Assisted living vs. home care vs. nursing home

Assisted living vs. home care vs. nursing home: the basics

Home care means a caregiver comes to your relative's home to help with bathing, dressing, meals, medication reminders and getting around. It can be a few hours a week or around the clock. See what in-home care is.

Assisted living is a residential community — usually a private apartment or room — with meals, housekeeping, activities and help with daily tasks. Staff are on site, but it isn't a medical setting.

A nursing home (skilled nursing facility) provides 24-hour care with licensed nurses on staff. It's for people with serious medical needs or who need hands-on help at all hours.

A fourth option runs underneath the first: paid family care at home, where Medicaid pays a relative to be the caregiver. It's the same home care benefit, delivered by someone your relative already trusts.

Cost of assisted living vs. home care vs. nursing home

CareScout's 2025 Cost of Care Survey, collected from providers from July to November 2025, reports these national medians:

Costs vary widely by state and city. For a closer look at home care prices, read the cost of in-home care and private pay home care.

What Medicare covers in each setting

Medicare is clear on this: it doesn't pay for long-term care. Most long-term care is non-medical help with daily activities, and Medicare and Medigap don't cover it, whether at home, in assisted living or in a nursing home.

Medicare does cover limited, short-term skilled care — for example, a stay in a skilled nursing facility after a qualifying hospital stay, or part-time home health visits from a Medicare-certified agency. Those are recovery services, not ongoing custodial care. Medicare also doesn't pay family caregivers — see does Medicare pay family caregivers?

What Medicaid covers: home care, assisted living and nursing homes

Medicaid is the program many families turn to for long-term care once savings run low, but it treats each setting differently. Your relative must qualify on income, assets and care needs, and the rules are set state by state within federal limits.

The assisted living gap matters. Federal waiver rules let states pay for home and community-based services but not room and board, so even with Medicaid, your relative usually pays the rent-and-meals part of assisted living out of their own income. Not every assisted living community accepts Medicaid for services, either.

Read more in Medicaid home care and Medicaid family caregiver programs.

When home care makes sense

• Your relative wants to stay home, and the home is safe or can be made safe.
• They need help with some daily tasks, but not constant medical supervision.
• Family is nearby and can cover part of the day — or be paid to cover it.
• Needs are part-time, so hourly care costs less than a facility.

Home care comes in many forms: non-medical home care, senior home care, part-time and short-term care and 24-hour home care.

When assisted living makes sense

• Your relative is lonely or isolated at home and would benefit from company and activities.
• The house is hard to maintain or unsafe, and modifying it isn't practical.
• They need some help each day, but not skilled nursing.
• They can afford the monthly rent and meals, with or without Medicaid help for services.

Ask each community what's included, how fees rise as needs grow, whether it accepts Medicaid waiver services, and what happens if your relative runs out of money.

When a nursing home makes sense

• Your relative needs skilled nursing or hands-on help around the clock.
• Medical needs are complex — frequent wound care, feeding tubes, or advanced dementia with safety risks.
• No combination of family and paid help can safely cover the hours at home.

Medicare's Care Compare lets you check nursing home ratings and inspection results. If needs are medical but a move isn't right yet, in-home nursing care may bridge the gap.

Home care vs. assisted living vs. nursing home: side by side

How paid family caregiving keeps someone at home longer

The main reason people move out of their homes isn't medical — it's that no one can cover the hours. Paid family caregiving changes that math. If your relative qualifies for Medicaid home care, the program can pay a daughter, son, grandchild or other relative for the approved hours instead of sending an agency aide.

That means the person doing the work is paid, the care comes from someone familiar, and the family isn't paying $35 an hour out of pocket. For many families it's the difference between a move this year and staying home for years. Read how to get paid to care for a family member.

Pay varies by state — see family caregiver pay rates — and so do the rules for spouses. When the caregiver lives in, stipend programs like Structured Family Caregiving and live-in caregiver arrangements can apply.

A checklist before choosing a facility

1. Get a needs assessment. Medicaid or your Area Agency on Aging can assess how many hours of help your relative needs.
2. Check Medicaid eligibility. Long-term care Medicaid has different rules than regular Medicaid. Check eligibility.
3. Ask who could be paid. A relative, a friend or a neighbor may qualify as the paid caregiver.
4. Price the home option. Add paid family hours, any agency hours, and home safety changes.
5. Tour facilities anyway. Know your options in case needs change quickly.

If you're just starting, our guide to caring for aging parents covers the first conversations and decisions.

How much it varies by state

Costs and Medicaid rules both vary widely. A few starting points:

• New York
• California
• Florida
• Texas
• Pennsylvania
• Ohio

Or browse all states. Each state page lists its programs, reported caregiver pay and how to apply.

Assisted living is also regulated by states, not the federal government, so what a community must provide — and what it may call itself — differs from one state to the next. Ask each community for its state license and its most recent inspection results, and compare them before you sign a contract.

Where to go next