Last updated 2026-07-23
TL;DR
Assisted living is a state-licensed residential option that helps people with daily tasks like bathing, dressing, and medication, but it isn't medical care and Medicare doesn't pay for it. A group home is usually smaller and houses a specific population, such as people with intellectual disabilities or mental illness. Nursing homes provide skilled, federally regulated medical care instead. In-home care keeps someone in their own house with paid help.
What is assisted living?
Assisted living is a residential setting where someone gets help with everyday tasks (bathing, dressing, taking pills on schedule) plus meals, housekeeping, and staff on site around the clock. It sits between living fully independently and needing a nursing home. Nobody is running IVs or doing wound care in a typical assisted living apartment. The National Institute on Aging describes assisted living as housing for people "who need help with some daily activities but do not require the intensive medical and nursing care provided in a nursing home" [1]. That line does a lot of work: it's the whole reason assisted living exists as its own category, separate from both independent senior apartments and skilled nursing. There is no federal license for assisted living. Every rule about staffing, room size, medication assistance, and who can be admitted comes from the state where the building sits, not from Washington. That's why a assisted living community in Florida can look and operate differently from one in Oregon, even though both use the same name.
What is a group home, and how is it different from assisted living?
A group home is a smaller residential home, often housing somewhere between three and ten people, built around a specific population rather than seniors in general. That could be adults with intellectual or developmental disabilities, people in mental health recovery, or people leaving addiction treatment. The Administration for Community Living tracks home and community-based service models built specifically for people with intellectual and developmental disabilities living in ordinary neighborhoods instead of institutions. Assisted living, by contrast, usually refers to larger licensed communities built mainly around aging and physical frailty, though plenty of states blur the line. Staffing ratios in a group home for adults with disabilities often look nothing like staffing in a senior assisted living building, because the support needs are different (behavioral support and skills training instead of mobility and medication help). Here's the honest complication: states don't use consistent names. What one state calls a group home, another calls a residential care home, an adult care facility, or a personal care home. Some states even license small assisted living homes under the same rules as group homes for other populations. You cannot assume terminology carries across state lines. Confirm with your state licensing agency which category your specific home and population fall under before you write a single policy page.
What is an assisted living facility, exactly?
An assisted living facility is the licensed building itself: private or shared rooms or apartments, a common dining area, staff present at all hours, and a set of state rules about who can live there, what staff must be trained to do, and how medications get handled. It is a facility license, not a medical license. At the national level, the CDC's National Center for Health Statistics counted roughly 28,900 residential care communities (the government's umbrella term covering most assisted living) with over 800,000 licensed beds in its most recent full survey of the sector [2]. The National Center for Assisted Living, the industry's trade association, puts current estimates in a similar range, describing assisted living as a licensed option in every state though the specific rules vary widely. Size varies enormously. Some assisted living facilities house six residents in a converted house. Others house 150 people across a multi-building campus with a memory care wing, a dining hall, and a full activities calendar. Both can hold the exact same state license category. If you're comparing options for a family member, a page like assisted living facility breaks down what to check on a tour versus what's just marketing.
What does assisted living provide day to day?
Most assisted living facilities provide help with what the industry calls activities of daily living: bathing, dressing, toileting, moving around safely, and eating. On top of that, expect medication reminders or administration (state rules differ on which staff can legally hand out pills versus just remind someone to take them), three meals a day, weekly housekeeping and laundry, transportation to appointments, and organized social activities. What assisted living generally does not provide is skilled nursing care: no round-the-clock RN, no IV therapy, no ventilator management, no complex wound care. When a resident's needs cross that line, most states require the facility to either bring in outside home health or hospice services, or discharge the resident to a nursing home. Assisted living facilities also almost always include an emergency call system in each room or apartment, a locked or monitored entrance, and staff awake and present overnight, even if that overnight staff is thin (sometimes just one or two people for an entire building, depending on state minimums). If you're weighing several local assisted living facilities, ask specifically what the overnight staffing count is, more than the daytime number that gets quoted in the sales tour.
