Last updated 2026-07-24
TL;DR
Assisted living and residential care homes provide housing, meals, and help with daily activities for people who don't need round-the-clock nursing care. Nursing homes provide skilled medical care. Medicare does not cover room and board at either; it may cover short-term skilled nursing under specific conditions. Reviews and licensing status both matter before you choose or open one.
What is assisted living?
Assisted living is a type of housing for older adults or people with disabilities who need help with daily activities like bathing, dressing, medication reminders, and meal prep, but don't need the level of medical care a nursing home provides. It's a middle tier between fully independent living and skilled nursing. Most assisted living communities offer private or semi-private rooms, common dining, housekeeping, and some level of staff supervision around the clock. The exact services required by law vary a lot by state because assisted living is regulated at the state level, not federally. The Centers for Medicare & Medicaid Services (CMS) does not license or directly regulate assisted living facilities the way it does nursing homes. When people search for reviews of assisted living or residential care homes, they're usually comparing two things at once: the lived experience (staff friendliness, cleanliness, food, activities) and the regulatory record (survey results, complaint history, license status). Both matter. A place can have glowing Google reviews and still have open licensing violations, and vice versa. Always check the state's official inspection or survey database before trusting star ratings alone. Most state agencies publish licensing lookup tools, often called 'facility search' or 'provider search' portals. If you're comparing options for a family member, don't stop at reviews. Cross-reference with the state's own assisted living facilities directory or inspection report system, since that's the only source that reflects official findings rather than personal impressions.
What is a group home?
A group home is a residential setting, usually a house in a regular neighborhood, where a small number of people (often 4 to 10) live together and receive support from paid staff. Group homes serve different populations depending on the state and license type: people with intellectual or developmental disabilities (IDD), people in mental health recovery, people in substance use recovery, or seniors who need adult foster care rather than a large facility. The defining feature is scale and setting. A group home looks and feels like a house, not an institution. Staffing ratios, physical plant requirements, and services offered depend entirely on the state license category. Some states use the term 'group home' in statute; others use 'adult foster care home,' 'community residential facility,' or 'residential care home' for very similar models. Because of this naming inconsistency, one of the first things anyone starting a facility should do is confirm exactly which license category their state uses for the population they intend to serve, and pull the specific regulation text rather than relying on general web searches. State licensing agency websites list the current chapter or administrative code number for each home type.
What is an assisted living facility?
An assisted living facility (ALF) is the licensed business entity that operates an assisted living residence. States license ALFs under specific statutes; for example, Florida licenses assisted living facilities under Chapter 429, Part I of the Florida Statutes, administered by the Agency for Health Care Administration [1]. California licenses similar homes as Residential Care Facilities for the Elderly (RCFE) under Health and Safety Code Division 2, Chapter 3.2, administered by the Department of Social Services [2]. Every state has its own name, statute number, and licensing agency for this business type, so 'assisted living facility' is a functional description more than a single national legal term. When you see the phrase 'what is assisted living facility' searched online, people usually want to know what the term legally covers in their state, which can only be answered by checking that state's code. Common requirements across most states include a written resident agreement, a documented service plan for each resident, staff training on topics like medication assistance and emergency procedures, a minimum staff-to-resident ratio (though the ratio itself varies widely and is sometimes left to the facility's discretion within broad rules), and regular unannounced inspections. For a side-by-side look at how these requirements differ, see our guide to assisted living facility licensing basics.
What does assisted living provide?
Assisted living typically provides housing, three meals a day, help with activities of daily living (ADLs) like bathing and dressing, medication management or reminders, housekeeping and laundry, transportation to appointments, and social or recreational activities. It does not typically provide skilled nursing care, ventilator support, or complex wound care, though some states allow 'assisted living with a nursing component' or similar hybrid licenses for higher-acuity residents. ADLs commonly tracked include bathing, dressing, toileting, transferring (moving from bed to chair), continence care, and eating, a framework that traces back to the Katz Index of Independence in Activities of Daily Living, first published in 1963 and still used in care assessments today [3]. Most states require a written, individualized service plan for each resident that spells out exactly what assistance they need and how often. Reviewers and family members should ask to see a sample plan, more than a brochure. A facility that can't produce a clear service plan on request is a red flag regardless of how nice the lobby looks. Costs vary widely by state and region. The Genworth Cost of Care Survey, one of the most cited sources on long-term care pricing, reported a 2023 national median monthly cost for assisted living of $5,350 [4]. That's a national median, not a floor or ceiling; actual costs in a given county can run well above or below that figure, so always confirm current local rates directly with facilities and cross-check with your state's aging or long-term care ombudsman office.
