Skilled Nursing vs. Assisted Living: Differences Explained
Written by Ari Parker — Updated: Wednesday, October 22, 2025
As we age, our health and independence levels can change. We may need more help caring for ourselves and managing the daily activities of life. Skilled nursing care and assisted living are two ways to do this. The major difference between skilled nursing vs. assisted living is that skilled nursing provides medical care, whereas assisted living helps with the activities of daily living (ADLs).
In this article, we’ll explore the main differences between skilled nursing and assisted living. We’ll look at costs, insurance coverage, and how to choose the right care for you or a loved one.
Key takeaways
Skilled nursing care offers round-the-clock medical supervision. In contrast, assisted living helps with daily tasks, such as bathing and meal prep.
Skilled nursing usually costs more than assisted living. However, Original Medicare may cover skilled nursing in certain cases.
Assisted living is best for individuals who are looking to maintain their independence but need a little extra help. Skilled nursing care is best for individuals who need specific medical care.
What is skilled nursing care?
Skilled nursing care is designed for individuals who need specialized medical care following an injury or illness or for people suffering from severe health conditions. The staff at a skilled nursing facility includes registered nurses, therapists, and other medical professionals. They provide:
24/7 medical supervision
Medication administration and monitoring
Pain management
Physical, occupational, and speech therapy
Specialized medical support
Assistance with activities of daily living
What is assisted living care?
Assisted living care helps people who are otherwise independent but need more help with daily activities than they can manage living independently. On-call nurses and trained care aides assist with:
Bathing
Meal preparation
Cleaning
Medication management and monitoring
Transportation to medical appointments and outings
In addition to helping with ADLs, assisted living also offers a community environment with planned social activities to help maintain connections and well-being.
Understanding the similarities and differences
Skilled nursing care and assisted living both offer extra care. The difference between them lies in their levels of care, costs, and environment.
Level of care
Skilled nursing care is the highest level of care offered outside a hospital. This includes specific medical care, such as giving prescription medications, providing physical therapy and IV therapy, and offering meals for special diets. Skilled nursing facilities also have a higher staff-to-resident ratio and round-the-clock care, so residents are more closely monitored.
On the other hand, assisted living helps with daily activities and personal care. This includes meal prep, bathing, housekeeping, transportation, and many more. While the staff at an assisted living facility helps with medication management and is trained in offering basic healthcare, they are not equipped to provide advanced medical care.
Environment
Skilled nursing care is provided in a more clinical setting, with private or semiprivate rooms that can accommodate medical equipment. Assisted living is offered in a residential environment with private rooms similar to an apartment. These rooms might have kitchens and separate living room areas. Couples can live together, and some assisted living facilities are even pet-friendly. Assisted living often includes common areas. Here, residents can socialize and join group activities.
Goals
In skilled nursing, the goal is to rehabilitate an individual who is recovering from an illness or injury. Skilled nursing care can also provide appropriate care for individuals who have complex health issues. Assisted living aims to help people with daily activities. This support helps them stay healthy and connected to their community.
Costs
Because skilled nursing requires more care, its costs are generally higher. Genworth and CareScout’s 2024 Cost of Care Survey found that the monthly median costs for skilled nursing care with a private room are $10,646. For a semi-private room, this goes down to $9,277 per month. Other factors also influence the cost, including additional therapy, staff-to-patient ratio, geographical location, and facilities.
The monthly median costs for assisted living are $5,900. Assisted living might also have additional costs, such as move-in fees, recreational costs, or specialized memory care. Costs may further increase depending on the number of ADLs you need help with, room type and size, and available amenities on-site.
Insurance coverage
Original Medicare doesn’t cover assisted living. However, it might cover skilled nursing care after a qualifying inpatient hospital stay. This coverage can be up to 100 days (in a semi-private room with a coinsurance to be paid from Day 21), but it depends on medical need. Medicaid may be used to help cover skilled nursing care, based on the individual’s income and assets. Medicaid might also be used to help cover assisted living care, but this is limited and can vary by state.
For individuals with long-term care insurance, this can cover a major portion of the costs of assisted living and skilled nursing care. However, this differs by plan, so you should check with your provider to see what they cover.
Requirements
Because assisted living doesn’t provide 24/7 medical care, individuals may need to complete a health assessment before admission. This makes sure that they are medically stable, not a danger to themselves or others, and can perform activities like feeding themselves or transferring from a chair to a bed.
For skilled nursing care, a doctor’s referral is usually needed, stating that the person requires daily medical care. The person must also have been admitted to a hospital for a minimum of three consecutive days during the past 30 days.
