Cost and Payment Structures
Nursing homes cost about $108,000 to $110,000 per year for a private room in the United States, according to the 2023 Genworth Cost of Care Survey. Home health care averages $61,000 per year for 44 hours of weekly skilled care, with hourly rates of about $27 for a home health aide and $30 for a registered nurse. Medicare Part A covers up to 100 days of skilled nursing facility care after a qualifying three-day hospital stay, while home health care is covered with no cost-sharing when the patient is homebound and under a doctor-certified plan of care. Medicaid covers nursing home costs for eligible low-income residents in all states, and many states also offer home and community-based services waivers that fund home care instead of institutional placement. For families paying privately, the daily rate for a nursing home often exceeds $300, while a home health aide costs roughly $27 per hour, making home care cheaper for part-time needs but potentially more expensive for full-time 24-hour care.
Long-term care insurance policies vary widely, with many covering home health care at the same daily benefit as nursing home care or reimbursing based on actual hours. The U.S. Department of Health and Human Services reports that about 70% of people turning 65 will need some form of long-term care, and the average length of stay in a nursing home is about 2.5 years. The Centers for Medicare and Medicaid Services publishes the Nursing Home Compare dataset updated annually, allowing families to compare star ratings, staffing levels, and inspection results for facilities in their area. For home health agencies, the Medicare Home Health Compare tool provides quality measures such as improvement in mobility and hospital readmission rates, helping families evaluate providers before signing a care contract.
Services and Care Models
Nursing homes provide 24-hour skilled nursing, medication management, rehabilitation therapies, meals, and assistance with daily living activities in a residential facility setting. Services typically include physical, occupational, and speech therapy on-site, social activities, and regular monitoring by licensed nurses, with higher-acuity facilities offering memory care units and specialized wound care. Home health care delivers skilled nursing, physical therapy, occupational therapy, and aide services directly in the patient's home, with care plans coordinated by a physician and reviewed at least every 60 days under Medicare rules. The home model allows patients to remain in familiar surroundings, which can reduce stress and improve outcomes for those recovering from surgery, managing chronic conditions, or receiving end-of-life palliative care.
Skilled vs Non-Skilled Care
Skilled home health care requires a doctor's order and is provided by licensed professionals such as registered nurses and therapists, while non-skilled home care assistance with bathing, dressing, and meal preparation is typically paid for privately or through state Medicaid programs. Nursing homes offer both skilled and custodial care on-site, with staff available around the clock to manage complex medical needs such as ventilator care, catheter management, and intravenous medications. The choice between the two depends on the level of medical oversight required, with patients needing daily skilled intervention better suited to a nursing home and those needing periodic therapy or supervision often qualifying for home health services.
Quality, Regulation, and Provider Landscape
The Centers for Medicare and Medicaid Services uses a five-star rating system for nursing homes based on health inspections, staffing levels, and quality measures, with the 2023 data showing that fewer than 3% of facilities earn a five-star overall rating nationwide. Home health agencies are also rated on Medicare's comparison tools, with quality measures including timely initiation of care, improvement in functional status, and hospital readmission rates. Major providers in the nursing home sector include Brookdale Senior Living, Sunrise Senior Living, and ProMedica, while leading home health companies include Amedisys