Last updated 2026-07-23
TL;DR
A nursing care home (skilled nursing facility) provides 24-hour medical care from licensed nurses for people who need daily clinical treatment. Assisted living and group homes provide housing plus help with daily tasks like bathing and medication, but not skilled nursing care. Medicare covers short skilled nursing stays under strict conditions; it does not pay for long-term assisted living or nursing home custodial care. Medicaid can cover both, depending on state rules.
What is a nursing care home?
A nursing care home, usually called a skilled nursing facility (SNF) or nursing facility in state law, is a licensed medical residence where nurses and aides provide hands-on clinical care around the clock. Think wound care, IV medication, catheter management, physical therapy after a stroke or hip fracture, and monitoring for people with serious chronic conditions. Federal law requires that a nursing home participating in Medicare or Medicaid have a registered nurse on duty at least eight consecutive hours a day, seven days a week, and licensed nursing staff available 24 hours a day [1]. This is the highest level of custodial and medical care outside a hospital. It's regulated under 42 CFR Part 483, the federal nursing home reform law that came out of the Nursing Home Reform Act of 1987 [1]. States layer their own licensing rules on top of that federal floor, so the exact staffing ratios, inspection cycle, and paperwork vary by state. You'll confirm current requirements with your state licensing agency before you build a staffing plan or budget. A nursing care home is not the same thing as assisted living, a group home, or a residential care home. Those settings house people who need support with daily activities but not ongoing skilled medical treatment. Mixing up the terms causes real problems on licensing applications, so it's worth being precise from the start.
What is assisted living?
Assisted living is a residential setting where people live in their own apartment or room and get help with activities of daily living, like bathing, dressing, medication reminders, and meals, without needing hospital-level medical care. It's a housing and personal care model, not a medical one. Staff are typically certified nursing assistants, medication aides, or direct care workers, not registered nurses working shifts around the clock. There is no single federal assisted living law. Unlike nursing homes, assisted living licensing is entirely a state function, which is why requirements for staffing ratios, medication administration, and admission/discharge criteria differ so much from Wyoming to New York. The Centers for Medicare & Medicaid Services (CMS) does not regulate assisted living directly because it isn't a Medicare or Medicaid institutional benefit category in the same way nursing homes are [2]. If you're comparing settings for a licensing application, it helps to read the specific state chapter you'll operate under. Our guide on assisted living facility licensing walks through what most states require at a baseline: background checks, a life safety inspection, a staffing plan, and an administrator qualification, before you get into state-specific add-ons.
What is an assisted living facility (and what does 'facility' change)?
An assisted living facility is the licensed building and business entity, more than the care model. States use different labels for the same basic thing: residential care facility, personal care home, adult care home, community-based residential facility, or assisted living residence. The word 'facility' in your state's statute usually triggers a specific chapter of licensing code, which sets minimum square footage per resident, fire code requirements, staffing ratios by shift, and required policies (medication management, elopement response, abuse reporting). So when someone asks 'what is assisted living facility,' the honest answer is: it's the licensed operation, whatever your state calls it, that provides housing plus personal care services to people who need daily support but not skilled nursing. The paperwork difference between 'assisted living facility' and 'group home' and 'residential care home' is mostly a state labeling choice, but it can change which statute, inspection checklist, and Medicaid waiver program applies to you. That's why the very first step of any application should be confirming the exact regulatory category with your state licensing agency, not guessing from a national definition. For operators comparing multiple state definitions side by side before choosing where to license, our assisted living facilities overview breaks down how states categorize these homes differently.
What is a group home, and how is it different from a nursing home or assisted living?
A group home is a small residential setting, often a house in a regular neighborhood, where a handful of residents (commonly 4 to 8, though state caps vary) live together and receive support from direct care staff. Group homes serve several different populations: people with intellectual or developmental disabilities (IDD), adults recovering from mental illness or substance use, and in some states, seniors who need a lower level of support than assisted living. The key difference from a nursing home is medical intensity. Group home staff generally are not licensed nurses providing clinical treatment; they're trained direct support professionals helping with daily routines, transportation, medication administration (often under a delegated nursing model, depending on the state), and behavioral support. The key difference from assisted living is usually scale and setting: group homes tend to be smaller, more residential in feel, and often licensed under disability services or behavioral health statutes rather than aging or health department statutes. Zoning is where this distinction actually matters day to day. Many states and the federal Fair Housing Act treat small group homes for people with disabilities as a residential use of property, not a commercial one, which affects whether a municipality can block you through zoning [3]. That protection doesn't automatically apply to larger assisted living buildings or nursing homes, which are usually zoned as institutional or commercial uses. If you're deciding which model fits your property, it's worth reading our assisted living at home piece, which covers small-home and in-home models that overlap with the group home category.