What is the difference between assisted living and a nursing home?
| Level of care | Help with daily activities, supervision | Skilled nursing, rehab, RN coverage | |
|---|---|---|---|
| Regulation | State licensing only | State licensing plus federal Medicare/Medicaid rules (42 CFR 483) | |
| Medicare coverage | Not covered | Up to 100 days per benefit period for qualifying skilled care | |
| Medicaid coverage | Services sometimes covered via HCBS waiver; room and board usually not | Nursing facility care is a mandatory Medicaid benefit | |
| Median monthly cost (2021) | $4,500 | $7,908 semi-private / $9,034 private | People sometimes move from assisted living into a nursing home when their care needs outgrow what personal care staff can legally or safely handle. That transition is common enough that many assisted living leases actually spell out the medical criteria that trigger a required discharge. |
The short version: assisted living helps with daily living tasks in a home-like setting, while a nursing home (also called a skilled nursing facility) provides actual medical and rehabilitative care under federal rules. Nursing homes must meet Medicare and Medicaid Conditions of Participation under 42 CFR Part 483, which require licensed nursing staff, physician oversight, and specific care planning for every resident. Assisted living has no equivalent federal rulebook. | Feature | Assisted living | Nursing home |
Does Medicare cover assisted living facilities?
No. Medicare does not pay for room, board, or personal care at an assisted living facility, full stop. Medicare.gov states plainly that "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need" [3], and assisted living is classified as custodial care, not medical care. What Medicare will pay for is short-term skilled nursing facility care, up to 100 days per benefit period, but only after a qualifying inpatient hospital stay and only for people who need skilled nursing or rehab, more than help with daily living. Medicare will also cover home health services (skilled nursing visits, physical therapy) delivered to someone's own home, including an assisted living apartment, if a doctor certifies the person is homebound and needs skilled care. That's a narrow benefit though; it doesn't touch the facility's room and board bill. Some Medicare Advantage plans now offer limited supplemental benefits, like meal delivery or in-home support services, under expanded rules from the 2018 CHRONIC Care Act. These are add-on benefits from specific plans, not a general Medicare assisted living benefit, and coverage varies plan by plan.
Does Medicaid cover assisted living, and what's an HCBS waiver?
Medicaid can pay for the care services delivered inside assisted living in most states, but federal Medicaid rules generally will not pay for room and board there. States use Section 1915(c) Home and Community-Based Services (HCBS) waivers, or sometimes 1115 demonstration waivers, to cover personal care, medication management, and similar services for Medicaid-eligible residents living in assisted living instead of a nursing home. Medicaid.gov describes HCBS programs as ways to deliver "services to people who need assistance," delivered in home and community settings rather than institutions, as an alternative to nursing facility placement. The room and board piece still has to get paid somehow, usually from the resident's own income, Social Security, or a state supplemental payment program layered on top of SSI. That combination varies enormously by state, and not every assisted living community accepts Medicaid waiver residents at all (many require private pay for at least the first year or two). Confirm with your state Medicaid agency and your state's assisted living licensing agency separately, because the two rules don't always line up.
How much does assisted living cost compared to home care and nursing homes?
Genworth's 2021 Cost of Care Survey, the most complete national dataset available, put the median monthly cost of assisted living at $4,500, a home health aide (44 hours a week) at $5,148, a semi-private nursing home room at $7,908, and a private nursing home room at $9,034. Genworth exited the long-term care insurance business and the survey has since continued under its spinoff, CareScout, which has published updated figures that run higher than the 2021 numbers. Treat the figures below as a real, cited floor, not a current-year quote, and check CareScout's newest release for this year's exact medians before budgeting.
In-home care vs assisted living: which one actually fits?
In-home care means paying an aide (through an agency or privately) to come into someone's own house or apartment and help there, on an hourly or live-in basis. Assisted living means moving into a licensed building where staff and services already exist on site. Neither one is automatically the better choice; it depends on how much care is needed and how many hours a day someone actually needs a person present. In-home care keeps someone in a familiar house, which matters a lot for people with early dementia or strong attachment to their home. But it scales expensive fast: a few hours a day is manageable for many families, but 24-hour in-home coverage often costs more than assisted living, because you're paying for round-the-clock staffing without the efficiency of shared common areas and shared staff across multiple residents. Assisted living, by comparison, spreads staffing cost across everyone in the building, which is part of why the median monthly cost runs lower than 24-hour home care despite including meals, housekeeping, and activities. It also builds in social contact automatically, something isolated in-home care often lacks unless a family works hard to arrange it. For readers comparing the two side by side, assisted living at home walks through what a hybrid setup (some paid in-home hours plus family caregiving) typically looks like in practice.
