apartment-style room | Hospital-like room, often shared | |
| Medicare coverage | Generally none | Short-term skilled stays only | The short version: assisted living covers help with daily life. Nursing homes cover ongoing medical and rehabilitative care that requires a licensed nurse. |
Assisted living typically provides: help with activities of daily living (bathing, dressing, toileting, mobility), medication management or reminders, three meals a day plus snacks, housekeeping and laundry, 24-hour staff presence, an emergency call system, and some level of social and recreational programming. What it generally does not provide is skilled nursing care, ventilator management, complex wound care, or IV therapy, though some states allow a higher "enhanced" or "limited nursing" tier for a bit more. A useful comparison table: | Service | Assisted Living | Nursing Home |
What is the difference between assisted living and a nursing home?
The core difference is medical acuity. Nursing homes (also called skilled nursing facilities) are staffed and licensed to provide daily nursing care, physical therapy, and management of complex medical conditions. Assisted living is built for people who are largely independent but need help with daily tasks and supervision. CMS requires nursing homes to have a registered nurse on duty at least 8 consecutive hours a day, 7 days a week, and to provide licensed nursing services 24 hours a day, as part of the federal conditions of participation for Medicare and Medicaid certified facilities [4]. Assisted living has no equivalent federal staffing rule at all, because it isn't federally regulated the way nursing homes are. Cost also tracks acuity. Genworth's 2023 Cost of Care Survey found a national median assisted living cost of $5,350 a month, compared to $9,733 a month for a semi-private nursing home room and $10,646 for a private room [5]. That gap reflects the extra nursing staff, medical equipment, and therapy services a nursing home has to carry. Another practical difference: nursing home stays are often short-term, for rehab after a hospitalization, while assisted living tends to be a longer-term living arrangement. If a resident's needs escalate past what assisted living can legally provide, most state licenses require a transfer to a higher level of care, sometimes with a required discharge notice period, commonly 30 days, though confirm with your state licensing agency since this varies.
How does a residential care home compare to both?
"Residential care home" is really an umbrella term, and in some states it's the actual regulatory name (residential care facility, residential care home, adult care home). Functionally, it sits in the same category as assisted living: non-medical support in a home-like or apartment-like setting, licensed by the state, not federally certified the way nursing homes are. Where residential care homes tend to differ from big assisted living campuses is scale and structure. A residential care home is often a converted single-family house serving somewhere around 4 to 10 residents, run more like a household than a hospitality business, with a smaller staff-to-resident ratio in the building at any given time (though not necessarily better staffing overall). Assisted living, by contrast, is often a purpose-built facility with dozens or hundreds of units, on-site amenities, and a more corporate management structure. Both types are licensed at the state level and both generally exclude ongoing skilled nursing care. If cost and licensing rules matter to your comparison, ask each facility for its exact license type and then look up that license category directly on your state agency's site, because "residential care home," "assisted living," and "personal care home" sometimes describe nearly identical services under different names depending on the state.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of assisted living, residential care homes, or long-term custodial care in a nursing home. Medicare.gov states plainly that "Medicare and most health insurance plans don't pay for long-term care" including help with daily activities like bathing, dressing, and using the bathroom [6]. What Medicare does cover, under Part A, is a short-term stay in a skilled nursing facility, but only after a qualifying hospital stay, and only for skilled care like rehab after a stroke or surgery. Medicare covers up to 100 days per benefit period in a skilled nursing facility, with the first 20 days at no cost to the patient and days 21 through 100 requiring a daily coinsurance amount that CMS updates annually [7]. After day 100, the beneficiary pays the full cost. This is the single most common misunderstanding families run into: Medicare will pay for rehab after a hip fracture, but it will not pay the monthly rent-equivalent cost of living in assisted living or a group home indefinitely. Medicaid, not Medicare, is the program that can help with long-term custodial costs, and even then, coverage rules differ sharply by state and by setting.
Does Medicaid cover assisted living, group homes, or residential care?
Medicaid covers nursing home care in every state as a mandatory benefit under federal Medicaid law. Assisted living and residential care home coverage is different: it's optional, and most states offer it through a Home and Community-Based Services (HCBS) waiver rather than as a straight benefit. Medicaid.gov describes HCBS waivers as programs that allow states to cover services "in home and community-based settings" for people who'd otherwise need institutional care, as an alternative to nursing home placement. Under these waivers, Medicaid typically pays for the care and services (personal care, medication management, some staffing costs) but usually still does not pay for room and board in assisted living or a residential care home. The resident (or their family) generally has to cover room and board separately, often from Social Security income, savings, or a long-term care policy. Waiver slots are also often capped and can have waiting lists, so "my state's Medicaid technically covers assisted living" doesn't always mean a slot is available right now. Confirm directly with your state Medicaid agency and your state's assisted living licensing agency what's actually covered, what room-and-board costs remain out of pocket, and whether there's a waitlist.
