The average nursing home cost per month is about $9,810 for a shared room (or $119,340/year) and $10,800 for a private room (or $129,575/year), per 2026 data from the American Council on Aging's Medicaid Planning Assistance program. However, the average median retirement savings of Americans aged 55 to 64 is only $185,000. At the shared-room rate, that's gone in less than 2 years. Often, family caregivers don't have the finances to cover that long-term
This guide will help your family prepare when you can’t afford a nursing home or assisted living facility. We’ll cover costs by state, what Medicare and Medicaid cover in 2026, and what families can do if they can’t afford a nursing home.
Families often choose private pay, a flat fee rate without help from federal programs or private insurance. Medicare isn’t an option because the program only partially covers 100 days of short-term skilled care but doesn’t cover long-term nursing home care.
Medicaid covers a shared room for qualified low-income seniors who meet strict income guidelines of under $2,982 monthly income (2026). Nursing home residents have a small monthly Personal Needs Allowance (PNA), but most of their income goes to the nursing home. Medicaid, where it applies, covers about 70% of the private-pay rate.
Insurance companies won’t pay nursing home bills until you meet the deductible - the amount paid out-of-pocket before insurance covers costs. Family caregivers have sticker shock at their first nursing home bill because they don’t realize all the actual costs for care. Compare private nursing home costs:
According to the AARP Public Policy Institute, from 2019-2024 the cost of long-term services and support (LTSS) increased by 23%-25% while median household income of age 65+ households only increased by 22%. The cost of nursing home private rooms increased by 5% yearly. Trends continued through 2025, meaning that a $129,000 private room today will cost $143,000+ by 2028.
Nursing home costs by state can increase. Even the metro area or county matters toward your final nursing home bill.
Several factors affect the actual costs of a nursing facility, like room type, location, and staffing. These fluctuate from year to year. How much does a nursing home cost? The daily nursing home rate doesn’t always show the true picture.
Shared rooms vs. private rooms make the biggest difference in cost. Medicaid doesn’t cover single private rooms, only shared rooms. Some states will let the family pay the difference to upgrade to a private room.
Some states treat a change to a private room as a disqualifying transfer or a gift, which triggers the Medicaid look-back period. The Medicaid program won’t pay for any services if a prohibited transfer of assets occurs. Your relative may lose their benefits and be penalized.
Always ask for an itemized cost breakdown before you choose a nursing facility. Why? The base rate doesn’t always include physical, occupational, or speech therapy. You may have to pay extra for memory care, wound care, or even medication management. Everything has a cost.
The nursing home bill is affected by location within the state. Urban facilities usually cost more than rural areas. For example, the daily rate in Rochester, New York is $515/day. Rural Central New York has a daily rate of $465/day. New York City’s daily rate is $502/day. That means the difference in cost between New York City and Central New York is $13,632 annually! Carefully look at rates in your state when deciding on long-term care plans.
Length of stay affects nursing home costs. Short-term rehabilitation’s goal is eventual independence and recovery. A patient might need rehab after a heart attack, stroke, fall, or hip replacement surgery. An OT or PT usually works with them several hours a week so they can safely go back home after a few weeks or months. This is very different from long-term care.
Long-term care maintains chronic conditions, disability or advanced illnesses like Alzheimer’s disease or Parkinson’s. With LTSS, nursing home residents receive round-the-clock care, medication management, and custodial care with nonmedical everyday tasks like bathing, eating, or getting dressed.
The goal of LTSS is not to send a patient back home. Instead, the point of these services is to provide a safe place for your family member to live and improve quality of life.
Post-hospital rehab and long-term custodial care have different cost structures and payers. Short-term rehab is covered by private insurance or Medicare. Medicare doesn’t pay for long-term care in a nursing facility. Families rely on Medicaid or pay out-of-pocket for LTSS. Always ask about the difference between short-term rehabilitation costs and long-term care.
Facility staffing levels affect nursing facility costs. Understaffed facilities have higher staff turnover, leading to increased operating costs. The facility may need to hire expensive travel nurses to fill in, train new nurses or see a drastic decrease in services and basic care.
The One Big Beautiful Bill Act delayed federal minimum staffing mandates for nursing homes for 10 years. Consumer advocates and families were concerned about how decreased personnel would affect safety. The Centers for Medicare and Medicaid Services (CMS) repealed this portion of the bill in December 2025, but understaffing is still critical.
Nursing home cost is only one factor that should affect your decision on a nursing facility. Quality of care differs wildly between nursing homes. Problems are invisible to families until after they have already chosen a nursing home. What should you look at before deciding on a facility?
CNA staff work daily with residents and have a turnover rate of 42.34% annually while the RN turnover rate in nursing homes is 36.5%, twice the turnover rate of RN hospital turnover of 16.4%. Facilities with a turnover rate of 30-39% are 1.5 times less likely to have abuse citations than facilities with 50-59% turnover.