How do I start a group home?
Starting a group home is a licensing project before it's anything else. Here's the realistic sequence, in the order most states expect it: 1. Pick your population and find your state's specific licensing category (adult residential care, assisted living, IDD group home, behavioral health residential, and so on all have different agencies and rules). Confirm with your state licensing agency which category applies before you sign a lease. 2. Read the actual state regulations, not a summary. Most states publish their administrative code online; find the specific chapter covering your license type. 3. Form your legal entity and get an EIN, since almost every state requires the license to be held by a business entity, not an individual. 4. Secure a property that can meet zoning and life safety code requirements (fire sprinklers, egress width, room size minimums) before you commit financially, since a home that looks perfect can still fail a fire marshal review. 5. Write your policy and procedure manual: medication administration, incident reporting, resident rights, grievance procedures, emergency preparedness, and a staffing plan with actual named shifts. 6. Hire staff who meet your state's training and background check requirements, and get them trained before the pre-licensing inspection, not after. 7. Submit your license application with floor plans and required fees. Application fees vary widely by state and license type; confirm the current amount with your state licensing agency rather than trusting an old number online. 8. Pass your pre-licensing inspection from the fire marshal, health department, and state surveyor. 9. If you plan to accept Medicaid HCBS waiver residents, start the separate Medicaid provider enrollment process, which usually runs on its own timeline apart from your facility license. That's a lot of paperwork running in parallel, which is exactly the problem the $299 State Group Home Licensing Kit is built to organize: state-specific application checklists, policy manual templates, and a staffing plan framework you edit instead of building from a blank page.
Staffing, zoning, and inspections: what new operators need to plan for
Staffing ratios are entirely state-set, and they differ sharply by population. A group home for adults with intellectual disabilities often requires awake, active overnight staff at a ratio far higher than a senior assisted living building operating under the same roof size, because supervision needs differ. Do not assume a ratio you read for one license type applies to yours; check your state's specific rule. Zoning is where a lot of new operators get surprised. Larger assisted living communities usually go through standard commercial or conditional-use zoning review, like any business. Smaller group homes, though, often get real legal protection from the Fair Housing Act, which requires local governments to make "a reasonable accommodation in rules, policies, practices, or services, when such accommodations may be necessary to afford such person equal opportunity to use and enjoy a dwelling," per 42 U.S.C. § 3604(f)(3)(B), cited on HUD's fair housing pages. Many states also have specific statutes that treat a small group home (commonly homes of six or fewer unrelated residents with disabilities) as a single-family use by right, overriding restrictive local zoning. The Americans with Disabilities Act's integration mandate, reinforced by the Olmstead decision, backs this up by requiring services be delivered in the most integrated setting appropriate, which courts have used to support group homes in ordinary residential neighborhoods. Inspections don't stop at opening day. Expect an initial pre-licensing survey, then a renewal survey (often annual, sometimes every two years depending on the state and license type), plus separate fire marshal life safety inspections and, if you prepare meals on site, a health department food service inspection. Keep your policy manual, staff training logs, and medication administration records organized and current year-round; most citations we hear about from operators come from paperwork gaps discovered mid-inspection, not from actual care failures. If you want a structured starting point instead of assembling all of this from scratch, the State Group Home Licensing Kit bundles the licensing checklist, policy templates, and staffing plan format into one $299 one-time purchase.
Frequently asked questions
What is assisted living?
Assisted living is a state-licensed residential setting where staff help residents with daily tasks like bathing, dressing, and medication, plus provide meals, housekeeping, and 24-hour staff presence. It's meant for people who need regular support but not the skilled medical care a nursing home provides. There's no federal assisted living license; every rule comes from the state where the building operates.
What is a group home?
A group home is a smaller residential home, often housing three to ten people, built around a specific population such as adults with intellectual or developmental disabilities, mental health conditions, or substance use recovery needs. Staffing, training, and licensing rules differ by population and by state. Names vary too; some states use "group home," others use "residential care home" or similar terms for the same concept.
What is an assisted living facility?
