Which States Have the Highest Nursing Home Care Costs?

The Quick Answer

How much does a nursing home cost per month in the US? The national median is $9,581 a month for a semi-private room. That's $315 a day, or $114,975 a year. A private room runs $10,798 a month. That's $355 a day, or $129,575 a year. This is based on the 2025 Cost of Care Survey. Costs range from about $5,627 a month in Texas to $27,831 a month in Alaska. That's almost a five-fold gap. Most of it comes down to local wages and cost of living.

Here's how the extremes compare. This is before we get into all 50 states:

A private room usually costs 10-20% more than a semi-private room in the same building. That gap changes by state. Alaska's survey didn't have enough private-room data this year. So we can't give a reliable number for that one.

One more thing worth knowing up front: most of these figures are "private pay" numbers. That means what a family covers out of pocket. No help from Medicare or Medicaid. If your loved one qualifies for Medicaid, your family's real cost looks very different. We cover how that works further down.

Is a Nursing Home the Right Level of Care?

Before you look up your state, it helps to ask a more basic question first. Does your loved one actually need a nursing home? Or would a lower level of care work just as well, for less money? We'd rather tell you that now than have you read 50 state entries first.

A nursing home is generally the right call when:

• -Care needs include 24-hour clinical supervision: IV therapy, feeding tubes, ventilator care, or frequent skilled wound care
• -A doctor has ordered skilled nursing care after a hospital stay or surgery
• -Dementia has reached the point of safety risks, like wandering, that a home can't be changed to prevent
• -Medical needs shift often enough that nursing staff must be on-site at all hours, not just on call

In-home care is often realistic when:

• -The main needs are daily tasks: bathing, dressing, meals, medication reminders, mobility, and company
• -Supervision is needed for safety, but not constant medical care
• -A family member can share caregiving hours, with paid care filling the rest
• -The goal is staying in a familiar home for as long as it's safe to do so

Real situations often sit somewhere between these two lists. That's normal. If you're not sure which side your family is on, that's exactly what a free care assessment is for. It's not a sales pitch. It's an honest read on what level of care your family actually needs. If a nursing home turns out to be the right answer, the state breakdown below will tell you what to expect to pay. If it isn't, in-home care is worth pricing out first.

Where Cottage Home Care operates: We're a licensed home care agency in 23 states. That list: Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. Non-medical caregiver rates across these regions start at $18–$21 per hour, with Cottage Home Care offering the highest competitive compensation based on state guidelines and caregiver experience. If your state is on that list, look for a Cottage mention in your state's section below. It will link to your local page. If your state isn't on the list, the cost data and the rest of this guide still apply. We just can't be the ones who help you use it.

Nursing Home Costs by State

Here's what a nursing home costs in every state. This is based on CareScout's 2025 survey. Figures are for a semi-private room unless noted. That's what most residents pay for. It's also what Medicaid will cover, unless a private room is medically necessary.

Looking for one state? Use the table below to find your number fast. Then click through for the full picture, including why that state costs what it does.

"Cottage-Served" marks the 23 states where Cottage Home Care has a direct presence. Now here's the full picture for every state. This includes why the number looks the way it does.

Alabama Nursing Home Costs

Monthly cost: $8,334 semi-private, $8,787 private · Annual cost: $100,010

Birmingham and Huntsville price close to the national figure. Rural counties cost less. Alabama's cost of living is low. So are nursing wages. That keeps the state median well under $9,581. Alabama Medicaid covers residents who meet the state's income and asset limits.

Alaska Nursing Home Costs

Monthly cost: $27,831 semi-private · Annual cost: $333,975

Alaska isn't just the most expensive state for nursing home care. It isn't close. Shipping supplies to remote towns costs more. Licensed nursing staff are hard to find. A small population is spread across a huge area. That adds costs other states don't carry. The 2025 survey didn't have enough private-room data in Alaska. So there's no reliable figure for that. DenaliCare, the state's Medicaid program, is the main path to affordable long-term care here.