How to choose skilled nursing or assisted living
Skilled nursing and assisted living both have unique benefits that make them a better option for people in particular situations. It’s also normal to need different levels of care over time and to transition between care levels.
Benefits of skilled nursing
Skilled nursing offers medical care for those recovering from a hospital stay or dealing with specific health issues. This includes:
Trained medical staff available 24/7
Regular medical monitoring and chronic condition management
Access to additional support, such as speech, occupational, and physical therapy
Specialized medical care, such as wound care and IV therapy
Medication administration and monitoring, including injections
Help with ADLs, including feeding, bathing, or toileting, or getting out of bed into a wheelchair
Secure, safe environment for individuals with more complex medical needs
Personalized care plan, including dietary plans and meals
Peace of mind for family members that their loved ones have the necessary medical care
Benefits of assisted living
Assisted living suits those who want to stay independent but need help with daily tasks. Benefits include:
A balance between independence and assistance with daily tasks like dressing, bathing, and preparing meals
A maintenance-free lifestyle for seniors who no longer wish to be responsible for tasks like daily chores, home repairs, or yard work
Nutritious meals in a restaurant-like environment
Recreational activities and outings
Transportation for shopping, appointments, and events
Medication management and basic healthcare
A sense of community that keeps seniors active and involved
Transitioning between care levels
Some people go to a skilled nursing facility after a hospital stay. Later, they may move to assisted living as their needs decrease. Others choose a community that offers both, so they can transition smoothly if their health changes. Some facilities even let you add services, such as memory care, before moving to skilled nursing care. This way, you can stay in assisted living longer.
The benefit of considering long-term care for seniors is that it provides the health and safety needed, along with a sense of community. It can also be more predictable. The alternative is aging in place, where someone chooses to remain in their own home and brings in support services when needed.
Making the right choice for your loved one
Choosing between a skilled nursing home and assisted living is a personal choice, and needs can change over time. Here is what to consider:
Care needs: If a person needs 24/7 medical care and monitoring, then skilled nursing is a better option. For example, if they are bed-bound and have serious or uncontrolled health conditions, skilled nursing care is better suited for their needs. Assisted living is best for people who need help with daily activities, like bathing and dressing, and a community environment for their mental well-being.
Medical conditions: For complex medical conditions or recovery from hospitalization, possibly after a stroke, cardiac emergency, or surgery, skilled nursing care is a better choice. For those with stable health who need help with medication, assisted living is better suited.
Lifestyle and independence: Assisted living is a good choice for people who want to maintain their independence and have access to activities and a social community. If safety and medical care are a priority over lifestyle and independence, skilled nursing care is recommended.
When transitioning to assisted living, it is important to balance your loved one’s needs and state of mind before making a decision. Some people may not immediately accept the idea of moving to a new environment due to emotional ties with their home or community.
In such cases, you can also consider aging in place for the time being, with the assistance of homemaker services or home health aides.
For people who are unsure of what the best choice is, consulting their doctor can provide additional insight.
Bottom line
Skilled nursing and assisted living differ mainly in care levels. Skilled nursing offers 24/7, professional medical care, while assisted living helps with daily activities.
When choosing between a nursing home vs. assisted living care, it’s important to match care levels to individual needs and preferences so that people get the care they need while retaining as much of their independence as possible. This decision doesn’t have to be made alone. Touring facilities helps you compare senior care options, and working with doctors can clarify the care level needed for you or your loved one.
Frequently asked questions
What’s the main difference between skilled nursing and assisted living?
The main difference between skilled nursing and assisted living is the level of care. Skilled nursing provides 24/7 medical care and monitoring, while assisted living helps with the activities of daily living, like bathing and meal preparation.
Does Medicare cover skilled nursing or assisted living?
Original Medicare does not cover assisted living. However, Original Medicare may cover skilled nursing care if you have a qualifying inpatient hospital stay. This coverage may be available for up to 100 days with a copayment after 20 days.
Can someone move from assisted living to skilled nursing?
Yes, people can move from assisted living to skilled nursing. This happens when assisted living no longer meets their personal or medical care needs.
Sources
Genworth Financial, Inc. (2025). Cost of Care Survey 2024: Annual median cost data tables (Report No. 282102). Retrieved from https://pro.genworth.com/riiproweb/productinfo/pdf/282102.pdf
National Institute on Aging. (2023, October 12). Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care. U.S. Department of Health and Human Services. Retrieved from https://www.nia.nih.gov/health/assisted-living-and-nursing-homes/long-term-care-facilities-assisted-living-nursing-homes