What is assisted living vs nursing home: the real comparison
| Primary regulator | State agency (varies by state) | State agency + federal CMS (42 CFR 483) [1] | |
|---|---|---|---|
| RN on staff 24/7 | Not required in most states | Required: RN 8 hrs/day min, licensed nurse 24/7 [1] | |
| Typical resident need | Help with ADLs, medication reminders | Skilled nursing, rehab, complex medical needs | |
| Medicare coverage | Not covered as a long-term benefit | Covers up to 100 days per benefit period, conditions apply [4] | |
| Medicaid coverage | Varies; often via HCBS waiver, not room/board in most states [5] | Covered as a Medicaid state plan benefit in all states [6] | |
| Typical setting | Private or semi-private apartment | Semi-private or private room, hospital-like unit | |
| National median annual cost (2024, Genworth survey) | ~$70,800 (assisted living, private one-bedroom) [7] | ~$116,800 (semi-private nursing home room) [7] | The cost gap is a real driver of the confusion. Families often start in assisted living, then move to a nursing home once medical needs escalate, and licensing operators need to understand both paths because discharge/transfer planning between levels of care is usually written into state assisted living regulations. |
The short version: assisted living is for people who need help with daily tasks but are medically stable. A nursing home is for people who need ongoing skilled nursing or rehabilitative care. Below is the comparison people search for most often. | Feature | Assisted living | Nursing home (SNF) |
What does assisted living provide day to day?
Assisted living provides a private or semi-private living space, meals, housekeeping, help with bathing/dressing/toileting/mobility, medication management or reminders, social and recreational activities, and 24-hour staff availability for emergencies. It does not typically provide skilled nursing treatments, IV therapy, or the kind of rehab services a hospital discharge to a nursing home would include. Most state regulations require a written resident service plan or care plan, updated on a schedule (often every 6 to 12 months, or whenever a resident's condition changes), documenting exactly which of these services a specific resident receives and at what frequency. This service plan becomes the document surveyors check during inspections, so it needs to match what's actually happening in the building, more than what's in the marketing brochure. Most states also require assisted living operators to have a plan for when a resident's needs exceed what assisted living can legally provide, meaning the facility has to have discharge or transfer criteria to a nursing home built into policy. This is one of the most commonly cited deficiencies in state surveys: a resident's documented needs no longer match the facility's licensed scope of care.
Does Medicare cover assisted living facilities or nursing home care?
No, Medicare does not cover the ongoing cost of assisted living. Medicare Part A and Part B are health insurance programs, and assisted living is considered a housing and personal care arrangement, not a covered medical benefit, no matter how much personal care a resident needs [2]. Medicare does cover nursing home care, but only in a narrow window: up to 100 days per benefit period in a Medicare-certified skilled nursing facility, following a qualifying inpatient hospital stay of at least three days, and only for skilled care needs like physical therapy or wound management, not custodial long-term care [4]. Medicare pays 100% of days 1 to 20, and the beneficiary pays a daily coinsurance for days 21 to 100 (the exact coinsurance amount is set annually; check the current figure on CMS.gov). After day 100, Medicare stops paying entirely. Medicare's own consumer guidance states plainly that long-term custodial care isn't covered when that's the only care a person needs [8]. That single sentence is the most important thing an aspiring operator or a family member can understand about Medicare and long-term residential care. Medicaid, not Medicare, is the primary public payer for both nursing home stays and, in many states, home and community-based waiver services that support assisted living or group home placement [5].
How do group homes and nursing homes get paid for through Medicaid?
Medicaid covers nursing facility services as a mandatory benefit in every state's Medicaid state plan, meaning if someone is Medicaid-eligible and meets the state's nursing facility level of care criteria, Medicaid pays for the nursing home stay [6]. This is why nursing homes are far more standardized nationally: the federal Medicaid mandate forces baseline consistency. Assisted living and group home services are usually funded differently. Most states use a Medicaid Home and Community-Based Services (HCBS) waiver, authorized under Section 1915(c) of the Social Security Act, to pay for personal care and support services in assisted living or group home settings. Critically, in most states this waiver pays for the services, not room and board, so residents (or their families) still pay rent/room-and-board out of pocket, Supplemental Security Income, or another source [5]. If you're building a licensing kit or business plan, this distinction changes your entire financial model. A nursing home operator plans around a Medicaid per-diem rate covering nearly everything. A group home or assisted living operator often plans around a mixed revenue stream: private pay room and board plus a waiver reimbursement for care hours. Confirm your state's specific waiver program name and reimbursement structure with your state Medicaid agency and licensing agency before finalizing a pro forma.
