Home Care vs. Nursing Home: Understanding the Real Differences

Home care and nursing home care serve different levels and patterns of need. Home care generally provides nonmedical, one-on-one assistance with bathing, dressing, meals, mobility, supervision, transportation, and other daily activities in a person's own home. Nursing homes provide residential care for people who need substantial ongoing assistance and nursing services that cannot reasonably be managed through a less intensive arrangement. A skilled nursing facility, or SNF, is not simply another name for every nursing home: SNF care specifically involves daily skilled nursing or rehabilitation, often for a limited period after an illness, surgery, or hospitalization. In 2022, about 1.2 million Americans lived in approximately 14,700 nursing homes. Whether home care or nursing-home care fits better depends on medical needs, supervision, mobility, cognition, caregiver availability, safety, cost, and whether required care can realistically be delivered at home.

"Nursing home," "skilled nursing facility," "home health," and "home care" are often used as if they mean roughly the same thing.

They don't.

And understanding the difference matters because these services solve very different problems.

A person who needs help bathing, dressing, preparing meals, and getting to appointments may do very well with home care.

A person recovering from a hip fracture who needs daily rehabilitation and skilled nursing may temporarily need a skilled nursing facility.

Someone with advanced illness who needs extensive personal assistance, nursing services, and supervision around the clock may require long-term nursing-home care, or a highly coordinated home-based care plan capable of safely meeting those same needs.

The important question isn't:

"Is a nursing home better than home care?"

It is:

"What care does this person actually require across a full 24-hour day, and where can that care be delivered safely and sustainably?"

HOME CARE VS. NURSING HOME CARE IN 30 SECONDS

Home care may fit when:

• Medical needs are reasonably stable
• The primary need is help with daily activities
• Care can be scheduled around predictable needs
• The home can be made reasonably safe
• Family and paid caregivers can reliably cover remaining hours
• The person strongly prefers remaining at home

Nursing-home care may fit when:

• Extensive assistance is needed throughout the day and night
• Skilled nursing needs are substantial or recurring
• Safe transfers or mobility require significant staff support
• Medical, cognitive, or behavioral needs cannot realistically be managed at home
• Family caregiving has become unsustainable
• The cost or complexity of providing the necessary level of care at home has become impractical

First: A Nursing Home and a Skilled Nursing Facility Are Not Exactly the Same Thing

This is the most important terminology correction.

People commonly say:

"Nursing home, also called a skilled nursing facility..."

But that is not quite accurate.

Medicare describes a skilled nursing facility (SNF) as a type of nursing facility with the staff and equipment necessary to provide skilled nursing and rehabilitative care. SNFs may be located within nursing homes or hospitals.

A nursing home, meanwhile, can provide both:

• Short-term rehabilitation and skilled nursing
• Long-term residential nursing and custodial care

Medicare explicitly distinguishes long-term nursing-home care from its short-term SNF benefit.

Think of It This Way

A person can therefore enter the same building for three weeks of Medicare-covered rehabilitation while another resident lives there for several years receiving long-term Medicaid-funded nursing-facility care.

The building may serve both purposes.

The payer, eligibility rules, care plan, and reason for being there are different.

Nursing Homes by the Numbers

The nursing-home system remains a major part of U.S. long-term care.

According to the CDC's National Center for Health Statistics:

• There were approximately 14,700 nursing homes in the United States in 2022.
• They contained approximately 1.6 million licensed beds.
• About 1.2 million people were living in nursing homes.
• Approximately 72.4% of nursing homes were for-profit facilities.

Medicaid also plays an enormous role in institutional long-term care.

In 2023:

• Approximately 1.29 million Medicaid beneficiaries used nursing-facility services.
• Nursing-facility users represented about 85% of Medicaid institutional LTSS users.
• Medicaid nursing-facility expenditures totaled approximately $68.8 billion.

WHY THESE NUMBERS MATTER

Nursing homes are not simply "rehab after the hospital."

They are also a major part of the country's long-term care system for people who require ongoing nursing, personal care, supervision, rehabilitation, and related services.