Arizona Nursing Home Costs

Monthly cost: $8,365 semi-private, $11,437 private · Annual cost: $100,375

Retirees keep moving to Phoenix and Tucson. That keeps demand for nursing home beds high. Even so, Arizona's semi-private rate sits close to the national median. The private room stands out more. It costs over 35% more. That's a wider gap than most states show. AHCCCS is Arizona's Medicaid program. Cottage Home Care operates in Arizona; see our locations for local contact details.

Arkansas Nursing Home Costs

Monthly cost: $7,452 semi-private, $8,060 private · Annual cost: $89,425

Only four states charge less than Arkansas. The state has a lower cost of living. Nursing wages are modest too. That keeps prices down, especially outside Little Rock. Arkansas Medicaid covers residents who meet the state's asset and income limits.

California Nursing Home Costs

Monthly cost: $12,167 semi-private, $15,178 private · Annual cost: $146,000

The Bay Area and Los Angeles push California's average well above the national figure. Facilities in the Central Valley cost less. Real estate is expensive here. Staffing rules are strict. Nursing wages are high. All of that shapes California's cost of living, and nursing homes are no exception. Medi-Cal is California's Medicaid program. Cottage Home Care serves California families; see our locations page.

Colorado Nursing Home Costs

Monthly cost: $10,159 semi-private, $12,182 private · Annual cost: $121,910

Denver, Boulder, and Colorado Springs have grown fast for years. Rising housing costs along the Front Range show up in nursing home rates too. Mountain and rural counties cost less than the state average. Health First Colorado is the state's Medicaid program. Cottage Home Care families in Colorado can find contact details on our locations page.

Connecticut Nursing Home Costs

Monthly cost: $15,208 semi-private, $16,729 private · Annual cost: $182,500

Connecticut is one of the five most expensive states for nursing home care. That fits the broader cost of living across the Northeast. Nursing wages are high. Real estate is expensive in Fairfield County and around Hartford. Both push the state average well past the national figure. HUSKY Health is Connecticut's Medicaid program. Cottage Home Care has a full-service Connecticut office; visit our Connecticut page to learn more.

Delaware Nursing Home Costs

Monthly cost: $14,494 semi-private, $15,132 private · Annual cost: $173,923

Delaware is small. But it sits inside the Philadelphia-to-Wilmington corridor. That's one of the pricier labor markets on the East Coast. Land is limited. Competition for nursing staff is real. Both push the state's median well above most of the country. The Diamond State Health Plan is Delaware's Medicaid program.

Florida Nursing Home Costs

Monthly cost: $10,342 semi-private, $12,167 private · Annual cost: $124,100

Florida has a huge retiree population. That keeps demand for nursing home beds high statewide. Hurricane-code building rules add to facility costs too. Even so, Florida lands only a bit above the national median. Regional labor costs here run lower than in the Northeast or California. Statewide Medicaid Managed Care (SMMC) is Florida's Medicaid long-term care program. Cottage Home Care has a Florida office serving Miami-Dade, Broward, and Monroe counties; visit our Florida page.

Georgia Nursing Home Costs

Monthly cost: $8,821 semi-private, $9,429 private · Annual cost: $105,850

Metro Atlanta costs more than the rest of Georgia. But the state's overall cost of living keeps the statewide median well under the national figure. Georgia Medicaid covers residents who meet eligibility rules. Cottage Home Care is active in Georgia; our locations page will point you to your nearest office.

Hawaii Nursing Home Costs

Monthly cost: $15,473 semi-private, $16,395 private · Annual cost: $185,679

Nearly everything in Hawaii costs more. Most supplies and equipment ship in from far away. Nursing homes are no exception. The islands also compete for a small pool of licensed nursing staff. Together, that puts Hawaii among the five most expensive states in the country. Med-QUEST is Hawaii's Medicaid program.

Idaho Nursing Home Costs

Monthly cost: $10,494 semi-private, $12,167 private · Annual cost: $125,925

Idaho's cost of living is generally low. So a rate above the national median is a bit of a surprise. Rural facilities here often pay more to keep licensed nursing staff. The population is spread out, and that costs money. That cost shows up in the bill. Idaho Medicaid covers eligible residents.