How to start a group home
Starting a group home means working through licensing, zoning, staffing, and funding in roughly this order, though states sequence it differently. 1. Pick your population and license category. Decide whether you're serving IDD, mental health, substance use recovery, or seniors, since this determines which state agency licenses you (developmental disability services, behavioral health, or aging/health department) and which statute chapter applies. 2. Confirm zoning before you sign a lease. Check local zoning code and any state law addressing group homes as a residential use, since some states have specific statutes limiting how municipalities can restrict small group homes [3]. Don't buy or lease property until you've confirmed the use is allowed. 3. Write your policy and procedure manual. Most states require written policies covering medication administration, emergency preparedness, abuse/neglect reporting, resident rights, admission/discharge criteria, and staff training before they'll issue a license. This is the single most time-consuming part of the application for first-time operators. 4. Build your staffing plan. States set minimum staff-to-resident ratios, often by shift and by resident acuity level. Background checks (often including a state and FBI fingerprint check) are required for anyone with resident contact. 5. Pass the pre-licensing inspection. This covers life safety code (fire extinguishers, exits, smoke detectors), physical plant condition, and sometimes a food safety inspection if you'll prepare meals on site. 6. Submit the license application with your policy manual, staffing plan, floor plan, and fee. Fees, timelines, and required forms vary enough by state that you should always confirm the current amount and process with your state licensing agency rather than relying on a national number. This is also the point where a lot of first-time operators either hire a consultant for several thousand dollars or try to build every policy from scratch and lose months to it. A structured $299 State Group Home Licensing Kit gives you the policy manual templates, staffing plan framework, and state-specific checklist structure so you're not starting from a blank page, though you'll still need to confirm your specific state's forms and fees directly with the licensing agency.
How do I start a group home if I've never run a facility before?
First-time operators without a facility management background can absolutely get licensed, but the states will look harder at your administrator qualifications and your policy manual. Most states require the administrator or designated manager to complete a specific training or certification program, sometimes tied to hours of experience in a related human services field, before the license is issued. Realistically, plan on this timeline: 2 to 4 months to research your state's requirements and choose a property, 1 to 3 months to write policies and assemble your staffing plan, and another 1 to 4 months for the state to review your application and schedule the pre-licensing inspection. Total time from decision to open doors commonly runs 6 to 12 months, though this varies enormously by state workload and how complete your first submission is. Get the license category right before you spend money on a building. A property that's zoned and sized correctly for a 6-bed IDD group home might not work at all for an assisted living license with different square-footage-per-resident rules. Call your state licensing agency and ask direct questions before you sign a lease or purchase agreement; most agencies have a licensing division phone line and will answer general questions from prospective applicants.
What paperwork and inspections should I expect after I'm licensed?
Licensing is not a one-time event. Nursing homes are surveyed by state agencies on behalf of CMS roughly every 9 to 15 months, with a national average interval mandated not to exceed 15.9 months [9]. Assisted living and group home inspection frequency is set by each state, commonly annual, though complaint-driven inspections can happen anytime. Expect surveyors to check: staffing records against your approved staffing plan, medication administration records, resident care plans against actual observed care, incident and injury reports, fire drill logs, and background check documentation for all staff. A gap between your written policy and what's actually happening in the building is the single most common source of citations across all these license types. Build a simple internal audit routine (monthly, ideally) where someone other than the person who did the work checks medication logs, staff schedules against ratios, and incident reports for completeness. It's far cheaper to catch a gap yourself than to have a state surveyor find it.
Frequently asked questions
What is assisted living?
Assisted living is a residential care setting where people live in a private or shared room or apartment and receive help with daily activities like bathing, dressing, and medication reminders, without needing 24-hour skilled nursing care. It's licensed and regulated at the state level, so specific services and staffing requirements vary depending on where the facility operates.
What is a group home?
A group home is a small residential home, often in a regular neighborhood, where a limited number of residents live together and get support from direct care staff. Group homes commonly serve people with intellectual/developmental disabilities, mental illness, or substance use recovery needs, and are usually licensed under disability or behavioral health statutes rather than nursing home law.
What is an assisted living facility?
