Research shows that between 50% and 70% of people over 65 will need long-term care at some point, requiring assistance with at least a few activities of daily living (ADLs) and, in some cases, more intensive care. About 20% of those who receive long-term care need it for 2 to 5 years, while roughly 13% require care for more than 5 years. There is, however, a wide range between needing occasional help with dressing or household chores and needing continuous nursing care.
As an individual’s needs change, and depending on their health and living situation, they may move to an assisted living community or a skilled nursing facility (often called a nursing home). Below is an overview of the services, living arrangements, and costs associated with each option to help you compare them.
What is assisted living?
Assisted living communities typically offer private bedrooms with shared common areas or independent one‑bedroom apartments. Their primary purpose is to help residents maintain independence in a home‑like environment while providing the support they need.
Residents usually require assistance with one or more ADLs — bathing, dressing, eating, toileting, transferring, and continence — and often need help with instrumental ADLs (IADLs) such as laundry, meal preparation, and household chores. Common services in assisted living include:
- One to three meals per day, depending on the resident’s accommodations and contract
- Medication monitoring and some basic medical services
- 24-hour emergency monitoring
- Planned social and recreational activities
How much does assisted living cost?
Pricing models vary. Some communities use an all‑inclusive model, but most use a fee‑for‑service system in which residents pay a base monthly fee plus additional charges for specific care services. Typical charges include:
- Community fee (one-time): A reservation or move‑in deposit to hold your chosen accommodations.
- Monthly base fee: A rent‑like charge covering utilities, basic housekeeping, maintenance, and some meals; this varies by unit size and whether you share the unit.
- Monthly care services fee: A tiered charge based on the level of assistance required (number of ADLs), ranging from a modest amount for low‑level needs to several thousand dollars for higher tiers.
- Medication and ancillary services fees: Charges for medication management or therapies (physical, occupational) and optional services such as extra meals or parking.
According to Genworth data from 2020, the national average cost for a private one‑bedroom assisted living unit was about $4,300 per month, or approximately $51,600 per year. Actual costs depend on location, level of care, and provider quality. Historical data from the National Center for Assisted Living reported an average assisted living stay of about 28 months, which illustrates how quickly costs can add up.
What is skilled nursing care (nursing home)?
Many assisted living residents — as many as 59% according to industry sources — eventually move to a skilled nursing facility. Skilled nursing care provides a higher level of medical and nursing services than assisted living and is delivered around the clock by licensed staff. Residents typically need regular help with ADLs and may have chronic conditions that require ongoing medical management.
Skilled nursing facilities support long‑term residents with chronic needs as well as short‑term residents who require rehabilitation after surgery or hospitalization. These facilities offer rehabilitative therapies including physical, occupational, respiratory, and speech therapy when needed. Living arrangements vary from private rooms to semi‑private rooms, with common areas for meals and activities when residents are able to participate.
How much does a nursing home cost?
Nursing homes typically bill monthly for basic care, with additional charges for ancillary or specialized services. Rates depend on the complexity of care, room type (private vs. semi‑private), and amenities. Genworth’s 2020 figures showed average monthly costs of $7,756 for a semi‑private room and $8,821 for a private room — roughly $93,075 and $105,850 per year, respectively. Costs vary widely by region and individual care needs.
Older data indicate the average nursing home stay is a bit over two years, though stays can be much shorter for those receiving temporary rehabilitation; for discharged residents the average is closer to nine months. Medicare covers skilled nursing care only under specific, limited conditions and for a limited duration.
Assisted living and nursing care in one location
Because care needs often progress, many people spend time receiving care at home, then move to assisted living, and later transition to a nursing home. Nearly 60% of assisted living residents may require nursing home care eventually. To minimize moves and preserve continuity of care, some people choose life plan communities (also called continuing care retirement communities or CCRCs), which provide independent living, assisted living, and skilled nursing on the same campus so residents can remain in one community as needs change.
How will you pay for your care needs?
It is difficult to predict how much care any individual will need. A reasonable estimate based on averages suggests around 4–5 years of cumulative long‑term care across home care, assisted living, and skilled nursing. In that scenario, total costs can easily exceed $300,000 and may be substantially higher depending on location and duration of care.
Because long‑term care is costly and often longer than people expect, planning is essential. Options include saving specifically for future care, purchasing long‑term care insurance, or exploring other financial strategies with a qualified financial planner. Note that Medicare does not cover assisted living and provides only limited, temporary coverage for skilled nursing care under strict conditions. Understanding contract terms and billing practices before moving into a facility helps avoid surprises when monthly invoices arrive.