How do I start a group home?
Starting a group home generally means six things, in roughly this order: pick the population you'll serve (IDD, mental health, recovery, or elderly adult foster care), confirm local zoning allows a group home use at your target property, apply for the state license specific to that population, write your policy and procedure manual, hire and train staff to the state's required ratios and background-check standards, and pass your pre-opening fire, health, and life-safety inspections. The zoning step trips up more first-time operators than any other. Many states and cities treat small group homes (often defined as six or fewer residents) as a residential use by right, similar to a single family, under fair housing protections. But larger homes, or homes serving certain populations, can face additional local zoning review, occupancy limits, or conditional use permitting. Check your local zoning code and your state licensing statute before signing a lease or making an offer on a property; a property that looks perfect can be legally unusable for your intended population. Every state's application packet, fee schedule, and required forms differ, sometimes by population type within the same state. Rather than assembling this from scratch, many first-time operators use a structured packet of state-specific application checklists, sample policy manuals, and staffing plan templates to avoid missing a required document. GroupHomePath's $299 State Group Home Licensing Kit (see the licensing kit builder) organizes those state-by-state requirements into one packet, though the licensing decision itself always rests with your state agency, not any third-party product.
How do I compare specific facilities when I'm choosing one for a family member?
Start with the license type and its scope of care, not the marketing brochure. Ask the facility directly: what's your exact license category, what level of care are you legally allowed to provide, and what conditions would trigger a required discharge or transfer? Then verify that answer independently with your state's licensing agency, since facility staff sometimes describe capabilities more generously than the license actually permits. Next, compare staffing. Ask for the current staff-to-resident ratio during the day and overnight, and ask whether a licensed nurse is on-site or on-call. For nursing homes, you can look up staffing hours per resident day and recent inspection results directly on CMS's Care Compare tool, which posts each Medicare-certified nursing home's health inspection history, staffing data, and quality measures . Finally, compare cost structure carefully. Assisted living and group homes typically charge a base rate plus add-on fees for higher care levels (a "level of care" pricing model), so the advertised monthly rate is often not the final bill. Ask for a full fee schedule showing every level of care and its associated price, more than the entry-level rate. For nursing homes, ask what Medicare will and won't cover for the specific stay type (skilled rehab versus long-term custodial), since those two categories are billed completely differently.
What questions should I ask during a facility tour or licensing check?
Bring a short, specific list rather than relying on memory during a tour, since these visits move fast and staff won't always volunteer the details that matter most. Ask: What is your exact license type and license number? Can I see your most recent state inspection report? What is your staff-to-resident ratio right now, during the day and overnight? Is a nurse on staff or on call, and what hours? What's included in the base rate, and what triggers an additional care-level charge? What's your policy for a resident whose needs increase, and how much notice do you give before requiring a transfer? Do you accept Medicaid waiver payments, and is there a waiting list? For nursing homes specifically, you can pull the facility's inspection history and staffing hours ahead of time using CMS's Care Compare site , which lets you compare multiple facilities side by side on health citations, staffing levels, and quality measures before you ever set foot on the property. For assisted living or group homes, your state licensing agency's website usually posts inspection or complaint history too, though the format and level of detail vary a lot by state.
Frequently asked questions
What is assisted living?
Assisted living is state-licensed housing for people who need help with daily activities like bathing, dressing, and medication reminders but don't need daily skilled nursing care. It typically includes meals, housekeeping, 24-hour staff presence, and an emergency call system. Rules and even the name for this license type vary by state, so always confirm scope of care with your state licensing agency.
What is a group home?
A group home is a licensed residential setting, usually a house-style property serving a small number of residents, that provides support for a specific population: intellectual/developmental disabilities, mental health, substance use recovery, or elderly adult foster care. It's licensed by a state agency and typically requires zoning compliance, a policy manual, staff background checks, and a fire/life-safety inspection before opening.
What is an assisted living facility?
An assisted living facility is the formal license name many states use for non-medical residential care that helps residents with daily living activities. Florida licenses these under Chapter 429 of its statutes through the Agency for Health Care Administration; California uses the term Residential Care Facility for the Elderly (RCFE) instead. The exact legal name and scope differ by state, so check your state's specific statute.