Illinois Nursing Home Costs

Monthly cost: $8,304 semi-private, $9,216 private · Annual cost: $99,645

Chicago-area facilities cost more than the downstate average. Even so, Illinois as a whole lands below the national median. The state's Medical Assistance Program covers nursing home care for residents who qualify. For Illinois families, Cottage Home Care's locations page is the fastest way to reach a local office.

Indiana Nursing Home Costs

Monthly cost: $8,943 semi-private, $10,326 private · Annual cost: $107,310

Indianapolis-area facilities cost more than the rest of the state. Smaller Indiana communities cost less. The statewide median lands a bit under the national figure. That fits the broader Midwest cost pattern. Hoosier Healthwise and the Healthy Indiana Plan (HIP) cover long-term care for eligible residents. Cottage Home Care has an Indiana presence too; check our locations page for details.

Iowa Nursing Home Costs

Monthly cost: $9,277 semi-private, $10,038 private · Annual cost: $111,325

Rural Iowa counties often cost less than the state's own average. Facilities near Des Moines and the state's college towns price above it. The two balance out. The result is a statewide median close to the national figure. IA Health Link is Iowa's Medicaid program.

Kansas Nursing Home Costs

Monthly cost: $8,669 semi-private, $9,064 private · Annual cost: $104,025

Outside the Kansas City and Wichita metro areas, Kansas has a low cost of living overall. Nursing home rates follow that same pattern. They land well under the national median. KanCare is Kansas's Medicaid program.

Kentucky Nursing Home Costs

Monthly cost: $9,718 semi-private, $11,254 private · Annual cost: $116,618

Louisville and Lexington cost more than the rest of Kentucky. That pulls the statewide median just past the national figure. Kentucky Medicaid covers eligible residents. Kentucky families can find their nearest Cottage Home Care office through our locations page.

Louisiana Nursing Home Costs

Monthly cost: $7,604 semi-private, $8,076 private · Annual cost: $91,250

Outside New Orleans and Baton Rouge, costs run even lower than the state figure suggests. Louisiana is one of the five least expensive states for nursing home care. That fits a lower cost of living and modest nursing wages. Healthy Louisiana is the state's Medicaid program.

Maine Nursing Home Costs

Monthly cost: $13,976 semi-private, $14,904 private · Annual cost: $167,718

Maine is one of the more expensive states for nursing home care. That surprises people who think a rural state should cost less. The opposite is true here. Maine has an older population than almost any other state. Licensed nursing staff are in short supply. Remote counties pay a premium to keep beds staffed. MaineCare is the state's Medicaid program. Cottage Home Care also has a presence in Maine; our locations page has the details.

Maryland Nursing Home Costs

Monthly cost: $12,927 semi-private, $14,448 private · Annual cost: $155,125

Montgomery County and the Baltimore-Washington corridor carry some of the highest wages and real estate costs on the East Coast. Maryland sits close to Washington, D.C. That pushes the whole state's nursing home median well above the national figure. Maryland Medicaid covers eligible residents. Cottage Home Care has a full-service Maryland office covering all 24 counties. Visit our Maryland page to learn more, including how Community First Choice can let a family member become a paid caregiver instead.

Massachusetts Nursing Home Costs

Monthly cost: $14,448 semi-private, $15,817 private · Annual cost: $173,375

Wages are high here. The health care workforce is unionized. Real estate around Boston is pricey. All of that puts Massachusetts among the costlier states. It fits the broader New England pattern. MassHealth is Massachusetts's Medicaid program. If you're in Massachusetts, Cottage Home Care's locations page will connect you to your nearest team.

Michigan Nursing Home Costs

Monthly cost: $11,254 semi-private, $11,969 private · Annual cost: $135,050

Detroit-area facilities pull Michigan's average above the national median. Northern and rural counties trend lower. Michigan Medicaid covers eligible residents. The state's Home Help program lets a family member get paid for in-home care too. Cottage Home Care is Medicaid-certified and MDHHS-approved across all 83 Michigan counties from our Detroit office; visit our Michigan page.

Minnesota Nursing Home Costs

Monthly cost: $10,646 semi-private, $13,870 private · Annual cost: $127,750

Minnesota sets a fairly high wage floor for nursing home staff. That supports care quality. It also keeps prices above much of the Midwest, and past the national median. Medical Assistance (MA) is Minnesota's Medicaid program.