An assisted living facility is the licensed building and business providing housing plus personal care services (bathing, dressing, medication help) to residents who need daily support but not skilled medical care. States use different names for this license category, including residential care facility and personal care home, so the exact statute depends on your state.
What is assisted living vs nursing home?
Assisted living serves people who need help with daily tasks but are medically stable; nursing homes serve people who need ongoing skilled nursing care, like wound treatment or IV medication, under a registered nurse's supervision. Nursing homes are federally regulated under 42 CFR Part 483; assisted living is regulated only at the state level.
What does assisted living provide?
Assisted living typically provides housing, meals, housekeeping, help with bathing/dressing/mobility, medication reminders or administration, social activities, and 24-hour staff for emergencies. It does not provide skilled nursing treatments like IV therapy or complex wound care, which is the domain of a licensed nursing home.
How do I start a group home?
Choose the population you'll serve, confirm zoning allows a group home use, write required policies (medication, emergency, abuse reporting), build a staffing plan meeting state ratios, pass a pre-licensing life safety inspection, and submit your license application with fees to your state licensing agency. Timelines and requirements vary significantly by state.
Does Medicare cover assisted living facilities?
No. Medicare does not cover the ongoing cost of assisted living, since it's considered housing and personal care, not a medical benefit. Medicare does cover up to 100 days of skilled nursing facility care per benefit period, but only after a qualifying hospital stay and only for skilled, not custodial, care needs.
Does Medicaid pay for nursing homes or assisted living?
Medicaid covers nursing facility care as a mandatory benefit in every state, for Medicaid-eligible people who meet the state's nursing facility level of care. For assisted living and group homes, most states pay for care services (not room and board) through a Home and Community-Based Services waiver, not the core Medicaid state plan benefit.
What is the difference between assisted living and nursing home cost?
The 2024 Genworth Cost of Care Survey found the median annual cost of assisted living (private one-bedroom) is about $70,800, versus about $116,800 for a semi-private nursing home room. Nursing homes cost more because they staff licensed nurses around the clock and provide skilled medical treatment.
Is a nursing home the same as a nursing care home?
Yes, 'nursing care home' and 'nursing home' typically refer to the same thing: a licensed skilled nursing facility providing 24-hour nursing care. Some countries and older documents use 'nursing care home' interchangeably, but in U.S. regulatory language, the formal term is skilled nursing facility (SNF) or nursing facility.
How many residents can live in a group home?
It depends entirely on the state and license category, but many states cap small group homes at 4 to 8 residents to preserve a residential (rather than institutional) character, especially for IDD and mental health group homes. Confirm the specific occupancy cap for your license type with your state licensing agency before finalizing a property.
Can a group home operate in a residential zone?
Often yes. Many states have laws treating small group homes for people with disabilities as a residential use of property, and the federal Fair Housing Act limits how municipalities can single out group homes for extra zoning restrictions. This protection doesn't automatically extend to larger assisted living buildings or nursing homes, which are usually zoned as institutional uses.
How often are nursing homes and assisted living facilities inspected?
Nursing homes participating in Medicare/Medicaid must be surveyed on an interval averaging no more than 15.9 months statewide, per CMS rules. Assisted living and group home inspection frequency is set by each state, commonly annual, with additional complaint-driven inspections possible anytime a concern is reported.
Sources
- 42 CFR 483.35(b), Nursing services staffing requirements: RN on duty at least 8 consecutive hours/day, licensed nursing staff 24/7 requirement for Medicare/Medicaid-certified nursing homes
- Medicare.gov, Long-term care coverage: Medicare does not cover assisted living or long-term custodial care
- HUD, Fair Housing Act and group homes: Federal fair housing protections affect zoning treatment of group homes for people with disabilities
- Medicare.gov, Skilled nursing facility care coverage: Medicare covers up to 100 days of SNF care per benefit period after a qualifying hospital stay
- Medicaid.gov, Home & Community-Based Services: States use HCBS waivers to fund personal care services in assisted living/group home settings, separate from room and board
- Medicaid.gov, Nursing Facilities: Medicaid covers nursing facility services as a mandatory state plan benefit
- Genworth, Cost of Care Survey 2024: Median annual cost figures for assisted living and nursing home semi-private room
- Medicare.gov, What Medicare doesn't cover: Medicare doesn't cover long-term custodial care if that's the only care needed
- 42 CFR 488.308, Frequency of standard surveys: Standard nursing home surveys must occur on a statewide average interval not exceeding 15.9 months