What Does a Nursing Home Actually Provide?

Medicaid-certified nursing facilities primarily provide three broad types of services:

1. Skilled nursing or medical care
2. Rehabilitation after illness, injury, or disability
3. Long-term health-related care and services that cannot otherwise be adequately provided in the community

Required nursing-facility services can include:

• Nursing care
• Personal care
• Medication services
• Dietary services
• Social services
• Rehabilitation
• Activities
• Assistance with activities of daily living
• Room and board
• Routine personal-hygiene services

Nursing Homes Provide More Than "Medical Care"

Many long-term residents do not require a complex medical procedure every hour.

They may instead need a combination of:

• Bathing
• Dressing
• Toileting
• Eating assistance
• Transfers
• Wheelchair mobility
• Medication administration
• Continence care
• Nursing monitoring
• Dementia supervision
• Skin care
• Fall prevention
• Nutrition management

Medicare itself notes that much long-term nursing-home care is custodial care involving activities such as bathing, dressing, eating, getting in and out of bed, moving around, and using the bathroom.

The difference is that these services are being provided within a residential environment that also has nursing infrastructure.

Does Every Nursing Home Provide Ventilator Care, IV Therapy, or Complex Wound Care?

No.

This is another important correction.

Some nursing facilities provide highly specialized care.

Others do not.

Depending on the facility, services may include:

• Complex wound management
• IV medications
• Tube feeding
• Respiratory services
• Tracheostomy care
• Specialized rehabilitation
• Dialysis coordination
• Ventilator care

But not every nursing home is equipped or licensed to manage every complex clinical condition.

Ventilator-dependent residents, for example, may require a facility with specialized respiratory staffing and equipment.

When complex needs are involved, ask:

• Does the facility currently manage this condition?
• How many residents with similar needs does it serve?
• What nursing coverage is available?
• What happens after hours?
• What equipment is available?
• What would cause the facility to transfer the resident to a hospital?

DIAGNOSIS DOES NOT DETERMINE THE SETTING BY ITSELF

Having a feeding tube, wound, dementia diagnosis, or wheelchair does not automatically mean someone requires a nursing home.

The more important questions are:

How complex is the care?

How often is skilled intervention required?

How much supervision is needed?

Can the required care be delivered safely in another setting?

What Does Home Care Actually Provide?

Home care generally refers to nonmedical or personal-care assistance delivered where a person lives.

Typical services include:

• Bathing
• Dressing
• Grooming
• Toileting
• Mobility assistance
• Transfers within permitted scope
• Meal preparation
• Light housekeeping
• Laundry
• Shopping
• Transportation
• Companionship
• Safety supervision
• Medication reminders
• Respite for family caregivers

Home care can range from three hours on Tuesday to multiple caregivers covering most or all of the day.

The important distinction is that ordinary home care is generally not skilled nursing.

Home Care vs. Nursing Home: Side-by-Side

When Home Care May Be Enough

Home care may be a good fit when the person's needs are primarily functional rather than continuously clinical.

Examples Include:

• Help bathing
• Dressing assistance
• Meal preparation
• Transportation
• Housekeeping
• Companionship
• Medication reminders
• Walking assistance
• Toileting
• Dementia supervision during specific periods
• Respite for family caregivers

A person can have several chronic illnesses and still remain at home safely.

The relevant issue isn't simply the number of diagnoses.

Someone with:

• Diabetes
• Arthritis
• Hypertension
• Heart disease

may be medically stable and primarily need assistance with everyday tasks.

Meanwhile, a person with only one diagnosis may have severe functional limitations requiring much more care.

When Skilled Home Health Can Be Added

Home care is not the only service that can be delivered at home.

Medicare-covered home health care may include:

• Part-time or intermittent skilled nursing
• Wound care
• Certain IV or nutrition therapy
• Injections
• Monitoring of serious illness
• Physical therapy
• Occupational therapy under applicable conditions
• Speech-language pathology
• Medical social services
• Limited home health aide services when qualifying skilled care is also being received

This can create a layered home-care plan:

EXAMPLE

Family caregiver: evenings and weekends

Home care agency: bathing, meals, and supervision

Home health nurse: wound management

Physical therapist: mobility rehabilitation

Physician: medical oversight

Someone can receive several different types of support without moving into a nursing facility.