Mississippi Nursing Home Costs

Monthly cost: $9,581 semi-private, $9,885 private · Annual cost: $114,975

Mississippi has one of the lowest costs of living in the country. So a rate that lands right at the national median, not below it, is worth a second look. A smaller number of licensed facilities, relative to the population, likely plays a role. MississippiCAN is the state's Medicaid program.

Missouri Nursing Home Costs

Monthly cost: $6,741 semi-private, $7,604 private · Annual cost: $80,893

Only three states charge less than Missouri. A lower cost of living helps. So does a large supply of facilities relative to demand. Together, they keep prices well under the national figure. MO HealthNet is Missouri's Medicaid program. Our St. Louis office covers Missouri; find contact details on our locations page.

Montana Nursing Home Costs

Monthly cost: $8,973 semi-private, $9,581 private · Annual cost: $107,675

Montana's low population density cuts both ways. Land and general costs are cheap. That keeps the state just under the national median. But spread-out communities also mean some facilities pay more to keep enough staff on hand. Montana Medicaid covers eligible residents.

Nebraska Nursing Home Costs

Monthly cost: $8,377 semi-private, $9,216 private · Annual cost: $100,521

Omaha and Lincoln facilities cost more than the rest of Nebraska. Even so, the statewide median lands well under the national figure. ACCESSNebraska runs the state's Medicaid program.

Nevada Nursing Home Costs

Monthly cost: $11,786 semi-private, $14,463 private · Annual cost: $141,438

Las Vegas and Reno have grown fast for years. That has driven up real estate and building costs across Nevada. Nursing home rates have climbed right along with them, well past the national median. Nevada Medicaid covers eligible residents.

New Hampshire Nursing Home Costs

Monthly cost: $12,243 semi-private, $13,444 private · Annual cost: $146,913

New Hampshire has an older population. Licensed nursing staff are hard to find here too. Both keep costs well above the national median. The same pressures show up across New England more broadly. NH Medicaid is the state's program. Cottage Home Care is also active in New Hampshire; see our locations page to connect with a local team.

New Jersey Nursing Home Costs

Monthly cost: $12,775 semi-private, $14,448 private · Annual cost: $153,300

North Jersey counties near New York City cost more than South Jersey, generally. But the state as a whole sits well above the national median. New Jersey is dense, and its cost of living is high. NJ FamilyCare is New Jersey's Medicaid program. Cottage Home Care serves all 21 New Jersey counties from our Jersey City office. Visit our New Jersey page, and see our detailed breakdown of New Jersey nursing home costs for a county-by-county look.

New Mexico Nursing Home Costs

Monthly cost: $9,125 semi-private, $10,633 private · Annual cost: $109,500

Albuquerque and Santa Fe facilities cost more than New Mexico's rural counties. Either way, the statewide median lands close to the national figure. Centennial Care is New Mexico's Medicaid program.

New York Nursing Home Costs

Monthly cost: $15,528 semi-private, $16,729 private · Annual cost: $186,333

New York is among the five most expensive states in the country. New York City and its suburbs drive that. Real estate and wages there rank among the highest in the nation. Upstate facilities cost a lot less than the state average. New York State Medicaid covers eligible residents. The state's Nursing Home Transition and Diversion program helps people move out of a nursing facility and back into their own home. Cottage Home Care has served New York families since 1992 from our Freeport headquarters; visit our New York page.

North Carolina Nursing Home Costs

Monthly cost: $9,733 semi-private, $10,798 private · Annual cost: $116,800

Charlotte and Raleigh cost more than the rest of North Carolina. That nudges the statewide median just past the national figure. NC Medicaid covers eligible residents. Our Charlotte office covers North Carolina; details are on our locations page.

North Dakota Nursing Home Costs

Monthly cost: $11,528 semi-private, $12,304 private · Annual cost: $138,335

Few people expect a state with North Dakota's small population to rank well above the national median. But two things push prices up. One is a tight labor market, partly a legacy of the state's energy-industry wages. The other is the cost of staffing facilities across a sparsely populated state. North Dakota Medicaid covers eligible residents.

