A skilled nursing facility — the medical term for a nursing home — provides 24-hour medical care and is Medicare-certified. Assisted living is state-licensed residential care for people who need help with daily tasks. CMS publishes quality data on 14,699 certified nursing homes; assisted living has no equivalent federal file.
The core difference
Both house older adults, but they sit at different points on the care ladder. Assisted living is housing first, with support services layered on. A skilled nursing facility is a medical setting first, with housing attached. The regulatory split follows the care split: one is federal, one is state.
- 24-hour skilled nursing and rehab
- Medicare- and Medicaid-certified
- Surveyed; quality & deficiency data published
- For people needing ongoing medical care
- 14,699 certified facilities
- Help with daily activities, not skilled care
- State-licensed, not Medicare-certified
- No single federal quality file
- For largely independent residents
- Mostly private-pay room and board
Level of care
Assisted living provides help with the activities of daily living — bathing, dressing, medication reminders, meals, housekeeping — for people who are largely independent. A skilled nursing facility adds licensed nursing, physician oversight, wound care, IV therapy, rehabilitation, and the staffing to support residents who cannot safely live in a lighter-touch setting.
Federal vs state oversight
Skilled nursing facilities participate in Medicare and Medicaid, so CMS surveys them against the federal Conditions of Participation and publishes the results. Assisted living is licensed and inspected by each state under its own rules, which vary widely. That is the single biggest reason a family can pull a nursing home’s full federal record but finds far less standardized public data on an assisted-living residence.
Who pays
Medicare pays for neither setting’s long-term room and board. It covers a short, skilled nursing-home stay after a qualifying hospital admission. Assisted living is largely private-pay, sometimes offset by long-term-care insurance or limited state waivers. For long nursing-home stays, Medicaid becomes the largest payer once a resident spends down assets to the state threshold.
Why the public data differs
Because nursing homes are federally certified, their quality is radically transparent: star ratings, staffing from the Payroll-Based Journal, deficiency citations, and enforcement penalties are all public. Across the file, CMS recorded $467M in penalties against 6,919 facilities and flags 85 of the worst as active Special Focus Facilities. No comparable federal scorecard exists for assisted living — a gap families should know about when they compare options.
Certified nursing homes, by the numbers
Check a nursing home
Open a certified nursing home’s rating, staffing, deficiencies, and penalties — each field traced to its CMS source and snapshot date.
Browse nursing home data →Frequently asked questions
- What is the difference between a nursing home and assisted living?
- A skilled nursing facility — the medical term for a nursing home — provides 24-hour nursing and medical care and is certified and surveyed by Medicare. Assisted living is residential housing with help for daily activities, licensed by the state, not Medicare. CMS publishes quality and inspection data on 14,699 certified nursing homes; assisted living has no equivalent federal file.
- Is assisted living the same as a nursing home?
- No. Assisted living suits people who are largely independent but need help with tasks like bathing, dressing, medication reminders, and meals. A nursing home is for people who need ongoing skilled nursing or rehabilitation that cannot be provided at a residential level. The medical intensity and the regulatory framework are different.
- Why can I look up nursing homes on Care Compare but not assisted living?
- Because nursing homes are Medicare- and Medicaid-certified, CMS surveys them and publishes the results — ratings, staffing, deficiencies, and penalties — on Care Compare. Assisted living is regulated at the state level, so there is no single federal database of assisted-living quality or inspections to mirror.
- Does Medicare pay for assisted living or a nursing home?
- Medicare does not pay for the room and board of long-term residential care in either setting. It covers a short, skilled nursing-home stay after a qualifying hospital admission. Long-term custodial care — the bulk of assisted living and long nursing-home stays — is paid privately, by long-term-care insurance, or by Medicaid once assets are spent down.
- How do I check the quality of a nursing home?
- Every certified nursing home carries a CMS quality rating plus its inspection, staffing, and enforcement history. Across the file, CMS recorded $467M in penalties against 6,919 facilities, and flags 85 of the worst performers as active Special Focus Facilities. Fonteum mirrors all of it with provenance on each field.
- Which is right for my family member?
- It depends on care needs. If someone needs help with daily living but is medically stable, assisted living may fit. If they need skilled nursing, rehabilitation, or round-the-clock medical supervision, a skilled nursing facility is the certified setting for that. Many people move from assisted living to a nursing home as needs rise.
Related
- What is a skilled nursing facility (SNF)? — the medical setting in full, and how CMS measures it.
- Home health vs. skilled nursing — care at home versus care in a facility.
- The CMS Five-Star Quality Rating — how nursing-home quality is scored 1 to 5.
- Who owns nursing homes — the ownership records behind each certified facility.
- Nursing home quality & enforcement data — per-facility ratings, staffing, deficiencies, and penalties.
- Nursing home payment denials (DPNA) — a federal enforcement tool with no assisted-living equivalent.