A long-term care facility is any residential setting that provides ongoing health or personal care services to people who can no longer manage everyday activities on their own. These facilities range from small board and care homes with a handful of residents to large nursing homes with round-the-clock medical staff. About 14,300 Medicaid-certified facilities currently operate in the United States, and the national median occupancy rate sits at 84 percent.
If you’re researching long-term care, you’re likely trying to figure out what kind of help a loved one needs, what the options look like, and what it all costs. Here’s what you need to know.
What Long-Term Care Facilities Actually Do
The core purpose of any long-term care facility is helping residents with activities of daily living: bathing, dressing, eating, grooming, oral hygiene, getting in and out of bed, walking, and using communication devices. These are the basic tasks that become difficult or impossible due to aging, chronic illness, disability, or cognitive decline. When someone can no longer safely perform several of these tasks at home, even with help from family, a residential facility becomes a practical option.
Beyond personal care, many facilities also provide meals, housekeeping, laundry, social activities, and varying levels of medical supervision. The key distinction from a hospital is that long-term care isn’t about treating an acute illness and sending someone home. It’s about providing a sustained living environment where daily needs are met for months, years, or the rest of a person’s life.
Types of Facilities and How They Differ
Board and Care Homes
These are smaller residential settings, sometimes called group homes, where residents receive personal care and meals with staff available around the clock. Nursing and medical care are typically not provided on-site. Board and care homes work well for people who need help with daily routines but don’t have complex medical needs.
Assisted Living
Assisted living facilities serve people who need more structured support than a board and care home but less than a nursing home. Residents typically have access to up to three meals a day, help with personal care, medication management, housekeeping, laundry, 24-hour supervision, security, and on-site staff. Social and recreational activities are a standard part of the experience. Assisted living tends to feel more like an apartment community than a medical facility, and residents generally maintain more independence in their daily schedules.
Nursing Homes (Skilled Nursing Facilities)
Nursing homes provide the most intensive level of residential care. Services focus heavily on medical needs and include nursing care, 24-hour supervision, three daily meals, assistance with all everyday activities, and rehabilitation services like physical, occupational, and speech therapy. If your loved one needs wound care, IV therapy, or recovery support after a surgery or stroke, a skilled nursing facility is typically where that happens outside of a hospital. About 14,600 skilled nursing facilities and swing beds currently participate in the Medicare program.
How Much Long-Term Care Costs
The expense is significant. A semi-private room in a nursing home averages $308 per day nationally, which works out to roughly $112,420 per year. Private rooms cost more. Assisted living is generally less expensive than nursing home care, and board and care homes tend to fall below assisted living in cost, though prices vary widely by region.
Medicare covers skilled nursing care only under specific conditions, usually for a limited period after a qualifying hospital stay. It does not cover long-term custodial care, which is the type most people associate with nursing homes. Medicaid does cover long-term nursing home care for people who meet financial eligibility requirements, and it is the largest single payer of nursing home costs in the country. Long-term care insurance, if purchased before care is needed, can offset some of these expenses. Many families end up paying out of pocket, at least initially.
Rights You Should Know About
Federal law gives nursing home residents a detailed set of protections. These aren’t guidelines or suggestions. They’re enforceable legal rights that every Medicare- and Medicaid-certified facility must honor.
Residents have the right to personal privacy, including privacy during medical treatment, personal care, phone calls, mail, and visits. Facilities must deliver mail and packages unopened. Residents also have the right to participate directly in developing their own care plan. That includes identifying who should be involved in the planning process, setting goals for their care, requesting changes to the plan, and reviewing it after any significant updates.
Discharge protections are especially important. A facility cannot transfer or discharge a resident unless one of a few specific conditions applies: the resident’s needs can no longer be met at the facility, the resident’s health has improved enough that the services are no longer necessary, the resident poses a safety risk to others, or the resident has failed to pay after proper notice. A facility closing entirely is also grounds for transfer. Outside of these situations, a resident has the right to stay.
How Care Needs Are Assessed
When someone enters a long-term care facility, staff evaluate how much help the person needs across a standard set of daily activities: grooming, dressing, oral hygiene, transferring (moving between bed and chair, for example), bed mobility, walking, eating, bathing, and using communication systems. This assessment determines the type and amount of care included in the person’s individualized care plan.
The care plan is a living document. As a resident’s condition changes, the plan should be updated, and the resident (or their representative) has the right to be informed of changes in advance and to participate in revisions. If you’re helping a family member navigate this process, ask to be included in care planning meetings and request a copy of the current plan at any time.
Choosing the Right Facility
The right facility depends on how much help your loved one needs right now and how those needs are likely to change. Someone with early-stage memory loss who can still dress and eat independently may do well in assisted living. Someone recovering from a hip replacement who needs daily physical therapy and nursing oversight will need a skilled nursing facility, at least temporarily.
When evaluating specific facilities, pay attention to staffing. Long-term care has historically struggled with workforce retention, with annual staff turnover rates ranging from 19 to 55 percent depending on the facility. High turnover can mean less continuity of care, which matters when residents depend on staff who know their routines and preferences. Ask about staff-to-resident ratios, how long current staff have been working there, and whether the same caregivers are assigned to the same residents consistently.
Visit in person at different times of day. Look at how staff interact with residents, whether common areas are clean and active, and whether residents seem engaged or isolated. Medicare publishes inspection results and quality ratings for every certified nursing home in the country through its Care Compare tool, which is a useful starting point but shouldn’t replace an in-person visit.
The number of long-term care facilities in the U.S. has been declining slowly. Between 2023 and 2024, both Medicare-participating and Medicaid-certified facilities dropped by about 1 percent. Demand for beds remains high in many areas, so if you’re planning ahead, starting the search before a crisis gives you more options.