What is assisted living vs nursing home?
| Level of care | Help with ADLs, non-medical | Skilled nursing, 24/7 licensed nurse | |
|---|---|---|---|
| Federal oversight | None (state-regulated only) | Yes, 42 CFR Part 483 [5] | |
| Typical setting | Apartment-style or house-style | Hospital-like, medical equipment | |
| Medicare coverage | Not covered (room and board) | Short-term skilled care may be covered | |
| Medicaid coverage | Varies by state waiver program | Widely covered as mandatory benefit | |
| Public inspection data | State agency dependent | CMS Care Compare, nationwide [5] | If you're trying to figure out which setting is appropriate for a specific person, a good starting question is: does this person need a licensed nurse present daily, or do they mainly need supervision and help with tasks? That single distinction usually points you toward the right category. |
The core difference is the level of medical care. Assisted living is for people who need help with daily activities but are otherwise medically stable. Nursing homes (also called skilled nursing facilities) are for people who need daily medical care, such as wound care, IV therapy, or rehabilitation after a hospital stay, and who require a licensed nurse on site around the clock. Nursing homes are regulated more heavily at the federal level. Facilities that accept Medicare or Medicaid payment must meet federal requirements under 42 CFR Part 483, which cover everything from resident rights to staffing to quality of care, and CMS publishes inspection results for every certified nursing home in the country through its Care Compare tool [5]. Assisted living has no equivalent federal certification or public rating system; oversight is entirely state-by-state. Here's a side-by-side comparison: | Feature | Assisted Living | Nursing Home |
Does Medicare cover assisted living facilities?
No. Medicare does not cover the cost of room and board at an assisted living facility, and it does not pay for custodial care, which is the non-medical help with bathing, dressing, and daily activities that assisted living mainly provides. Medicare.gov states plainly that Medicare does not cover long-term care (also called custodial care) if that's the only kind of care a person needs [6]. Medicare may cover certain medical services delivered to someone who happens to live in assisted living, such as doctor visits, physical therapy ordered by a doctor, or short-term skilled nursing care following a qualifying hospital stay, but it will not pay the facility's monthly rent or care fees. Medicaid is a different story, though still limited. Many states offer a Medicaid Home and Community-Based Services (HCBS) waiver, authorized under Section 1915(c) of the Social Security Act, that can help cover the cost of care services (not room and board) in some assisted living or residential care settings for people who qualify financially and medically [7]. Coverage, eligibility, and which facilities accept these waivers vary enormously by state, so anyone counting on Medicaid to help pay for assisted living needs to check directly with their state Medicaid agency and the specific facility's payment policies. Don't assume a facility that says it 'accepts Medicaid' takes the waiver program relevant to your situation; ask which specific program and get it in writing.
How to start a group home
Starting a group home means working through five stages: choosing your population and license type, forming your business entity, securing a property that meets zoning and building code, submitting your state license application with policies and staffing plans, and passing your pre-licensing inspection. None of these steps can be skipped, and the order matters because some states won't process a license application without proof of an approved physical location first. Step one is picking exactly which population you'll serve and which license category fits: IDD group home, adult foster care, mental health residential, substance use recovery residence, or senior residential care. This decision drives every requirement downstream, including staff qualifications and physical plant rules, so don't skip ahead to property hunting before you've confirmed the license type with your state licensing agency. Step two is business formation: LLC or corporation registration, an EIN from the IRS, general liability and professional liability insurance, and often a surety bond depending on the state. Step three is property. Zoning matters a lot here. Many states have fair housing protections that treat small group homes (typically 6 or fewer residents) as a permitted residential use rather than a special commercial use, following principles established under the federal Fair Housing Act as amended in 1988, which prohibits discrimination against housing for people with disabilities [8]. But zoning rules and occupancy limits still vary by municipality, so confirm with your local planning department and your state licensing agency before signing a lease. Our zoning and property coverage on this site walks through common issues like occupancy caps, fire code triggers, and separation requirements between group homes. Step four is the application package itself: policy and procedure manual, staffing plan, emergency and disaster plan, sample resident agreement, background check documentation for all staff and owners, and often proof of CPR/first aid training. This is the paperwork-heaviest stage and the one where most first-time applicants lose weeks to back-and-forth corrections. Step five is the inspection. State surveyors will check the physical building (fire safety, exits, accessibility), review your files, and sometimes interview staff. Passing on the first try requires having every policy actually implemented, more than written down. See our inspections hub for what surveyors commonly check.
