The key differences between assisted living and skilled nursing

Elder care in the United States has become extremely expensive, making it an important topic of discussion for many families as they care for their aging parents. In-home care typically costs more than$6,000 per month, while nursing home care can cost over $10,000 per month. 

There are several classifications of elder care, each with distinct characteristics, including cost and level of care. Two of the most common are assisted living and skilled nursing. Here, we break down the differences between these two arrangements and explain what factors to consider when choosing the right one for your senior loved ones.

What are assisted living facilities?

An assisted living facility is a type of community designed for older adults who require assistance with daily care while maintaining some level of independence. While it's not quite as independent as a retirement community that offers complete independent living, an assisted living facility allows residents to live in the owner's apartments or rooms and share common areas. You may pay for various levels of care, depending on any extra or specialized services needed.

Assisted living facilities typically offer services such as meals, assistance with personal care, medication management, housekeeping, laundry, social and recreational activities, and 24-hour supervision and security. Some facilities offer multiple levels of care, including independent living or skilled nursing care.

What does assisted living cost?

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Generally, assisted living is more expensive than living independently, but less than a nursing home. Medicare doesn't cover assisted living expenses, so residents and their families typically have to pay the full cost themselves. Depending on the state and an individual's eligibility, Medicaid may cover some aspects of assisted living care. However, 

What are skilled nursing facilities?

Also known as nursing homes, skilled nursing facilities focus more on medical care than typical assisted living facilities. These facilities offer many of the same services as assisted living facilities, including meals, assistance with everyday activities, and nursing care. They may also provide rehabilitation services, such as physical, occupational, and speech therapy.

What do skilled nursing homes or facilities cost?

Like assisted living facilities, most residents and their families must pay for nursing home care themselves because Medicare typically doesn't cover long-term nursing home stays. Sometimes, Medicare will cover short-term stays for surgery or severe injuries, as well as select related costs, such as doctor visits or hospital services. 

Depending on the state and the individual's eligibility, Medicaid may also cover some expenses. Some people opt for long-term care insurance to help reduce the cost of nursing home care.

Assisted living vs. skilled nursing: What's the difference?

There are key differences between assisted living and skilled nursing, primarily in the level of care provided.

Costs of assisted living vs. skilled nursing

The median cost of assisted living in the United States ranges from $4,000 to $8,000 per month. The national median cost for skilled nursing care is $9,733 per month. Several factors impact the total price, including the level of care required, the type of residence (private vs. shared room), and the state. That last factor is the most important—an area's cost of living primarily influences the cost of care. For instance, a facility in Alabama is likely less expensive than one in Massachusetts.

As mentioned, in either case, Medicare typically doesn't cover long-term care costs (although it may help pay for related expenses, such as medical care provided while a resident is in a facility). Medicaid can help cover some costs, depending on the state and individual's eligibility, including personal care assistance for activities such as bathing, dressing, toileting, and eating, as well as transportation, housekeeping services, case management, and personal emergency response systems. However, it does not cover room and board.

Apply for care early

• Many families consider long-term care insurance, but you need to apply for care several years before you actually plan to use it.

• When applying, note any limitations on your policy. 

• It's a good idea to build long-term care costs into an estate plan.

How to choose between assisted living vs. skilled nursing

There are several factors to consider, including costs and how your family plans to finance these services. Some key considerations:

• Age: The most common age for older adults to enter assisted living is between 75 and 84 years old. While reaching this age doesn't automatically mean your parent should enter a care facility, it's a good time to be aware of and look out for signs that they may need help with self-care.

• Level of engagement: For older adults who need occasional help but still have control of their mental and physical faculties, an assisted living facility that offers a variety of activities and community may be a good choice.

• Level of care needed: If your parent has a hard time doing basic activities of daily living (ADLs), like getting dressed, bathing, taking medication, or preparing food for themselves, they may need nursing care — especially if they've suffered a recent medical event, like a stroke or heart attack, and are still recovering.

• Cost and coverage: Skilled nursing is more expensive, but long-term care insurance may help defray some expenses if you need more extensive services. When comparing facilities, it's worth asking if any prices or fees are negotiable.

• Goal of care: Assisted living is designed to be a long-term living arrangement. Skilled nursing care is for individuals who require specialized care that cannot be provided in a home environment. If in-home care isn't feasible, skilled nursing may be a good option.

• Type of staff: Look for facilities that cater to your loved one's specific needs, whether they need a speech pathologist, occupational therapist, or other specialized services onsite.

As you explore options, it's a good idea to tour any potential facilities to see how they look and operate on a day-to-day basis. Take the time to discuss the specifics of care, life at the facility, and financing options. And protect your family's finances so they get the care they need! Programs like Family Shield* help protect loved ones** against fraud, scams, and theft. 

FAQs

Does my parent need assisted living or a nursing home?

The primary difference between assisted living and a nursing home is the level of medical care provided. If your parent is still independent in some ways and can mostly take care of themselves, an assisted living facility may be a better option. If they're no longer able to perform ADLs or even take medication, they may need nursing care.

Will Medicare pay for assisted living?

No, Medicare does not pay for assisted living.

How do people afford to live in assisted living?

Many older adults pay for assisted living out of their own savings. Families may also establish a trust or appoint a trusted family member as a power of attorney to manage a senior loved one's financial affairs. Some families opt for a long-term care insurance policy, while others rely on Medicare and Medicaid to cover some expenses.

What is the best age to move to assisted living?

There isn't a best age to move to assisted living; it's more a matter of deciding when the time is right for your parent and the family. That said, most people begin at least considering assisted living between the ages of 75 and 84.

Can you negotiate assisted living costs?

You may be able to negotiate some assisted living costs. Costs like monthly room and board may be non-negotiable, but you may have more flexibility on other charges, such as move-in fees, community fees, or additional services. Some services may also be subject to reduction depending on the facility's occupancy rate, time of year, and your financial situation. It's always worth discussing with the facility.

*Greenlight customers who register for or upgrade to the Family Shield Plan beginning on 05/12/2025 will receive the Plan at a discounted rate of $19.98/month as long as they remain on the Plan. Offer will end immediately before midnight ET on the day after the 5,000th customer registers for Family Shield. Offer is void upon account closure or downgrade. Offer subject to change. Terms apply.

**Loved ones refers to covered family members as defined in the policy i.e. supported adults for which you control or assist with their finances.