Assisted Living vs. Nursing Homes

Assisted living facilities provide a supportive, home-like environment for older adults who need help with daily tasks but seek to maintain their independence. Nursing homes differ by delivering 24/7 medical care for residents beyond common responsibilities like meal prep, bathing, and dressing.

Costs align with these included services, as nursing homes typically charge higher rates than assisted living. With additional staff, increased responsibilities, and more advanced monitoring, nursing homes offer more comprehensive care than assisted living facilities.

As you age, you will likely need to consider which type of long-term care best meets your needs. Around 70% of people over 65 will need long-term care during their lives, making it a reality most individuals and families will someday have to face. 

For many, this means having to choose between a nursing home vs. assisted living. While both options support seniors who need a safer, more supportive living environment, each option provides a different level of care. Assisted living best suits older adults who still live independently but need help with everyday tasks, while nursing homes provide round-the-clock medical care and support for people with more complex health needs.

This guide breaks down the differences and covers how to pay for each option to help you make the best choice for yourself or a loved one.

Seniors who are mostly independent but need extra help with activities of daily living (ADLs) may find assisted living to be a great fit. These facilities support tasks like getting dressed, preparing meals, or managing medications.

They're also a great fit for older adults who do not require round-the-clock medical care but feel more comfortable having support nearby, just in case. 

Assisted living facilities aim to feel like home while supporting residents who value their independence and autonomy. There are different types of assisted living facilities, but most offer a few essential services at their core, including:

• Nutritious meals
• Accessible living spaces 
• Medication management
• Help with bathing, dressing, and grooming
• Daily on-site activities
• Housekeeping and laundry services 
• Complimentary transportation within and outside the facility 

Most assisted living facilities have staff available to support ADLs, with optional perks that include a salon or barber shop, fitness center, outdoor walking areas, etc.

A nursing home or skilled nursing facility (SNF) can provide full-time care and support when it's no longer safe or manageable to live alone.

In these facilities, trained nurses and caregivers provide necessary treatment or assistance, keeping you or your loved one comfortable and safe. A nursing home is often the best option when you're living with a serious health condition or need more care than what an assisted living or other long-term community can provide.

Nursing homes can be the right fit when you or a loved one is recovering from an illness or needs more hands-on medical care. These facilities offer a safe, supportive environment with extra attention paid to meeting your daily needs. 

Services you can expect in a nursing home include:

• Health monitoring 
• 24-hour nursing assistance
• Rehabilitation services to assist in recovery 
• Medicine management
• Assistance with ADLs
• Meals
• Social engagements for residents
• Transportation
• Housekeeping

If you're recovering from surgery or an injury, a short-term stay in a nursing home can provide the medical support you need before heading back home. For chronic conditions or disabilities that require ongoing care, a longer stay may be a better option.

Assisted living and nursing homes provide day-to-day support for older adults. The primary difference lies in the level of care each service provides. 

Assisted living is best suited for self-reliant individuals who need help with daily tasks like dressing, bathroom use, meal preparation, and medication management. This setting offers a home-like environment with the right level of support to stay comfortable.

Nursing homes provide more hands-on care and medical attention for individuals with more complex needs, often resulting from serious health issues, mobility challenges, or recovery from illness or surgery. In short, assisted living helps with day-to-day routines, while nursing homes offer more advanced medical care and personal support as necessary.

Assisted living facilities and nursing homes provide valuable support with different levels of care. Nursing homes typically deliver more intensive supervision and medical attention, which also means they tend to be more expensive.

According to CareScout's Cost of Care survey, the median monthly cost for assisted living is $5,900. In comparison, a semi-private room in a nursing home costs a median of $9,277/month, while the median cost of a private room is $10,646. That breaks down to roughly $305/day for a semi-private room and $350/day for a private space.

In assisted living, state rules require at least three meals a day — two of them hot — served at regular times. Meals must be safely prepared, planned in advance, and tailored to meet residents' nutritional needs. There should also be no more than 14 hours between dinner and breakfast.

Nursing homes follow stricter guidelines to ensure residents receive the specialized care they need. Meals must match each resident's medical and dietary requirements, including special diets prescribed by doctors and managed by dietitians. Residents should have access to snacks between meals, along with alternative meal options.

