What does a nursing home actually cost? — the number that scares everyone
This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.
There's a particular kind of silence that happens when someone tells you what a nursing home costs. It's the silence where the world gets a little quieter and your mind is doing math that doesn't have a good answer. You're thinking: How am I supposed to pay for that? Is that per month? Did I hear that right?
You probably heard it right. And yes, it's per month. And the number is bigger than your parent's entire annual income, bigger than your annual income, probably bigger than you thought anything in the world of elder care could actually cost.
My cousin went through this a few years back. His mother needed a nursing home—she had advanced dementia and her care needs had moved well past what any family situation could manage, even with everyone pitching in. He got the estimate from the facility they felt was best. He sat in the parking lot afterward and called me. The number he quoted me seemed impossible. It was roughly $8,500 a month, and that was for a semi-private room in a place that was decent but not fancy. He kept saying it like he was asking me if he'd misunderstood, as if saying it out loud multiple times would change what it actually was.
Nursing homes operate in a different universe than assisted living. The level of care is simply not the same. A nursing home is providing skilled nursing care, medical care, rehabilitation services. They have nurses on staff. They have doctors involved. They have round-the-clock monitoring. This isn't someone helping your parent get dressed in the morning and reminding them to take their pills. This is medical care in an institutional setting. That's a different product, and it costs like it.
The conversation about nursing home costs is also a conversation about the end of someone's independence in a way that assisted living sometimes isn't. People go to assisted living and sometimes stay in their own apartment-like unit, stay connected to their community, maintain some structure of normal life. A nursing home is institutional. It's a bed in a room. It's medical care as the center of everything. That reality is worth acknowledging straight up, separate from the financial question, because the cost is partly what it is because of what it actually is.
But if you're looking at this number and trying to figure out how to make it work, you need to understand what you're actually looking at and what options might exist.
Understanding What Nursing Homes Actually Cost
The national average for nursing home care is somewhere in the range of $8,000 to $9,000 per month for semi-private rooms, and $9,000 to $10,000 or more for private rooms. This is significantly higher than assisted living. The gap between assisted living and nursing home costs is not subtle.
Geography matters, but the variance is interesting. Some states are cheaper. Texas, Oklahoma, and some Southern states might run $6,000 to $8,000. New York and California are in the $9,000 to $12,000 range. Massachusetts and Connecticut are pushing $10,000 to $12,000 or higher. Rural areas are sometimes cheaper, but sometimes not significantly cheaper because there are fewer facilities and less competition.
That base cost doesn't include a lot of what your parent might need. That base cost gets you a bed, nursing care, meals, and basic services. If your parent needs medication management beyond what's standard, that might be extra. If your parent needs special wound care or specific therapies, that might be extra. If your parent needs psychiatric care or specialized dementia care, that might be extra. Some facilities are straightforward about what's included and what's not. Some facilities use add-ons the way assisted living does, starting with a number that sounds manageable and then adding everything else.
Here's what catches most families: Medicare does cover nursing home care, but only under specific conditions and only for a limited time. Medicare will cover skilled nursing facility care after a hospital stay if you've been hospitalized for at least three days. Medicare will pay for up to 20 days fully, and then for days 21 through 100, you pay a copay (which in 2024 is around $194 per day, though that amount changes yearly). After 100 days, you're paying full price. And that's only if you had a hospital stay to qualify in the first place.
This is where a lot of people misunderstand the Medicare situation. They think: My parent is in a nursing home, Medicare should pay. It doesn't work that way. Medicare pays for rehabilitation in a nursing home for a limited time after a hospital stay. Medicare doesn't pay for long-term care in a nursing home. If your parent is in a nursing home because they need ongoing care for dementia, or because their arthritis is so bad they can't live independently, or because they're generally declining—Medicare doesn't care. That's not what Medicare does.
Medicaid is the actual funding source for long-term nursing home care for most people. About a quarter of the population in the U.S. nursing homes is covered by Medicaid. Most of the rest either have long-term care insurance or are paying privately. Medicaid covers nursing home care in all states, but you have to qualify. Medicaid is a needs-based program. You have to be poor enough or nearly poor enough to qualify. You can have limited assets and limited monthly income.