Ohio Nursing Home Costs

Monthly cost: $9,186 semi-private, $10,389 private · Annual cost: $110,230

Columbus, Cleveland, and Cincinnati facilities cost more than Ohio's statewide average. That average itself lands just under the national median. Ohio Medicaid, run in part through MyCare Ohio, covers eligible residents. Our Columbus office covers Ohio; you'll find contact information on our locations page.

Oklahoma Nursing Home Costs

Monthly cost: $7,026 semi-private, $7,756 private · Annual cost: $84,315

Only Texas, Missouri, and Arkansas charge less than Oklahoma. That reflects the state's low cost of living and modest regional wages. SoonerCare is Oklahoma's Medicaid program.

Oregon Nursing Home Costs

Monthly cost: $16,760 semi-private, $18,448 private · Annual cost: $201,115

Oregon is the second most expensive state in the nation for nursing home care. It's the single most expensive for a private room. Strong wage and labor rules for health care workers are the main reason. High housing costs around Portland add to it. The Oregon Health Plan (OHP) is the state's Medicaid program.

Pennsylvania Nursing Home Costs

Monthly cost: $11,954 semi-private, $13,688 private · Annual cost: $143,445

Philadelphia and Pittsburgh cost well above Pennsylvania's rural counties. That keeps the statewide median above the national figure. The state's Medical Assistance (MA) program covers eligible residents. Cottage Home Care has offices in Pittsburgh and Philadelphia covering Pennsylvania; see our locations page for contact details.

Rhode Island Nursing Home Costs

Monthly cost: $12,106 semi-private, $13,383 private · Annual cost: $145,270

Rhode Island is small and dense. It carries the same cost pressures as its New England neighbors. The cost of living is high. Competition for licensed nursing staff is stiff. The RI Medical Assistance Program is Rhode Island's Medicaid program.

South Carolina Nursing Home Costs

Monthly cost: $9,034 semi-private, $9,612 private · Annual cost: $108,405

Coastal South Carolina has drawn a steady stream of retirees in recent years. Even so, the state's nursing home costs land below the national median. That's thanks to a generally lower cost of living statewide. Healthy Connections is South Carolina's Medicaid program. Our Columbia office serves South Carolina families; see our locations page for contact information.

South Dakota Nursing Home Costs

Monthly cost: $9,444 semi-private, $10,190 private · Annual cost: $113,333

South Dakota's low cost of living gets offset by the cost of keeping rural facilities properly staffed. That lands the state close to the national median, not well under it. South Dakota Medicaid covers eligible residents.

Tennessee Nursing Home Costs

Monthly cost: $9,429 semi-private, $10,038 private · Annual cost: $113,150

Nashville and Memphis facilities cost more than the rest of Tennessee. Even so, the statewide median lands close to the national figure. TennCare is Tennessee's Medicaid program. Our Memphis office covers Tennessee; find contact details on our locations page.

Texas Nursing Home Costs

Monthly cost: $5,627 semi-private, $7,604 private · Annual cost: $67,525

No state charges less for nursing home care than Texas. It isn't close, either: over $1,100 a month cheaper than the next-lowest state. A large supply of facilities helps. So does a lower overall cost of living, and lower regional wages. STAR, Texas's Medicaid managed care program, covers eligible residents.

Utah Nursing Home Costs

Monthly cost: $8,669 semi-private, $10,646 private · Annual cost: $104,025

Utah's semi-private rate lands well under the national median. But the jump to a private room is steep here: over 20% higher. That's a wider gap than most states show. Utah Medicaid covers eligible residents.

Vermont Nursing Home Costs

Monthly cost: $14,113 semi-private, $15,528 private · Annual cost: $169,360

Small and rural doesn't mean cheap in Vermont. Licensed nursing staff are in short supply. Running facilities across a spread-out state costs more too. Both push prices well above the national median, one of the higher rates in the country. Vermont Medicaid, sometimes called Dr. Dynasaur for its children's coverage, runs the state's program.

Virginia Nursing Home Costs

Monthly cost: $10,250 semi-private, $11,680 private · Annual cost: $123,005

Northern Virginia sits close to Washington, D.C. That pulls the statewide median just past the national figure. The rest of the state runs more moderate. Virginia Medicaid, also known as Cardinal Care, covers eligible residents. Our Richmond office covers Virginia; see our locations page for contact details.

