Nursing Home vs. Assisted Living

Hospice & Senior Care Finder · Published October 27, 2026

A nursing home is for someone who needs care around the clock. Assisted living is housing with help for daily life, for people who can't live on their own but usually don't need that level of nursing care. The two are also regulated and paid for in different ways. That's where many families get conflicting answers, because Medicare pays for some nursing home stays but not for long-term care in either setting.

How the level of care differs

Medicare describes nursing homes as facilities for people who usually need 24-hour care. They give two kinds of care. One is short-term skilled nursing or rehabilitation, often after a hospital stay. The other is long-term custodial care, meaning help with daily activities like bathing, dressing and eating. Most nursing home care is the custodial kind.

Assisted living sits a step below. A 2011 report from the U.S. Department of Health and Human Services describes assisted living facilities and personal care homes as giving housing and supportive services to people who cannot live independently but generally do not need the skilled care a nursing home provides. There is no single federal definition of assisted living. Each state writes its own.

If you're not sure which setting fits, ask your parent's doctor, or the hospital social worker if your parent is in the hospital. Medicare suggests asking the social worker about discharge planning as early as possible.

Who regulates each one

A nursing home that takes Medicare or Medicaid has to meet federal requirements, set out in 42 CFR Part 483, and those requirements are the basis for its inspections. State inspectors check homes against Medicare and Medicaid rules, usually every year. CMS then uses the inspection results in its nursing home star ratings.

Assisted living has no federal certification program like this. States regulate it, and the same 2011 HHS report found that their approaches vary widely. So what you can look up about a facility, from its license to its inspection history, depends on the state your parent lives in.

Assisted living goes by different names

Because each state writes its own rules, each state also picks its own names. In October 2026 we reviewed the official licensing sources for all 50 states and Washington, D.C. Here are six states where we opened the state's own source:

Two of these license something other than a building. Connecticut licenses the agency that provides assisted living services, and Iowa certifies programs rather than licensing buildings.

Access varies too. In our review, 17 of the 51 sources offered a list you can download and 10 offered only an online search or a PDF. For the rest, we either couldn't open the state's site or found no current list.

The practical point: search your state's licensing agency using its own term. A search for "assisted living" may miss a place that is licensed as a personal care home or an adult care home.

What Medicare pays for in a nursing home

Medicare Part A covers a short stay in a skilled nursing facility (SNF), not long-term living in a nursing home. Your parent generally needs all of these:

• A qualifying hospital stay: at least 3 days in a row as an inpatient, counting the day of admission but not the day of discharge.
• Admission to the SNF within a short time of leaving the hospital, generally 30 days.
• A doctor's decision that they need daily skilled care, whether to improve their condition, maintain it, or prevent or delay it getting worse.
• Days left in their benefit period.
• A Medicare-certified SNF.

Check the 3-day count carefully. Time spent under observation or in the emergency room before admission doesn't count, even if your parent was there overnight, so ask the hospital whether your parent has been formally admitted as an inpatient. Some doctors in Accountable Care Organizations approved for a "Skilled Nursing Facility 3-Day Rule Waiver" don't need the 3-day stay, and some Medicare Advantage plans may waive it.

What you pay in each benefit period, according to Medicare.gov's 2026 figures:

Part A covers up to 100 SNF days in each benefit period. If your parent already paid the Part A deductible for a hospital stay in the same benefit period, there's no second deductible for the SNF. Medicare Advantage plans may charge copayments during the first 20 days. Covered services include a semi-private room, meals, skilled nursing, therapy, medical social services, medications, supplies and dietary counseling.

What Medicare doesn't pay for

Long-term care. Most of it is non-medical, and Medicare doesn't pay for it. Neither does most health insurance, including Medicare Supplement Insurance (Medigap). That's true whether the care is given at home, in assisted living or in a nursing home, and you pay all costs for services Medicare doesn't cover. Original Medicare doesn't cover custodial care if that's the only care your parent needs.

Some coverage carries on while your parent lives in a nursing home. Part B still covers doctor visits and physical, speech or occupational therapy, and Part D covers prescription drugs.

Most people who move into a nursing home start out paying for it themselves.

If a parent in either setting is nearing the end of life, Medicare hospice can usually be given where they live, including assisted living or a nursing home. Our guide to the Medicare hospice benefit explains what it covers.

Where Medicaid fits

Medicaid is a joint federal and state program that helps pay health care costs for people with limited income, and in some cases limited resources, who meet other requirements. Your state's Medicaid program may cover long-term nursing home care if your parent qualifies, even though Medicare doesn't. Medicaid pays for the largest share of long-term care in nursing homes. Most nursing homes accept Medicaid, but not all, so ask each home directly.

For assisted living, Medicaid may help cover services, depending on your parent's needs and the state. Medicaid programs vary from state to state, so check the rules in your parent's state before counting on it.

What you'll find on this site

Our directory currently lists nursing homes certified by Medicare, Medicaid or both, with their CMS ratings, staffing and inspection data. You can browse by state, and our methodology page explains where the data comes from. We don't list assisted living. For that, your state's licensing agency is the place to look, under whatever name your state uses.

If a nursing home is the right fit, our guide on how to choose a nursing home goes through comparing and visiting them.