Home › Nursing home vs assisted living
Nursing home vs assisted living
The biggest practical difference for checking a facility is who inspects it. A nursing home that takes Medicare or Medicaid must meet federal requirements and gets federal inspections, which CMS publishes and rates. Assisted living is licensed and inspected only by the state, so its records live on state websites, each one different.
| Nursing home (Medicare/Medicaid certified) | Assisted living | |
|---|---|---|
| Who sets the rules | Federal requirements for Medicare/Medicaid participation, plus state licensing | The state licensing agency only |
| Inspections | Unannounced standard inspection, on average once a year, plus complaint and infection control inspections | Set by state law. Examples: Louisiana licensing and complaint surveys are unannounced; Florida allows an abbreviated biennial inspection for facilities with good records |
| Public ratings | CMS 1–5 star ratings (overall, health inspections, staffing, quality measures) | No federal rating |
| Where to see inspections | Medicare Care Compare and CMS data files (and every facility page on this site) | State tools: Texas TULIP, FloridaHealthFinder and the AHCA record search, or a Louisiana public records request |
| Typical care | Long-term care, and in many cases skilled nursing facility care such as daily skilled nursing or therapy. Medicare notes that many nursing homes also offer SNF care | Personal care and help with daily activities in a home-like setting. Texas lists meals, bathing, dressing, toileting and administering or supervising medication |
| Medicare coverage | Part A can cover skilled nursing facility care after a qualifying inpatient hospital stay of at least 3 days in a row, up to 100 days per benefit period | Medicare does not pay for long-term (custodial) care |
Nursing home inspections: CMS Technical Users’ Guide: www.cms.gov · last checked October 24, 2026
Skilled nursing facility coverage: Medicare.gov: www.medicare.gov · last checked October 24, 2026
Assisted living services (Texas example): HHSC: www.hhs.texas.gov · last checked October 24, 2026
Paying for care
Medicare says most long-term care is non-medical, so Medicare and most health insurance, including Medigap, do not pay for it. That includes care in a nursing home or in the community. You may qualify through Medicaid under your state’s rules, or you can buy private long-term care insurance. Medicare also notes you can get non-medical long-term care at home, in the community, in an assisted living facility or in a nursing home.
Source: Medicare.gov, Long-term care: www.medicare.gov · last checked October 24, 2026
For a short skilled stay, Medicare Part A in 2026 covers days 1–20 at $0 per day after the Part A deductible ($1,736), and days 21–100 at $217 per day. After day 100 you pay all costs. You must enter the SNF within a short time (generally 30 days) of leaving the hospital and need daily skilled care. Time under observation or in the emergency room does not count toward the 3-day stay.
Source: Medicare.gov, Skilled nursing facility care: www.medicare.gov · last checked October 24, 2026
Assisted living goes by different names
- Louisiana: Adult Residential Care Provider (ARCP), licensed by Louisiana Department of Health, Health Standards Section (HSS). How to check one.
- Texas: Assisted living facility (ALF), licensed by Texas Health and Human Services Commission (HHSC). How to check one.
- Florida: Assisted living facility (ALF), licensed by Florida Agency for Health Care Administration (AHCA). How to check one.
- Georgia: Assisted living community (ALC) or personal care home (PCH), licensed by Georgia Department of Community Health, Healthcare Facility Regulation Division (HFR). How to check one.
Checking either kind
- Nursing home: open its page here (search your state) or on Care Compare. Look at G–L citations, repeat tags, fines and staffing. See how to read an inspection report.
- Assisted living: confirm the license is current with the state, then pull its inspection reports and complaint history from the state tools listed on your state’s page.
- Either way, visit, and ask to see the most recent inspection report and plan of correction. CMS recommends visiting and not relying on star ratings alone.
Source: CMS Five-Star Quality Rating System: www.cms.gov · last checked October 24, 2026