Washington Nursing Home Costs

Monthly cost: $13,155 semi-private, $15,969 private · Annual cost: $157,859

Wages are high around Seattle. So are housing costs. Both put Washington among the more expensive states in the country. Facilities east of the Cascades cost a lot less. Apple Health is Washington's Medicaid program.

West Virginia Nursing Home Costs

Monthly cost: $12,836 semi-private, $13,262 private · Annual cost: $154,030

West Virginia's nursing home costs run well above what the state's low cost of living would suggest. That's likely down to fewer facilities competing for residents. Staffing homes across a rural, mountainous state costs more too. West Virginia Medicaid covers eligible residents.

Wisconsin Nursing Home Costs

Monthly cost: $10,646 semi-private, $12,319 private · Annual cost: $127,750

Like neighboring Minnesota, Wisconsin sets a fairly high wage floor for nursing home staff. That keeps the state's median above the national figure. It does this even though the state's general cost of living is unremarkable. BadgerCare is Wisconsin's Medicaid program.

Wyoming Nursing Home Costs

Monthly cost: $9,916 semi-private, $10,923 private · Annual cost: $118,990

General costs in Wyoming run low. But its tiny, spread-out population means facilities often pay a premium to keep enough licensed staff on hand. That's enough to push the state a bit past the national median. Wyoming Medicaid, also called Equality Care, covers eligible residents.

What Affects the Cost of a Nursing Home

Location. This is the biggest factor by far. A facility in a high-cost metro area pays more for real estate, insurance, and staff. It passes that cost on to residents. That's why New York, Alaska, and Oregon sit at the top of the list. It's why Texas, Missouri, and Oklahoma sit at the bottom. Even within one state, a facility in a big city usually costs more than one in a rural county.

Private vs. semi-private rooms. A semi-private room means sharing with one roommate, usually with a curtain in between. It costs less. It's also what Medicaid will pay for, unless a private room is medically necessary. Nationally, a private room runs about 13% more than a semi-private one. That gap is much wider in some states, like Utah, than others.

Medical care requirements. A resident who needs wound care, IV therapy, or frequent monitoring costs more to staff for. That shows up in the bill. It shows up either as a higher base rate, or as extra charges.

Facility amenities. Basic nursing homes offer a room, meals, laundry, and supervision. Some facilities add extras, like on-site rehab gyms, salons, or nicer dining. Those push the price above the local average. It's worth asking about these directly. They're rarely required for good care.

Local labor costs. Nursing homes need a lot of staff. States with higher wage floors, or a tight labor market for RNs, LPNs, and certified nursing assistants, rank higher on the list. This happens even when their general cost of living is moderate. Maine, Vermont, and North Dakota are good examples. None of them are known for a high cost of living. But a real shortage of licensed nursing staff pushes their prices well above the national median.

How a Nursing Home Compares to Other Types of Senior Care

A nursing home isn't the only option. For a lot of families, it isn't the cheapest one either. Here's how the national medians compare, using the same 2025 survey data:

The gap makes sense once you separate what each option gives you. A nursing home builds 24-hour skilled nursing into the base rate. It does this whether a resident needs that level of care every hour or not. In-home care and assisted living are priced closer to what a specific person actually needs. That's why they often cost less for people who need help with daily tasks, like bathing or meal prep, but not round-the-clock medical care.

That said, in-home care isn't automatically cheaper. If someone needs true 24/7 supervision, enough caregiver hours to cover that can cost as much as a nursing home. Sometimes more. The honest comparison depends on how many hours of help a specific person actually needs. That's exactly where a home care vs. nursing home comparison should start, not a blanket guess either way. If your family is weighing this choice, a free care assessment can tell you what your situation would actually cost, in either direction, before you commit to anything.

One more point worth making clearly: Medicaid doesn't only pay for nursing homes. Every state also runs Medicaid Home and Community-Based Services (HCBS) programs. Some call it a waiver. Some use a different name. Either way, it can pay for in-home care instead. Michigan's Home Help program is one example. So is Maryland's Community First Choice. So is Connecticut's Adult Family Living. So is New York's Nursing Home Transition and Diversion program. All are mentioned in the state sections above. In some of these programs, a family member can even become a paid caregiver. If cost is what's pushing your family toward a nursing home, check whether your state's HCBS program would cover home care instead. Don't assume private pay is the only path either way.

