Nursing Homes Explained: Costs, Care and How to Choose

Key Takeaways

Nursing homes provide 24-hour skilled nursing and medical care — they are not the same as assisted living, which offers far less clinical support.
The national median cost of a nursing home is $9,581/month for a semi-private room and $10,798/month for a private room (2025).
Medicare does not pay for long-term nursing home stays. It covers up to 100 days of skilled nursing care after a qualifying hospital stay — and the coinsurance for days 21–100 is $217/day in 2026.
Medicaid is the primary payer for long-term nursing home care in the U.S. To qualify, most people must first spend down assets to roughly $2,000 (varies by state).
Use Medicare’s Care Compare tool (medicare.gov/care-compare) to check star ratings, inspection results, staffing levels, and staff turnover rates for any facility you’re considering.

When a parent, spouse, or sibling can no longer safely manage at home — and when the level of care they need goes beyond what family or home aides can realistically provide — the idea of a nursing home comes up. It’s one of the hardest conversations a family can have, and it often happens fast: after a fall, a stroke, or a diagnosis that changes everything overnight.

If you’re in that moment right now, this guide is for you. We’ll explain what nursing homes actually are (and how they differ from other facilities), what they cost in 2024, how Medicare and Medicaid fit in, and — critically — how to evaluate and choose a facility that will give your loved one good care. We won’t oversimplify, but we won’t bury you in jargon either.

What Is a Nursing Home?

A nursing home — also called a skilled nursing facility (SNF) or long-term care facility — is a residential setting that provides around-the-clock medical and personal care for people who can no longer manage independently.

The key word is skilled. Nursing homes are staffed by registered nurses, licensed practical nurses, and certified nursing assistants at all hours. This distinguishes them clearly from assisted living communities, which offer help with daily tasks but typically don’t have nurses on staff 24/7.

What services does a nursing home typically provide?

Skilled nursing care (wound care, IV therapy, catheter care, medication management)
Physical, occupational, and speech therapy
Help with all activities of daily living: bathing, dressing, eating, toileting, mobility
Medical monitoring and physician oversight
Social services and activities
Nutritional support and meal preparation
Memory care units (in many facilities)
Hospice and palliative care coordination

Nursing homes serve two broad groups of residents. Some people are there short-term — recovering after a hip replacement, a stroke, or serious pneumonia — before returning home. Others are there long-term, when their care needs are permanent and too complex for any other setting. Both types of residents are commonly in the same building, though some facilities specialize in one or the other.

Nursing Home vs. Assisted Living: The Key Differences

These two terms get confused all the time, and the confusion has real consequences. Families sometimes move a loved one into assisted living thinking it’s equivalent to a nursing home — and then face a crisis when the care level isn’t enough.

Feature	Nursing Home	Assisted Living
Medical / nursing care	24/7 RNs and LPNs on staff	Caregivers and aides; nurses often not 24/7
Help with daily activities	Full assistance with all ADLs	Help with some ADLs
Level of medical complexity	High — manages serious chronic conditions	Low to moderate
Memory care	Often available in dedicated units	Sometimes available
Medicare coverage	Yes, for short-term skilled care (up to 100 days)	No
Medicaid coverage	Yes, for long-term care	Rarely, and very limited by state
Typical annual cost (2025)	$114,975–$129,575	$74,400
Environment	More clinical	More residential

The practical rule of thumb: if your loved one needs a registered nurse to manage their care regularly — not just occasionally — a nursing home is the right level of care. If they need help with bathing and meals but are medically stable, assisted living may be enough. → assisted living guide

Nursing Home Costs in 2025

Nursing homes are expensive. There’s no way to soften that reality. But knowing the real numbers — and what drives them — helps you plan.

According to the 2025 Cost of Care Survey by CareScout (Genworth) (the most comprehensive annual survey of long-term care costs in the U.S., collecting more than 25,000 rates from providers nationwide between July and November 2025), the national median costs are:

Room Type	Monthly Cost	Annual Cost	Change vs. 2024
Semi-private room ($315/day)	$9,581	$114,975	+2%
Private room ($355/day)	$10,798	$129,575	+1%

These are national medians (see our senior care costs guide for a full breakdown by care type). Your actual cost depends heavily on where you live. In the 2025 survey, the state median for a semi-private room ranged from $5,627/month in Texas to $27,831/month in Alaska. Five states had medians above $15,000/month: Alaska, Oregon ($16,760), New York ($15,528), Hawaii ($15,473), and Connecticut ($15,208). See nursing home costs for every state.

What’s typically included in the base rate:

Room and board
Three daily meals
Basic nursing care
Standard activities and social programming
Routine physician visits

What often costs extra:

Physical, occupational, or speech therapy (beyond what Medicare covers)
Specialized memory care unit fees
Private-duty nursing or one-on-one aide time
Personal care items (incontinence products, toiletries)
Transportation to outside appointments
Cable, internet, phone

Always ask for a complete written fee schedule before signing an admission agreement. Some facilities advertise a base rate that doesn’t include items your loved one will need every day.

How Medicare Covers Nursing Homes

Here is the single most important thing to understand: Medicare does not pay for long-term nursing home care.