Home Health Is Not Necessarily Only Short-Term

Home health is sometimes described as "short-term, physician-ordered nursing or therapy."

That is too narrow.

Medicare states that qualifying home health can help someone:

• Get better
• Maintain their current condition or level of function
• Slow deterioration

In other words, Medicare coverage is not limited solely to situations in which a patient is expected to improve quickly.

What Medicare does limit is the amount and type of home health care.

The beneficiary generally must need part-time or intermittent skilled services and meet Medicare's homebound and other eligibility requirements. Medicare does not cover 24-hour-a-day care in the home through the home-health benefit.

HOME HEALTH IS NOT 24-HOUR HOME NURSING

Medicare home health may provide valuable skilled care at home.

But Medicare specifically does not cover 24-hour-a-day home care through this benefit.

A person who requires continuous nursing supervision needs a different care plan.

When a Nursing Home May Be the Better Fit

No single diagnosis automatically determines that someone needs a nursing home.

Instead, look at the combined intensity of care.

A Nursing Facility May Become Appropriate When:

• Skilled nursing needs are frequent
• Extensive personal care is required throughout the day and night
• The person cannot safely transfer without substantial assistance
• There are repeated falls despite intervention
• Nutrition or hydration requires extensive support
• Medication administration is complex
• Wounds require substantial nursing management
• Rehabilitation needs are intensive
• Dementia-related behaviors cannot be safely managed in the current environment
• The person cannot safely be left alone at any time
• Family caregivers are physically unable to continue
• The home environment cannot reasonably support the required care
• Paying for the necessary level of home staffing has become financially unsustainable

The Key Issue Is Often Coverage, Not the Task Itself

Consider toileting.

A home caregiver may be perfectly capable of helping someone use the bathroom.

But if the person needs assistance:

• At 7:00 a.m.
• At 10:30 a.m.
• At 1:00 p.m.
• At 4:00 p.m.
• At 8:00 p.m.
• Twice overnight

the real problem isn't:

"Can a home caregiver provide toileting help?"

The problem is:

"Who will reliably be present every time the person needs it?"

That same logic applies to:

• Transfers
• Meals
• Wandering
• Falls
• Medication
• Incontinence
• Nighttime confusion

THE 24-HOUR TEST

Write down what the person needs across an entire day.

Then assign a real person or provider to every need.

If the plan has repeated blank spaces, the home arrangement may not be as complete as it appears.

Map the Care Day

Then ask:

Can this schedule actually be staffed seven days a week?

This exercise often makes the home-versus-facility decision much clearer.

Dementia Does Not Automatically Mean Nursing Home

A dementia diagnosis alone does not determine where someone should live.

Many people with dementia remain at home for years with a combination of:

• Family caregiving
• Home care
• Adult day services
• Safety modifications
• Respite
• Medical care
• Dementia-specific routines

Our guide on dementia care at home covers those supports in more detail.

The decision becomes harder when dementia creates:

• Repeated wandering
• Nighttime wakefulness
• Unsafe cooking
• Aggression
• Severe personal-care resistance
• Falls
• Inability to be left alone
• Difficulty eating
• Extensive toileting needs

At that point, families may need to compare:

• More extensive home care
• Memory care
• Nursing-home care
• Other specialized dementia settings

Importantly, memory care and nursing-home care are not automatically the same thing.

Memory-care programs are often part of assisted living or residential care and may not provide the same level of nursing care as a nursing facility.

What Does "Nursing Facility Level of Care" Mean?

Families applying for Medicaid long-term services often encounter the phrase Nursing Facility Level of Care, sometimes shortened to NFLOC.

This does not necessarily mean the person has to enter a nursing home.

States establish criteria defining who requires nursing-facility-level services. Medicaid-certified nursing-facility services are available to eligible people who meet the state's requirements, while certain Medicaid HCBS programs can serve people who meet institutional level-of-care criteria but receive services in their homes or communities instead.