Living arrangements are structured differently between assisted living and nursing homes. Assisted living communities often feel more like traditional housing, offering options like studios or two-bedroom apartments. Nursing homes typically offer a more clinical setup, providing residents with private or shared/semi-private rooms with other people.

While assisted living communities often have spacious common areas and outdoor environments, nursing homes provide fewer shared spaces to support safety and medical needs, especially for those with mobility or cognitive challenges.

Social activities are a necessary part of daily life, especially in nursing homes and assisted living facilities. In assisted living, where residents are often more active, social calendars may include outings to the movies, group walks, exercise classes, and fun community events.

Nursing homes offer a gentler pace, with thoughtful activities like birthday celebrations, book clubs, chair yoga, and crafts — all designed to encourage connection and keep the mind engaged.

Nursing homes provide high-level, around-the-clock medical care, also called skilled nursing. Registered nurses, therapists, and doctors are available to assist with tasks such as wound care, IV therapy, medication management, and post-illness or surgical recovery support.

Assisted living focuses more on daily support. Because most residents have simpler medical needs, staff can help with medications, monitor their health, and coordinate with outside doctors as needed.

Nursing homes provide 24/7 medical care with teams that include licensed nurses, CNAs, therapists, and physicians. By law, residents must receive at least 3.48 daily hours of nursing care, with a registered nurse available at all times.

Assisted living offers less intensive support. Staff typically includes personal care aides, medication techs, and licensed nurses. Care focuses on daily tasks, with typical ratios of around one caregiver for every eight residents.

Admission to a nursing home or assisted living facility usually requires an assessment to determine the level of care needed and the best fit.

Each facility will have specific admission requirements, but factors like age, medical history, and daily support help decide where a senior belongs. For nursing homes, a doctor must confirm the need for medical care. Assisted living is typically based on age, overall health, and how much help a person might need to carry out daily tasks.

Long-term care can be costly, but Medicare, Medicaid, and private insurance may help to cover costs, depending on your eligibility and care needs. However, H.R. 1 (nicknamed the Big Beautiful Bill) could reduce future coverage by cutting Medicaid funding and limiting eligibility requirements.

 

• Medicare: Medicare can cover the full cost of nursing home care for the first 20 days, then $204/day from days 21-100. After that, coverage stops. Assisted living isn't considered a medical service, instead classified as long-term care, so Medicare doesn't cover those costs.

• Medicaid: Most nursing homes accept Medicaid, as the program fully covers extended nursing home care if a person meets eligibility requirements. This program also covers assisted living costs minus room and board.

• Social Security: Social Security benefits can help offset the cost of nursing home or assisted living care, but they usually aren't enough to cover everything. Many seniors rely on additional income or savings to manage their full expenses.

• Private Pay: You can pay out of pocket with savings, pensions, and Social Security income to cover nursing home costs when Medicaid isn't an option, whether you're waiting for approval or choosing a facility not covered by insurance. While it offers flexibility, costs can add up quickly.

• VA Benefits: Veteran benefits can help cover care costs in nursing homes or assisted living for eligible veterans and spouses. Some may also qualify for full care in VA nursing homes based on service and health needs.

The decision to move from assisted living to a nursing home requires careful consideration and research. Knowing when more comprehensive medical care is needed can make a meaningful difference in safety, well-being, and overall quality of life.

The table below offers a helpful guide to determine when that transition may be the right next step.

Assisted living offers support with daily life while preserving independence in older adults. As medical needs grow, nursing homes can provide the care and safety that loved ones deserve.

Choosing the right path between these care options means ensuring comfort, dignity, and peace of mind. For more support, check out our senior living resources hub.

• Assisted living facility food code highlights. (n.d.). Minnesota Department of Health
• Caregiver resources & long-term care. (2022). U.S. Department of Health and Human Services  
• How can I pay for nursing home care? (n.d.). Centers for Medicare & Medicaid Services
• Long-term care facilities: Assisted living, nursing homes, and other residential care. (2023). National Institute on Aging
• State Operations Manual: Appendix PP – Guidance to surveyors for long term care facilities. (2023). Centers for Medicare & Medicaid Services