High turnover means reduced care for patients. They experience changes in aides, routines, and daily schedules. Dementia patients thrive with familiar faces. Constant change causes confusion. Low staffing is a red flag.
“Continuity of nursing home staff and of leadership is linked to improving quality of resident care -- from onsite treatment or post-hospital care for complex medical issues to assistance with basic care needs such as eating and bathing.” - Regenstrief Institute and Indiana University School of Medicine researcher-clinicians, Jennifer L. Carnahan, M.D., MPH, and Kathleen Unroe, M.D., MHA, published in Science Daily
Before committing to a nursing home, ask for their patient/staff ratios in writing. Patient outcomes are directly affected by hours spent with staff. Unfortunately, the amount of hours spent with each resident has steadily declined over the past decade, leading to about 3.75 staffing hours daily per resident.
The 2024 federal minimum staffing rule would have required nursing homes to provide 0.55 RN hours and 2.45 nurse aide hours per resident per day, with a registered nurse on-site 24/7. The One Big Beautiful Bill Act first postponed enforcement until 2034, and on December 2, 2025, HHS and CMS repealed the requirement outright. Facilities are now held to the pre-2024 standard instead: a registered nurse on-site at least 8 consecutive hours a day, seven days a week — not around the clock.
Ask any facility you're considering what their actual staffing ratio is; there's currently no federal floor holding them to more
CMS publishes an online tool for all Medicare and Medicaid certified nursing facilities that ranks facilities with a 5-star rating system. Ratings include data on health inspections, staffing levels, and quality measures. High cost doesn’t always mean higher quality of care. A facility can cost a lot but have understaffing, abuse complaints, and poor care.
The choice to keep a loved one at home isn’t just about finances. The harsh reality of nursing homes - understaffing, neglect, abuses, lack of privacy, and impersonal institutional routines - regularly shows up in the news headlines. The COVID pandemic exposed gross negligence and understaffing in America, which hasn’t much improved since then.
Home care means your relative is surrounded by friends and family, in their own community, in their own familiar home. They live on their schedule and enjoy independence. Quality of life and health outcomes aren’t dependent on a facility’s budget and turnover rates. It’s dependent on people who care about them.
No, Medicare doesn’t cover long-term nursing home care. Medicare partially covers short-term skilled nursing for 100 days, after a qualified 3-day inpatient hospital stay. The emergency room doesn’t count towards the inpatient stay, even if overnight. Medicare Advantage plan participants may have a copay for the first 20 days.
2026 SNF pay structure per day:
Common scenario (illustrative): Maria’s father has to go to the hospital for a hip replacement. He’s sent to a facility for short-term rehab after a three-day inpatient hospital stay. The family assumes Medicare will cover the rehab facility indefinitely. Medicare covers the first 20 days for free, then the daily $217 copay starts on day 21. After 100 days, her father’s stay is no longer covered. The bill arrives after a few weeks, to Maria's shock. Now they owe thousands of dollars.
Medicaid is the largest payer of nursing home care, but qualifying has become more difficult. Each state has its own eligibility requirements for people with disabilities, seniors, and pregnant women. Medicaid has both financial and functional requirements:
Single seniors must have a monthly income of $2,982 or less and up to $2,000 in countable assets. Married couples are allowed up to $2,982 each, or $5,864 per month. If the applicant lives with their spouse, a child under 21, or a blind or disabled child of any age, their home equity doesn’t count towards assets.
Married couples’ countable assets are counted jointly, and they can have up to $3,000 to $4,000 in joint assets depending on the state. Some people will “spend down” the difference in income and Medicaid requirements if income is too high.
During the Medicaid Look-Back Period, Medicaid reviews any asset transfers (gifts) over the past five years. If they find the applicant gifted countable assets or sold them below market value, there may be a penalty and loss of Medicaid benefits.
Functional, or level-of-care, rules differ depending on the state. Your family member needs to show they need help with Activities of Daily Living (ADLs) like housecleaning, medication management, or cooking. Dementia, Parkinson’s, or Alzheimer’s disease doesn’t automatically qualify. A medical professional needs to determine they need a Nursing Home Level of Care (NHLOC).
The 2025 One Big Beautiful Bill will result in $940 billion in Medicaid reductions in the next 10 years, largely due to administrative barriers. While the bill should not affect applicants in the aged, blind or disabled category, retroactive coverage now covers the last 60 days, not the last 90 days. Some targeted states received harsher penalties, which results in more budget cuts.
“You could be cut off and not know it, and then find out when you end up in the emergency room. I think there are a lot of us who kind of use health care as needed and, fortunately, don’t need it very often. But then when you do, you really need that retro coverage to get you back on.” - Thomas Lodwick, Attorney at non-profit law firm Pisgah Legal Services.
Medicaid has strict income limits and reviews the last five years of financial transactions during the Medicaid Look-Back Period. Some families try to “spend down” the extra assets, but this needs careful planning and working with an elder law attorney. Avoid last-minute transfers or gifts to avoid a penalty or loss of Medicaid benefits.