The exact assessment varies by state.

It may consider factors such as:

• ADL limitations
• Cognitive status
• Nursing needs
• Medical conditions
• Behavioral needs
• Supervision
• Mobility

NFLOC DOES NOT AUTOMATICALLY EQUAL "MOVE TO A NURSING HOME"

A person may meet a nursing-facility level of care and still receive Medicaid-supported services at home if an appropriate HCBS pathway is available and the person's needs can be safely met there.

Medicaid Treats Nursing Facilities Differently From Many HCBS Programs

There is an important policy distinction families may encounter.

Medicaid nursing-facility services are a required benefit for eligible individuals age 21 and older who meet applicable requirements. States may not place this nursing-facility benefit on a waiting list in the same way they can limit enrollment in some HCBS waiver programs.

That can create a frustrating situation:

A person may qualify medically and financially for nursing-home Medicaid but encounter limited availability or enrollment restrictions in a particular home- and community-based program.

That does not mean home care is impossible.

It means Medicaid coverage pathways can differ significantly.

Cost: Home Care vs. Nursing Home

Cost depends heavily on how many hours of home care are needed.

The 2025 CareScout Cost of Care Survey, published in 2026, reported these national medians:

These figures show why the statement "Keeping someone home is cheaper" is only sometimes true.

Limited Home Care Can Cost Much Less

If someone needs 10 hours of home care per week, the paid-care cost may be far below an entire year of nursing-home residence.

Extensive Home Care Can Change the Calculation

If someone requires:

• Morning assistance
• Daytime supervision
• Evening assistance
• Overnight coverage

the number of paid caregiving hours can increase dramatically.

And if the care must involve licensed private-duty nurses rather than nonmedical caregivers, the cost structure changes again.

CareScout reported a 2025 national median of $90 per hour for private-duty nursing, illustrating how costly intensive one-on-one skilled nursing can become when privately purchased.

DON'T COMPARE A NURSING HOME WITH 8 HOURS OF HOME CARE IF THE PERSON REALLY NEEDS 20 HOURS OF COVERAGE

Compare the care the person actually needs.

Include:

• Paid caregivers
• Skilled nursing
• Family caregiving
• Housing
• Food
• Equipment
• Home modifications
• Transportation
• Overnight coverage

The cheapest incomplete plan isn't the cheapest safe plan.

Medicare and Nursing Homes: What Is Actually Covered?

Medicare coverage is frequently misunderstood.

Medicare Does Not Pay for Indefinite Nursing-Home Residence

Original Medicare does not pay for ongoing long-term custodial nursing-home care simply because someone needs assistance with daily life.

Medicare Part A Can Cover Short-Term SNF Care

Under Original Medicare, Part A can cover skilled nursing facility care for a limited period when coverage requirements are met.

Medicare generally requires:

• Medicare Part A eligibility
• Available SNF benefit days
• A qualifying inpatient hospital stay
• Admission to a Medicare-certified SNF within the required period
• A need for daily skilled nursing or rehabilitation services

For Original Medicare, the qualifying hospital stay is generally at least three consecutive inpatient days, not counting time spent in observation status before inpatient admission. Certain approved arrangements, such as some ACO SNF three-day-rule waivers, can create exceptions.

Medicare SNF Coverage Is Not Only "Active Rehabilitation"

It may involve skilled rehabilitation such as physical therapy, but the benefit can also cover skilled nursing services such as certain IV treatments.

The key is whether the person meets Medicare's requirements for daily skilled care, not simply whether someone is "doing rehab."

How Long Can Medicare Cover SNF Care?

Medicare can provide up to 100 SNF benefit days in a benefit period when requirements remain satisfied.

That does not mean every person automatically receives 100 days.

Coverage ends when eligibility requirements are no longer met or available benefit days are exhausted.

THE 100-DAY MYTH

"Medicare pays for 100 days in a nursing home."

Not automatically.

Medicare provides up to 100 covered SNF days per benefit period when the beneficiary continues to meet Medicare's skilled-care requirements.