Medicare covers nursing home care only when all of these conditions are met:

Your loved one had a qualifying inpatient hospital stay of at least 3 days (not under “observation status” — that doesn’t count).
The nursing home admission happens within 30 days of leaving the hospital.
They need medically necessary skilled care — not just help with bathing or eating, but actual skilled nursing or therapy services.
The nursing home is Medicare-certified.

When those conditions are met, Medicare Part A covers care as follows — using the 2026 benefit period rates (effective January 1, 2026, per CMS Change Request 14279):

Days in Facility	What You Pay	What Medicare Pays
Days 1–20	$0	100% of approved costs
Days 21–100	$217/day coinsurance	Remainder of approved costs
Day 101+	All costs	Nothing

For reference, the 2024 coinsurance was $204/day and the 2025 rate was $209.50/day — this cost increases most years. Medicare also covers doctor visits and physical, speech, or occupational therapy provided in a nursing home under Part B, even if the stay itself isn’t covered.

What Medicare never covers:

Custodial care when that is the only type of care your loved one needs
Long-term stays once skilled care is no longer medically necessary
Assisted living costs (at all)

Most families are surprised to discover that Medicare’s nursing home coverage runs out much sooner than they expected. After 100 days, you’re paying privately or relying on Medicaid.

How Medicaid Covers Nursing Home Care

Medicaid is the primary payer for long-term nursing home care in the United States. The majority of long-term nursing home residents are covered by Medicaid.

Medicaid is a federal-state program, and every state runs it differently — but the federal rules set the floor. Here’s what you need to know:

Who qualifies? Medicaid is needs-based. To qualify for nursing home coverage, your loved one generally must:

Have income and assets below their state’s limits
Require the level of care a nursing home provides
Be a U.S. citizen or qualified immigrant and a state resident

The asset limits are strict. For an individual, most states require countable assets to be reduced to roughly $2,000 before Medicaid coverage begins. The family home may be exempt (if a spouse or dependent still lives there), as are certain personal belongings, one car, and prepaid funeral arrangements.

The spend-down process: If your loved one has assets above the Medicaid limit, they must “spend down” those assets on care costs before Medicaid kicks in. This is legal and expected — it’s not a loophole, it’s how the system is designed. You can spend down on nursing home bills, medical expenses, home modifications, and other approved costs.

Important: Medicaid has a 5-year look-back period. Any assets transferred to family members or others within 5 years of applying may result in a period of Medicaid ineligibility. Consult an elder law attorney before making any gifts or asset transfers.

Spousal protections: Federal law protects a community spouse (the spouse still living at home) from losing all their resources. The Community Spouse Resource Allowance lets the at-home spouse keep a portion of the couple’s assets. Rules vary by state.

Income rules: Once Medicaid covers nursing home care, nearly all of your loved one’s monthly income (Social Security, pension, etc.) goes toward the cost of care. Medicaid pays the balance. Your loved one is allowed to keep a small Personal Needs Allowance (PNA) for personal expenses. This amount varies significantly by state — from as low as $30/month to as high as $200/month, with the national average around $70/month (2024). The federal minimum has not been raised since 1988.

Other Ways to Pay for Nursing Home Care

Medicare and Medicaid don’t cover everyone. Here are the other main options:

Private pay (out of pocket): Many residents begin by paying privately. At $9,000–$10,000+ per month, savings deplete quickly. Some facilities offer better accommodations or amenities to private-pay residents and may transition to Medicaid once assets are spent down — ask specifically whether a facility accepts Medicaid before admitting a resident who may eventually need it.

Long-term care insurance: Policies purchased before health declines may cover nursing home costs up to a daily or monthly benefit cap, for a set benefit period. Premiums are high and coverage varies widely.

Veterans benefits (VA Aid & Attendance): Wartime veterans and their surviving spouses may qualify for the VA’s Aid & Attendance pension benefit, which pays a tax-free monthly amount toward the cost of nursing home care. For 2026 (rates effective December 1, 2025 through November 30, 2026), the maximum amounts are:

Single veteran: $2,424/month
Married veteran: $2,874/month
Surviving spouse: $1,558/month

One important caveat: If your loved one is also on Medicaid for their nursing home stay, VA Aid & Attendance payments are generally reduced to a small personal-needs amount, because the VA doesn’t duplicate costs another government program already covers. To apply, veterans file VA Form 21P-527EZ; surviving spouses file VA Form 21P-534EZ. The VA also operates its own Community Living Centers (VA-run nursing homes) in many regions, which is a separate program from Aid & Attendance.

Medicare Supplement (Medigap) plans: Some Medigap policies cover the Medicare SNF coinsurance for days 21–100 — at $217/day in 2026, that protection can save a family thousands if the Medicare-covered stay extends that long.

How to Choose a Nursing Home

Choosing a facility takes time, but there is a clear process. Here’s how to approach it without feeling overwhelmed.

Step 1: Start with Medicare’s Care Compare Tool

Go to medicare.gov/care-compare and search for nursing homes near you.