Families try to spend down in a number of ways:
Every state has different “spend down” rules, and some even have programs for families that exceed income limits. Always consult with an elder law attorney before spending down assets.
Home care can cost a lot less if full-time skilled nursing isn’t needed. With home care, your family member has help with preparing meals, light housekeeping, pet care, and transportation in the comfort of their home. Compare the costs:
A part-time home caregiver often meets the needs of their family member, which costs a lot less than private nursing homes or assisted living facilities.
Medicaid has dozens of waiver programs most families never hear about.
See what’s available in your state.
If a senior can’t afford a nursing home, they have several options. Families don’t need to panic. Medicaid waivers offer solutions.
"I didn't know how I was going to do it. I was drowning in paperwork and couldn't afford to quit my job, but I also couldn't leave my dad alone. Givers made keeping my dad at home possible — and now I actually get paid for the care I was already providing." - Tawanna M., Family Caregiver for her dad
A Medicaid application takes time. Always check that the nursing home is Medicaid-certified. Families often find themselves paying privately while waiting for a Medicaid application to go through and trying to “spend down” assets. Always consult with an elder law attorney during this process.
Family caregivers can get paid for caring for a relative. Many states run Home and Community-Based Services (HCBS) waiver programs that cover home care and caregiving.
Find out if a family member can get paid to care for your parent
Some states have Structured Family Caregiving (SFC) or consumer-based programs that allow the care recipient to pay a spouse, adult child, or relative for caregiving. HCBS is available in 11 states.
How to get paid as a caregiver in Connecticut
How to get paid as a caregiver in Georgia
How to get paid as a caregiver in Michigan
How to get paid as a caregiver in Ohio
For seniors who don’t need round-the-clock care, assisted living may be the best option. Some states' Medicaid waivers cover assisted living costs ($6,200 national median cost).
Veterans with service-related disabilities might qualify for VA Aid and Attendance coverage of LTSS, up to $2,874/month for a married veteran. The Veterans Pension net worth limit is $163,699. Other financial restrictions apply. The VA pays the veteran directly.
If your relative has a long-term care insurance policy, this is the time to use the benefits. Most will require doctor-verified functional limitations, like being unable to perform 2+ ADLs. Benefits range from $2,000 to $10,000/month.
Some seniors surrender or sell their whole life insurance at 50-75% of face value to pay for long-term care. Another option is taking out a bridge loan while waiting on a home sale or asset transfer. Payment may be deferred up to 90 days depending on the loan terms.
Speak with a financial advisor or elder law attorney before taking out a loan or cashing in an insurance policy.
The average cost of a nursing home in 2026 is about $9,810/month ($119,340/year) for a shared room, and closer to $10,800/month ($129,575/year) for a private room.
Missouri has the cheapest nursing home cost by state at $144/day for a shared room ($52,560/year) in Cape Girardeau. Texas, Louisiana, Oklahoma and South Carolina also have some of the cheapest nursing home costs in the US.
No. Medicare doesn’t cover long-term nursing home care. Medicare partially pays for short-term skilled nursing after a 3-day qualified hospital stay. Medicare covers the first 20 days. After day 21, there is a copay of $217/day. Medicare does not cover costs after 100 days. The patient pays out-of-pocket after 100 days.
The average long-term nursing home stay is 2.5 years for women, and 1.5 years for men. However, many residents unexpectedly stay 5 years or more.
In most cases, a nursing home can’t discharge a Medicaid-eligible resident. Once the person spends down to eligibility, a Medicaid-certified facility must accept Medicaid reimbursement; despite this, some facilities may and do find loopholes in state laws that would allow them to evict.
“In my experience, a resident may be at risk for eviction because of an outstanding and unpaid balance on their account, or because the nursing home wishes to replace a resident whose bills are being paid by Medicaid or Medicare with a resident who will pay from their personal funds so the nursing home will make more money.” -2026 Law Office of Kathy Roux
Always consult with an elder attorney before assets are gone since protections differ by state.
Yes. A family member can get paid to be a caregiver in states with Medicaid-directed care programs (ex., Georgia, Ohio, Connecticut, Louisiana, Massachusetts, and North Carolina). These states have programs that pay family caregivers.
The One Big Beautiful Bill Act cuts Medicaid spending by $940 billion over 10 years. Nursing home residents under the aged, blind, or disabled category shouldn’t be affected directly. However, Medicaid’s retroactive coverage window is now 60 days, instead of 90 days. An estimated 10.5 million Americans will lose Medicaid and Children’s Health Insurance Program (CHIP) benefits by 2034, mostly because of paperwork problems.
Yes. In some cases, nursing home expenses up to 7.5% of the adjusted gross income are tax deductible as medical expenses if the cost isn’t covered by insurance. In general, you can only deduct the actual medical costs, especially if the nursing home resident is there for non-medical reasons. Consult with a tax professional for your specific case.