Medicare and Home Care: What Is Covered?

Original Medicare does not pay for unlimited nonmedical caregivers at home.

It does not generally cover:

• 24-hour home care
• Ongoing homemaker services unrelated to a skilled care plan
• Custodial personal care when that is the only help needed

Medicare may cover qualifying home health when a person needs part-time or intermittent skilled care and meets the other eligibility requirements.

So Medicare's choice is not simply nursing home or home caregiver.

Different benefits apply depending on the services required.

Medicaid and Long-Term Nursing-Home Care

Medicaid is the major public payer for long-term nursing-facility services for financially and functionally eligible individuals.

Medicaid-certified nursing facilities can provide:

• Nursing services
• Rehabilitation
• Long-term health-related care
• Dietary services
• Pharmaceutical services
• Social services
• Activities
• Room and bed maintenance

Unlike Medicare, Medicaid can pay for long-term nursing-home residence for someone who meets state financial and level-of-care rules.

States establish their own nursing-facility level-of-care requirements.

Medicaid Can Also Support Care at Home

Qualifying for nursing-facility-level care does not necessarily mean institutional care is the only Medicaid option.

States can provide home and community-based services through programs such as 1915(c) HCBS waivers and other Medicaid authorities.

Depending on the state and program, those services can include:

• Personal care
• Home health aides
• Homemaker services
• Respite
• Adult day programs
• Case management
• Other long-term supports

This is why families investigating nursing-home Medicaid should also ask:

"Are there Medicaid home- and community-based programs that could safely meet these needs instead?"

What About VA Benefits?

Eligible Veterans may also have access to home- and community-based services, home care, skilled home health, adult day health, respite, or nursing-home options through VA programs depending on eligibility, clinical need, availability, and location.

Families caring for a Veteran should ask the VA care team or social worker about both institutional and home-based options rather than assuming a nursing-home placement is the only path.

When Staying Home Can Work Even With Significant Needs

Some families successfully manage substantial care at home.

A more intensive home arrangement may include:

• Family caregivers
• Nonmedical home care
• Private-duty nursing
• Medicare home health
• Hospice
• Physical therapy
• Occupational therapy
• Medical equipment
• Home modifications
• Remote monitoring
• Respite
• Adult day care

The fact that someone meets nursing-facility-level criteria does not necessarily prove that a nursing home is the only safe setting.

But an intensive home plan has to be real, not aspirational.

Someone has to perform every required task.

Someone has to cover every necessary hour.

Family Care Is Part of the Cost

A common home-care budget looks affordable because it counts only the paid caregiver.

For example:

Paid home care: 25 hours/week

Sounds manageable.

But then the daughter provides 30 hours/week and the spouse provides 40 hours/week.

The true care plan requires 95 hours of caregiving each week.

The family is paying for only 25.

COUNT UNPAID CAREGIVING HOURS

Ask:

• Who handles nights?
• Who covers weekends?
• Who responds to falls?
• Who changes briefs at 2:00 a.m.?
• Who stays home when the paid caregiver calls out?
• Who manages appointments and medications?

A home plan is sustainable only if the people filling those gaps can continue doing it.

When Family Caregiver Capacity Becomes the Deciding Factor

Sometimes the older adult's needs have not suddenly changed.

The caregiver's ability to meet them has.

A spouse may develop:

• Arthritis
• Heart disease
• Back problems
• Sleep deprivation
• Cognitive changes
• Their own need for surgery

An adult child may be:

• Working full time
• Raising children
• Living hours away
• Financially unable to reduce work

That matters.

A home care plan is not safe simply because one exhausted family member is still technically keeping it together. Our caregiver burnout and respite guide covers warning signs and relief options.

How to Know Whether Home Care Is Still Realistically Enough

Ask these questions:

Several "no" answers do not automatically require nursing-home placement.

They do mean the current care plan deserves serious reassessment.

Home Care, Assisted Living, or Nursing Home?

Sometimes the true choice isn't only home versus nursing home.

Assisted living may be the middle option. Our home care vs. assisted living guide compares those two settings in detail.