What is the difference between assisted living and a nursing home?
Assisted living helps with daily living tasks in a home-like or apartment setting, with no federal requirement for 24-hour licensed nursing staff. Nursing homes provide skilled medical and rehabilitative care and, under CMS conditions of participation, must have licensed nursing services available 24 hours a day and a registered nurse on duty at least 8 hours daily, 7 days a week.
Does Medicare cover assisted living facilities?
No. Medicare.gov states that Medicare does not pay for long-term care, including help with daily activities in assisted living. Medicare Part A only covers a short-term skilled nursing facility stay after a qualifying hospitalization, up to 100 days per benefit period, with coinsurance starting on day 21. It never covers ongoing room-and-board costs in assisted living.
Does Medicaid cover assisted living or group homes?
Medicaid covers nursing home care in every state as a mandatory benefit. Assisted living and group home coverage is optional and usually delivered through a Home and Community-Based Services (HCBS) waiver, which typically covers care services but not room and board. Waiver availability, waitlists, and covered services differ by state, so confirm with your state Medicaid agency directly.
How do I start a group home?
Pick the population you'll serve, confirm local zoning allows a group home at your target property, apply for the state-specific license for that population, write a policy and procedure manual, hire staff meeting state ratio and background-check rules, and pass pre-opening fire and health inspections. Requirements, fees, and timelines vary significantly by state and population type, so start with your state licensing agency's application packet.
How do I start a group home for people with disabilities specifically?
The process is largely the same as any group home, but you'll apply through your state's disability services or Medicaid HCBS agency rather than a general adult care licensing office, since IDD group homes usually require additional staff training on behavior support, individualized service plans, and often a separate Medicaid provider enrollment step. Confirm the exact agency and application with your state's developmental disabilities division.
What does assisted living provide that a nursing home doesn't?
Assisted living generally provides a more independent, apartment-style living arrangement with help for daily tasks like bathing and medication reminders, without the clinical, hospital-like environment of a nursing home. Nursing homes provide skilled nursing, daily therapy, and management of complex medical conditions that assisted living is not licensed or staffed to handle.
How much does assisted living cost compared to a nursing home?
Genworth's 2023 Cost of Care Survey found a national median assisted living cost of $5,350 per month, compared to $9,733 per month for a semi-private nursing home room and $10,646 for a private nursing home room. Actual costs vary widely by state, region, and level of care, so treat these as national medians, not local estimates.
Is a residential care home the same as assisted living?
Functionally, yes in most cases: both are non-medical, state-licensed residential settings for people needing help with daily living. In some states 'residential care home' is simply the official regulatory term used instead of 'assisted living.' Always check your specific state's licensing statute to see which term applies and what services that license category actually allows.
What happens if a resident's care needs exceed what assisted living can provide?
Most state licenses require a transfer to a higher level of care, such as a nursing home, once a resident's needs exceed what the assisted living license permits, often things like needing two-person transfers, ventilator care, or complex wound care. States commonly require advance written notice before a discharge or transfer, frequently around 30 days, though the exact requirement varies, so confirm with your state licensing agency.
How do I check a facility's inspection history before choosing it?
For Medicare-certified nursing homes, use CMS's Care Compare tool, which posts health inspection results, staffing data, and quality measures for every certified facility nationwide. For assisted living, residential care homes, and group homes, check your state licensing agency's website, since most states post inspection or complaint records, though the format and detail level differ by state.
Sources
- CMS, Nursing Home Data and Regulation Overview: Assisted living is regulated at the state level rather than federally, unlike Medicare-certified nursing homes
- Florida Legislature, Statutes Chapter 429, Assisted Living Facilities: Florida licenses assisted living facilities under Chapter 429 of its statutes
- California Department of Social Services, Residential Care Facilities for the Elderly: California licenses assisted living under the name Residential Care Facility for the Elderly (RCFE)
- CMS, State Operations Manual Appendix PP, Nursing Home Requirements: Nursing homes must provide 24-hour licensed nursing services and a registered nurse on duty at least 8 consecutive hours a day, 7 days a week
- Genworth, Cost of Care Survey 2023: National median monthly cost of assisted living was $5,350 versus $9,733 (semi-private) and $10,646 (private) for nursing homes in 2023
- Medicare.gov, Skilled Nursing Facility Care Costs: Medicare Part A covers up to 100 days per benefit period in a skilled nursing facility, with coinsurance beginning on day 21
- Medicaid.gov, Home & Community-Based Services: Medicaid HCBS waivers allow states to cover long-term services in home and community-based settings as an alternative to institutional care