How do I start a group home? (state-by-state reality check)
The honest answer is: it depends entirely on which state and which population, because there is no single national group home license. Each state names its own agency, sets its own fee schedule, and writes its own administrative code chapter for each home type. For example, Texas licenses assisted living facilities through the Health and Human Services Commission under Texas Health and Safety Code Chapter 247 [9], while Ohio licenses residential care facilities through the Ohio Department of Health under Ohio Revised Code Chapter 3721 [10]. The application forms, required staffing ratios, and fee amounts in these two states are not interchangeable, and neither are the inspection checklists. Because of that variation, the most useful thing an aspiring operator can do early on is build a state-specific checklist rather than working from generic advice. That means pulling your state's actual statute number, application form, and fee schedule directly from the licensing agency's website rather than guessing based on what a neighboring state requires. This is also where a lot of first-time applicants waste money: hiring a general consultant who gives boilerplate policy templates that don't match the state's actual code language, which then bounces back from the reviewer with corrections. If you want a structured starting point instead of assembling every document from scratch, the $299 State Group Home Licensing Kit at grouphomepath.com/licensing-kit-builder organizes the policy manual, staffing plan, and application checklist by state and population, built around the actual statute and agency your home will be licensed under. It doesn't replace your state's review process or guarantee approval, but it does save you from rebuilding boilerplate documents that a reviewer will just send back anyway.
What is the difference between assisted living and nursing home in day-to-day practice?
Beyond the regulatory definitions, the daily experience differs a lot. Assisted living residents generally keep more independence: they may come and go, manage some of their own medications with reminders, and have private rooms or apartments with kitchenettes. Nursing home residents typically have higher medical needs, more staff involvement in daily routines, and shared rooms are still common in many facilities, though private room availability has grown. Staffing looks different too. Nursing homes are required to have a registered nurse on duty for at least 8 consecutive hours a day, 7 days a week, plus licensed nursing staff sufficient to meet resident needs around the clock, under federal nursing home requirements found at 42 CFR 483.35 [5]. Assisted living staffing requirements are set entirely by the state and vary from a simple 'sufficient staff to meet resident needs' standard to specific numeric ratios tied to resident count and acuity. Cost structure also differs. Nursing home care is billed at a much higher daily rate reflecting the medical staffing, and Medicaid (not Medicare) is the primary long-term payer for most nursing home residents nationally, since Medicaid nursing facility coverage is a mandatory benefit under federal Medicaid law, while Medicare only covers short skilled-nursing stays after a qualifying hospitalization [6].
How do reviews and inspection reports fit together?
Online reviews reflect one family's experience on one day. Inspection reports reflect what a trained state surveyor found against a specific legal standard. Neither one alone tells the full story, and relying on just one is how people end up surprised after move-in. A facility can rack up five-star reviews from happy families about the food and the activities calendar while sitting on unresolved deficiencies related to medication administration or staffing shortfalls, because reviewers usually aren't trained to spot regulatory issues; they're describing their emotional experience. Conversely, a facility can have a clean inspection history but a genuinely cold, understaffed feel that reviews would catch and a compliance checklist wouldn't. The practical move: pull the facility's most recent state inspection or survey report (most states post these online, and CMS Care Compare covers Medicare/Medicaid-certified nursing homes specifically [5]), read the last two or three reviews in detail rather than just the star average, and if possible, visit unannounced at a mealtime. That combination catches most of what either source misses alone.
What should reviewers and operators both watch for in staffing plans?
For families reading reviews, staffing complaints ('nobody answered the call button,' 'the same three staff cover every shift') are one of the most reliable red flags, because understaffing shows up in review language well before it shows up in a formal inspection finding. For operators building a facility, the staffing plan is one of the most heavily scrutinized parts of a license application. Reviewers want to see shift-by-shift coverage, more than a total headcount, plus a credible plan for call-outs and emergencies. States that specify numeric ratios usually tie them to the number of residents and their care level; states without numeric ratios still expect the plan to demonstrate 'sufficient staff to meet needs' with actual math behind it, not a vague assurance. A staffing plan that only works if every scheduled employee shows up every single shift is not a real plan. Surveyors and, frankly, family members reading reviews both catch this eventually.
Frequently asked questions
What is assisted living?
Assisted living is housing for people who need help with daily activities like bathing, dressing, and medication reminders but don't need full-time nursing care. It typically includes meals, housekeeping, and staff supervision. States, not the federal government, license and regulate assisted living, so exact services required vary by state [1][2].
What is a group home?
A group home is a small residential setting, usually a house, where a limited number of people live together with paid staff support. States use different license names for similar setups, including adult foster care home and community residential facility, depending on the population served and the specific state's statute.