The right answer depends on the intensity of care.

A Better Way to Decide: Start With Needs, Not Settings

Instead of beginning with:

"Do we need a nursing home?"

Start with a list.

Personal Care

Does the person need help with:

• Bathing?
• Dressing?
• Toileting?
• Eating?
• Transfers?
• Walking?

Clinical Care

Does the person need:

• Wound care?
• Injections?
• IV therapy?
• Feeding-tube management?
• Respiratory support?
• Frequent nursing assessment?
• Intensive rehabilitation?

Supervision

Can the person:

• Be alone?
• Recognize emergencies?
• Use a phone?
• Avoid wandering?
• Remember mobility precautions?
• Manage nighttime safely?

Caregiver Capacity

Can the family:

• Provide nights?
• Provide weekends?
• Safely perform transfers?
• Continue indefinitely?
• Afford necessary professional coverage?

The setting should follow the answers.

Who Can Help Determine the Right Level of Care?

There is not one universal professional who alone makes every home-versus-nursing-home decision.

Useful people can include:

• Primary care physician
• Geriatrician
• Hospital discharge planner
• Nurse
• Physical therapist
• Occupational therapist
• Social worker
• Geriatric care manager
• Medicaid assessor
• Home health clinician

For Medicaid nursing-facility eligibility, the formal level-of-care determination follows state-specific criteria and processes.

For someone leaving the hospital, the discharge-planning team can help identify whether skilled rehabilitation, home health, equipment, or another level of care is appropriate.

ASK FOR A FUNCTIONAL ASSESSMENT, NOT JUST A DIAGNOSIS

"Dad has Parkinson's" does not tell you where he should live.

More useful information is: he needs two-person assistance to transfer, cannot safely walk, requires help toileting six times daily, and his wife cannot physically assist him.

Care decisions should be based on function and actual care requirements.

Choosing a Nursing Home: Don't Stop at the Star Rating

If nursing-home care becomes necessary, families can use Medicare's Care Compare system to compare Medicare-certified facilities.

Medicare's nursing-home ratings incorporate three major areas:

• Health inspections
• Staffing
• Quality measures

But Medicare also advises families to investigate facilities directly rather than relying solely on online ratings.

Ask the Nursing Home:

• Does the facility currently have a bed available?
• Does it accept the person's payer?
• Is it Medicaid-certified?
• Can the facility manage the person's diagnosis and care needs?
• How much nursing and aide staffing is available?
• What is staff turnover like?
• Who is present overnight?
• What rehabilitation is offered?
• How are medications managed?
• How are falls handled?
• How are families notified about changes?
• Can hospice provide services there?
• What happens if the resident becomes more medically complex?

Visit in Person When Possible

Observe:

• Staff interaction
• Call bells
• Cleanliness
• Odors
• Meals
• Resident engagement
• Noise
• Hallway activity
• Whether staff seem rushed
• Whether residents appear appropriately dressed and cared for

The facility closest to home may also deserve serious consideration because regular family visits can matter greatly to quality of life and oversight. Medicare's current quality guidance acknowledges that proximity can be an important factor when families compare facilities.

What Happens After Rehabilitation?

One of the most useful questions to ask before a short-term SNF stay is:

"What is the discharge plan?"

Possible outcomes include:

Return Home Independently

The person regains enough function to return home without significant assistance.

Return Home With Home Health

Skilled nursing or therapy continues at home under an eligible home-health plan.

Return Home With Home Care

The person is medically stable but needs help bathing, dressing, eating, moving, or managing everyday life.

Return Home With Both

Home health handles clinical services while home care provides personal assistance.

Transition to Long-Term Nursing Care

The person may be unable to safely return home and remain in or move to a nursing facility for long-term care.

Short-term SNF rehabilitation and long-term nursing-home care can therefore occur in the same facility but under completely different care and payment arrangements.

Can Home Care Prevent or Shorten a Nursing-Home Stay?

Sometimes.

Medicare notes that home health can sometimes provide effective skilled care at home that would otherwise occur in a hospital or skilled nursing facility.