Every Medicare- and Medicaid-certified nursing home in the country is rated here on a 1 to 5 star scale across four areas:

Overall rating — a combined score
Health inspections — how the facility performed during unannounced state surveys
Staffing — nurse-to-resident ratios, including RN hours per resident per day
Quality measures — outcomes like percentage of residents with pressure sores, falls, or urinary tract infections

A 1-star overall rating is a warning sign. A 5-star rating doesn’t guarantee everything will be perfect, but it’s a meaningful data point. Look especially at the staffing and health inspection sub-scores — these are harder for facilities to game than the overall number.

Use the turnover data. Since January 2022, CMS posts staff turnover rates — the percentage of nursing staff who left each facility over a 12-month period — directly on Care Compare. Nationally, nursing home staff turnover exceeds 50% per year; facilities with significantly higher turnover than their local average deserve extra scrutiny.

Step 2: Make a Short List and Call

From your Care Compare search, identify three to five facilities to investigate further. Call each one and ask:

Do you accept Medicaid? (Critical if your loved one may eventually need it)
Do you have a waitlist? How long?
Do you have a dedicated memory care unit? (If relevant)
What is the nurse-to-resident ratio during the day? At night and on weekends?
What is your staff turnover rate, and how does it compare to state averages?

High staff turnover means residents are constantly cared for by unfamiliar faces — and that instability affects the quality and continuity of care. Ask the facility directly and compare their answer against the Care Compare data.

Step 3: Visit — More Than Once

The National Institute on Aging and Medicare both recommend visiting at different times of day, including evenings and weekends, when staffing can be thinner.

During your visit, pay attention to:

Does the facility smell clean? Is it tidy?
Are residents dressed and out of bed during the day, or in rooms with doors closed?
Do staff address residents by name? Do they seem rushed or attentive?
Is there active programming happening, or just a TV on in the corner?
Talk to residents or family members if you can — ask them directly what they think.

Medicare provides a free printable nursing home checklist you can use during visits: medicare.gov/care-compare/en/assets/resources/nursing-home/nursing-home-checklist.pdf

Step 4: Review the Admission Agreement Carefully

Before signing anything, read the contract thoroughly. Key things to look for:

Is the base rate clearly defined, and what does it include?
What triggers additional charges?
What is the facility’s policy for holding a bed if your loved one is hospitalized?
Under what conditions can the facility discharge a resident?
Does the contract comply with federal rules — for example, it cannot require a family member to personally guarantee payment as a condition of admission.

Federal law gives nursing home residents a defined set of rights, including the right to be informed about their care, participate in care planning, refuse treatment, and be free from abuse or unnecessary restraint. Facilities must provide a written description of these rights at admission.

Your Loved One’s Rights in a Nursing Home

Federal law establishes specific rights for every nursing home resident. The nursing home must explain these rights in writing, in a language the resident understands. At minimum, federal law requires that facilities:

Treat residents with dignity and respect at all times
Involve residents in their own care planning
Allow residents to make choices about their daily lives (when to get up, what to eat, whether to participate in activities)
Protect residents from abuse, neglect, and exploitation
Allow unrestricted visitor access
Not discharge a resident without proper notice and due process

If you believe a facility is not honoring a resident’s rights, contact your state’s Long-Term Care Ombudsman. Every state has one, and it’s a free service. Find yours at eldercare.acl.gov.

Frequently Asked Questions

What is a nursing home, exactly?

A nursing home is a licensed residential facility that provides 24-hour skilled nursing care, medical supervision, and personal care for people who can no longer live independently. They are also called skilled nursing facilities (SNFs). Nursing homes differ from assisted living in that they have registered nurses and licensed medical staff on site at all hours.

How much does a nursing home cost per month in 2025?

The national median is $9,581/month for a semi-private room and $10,798/month for a private room (2025). Costs vary significantly by state — a semi-private room has a state median from $5,627/month in Texas to $27,831/month in Alaska.

Does Medicare pay for nursing home care?

Medicare pays only for short-term skilled nursing care — up to 100 days per benefit period after a qualifying hospital stay of at least 3 days. It does not cover long-term custodial care, which is what most nursing home residents need. For days 21–100, patients owe $217/day in coinsurance (2026 rate). After day 100, Medicare pays nothing.

How do I qualify for Medicaid to cover a nursing home?

Medicaid eligibility for nursing home care requires that your loved one needs the level of care a nursing home provides and that their income and assets fall below state limits — often around $2,000 in countable assets for an individual. Those with more assets must spend them down on care costs first. Rules vary significantly by state. Contact your state Medicaid office or an elder law attorney for guidance.

How do I find a good nursing home near me?

Start at Medicare’s Care Compare tool (medicare.gov/care-compare). Search by ZIP code, review star ratings — especially the health inspection and staffing sub-scores — and check the published staff turnover rate for each facility. Then visit your top choices in person at different times of day. Ask about Medicaid acceptance and request a full written fee schedule.

Can a nursing home discharge my family member against our wishes?

A nursing home can discharge a resident only under specific circumstances: if the resident’s needs can no longer be met there, if the resident’s health has improved enough to leave, for non-payment (with proper notice), or if the facility closes. The facility must provide written notice and give the resident time to appeal. This is a federally protected right.

Sources

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