What is an assisted living facility?
An assisted living facility is the licensed business that operates an assisted living residence under a specific state statute, such as Florida's Chapter 429 or California's RCFE program under Health and Safety Code Division 2 [2][3]. Requirements, fees, and terminology differ by state, so there's no single national definition.
What does assisted living provide?
Assisted living typically provides a room, meals, help with activities of daily living, medication reminders, housekeeping, transportation, and social activities. It generally does not provide skilled nursing care. The 2023 national median monthly cost was $5,350 according to the Genworth Cost of Care Survey [5], though local rates vary widely.
What is the difference between assisted living and nursing home?
Assisted living serves people who need help with daily tasks but are medically stable. Nursing homes provide skilled medical care with a licensed nurse required on site under federal rules (42 CFR 483.35) [6]. Nursing homes face federal oversight and public CMS inspection data; assisted living oversight is state-only.
Does Medicare cover assisted living facilities?
No. Medicare does not cover room and board or custodial care at assisted living facilities, per Medicare.gov guidance on long-term care coverage [7]. It may cover unrelated medical services like doctor visits or short-term skilled care after a qualifying hospital stay, but not the facility's monthly fees.
How do I start a group home?
Choose your population and license type, form your business entity, secure a property that meets zoning and fire code, prepare your policy manual and staffing plan, submit your state application, and pass your pre-licensing inspection. Every state's specific statute, agency, and fees differ, so confirm details directly with your state licensing agency.
How do I start a group home if I've never done this before?
Start by contacting your state's licensing agency directly to get the exact statute and application checklist for your intended population (IDD, mental health, senior, recovery). Build your policy manual and staffing plan around that specific code language before you sign a lease, since property and licensing timelines are often linked.
Is a residential care home the same as assisted living?
Often yes, in practice, though the legal term varies by state. Some states use 'residential care home' as their official license category for what other states call assisted living. Always check your specific state's licensing agency for the exact term and statute that applies to your setting.
Does Medicaid pay for assisted living?
Sometimes, through state-specific Home and Community-Based Services waivers authorized under Section 1915(c) of the Social Security Act [8]. These waivers can cover care services but generally not room and board, and availability, income limits, and participating facilities vary by state. Confirm directly with your state Medicaid agency.
What's the biggest difference families notice between assisted living and nursing homes?
Independence level. Assisted living residents typically keep private rooms or apartments and more autonomy over their schedule. Nursing home residents usually need more hands-on medical care and staff involvement throughout the day, reflecting the federal requirement for licensed nursing staff around the clock [6].
How much does assisted living cost?
The Genworth Cost of Care Survey reported a 2023 national median of $5,350 per month for assisted living [5]. Actual cost depends heavily on state, region, room type, and level of care needed, so treat this figure as a benchmark, not a quote, and confirm current pricing with local facilities.
Can I trust online reviews when choosing assisted living or a group home?
Reviews are useful for tone and daily-life impressions but don't reflect regulatory compliance. Always cross-check reviews against your state's official inspection or survey reports, and for Medicare/Medicaid-certified nursing homes, check CMS Care Compare for federal inspection history [6].
Sources
- Online Sunshine, Florida Statutes Chapter 429 Part I: Florida licenses assisted living facilities under Chapter 429, Part I
- California Department of Social Services, Community Care Licensing / RCFE program: California licenses Residential Care Facilities for the Elderly under Health and Safety Code Division 2, Chapter 3.2
- Katz Index of Independence in Activities of Daily Living, original 1963 publication reference: The ADL framework used in care assessments traces to the Katz Index, first published in 1963
- Genworth, Cost of Care Survey 2023: 2023 national median monthly cost of assisted living was $5,350
- eCFR, 42 CFR Part 483 Subpart B, nursing home requirements: Federal nursing home requirements including 24/7 RN staffing rules
- Medicare.gov, Long-term care coverage: Medicare does not cover long-term custodial care if that is the only care needed
- Medicaid.gov, Home & Community-Based Services 1915(c) waivers: States may cover home and community-based services, including some assisted living care costs, through 1915(c) waivers
- U.S. Department of Justice, Fair Housing Act overview: The Fair Housing Act as amended in 1988 prohibits housing discrimination against people with disabilities, affecting group home zoning treatment
- Texas Health and Safety Code, Chapter 247: Texas licenses assisted living facilities under Health and Safety Code Chapter 247
- Ohio Revised Code, Chapter 3721: Ohio licenses residential care facilities under Revised Code Chapter 3721