$70,800/Year for Assisted Living vs $127,750 for a Nursing Home Private Room

We ran the 2024 Genworth/CareScout Cost of Care Survey — the industry-standard annual reference, published since 2004 — through all four common elder-care paths side by side. The spread is bigger than most people expect going in.

The four numbers, side by side

The gap between the cheapest and most expensive option here is $56,950 a year — more than the median US household income. And the ranking isn’t what most people assume going in: full-time in-home care actually costs more than assisted living, not less.

Why “keep them at home” isn’t automatically the cheap option

The intuition that in-home care is the budget-friendly choice comes from picturing a few hours a week of help. At that scale, it is cheap — a couple hours a day of paid assistance runs a few hundred dollars a month. But Genworth’s $77,792/year figure assumes a standard 44-hour week, and the math scales linearly from there. Someone who actually needs near-continuous supervision — common with moderate-to-advanced dementia, for instance — can need 60-80+ hours of paid coverage a week, which pushes the home-care total past even the private nursing home room.

The honest way to plan is to estimate the actual hours needed first, then compare. Ten hours a week of home aide support runs roughly $1,470/month ($17,680/year) — genuinely the cheapest option on the list. Forty-four-plus hours a week flips the comparison entirely.

What drives the nursing-home premium

Nursing homes cost roughly 60-80% more than assisted living because they provide a different service: skilled nursing care (medication management, wound care, rehabilitation, 24/7 licensed nursing staff) rather than assistance with daily living (bathing, dressing, meals, medication reminders). The $16,425/year gap between semi-private and private rooms is almost entirely about privacy and space — the level of medical care is the same.

Medicaid, after a spend-down process, covers nursing-home-level care for people who qualify; it generally does not cover assisted living in most states. That single fact drives a lot of families toward assisted living for as long as it’s medically appropriate, purely on cost grounds — not because it’s a lesser form of care, but because private-pay assisted living is meaningfully more affordable than private-pay nursing care, and Medicaid doesn’t backstop it the same way.

Where this comparison doesn’t apply

• Your metro area. These are national medians. Genworth’s underlying state-level data shows real spread — some high-cost metros run 40-60% above the national figure for assisted living, some rural areas run well below it.
• Memory care units. A dedicated memory-care wing for dementia patients typically adds 20-30% on top of the standard assisted-living baseline shown here.
• Medicaid-covered nursing care. These are private-pay figures. Someone who has spent down assets to qualify for Medicaid pays a different (usually much lower) out-of-pocket amount for nursing-home-level care.
• VA Aid & Attendance. Veterans and surviving spouses may qualify for a benefit that covers some or all of these costs — not reflected in the private-pay numbers above.

What to actually do

1. Get the real hours-needed estimate before assuming home care is cheaper — call it conservatively high, since needs tend to increase, not decrease.
2. Get 2-3 actual quotes for your specific metro area; national medians are a starting point, not a budget.
3. If the number is uncomfortably large relative to savings, check whether long-term care insurance changes the math (see the LTC break-even tool below).
4. Ask about Medicaid spend-down eligibility and VA Aid & Attendance before assuming private-pay is the only path.
5. If more than one adult child will help fund this, model the cost split before a crisis forces an unplanned conversation.

Open the Elder Care Cost Comparison Calculator → and run your specific care-hours estimate against all four options.