Home care may also make discharge home possible by addressing nonmedical needs such as:

• Bathing
• Dressing
• Meals
• Mobility
• Supervision
• Transportation

But the possibility of home discharge depends on whether the entire care plan can safely work.

A promise that "we'll make it work somehow" is not a discharge plan.

A Home-vs.-Nursing-Home Decision Worksheet

Then ask:

1. Can every necessary care task be assigned to someone reliable?
2. Can that arrangement work seven days a week?
3. Can it handle nights?
4. Can it handle an unexpected caregiver absence?
5. Can the family afford it for more than a few months?
6. Can family caregivers sustain their part?
7. What does the person receiving care want?

The Bottom Line

Home care and nursing homes should not be compared simply as home equals independence and nursing home equals medical care.

The real picture is more nuanced.

Home care can support someone with substantial personal-care needs while preserving a familiar environment and providing individualized attention.

Skilled nursing and therapy can sometimes be added at home through home health or other clinical services.

Medicaid HCBS programs may allow some people who meet institutional levels of care to remain in the community.

But home care has one major limitation:

Every required hour of assistance has to come from somewhere.

If someone needs help bathing in the morning, toileting throughout the day, transferring in the evening, skilled nursing services, and supervision overnight, a home plan must identify who will reliably provide all of it.

A nursing home places nursing services, personal care, meals, medication management, supervision, rehabilitation, and housing within one residential system.

That may be far more support than one person needs.

Or it may be exactly what another person requires.

Current national data puts the scale in perspective: approximately 1.2 million people live in about 14,700 U.S. nursing homes, while Medicaid spent nearly $69 billion on nursing-facility care in 2023.

Cost also complicates the decision.

The 2025 national median was $35 per hour for nonmedical home care, compared with approximately $115,000 annually for a semiprivate nursing-home room and $130,000 for a private room.

A small amount of home care can therefore be dramatically less expensive.

An intensive home-care plan involving many daily hours, or private-duty nurses, may not be.

So don't begin with:

"How do we keep Mom out of a nursing home?"

And don't begin with:

"Isn't it time for a nursing home?"

Begin with:

"What does Mom need from the moment she wakes up until the next morning, and what arrangement can reliably provide that care?"

Once the full care day is visible, the right setting becomes much easier to evaluate.

Sources and Further Reading

1. Medicare, Skilled Nursing Facility Care Coverage. Current Medicare requirements for short-term SNF coverage, including skilled-care requirements, qualifying hospital stays, benefit periods, and the three-day inpatient rule.
2. Medicare, Getting Started: Medicare & Skilled Nursing Facility Care. Official explanation of what a skilled nursing facility is, covered services, and the maximum 100 SNF days per benefit period when eligibility requirements remain satisfied.
3. Medicare, Nursing Home Coverage. Official distinction between short-term skilled nursing care and long-term custodial nursing-home care.
4. Medicaid.gov, Nursing Facilities. Federal information about Medicaid-certified nursing facilities, required services, nursing-facility level-of-care requirements, Medicaid coverage, and differences between institutional and community services.
5. CDC/National Center for Health Statistics, Nursing Home Care FastStats. Current federal national estimates of nursing homes, beds, ownership, and residents.
6. Medicaid.gov, Medicaid LTSS Users and Expenditures by Service Category, 2023. Current national data on Medicaid nursing-facility users and spending compared with HCBS and other institutional care.
7. Medicare, Home Health Services. Current coverage guidance for skilled nursing, therapy, wound care, IV/nutrition therapy, home health aides, eligibility, and Medicare's exclusion of 24-hour home care.
8. Medicare, Medicare & Home Health Care. Detailed federal guidance explaining that qualifying home health may restore function, maintain function, or slow deterioration and is not limited solely to short-term rehabilitation.
9. CareScout, 2025 Cost of Care Survey, published 2026. Current national median costs for nonmedical caregivers, private-duty nursing, semiprivate nursing-home rooms, and private nursing-home rooms.
10. Medicare Care Compare, Nursing Homes. Federal nursing-home comparison information using health inspections, staffing, and quality measures.