The asset limit varies by state, but it's usually very low. You might be able to keep your home, but you probably can't have more than a few thousand dollars in liquid assets. Your monthly income can be low,often the Medicaid payment is close to your actual monthly income plus your Medicaid benefit, so someone on Social Security might be paying most of their Social Security to the nursing home while Medicaid makes up the rest.
This is where the financial planning comes in. If your parent has significant assets, they need to spend down to Medicaid eligibility levels if they're going to need long-term nursing home care. If they have no assets, they're probably eligible now and can apply. If they have some assets, it depends on the specifics.
There are legal strategies for this,legitimate Medicaid planning done by elder law attorneys,that allow families to plan for this situation while protecting some assets. There are also aggressive strategies that people sometimes try that are actually fraud. The line between them is important and worth understanding if you're in this situation, which is another reason to talk to an elder law attorney rather than trying to figure it out on your own.
The Reality of Who Pays
Private pay nursing home residents are in a minority. Most nursing homes have a mix of private pay, Medicare, and Medicaid residents. If you're paying privately, you're paying the full rate, and you're essentially funding some of the care for the Medicaid residents through that full rate. This is the economics of how it works.
If your parent has long-term care insurance, the policy will specify what it covers. Some policies cover nursing home care generously. Some have daily benefit limits that look good on paper but don't actually cover much of the real cost. Some policies have waiting periods, or lifetime benefit limits, or specific requirements about what kind of nursing care qualifies. You need to read the policy, and you might need to call the insurance company to understand exactly what's covered.
If your parent doesn't have long-term care insurance and doesn't qualify for Medicaid, you're looking at private pay. That's where families face a brutal math problem. If your parent has $300,000 in savings and needs $108,000 a year for nursing home care, that's less than three years. If your parent lives to ninety-five and needs care from eighty-five onward, you're looking at a ten-year funding gap.
This is when families have to make impossible choices. Sometimes they sell the parent's home. Sometimes multiple adult children contribute financially. Sometimes they look at whether shorter-term care at a lower acuity facility might be possible, or whether home care could work instead. Sometimes they apply for Medicaid and accept that the parent's assets will go to pay for care until they've spent down to Medicaid levels.
The situation changes if there's long-term care insurance in place. Even policies that seem modest,say, $150 a day,cover a significant portion of the cost and can extend how long private funds last. Some families who didn't think they could manage nursing home care find that insurance makes it possible. Other families have insurance that doesn't actually work the way they thought it did, and that conversation is not a pleasant one to have in the middle of a crisis.
Making Plans That Actually Survive Contact with Reality
If you're trying to plan for this situation, you need to have conversations with your parent before crisis hits. Does your parent have long-term care insurance? Is it still in force, or did it lapse? What was the thinking about care in the future,has your parent ever thought about this, or is it something they're avoiding?
You need to know what assets your parent has. Can you have that conversation? Sometimes parents will share this information more easily with an accountant or financial advisor than with their kids. Some families use it as an opening: We should probably review the financial plan and make sure we're all thinking about the same things. That's less confrontational than: I need to know everything you have so I can figure out how to pay for your nursing home.
If your parent has substantial assets, talking to an elder law attorney about Medicaid planning might make sense. Not because you're trying to hide money illegally, but because there are legitimate strategies that allow you to protect some assets while your parent gets the care they need and eventually qualifies for Medicaid coverage. This is normal planning, and there's nothing shameful about it, but it requires professional help.
If your parent has modest assets or no assets, the planning is different. You're looking at what's available now, what monthly income will cover, and when to apply for Medicaid. Medicaid has rules about look-back periods and asset transfers, so the timing of this matters. You don't want to transfer assets too close to applying, or you could disqualify your parent. Again, this is where professional help matters.
If you're a sibling group and one or more of you might help fund care, have that conversation early. Are you going to contribute? How much? For how long? This is not a fun conversation, but having it while everyone is calm is better than discovering in a crisis that there are different assumptions about who's paying for what.
Nursing home care is genuinely expensive, and there are no perfectly good solutions to that problem. But there are strategies that work better than others, and they all require knowing your actual financial situation and planning deliberately rather than just hoping it works out. The people who end up in the worst situations are usually the ones who face this decision without any planning or information, trying to solve a three-million-dollar problem while they're already in crisis.
Get the information. Have the conversations. Know what options actually exist in your situation. Then make the best choice you can with what you have.
How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.