Common Mistakes Families Make When Budgeting for Nursing Home Care

Mistake 1: Budgeting only for the base room rate. The monthly figures in this guide cover room, board, and standard nursing supervision. They usually don't include a private room upgrade, unless it's medically necessary. They may not include transportation to appointments either. Or special medical supplies. Or personal items like toiletries. Ask any facility for a full, itemized rate sheet before you sign anything. Not just the advertised starting price.

Mistake 2: Assuming Medicare covers long-term care. Medicare Part A covers up to 100 days in a skilled nursing facility. That's after a qualifying hospital stay. It pays in full only for the first 20 days. From day 21 to day 100, the resident pays a daily copay. After day 100, Medicare stops paying entirely. Medicare was never built to cover long-term custodial care. Treating it as a long-term funding source is one of the most expensive assumptions a family can make.

Mistake 3: Waiting until a crisis to learn the Medicaid rules. Medicaid has a 60-month look-back period on asset transfers. Say assets were given away, or sold below fair value, in the five years before applying. That can delay eligibility with a penalty period. And it happens right when a family needs coverage to start. Learn your state's Medicaid rules well before a placement decision is needed. That gives you far more options than sorting it out during a hospital discharge.

Mistake 4: Comparing your own quote to a state average and assuming something's wrong. The averages in this guide are useful for planning. But the actual rate for one facility in one county can run higher or lower, sometimes by a lot. A high quote isn't automatically a red flag. A low one isn't automatically a bargain. Ask what's included before you compare on price alone.

Mistake 5: Not pricing out home care before assuming a nursing home is the only option. Not every urgent situation actually needs 24-hour skilled nursing. Some families assume "nursing home" is the only path. They skip a comparison that could save several thousand dollars a month. And it could let their loved one stay in a familiar home too. This is worth a real conversation with a home care provider. Not just an assumption. Have that talk before you sign a nursing home contract.

If your family is dealing with a fall, a hospital discharge, or a diagnosis that's forcing a fast decision, it's worth a call to a home care provider first. Do this before you sign anything long-term. A same-day assessment can tell you, in plain numbers, whether staying home is realistic right now. If it isn't, it can tell you what would need to change. Cottage Home Care offers a free care assessment with no obligation attached.

Your Checklist Before Choosing a Nursing Home

Documents and information to gather:

• -A written rate sheet from the facility, broken out by room type and any add-on services
• -Your state's current Medicaid income and asset limits (these change yearly)
• -Records of any asset transfers or gifts made in the last five years, in case of a look-back review
• -A recent doctor's assessment of the level of care actually needed
• -Your loved one's Medicare, Medicaid, and any long-term care insurance information, in one place
• -A look at other government benefits for seniors your loved one may already qualify for; these sometimes get missed in the rush to sort out nursing home costs

Questions to ask a facility before signing anything:

1. What's included in the base daily or monthly rate? What costs extra?
2. Is there a one-time entrance or community fee? Is it refundable?
3. What's your current CMS Care Compare star rating? What explains a recent change in it?
4. How is staffing handled on nights and weekends?
5. What happens financially if a resident's needs increase, or private funds run out?

Warning signs to take seriously:

• -A facility that won't give you a written, itemized rate sheet before you sign
• -Pressure to sign quickly, especially tied to a hospital discharge deadline
• -Vague answers about staffing ratios or recent inspection results
• -A quoted rate far out of line with your state's average, with no clear explanation why

Next steps: If cost is the main worry, and the level of care needed is unclear, get a professional care assessment first. Do this before choosing between a nursing home and in-home care. It costs nothing to ask. It can save a family from paying for more care than they actually need. Some families won't qualify for Medicaid right away. Others would rather not wait through an application. Either way, private-pay home care is a direct, no-waitlist option worth a look. If Medicaid eligibility is a factor, talk to an elder law attorney or your state's Medicaid office before you file an application.

Frequently Asked Questions