Assisted living communities support seniors who are generally active but need some help with everyday tasks, while nursing homes provide 24-hour monitoring, as well as more intense and long-term medical care for people who have serious health issues. The higher level of care provided in nursing homes costs more: the median monthly cost of a private room in a nursing home is $10,646, while the median monthly cost of an apartment in an assisted living community is $5,190. A physician’s recommendation is required for nursing home admittance; assisted living communities don’t require a doctor’s approval.
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Assisted living communities provide long-term housing for older adults who are generally active but need support with activities of daily living (ADLs). These include bathing, dressing, and using the toilet.
Nursing homes serve adults who require full-time monitoring and skilled nursing care. These facilities offer the highest level of care for individuals who don’t require hospitalization.
“A typical assisted living resident is someone who needs some extra assistance along with meals and socializing,” says Carol Bradley Bursack, a senior living expert, caregiver, and author of Minding Our Elders: Caregivers Share Their Personal Stories.
“Depending on the facility, extra services can be added to the assisted living package so that those who need more care can remain there longer. Alternatively, people who need significant medical care from nurses and physicians may qualify for a nursing home. This could include someone who has had a major stroke, a disabling fall, or a chronic disease,” Bursack explains.
The national median monthly cost of assisted living is $5,190, according to A Place for Mom’s proprietary cost data.[01] Nursing homes are more expensive: the national median monthly cost of a private room is $10,646.[02]
“Nursing homes are nearly always more expensive than assisted living due to their need to provide ongoing medical care,” says Bursack. “They have significantly more medically trained staff available as well as a need for more staff in general.”
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Assisted living communities generally offer a variety of floor plans, ranging from studio to two-bedroom apartments. In contrast, nursing homes tend to offer either shared (also called semi-private) or private rooms in a more hospital-like setting.
Services and amenities provided in assisted living communities are designed to help residents be as healthy, socially engaged, and independent as possible. While nursing homes offer similar supports, their focus is providing round-the-clock medical care to manage and treat more serious health issues.
“Assisted living services are geared toward those who may need some support from staff along with meals and socialization. Therefore, these facilities focus on many different types of activities and entertainment,” says Bursack.
For example, many assisted living communities offer:
Nursing homes provide skilled nursing care, which means that trained medical professionals are always available. If your loved one has a serious medical condition, they may need specialized care from licensed health care professionals at a skilled nursing facility. Senior care aides in an assisted living community are highly trained but may not be medically certified.
“Nursing homes try to offer activities that nourish their residents, but due to their focus on providing actual health care to often severely ill or compromised people, they are, by nature, more medical in their approach,” Bursack explains.
For example, nursing homes typically provide:
States, rather than the federal government, regulate assisted living communities. The federal government, through the Centers for Medicare and Medicaid Services (CMS), regulates and rates nursing homes and skilled nursing facilities.[03]
In some cases, an assisted living community or a nursing home is part of a larger continuing care retirement community, or CCRC. These facilities also offer independent living on the same campus so that residents can stay where they are rather than move each time their care needs change. CCRC regulations reflect a combination of state and federal rules.
While registered nurses (RNs) and licensed practical nurses (LPNs) may be among the staff of an assisted living community, most of the employees of assisted living communities are certified nurse’s aides (CNAs) and patient care assistants (PCAs). The ratio of staff to residents in assisted living is about 1:8, meaning that every caregiver will have about 8 people to support.
Because of the level of care they provide, nursing homes employ more nurses and physicians. CMS requires that each nursing home resident have access to about 3.5 hours of care per day from licensed nursing professionals, including RNs, LPNs, and nursing aides.[04]
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While assisted living communities may require residents to meet certain health standards and functional requirements, nursing homes must confirm that residents require a higher level of care before being admitted.
For instance, an assisted living community may require a resident be able to eat independently or transfer between a bed and a wheelchair without extensive assistance. They may also not accept residents who have severe cognitive impairment or behavioral issues.
To qualify for nursing home care, a resident must undergo a physical assessment and at least one physician must sign off on the recommendation, says Bursack.
While both assessments are intended to determine an older adult’s need for care and health histories are required, assisted living assessments and nursing home assessments differ. It’s also important to understand that state requirements vary.
An assisted living assessment focuses on how a person scores in completing general ADLs. The staff will also ask about dietary needs, their level of mobility, and their cognition, so care levels can be determined. Medical needs will also be addressed. Often, extra help can be hired to enhance care, but at an increased cost.
A nursing home assessment focuses on debilitating physical illnesses. While the staff typically ask about abilities and preferences, the person’s illness and physical abilities will need to be documented, and the admission approved by a physician.
Families typically use a variety of sources to pay for assisted living and nursing home care. Seniors may rely on their income, savings, and personal assets to cover most assisted living costs, while government assistance may be available to help lower-income residents pay for nursing home care.
For families choosing between assisted living and nursing home care, Bursack offers the following advice.
“If an older adult is relatively self-sufficient but needs extra support for safety and possibly more socialization, then assisted living is likely the right choice. However, if your loved one has significant challenges with activities of daily living, such as dressing or feeding themselves, or has a severe or chronic illness, it’s good to work with a doctor to see what care is best for them.”
Your loved one’s physician should be included when any type of placement is discussed. Some assisted living facilities require bloodwork or chest X-rays before admission, so if only for that reason, their doctor should be on board. Of course, for nursing home placement, such involvement is required since a physician will determine a person’s eligibility.
Assisted living is an ideal choice for seniors who:
A nursing home is an ideal choice for seniors who:
Finding the best option that meets your loved one’s needs is an important part of keeping them healthy, active, and safe.
If you’re unsure which care type fits your parent’s needs, reach out to one of A Place for Mom’s Senior Living Advisors. They can answer your questions about senior living options, connect you with local communities, and schedule tours, all at no cost to your family.
If your loved one requires pureed meals, becomes bedridden, or is frequently hospitalized, it may be time to consider moving them from assisted living to a nursing home.
No, Medicare won’t pay for assisted living, but it will cover short-term nursing home stays.
Couples often live together in assisted living communities, but don’t typically live together in nursing homes. Assisted living communities offer larger living spaces than nursing homes and can provide different levels of care to each person.
Key Takeaways
A Place for Mom. (2025). A Place for Mom proprietary data.
CareScout. (2025). Cost of care survey.
U.S. Centers for Medicare and Medicaid Services. Find and compare providers near you. Medicare.gov.
U.S. Centers for Medicare and Medicaid Services. (2024, April 22). Medicare and Medicaid programs: Minimum staffing standards for long-term care facilities and Medicaid institutional payment transparency reporting final rule (CMS 3442-F).
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