An assisted living facility is the actual licensed building: private or shared rooms, common dining space, and staff on site around the clock, operating under a state license that sets rules for staffing, medication assistance, and admissions. Size ranges from a six-bed converted house to a 150-resident campus, and both can hold the same license category depending on the state.
What is the difference between assisted living and a nursing home?
Assisted living helps with daily living tasks in a home-like setting under state licensing rules only. A nursing home provides skilled medical and rehabilitative care under federal Medicare/Medicaid Conditions of Participation (42 CFR Part 483), with required nursing staff and physician oversight. Nursing homes handle medical needs assisted living legally cannot, like IV therapy or complex wound care.
Does Medicare cover assisted living facilities?
No. Medicare classifies assisted living as custodial, non-medical care and does not pay for room, board, or personal care there. Medicare will cover up to 100 days of skilled nursing facility care per benefit period after a qualifying hospital stay, and it will cover skilled home health visits for homebound patients, but neither benefit pays an assisted living facility's monthly bill.
Does Medicaid cover assisted living?
Sometimes, for the services, not usually for room and board. States use Home and Community-Based Services (HCBS) waivers to let Medicaid pay for personal care and medication help inside assisted living instead of a nursing home. Room and board typically still comes from the resident's own income or a state supplemental payment. Coverage details vary heavily by state; confirm with your state Medicaid agency.
How do I start a group home?
Pick your population and confirm the exact license category with your state licensing agency, read the specific state regulations, form a business entity, secure a property that meets zoning and fire life safety rules, write policy and staffing manuals, hire and train staff, submit your application and fees, and pass a pre-licensing inspection. Medicaid provider enrollment, if needed, runs as a separate process.
What does assisted living provide?
Typical assisted living services include help with bathing, dressing, and mobility, medication reminders or administration, three daily meals, housekeeping and laundry, transportation, organized social activities, and 24-hour staff presence with an emergency call system. It does not include skilled nursing, IV therapy, or complex medical treatment; those needs usually require outside home health services or a move to a nursing home.
What's the average cost of assisted living versus in-home care?
Genworth's 2021 Cost of Care Survey put median assisted living at $4,500 a month and a home health aide at $5,148 a month for 44 hours of weekly care, a snapshot showing facility care can run cheaper than substantial part-time home care [6]. Newer CareScout data runs higher across the board, so check the current year's release before budgeting a real decision.
Can I open a group home in a residential neighborhood despite zoning rules?
Often yes, for small group homes. The Fair Housing Act requires reasonable accommodation for people with disabilities in housing decisions, and many states treat small group homes (commonly six or fewer unrelated residents with disabilities) as a permitted single-family use regardless of local zoning. Larger assisted living communities usually still need standard commercial or conditional-use zoning approval. Confirm both federal and local rules with a local land-use attorney.
What license do I need to open a group home?
It depends entirely on your state and the population you plan to serve; there is no single national "group home license." States separate licenses by category, such as adult residential care, IDD group homes, behavioral health residential, or assisted living. Contact your state's health, social services, or disability services agency directly to confirm which specific license and agency applies to your planned home.
Is a group home the same as an assisted living facility?
Not exactly, though they overlap. "Assisted living" usually describes larger licensed communities built mainly around aging and physical frailty. "Group home" usually describes smaller homes built around a specific population, like intellectual disabilities or mental health recovery, with different staffing and training rules. Some states blur these categories or use different names entirely, so terminology alone can't tell you which license applies.
Sources
- National Institute on Aging, "Assisted Living": Definition of assisted living as help with daily activities short of nursing home level medical care
- CDC/NCHS, Long-Term Care Providers and Services Users in the United States report: National count of residential care communities and licensed beds
- Medicare.gov, long-term care coverage page: Medicare does not cover custodial long-term care such as assisted living
- Medicaid.gov: Medicaid can cover assisted living services through Home and Community-Based Services (HCBS) waivers
- Medicaid.gov: HCBS waivers are authorized under different sections of the Social Security Act, such as Section 1915(c), allowing states to cover services outside of nursing facilities
- Social Security Administration: Section 1915(c) of the Social Security Act establishes the legal basis for HCBS waiver programs
- Medicaid.gov: Medicaid coverage rules for nursing facility care differ from those for assisted living or home-based care
- Agency for Healthcare Research and Quality (AHRQ): Federal guidance on quality and safety standards for home and community-based long-term care settings, including assisted living