What is each one actually licensed to do?
The difference is not one of degree, it is written into two statutes. Assisted living is a housing arrangement where care and supervision is provided, and care and supervision means ongoing assistance with the activities of daily living. Housing, with help in it. A skilled nursing facility is a health facility, the code's own word, for skilled nursing care on an extended basis. Not a larger version of the first, and not a stricter one.
So a care home can do more than families expect: bathing, dressing, toileting, transfers, meals, supervision overnight, medications. What it cannot do is nursing. The code keeps a separate phrase for that, health related services, delivered by a skilled professional who comes in. A person can have a nurse in assisted living. The nurse just does not work there.
Whether a home may keep a resident who cannot get out of the building unaided turns on the fire clearance it holds. Someone who becomes bedridden generally cannot stay unless that clearance is right, a physician documents the need, and the department agrees she is safe. What the license permits and where it stops goes through it. Ask which one a home holds before anyone signs.
How do the two compare, line by line?
Side by side, on the things that decide it rather than the ones a brochure leads with.
| Where they differ | Assisted living, an RCFE | Skilled nursing facility |
|---|---|---|
| Who licenses it | Department of Social Services, through Community Care Licensing | Department of Public Health |
| Who is on staff | Caregivers under a certified administrator. No nurse required in the building | Registered and vocational nurses with certified nursing assistants, around the clock |
| The floor California sets | Enough competent staff to meet residents' needs. No ratio and no hours per resident | 3.5 direct care hours per patient day, at least 2.4 of them from certified nurse assistants |
| How it is usually paid | Private funds. The Medi-Cal Assisted Living Waiver can cover care services for eligible enrollees in participating homes, never room and board, and there is a waiting list | Medicare for a short stay after a qualifying hospital admission, 100 days at most with a daily coinsurance from day 21. Medi-Cal for a long one, the resident contributing most of her income as a share of cost |
| Typical Los Angeles cost | $4,500 to $8,000 a month in a larger community, $3,500 to $6,000 a month in a licensed six bed home | $10,500 to $15,000 a month at private pay rates, quoted by facilities as $350 to $500 a day |
These are typical Los Angeles market ranges rather than prices we set or quote, and they move with care level, room type, and neighborhood. Confirm coverage with Medicare or Medi-Cal.
Who pays for which, and why do families get this backwards?
What Medicare can cover is a skilled nursing facility stay, and only when every one of these holds at once. Part A with days left in the benefit period. A medically necessary inpatient hospital stay of at least 3 days in a row. Entry generally within 30 days of leaving the hospital. A doctor determining daily skilled care is needed, in a Medicare certified facility. It ends the moment daily skilled care is no longer needed, usually well short of that.
Observation hours and emergency room time do not count toward the 3 days, so your father can spend three nights in a hospital bed without a qualifying stay. Ask on the first day whether he is admitted as an inpatient. The rest, including how a Medicare Advantage plan can waive the 3 day minimum, is on what Medicare does and does not pay for.
Medi-Cal runs the other way, paying for the expensive setting and not the cheap one, so a family that budgeted for assisted living finds no help with the rent while the nursing home they dreaded is the one the state covers. What Medi-Cal pays for in assisted living and who qualifies for the waiver take it from there.
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How do you tell which one she needs right now?
Walk through an ordinary day and, for each thing that has to happen, ask who is legally allowed to do it. Most of a hard day is not nursing. These are the things that are.
- A wound a nurse has to assess and dress every day
- Intravenous medication or fluids, or feeding through a tube
- A tracheostomy, a ventilator, or suctioning
- Injections or treatments a home's caregivers may not give
- A condition unstable enough to need a nurse's judgment daily
- Rehabilitation only an inpatient program delivers, straight after a hospital stay
What if none of that is true and she still cannot manage?
Then you are looking at assisted living, however frightening the month has been. Falling, not eating alone, not safe overnight, two people for a safe transfer, dementia by itself: none of that is a nursing home question.
Now ask the one that changes the answer more often than any other. Can a visiting service do the medical part where she already lives? Home health, wound care, therapy and hospice all come into a licensed care home, and that route is open far more often than families are told.
The reverse mistake is quieter and costs as much. A parent sent to a skilled nursing facility for rehabilitation has not moved into a nursing home, and rehabilitation ends. Ask on the second day where he goes when Medicare stops paying.
Where do I check each one?
Two records, two places, and neither costs anything. Homes are in the CCLD Care Facility Search, whose May 25, 2025 extract recorded 1,648 licensed RCFEs in Los Angeles County, 1,361 of them licensed for six residents or fewer. Nursing facilities are in Cal Health Find instead, which carries the certification a Medicare stay depends on.
If something has already gone wrong, the CDSS resources for residents and families page carries the complaint route and the Long Term Care Ombudsman.
- CCLD Care Facility Search, California Department of Social Services, Community Care Licensing Division
- Cal Health Find, California Department of Public Health, Center for Health Care Quality
- CDSS resources for residents and families, California Department of Social Services
How is Senior Placement Agency LA paid?
Nothing comes from your family. When someone moves into a home we introduced them to, that home pays us a referral fee, so a move happening is worth something to us and staying put is not. Ask us anyway whether a visiting nurse could keep your mother where she is.
Keep reading
- What Medicare does and does not pay for in senior living
- What an RCFE license lets a home do, and where it stops
- Board and care compared with a larger assisted living community
- Nursing home and skilled nursing placement in Los Angeles
- What long term care insurance covers in assisted living
- Told a parent cannot go home: what to do in the first 72 hours
Tell us what actually has to happen each day
If somebody at the hospital has said skilled nursing and it does not match the person you visited last month, this is the call to make. Tell us what has to be done for her on her worst day, and we will say which settings can legally take her.
Questions families ask us
- Is skilled nursing the same thing as a nursing home?
- In ordinary use, yes. Skilled nursing facility is the term California and Medicare use on paper, nursing home is what families say out loud, and both mean a health facility licensed by the Department of Public Health. No third thing hides between them.
- Is a board and care home a nursing home?
- No. A board and care home in Los Angeles is almost always a Residential Care Facility for the Elderly licensed for six residents or fewer, which is the assisted living license in an ordinary house. It is not licensed for nursing care.