Families often use "nursing home" to mean any place an older person lives with care. But nursing homes and assisted living communities are quite different: in who they serve, who works there, how they're regulated and how they're paid for.
This guide compares the two side by side and explains the signs that point to each, so you can match the setting to your parent's needs.
Side-by-side comparison
| Assisted living | Nursing home | |
|---|---|---|
| Main purpose | Help with daily activities | Skilled nursing and rehab |
| Medical staff | Some nursing; varies by state | Licensed nurses 24/7 |
| Living space | Private or shared apartment | Usually a private or shared room |
| Oversight | State licensing | State licensing plus federal standards |
| Inspection results | State records | State records and Care Compare |
| Medicare | Doesn't pay | Short rehab stays only |
| Medicaid | Some states help with services | Covers care for people who qualify |
Rules vary by state. Ask each provider what it can and can't do.
What assisted living offers
Assisted living is for people who need help with daily activities, supervision or medicine management, but who don't need nursing care around the clock. Residents usually have their own apartment, eat meals together, and get help from staff available 24 hours a day1.
The emphasis is on independence and quality of life. Residents set much of their own schedule, and communities offer activities, outings and housekeeping. Some nursing services may be available, depending on the state and community. See our assisted living guide.
What a nursing home offers
Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services, with more medical care than most assisted living. They offer 24-hour supervision, meals and help with daily activities, and many provide short-term rehab after a hospital stay1.
Nursing homes that take Medicare or Medicaid must meet federal requirements covering resident rights, care planning, staffing, infection control and more2. Their inspection results are posted on Medicare's Care Compare3. Learn more in our nursing homes guide.
Read moreHow to Check a Senior Care License and Inspection Report
Key differences in detail
Medical care
Nursing homes care for people with complex health needs: wound care, IV medicines, feeding tubes, oxygen, rehab therapy, and close monitoring after illness. Assisted living may offer some nursing services, but most communities can't provide intensive or round-the-clock skilled care.
Staff
Nursing homes must have licensed nurses on duty and a medical director. Assisted living is staffed mostly by aides, with nurses on site or on call depending on state rules and the community.
Setting and daily life
Assisted living feels more like an apartment building, with private spaces, a dining room and an activity schedule. Nursing homes feel more clinical, with shared rooms common and more structured routines, though many work hard to feel homelike.
Resident rights and planning
Nursing home residents have specific federal rights, including the right to take part in care planning and to be free from abuse and unnecessary restraints2. Assisted living residents have rights set by state law and their contract.
Signs that point to each
Assisted living may be enough if your parent:
- Needs help with bathing, dressing or medicines, but is otherwise stable.
- Can move around alone or with a walker, or needs help from one person to transfer.
- Doesn't need skilled nursing every day.
- Would benefit from company, meals and a safer home.
A nursing home may be needed if your parent:
- Needs daily skilled nursing care or therapy.
- Needs two people to help them move, or is bedbound.
- Has frequent hospital stays or rapidly changing health.
- Has needs beyond what assisted living communities in your state can legally meet.
A doctor's assessment is the best guide. Ask your parent's doctor or the hospital discharge planner which level of care they recommend, and why.
Short-term rehab vs. long-term care
Many people go to a nursing home for a short stay after a hospitalization, to recover strength with physical or occupational therapy, then return home or move to assisted living. Medicare Part A may cover this kind of skilled nursing facility care for a limited time after a qualifying hospital stay4. Long-term stays for custodial care aren't covered by Medicare5.
If your parent has dementia
Dementia doesn't automatically mean a nursing home. Many people with Alzheimer's or another dementia live in assisted living or in memory care, a specialized setting with secure exits and staff trained in dementia care6. A nursing home may be the better fit when dementia comes with serious medical needs, such as difficulty swallowing, frequent infections or being unable to walk.
Our guides to assisted living vs. memory care and memory care vs. nursing homes go into more detail.
When a move from assisted living is needed
Assisted living residency agreements usually explain when a resident may need to move, such as needing skilled nursing every day, being unable to evacuate in an emergency, or needing more care than staff can safely give. State rules also limit what assisted living can provide7.
- Ask for the move-out policy in writing before your parent moves in.
- Ask how much notice the community gives and whether it helps find a new placement.
- Ask whether home health or hospice can come in to help your parent stay longer.
- If a move is needed, look for nursing homes that accept Medicaid, in case it's needed later.
Federal rules also limit when a nursing home can transfer or discharge a resident, and require notice in most cases2.
Paying for each
Nursing home care generally costs more than assisted living because of the medical care involved. How families pay differs too:
- Assisted living. Mostly paid privately, sometimes with long-term care insurance or VA benefits. Some states' Medicaid waivers help with services, but usually not room and board8.
- Nursing homes. Medicaid covers nursing facility care for people who meet income and asset rules; it's a mandatory benefit in every state9. Medicare covers only short skilled stays.
For more, see Medicare vs. Medicaid for long-term care and paying for senior living.
Questions to ask either one
- What care needs can you meet, and what would require a move?
- How many nurses and aides are on duty on each shift, including nights and weekends?
- How do you handle medical emergencies and hospital transfers?
- Can my parent keep their own doctor?
- Do you accept Medicaid, now or if my parent's savings run out?
- Can I see your most recent inspection report?
Bring our senior living touring guide when you visit.
