Assisted living vs nursing home cost: how the two compare

When a family compares assisted living and a nursing home, the two costs are not close, and the reason is the level of care, not the address. This guide lays out what each one runs, why the gap is as wide as it is, and which sources actually pay for each. If you are still deciding which type of care your parent needs, start with nursing home vs assisted living, then come back here for the money side. Treat every figure below as a national middle, not a bill for your state.

What does each type of care cost?

The clearest snapshot comes from the 2024 Cost of Care Survey by Genworth and CareScout, which collected prices from July to December 2024 across all 50 states and 383 regions and published in March 2025. Here are its national median costs. A nursing home is quoted two ways because a semi-private room (shared) costs less than a private one.

For context, staying at home is not automatically cheaper once real care is needed. The same survey put an in-home health aide at roughly $33 to $34 an hour, which works out to about $77,792 a year for full-time coverage, more than the median for assisted living. The right comparison is always care level against care level, not building against building.

Why is a nursing home so much more expensive?

The gap between about $70,800 a year for assisted living and $111,325 or more for a nursing home comes down to what you are paying staff to do. A nursing home is a medical setting: it has licensed nurses on duty around the clock, delivers skilled care like wound management, IV medication, and rehabilitation, and serves people who cannot safely live without ongoing clinical support. That continuous, licensed staffing is expensive, and it is the single biggest driver of the price.

Assisted living is a residential setting with services layered on. Caregivers help with what are called activities of daily living, such as bathing, dressing, meals, and medication reminders, but they are not there to provide continuous medical care. You are paying for housing, meals, and daily support rather than a clinical team, so the monthly figure is lower. It is the same reason a private nursing home room costs more than a semi-private one: more of the resource is dedicated to a single person.

Does Medicare or Medicaid pay for either?

This is where families are most often caught off guard. Medicare does not pay for long-term custodial care, the ongoing help with daily living, in assisted living or a nursing home. It covers only short, skilled stays, such as rehabilitation after a qualifying hospital admission, and only for a limited number of days. Once someone needs open-ended daily care rather than skilled recovery, Medicare coverage ends in both settings.

Medicaid is the largest single payer of long-term nursing home care in the country, but it is means-tested: a resident must fall under income and asset limits that vary by state and meet a medical level-of-care requirement. Assisted living is a different story. It is mostly private pay, funded from savings, a pension, or home equity, with only limited Medicaid help in some states through home and community-based services (HCBS) waivers, and those waivers often do not cover room and board. So for assisted living, plan to pay privately in most cases; for a nursing home, understand Medicaid's rules early. Our deeper guide on nursing home cost and Medicaid walks through eligibility, the look-back period, and private pay.

How much does the price vary by state?

A lot. The figures above are national medians, and the survey found wide variation across the 50 states and 383 regions it measured. A high-cost state can run far above the national middle, and a lower-cost region well below it, for the very same level of care. That is why these numbers are useful for orientation and planning, but should never be treated as a quote for a specific home. Before you commit to a budget, get current local prices from the facilities you are actually considering, and remember that costs have been rising year over year, so a figure from an old article may already be low.

Which is the right level of care to pay for?

Match the setting to the care actually needed, not to the price. If your parent needs help with medications, meals, and bathing but is otherwise stable and mobile, assisted living is usually the right, less costly fit. If they have complex medical conditions, need skilled nursing, or can no longer be kept safe with lighter support, a nursing home is the appropriate level of care, and paying for it is not optional. Paying for a nursing home when assisted living would do wastes tens of thousands of dollars a year; paying for assisted living when skilled nursing is needed risks safety. Decide the care level first, using our guide on nursing home vs assisted living, and the budget follows from there.

Where our report fits

Cost and quality are separate questions, and a higher price is not a promise of better care. Our report covers Medicare-certified nursing homes, the category with the official 5-star data behind it. Once you have decided that skilled nursing is the right level of care and understand roughly what it costs, we rank the certified homes near your ZIP on their CMS ratings, staffing hours, inspection history, and abuse flags, so you can compare the homes you can realistically afford. Our guide on how CMS ratings work shows you how to read that record. If assisted living is where you are leaning, this report is not the right tool, and we would rather tell you that than sell you something that does not fit.

This is general information, not financial or legal advice. Cost figures are national medians from the 2024 Genworth and CareScout Cost of Care Survey and vary widely by state; confirm current local prices and your coverage with a benefits specialist, and always visit a home in person before deciding.