What long-term care means
Long-term care refers to services that help a person with daily living over an extended time, rather than treatment for a single illness or injury. The need is usually measured by how much help someone requires with everyday tasks.
Two kinds of tasks are commonly used to describe those needs. "Activities of daily living" (ADLs) are basic self-care tasks such as bathing, dressing, eating, using the toilet, and moving between a bed and a chair. "Instrumental activities of daily living" (IADLs) are tasks needed to live independently, such as managing medications, preparing meals, handling money, and getting around the community.
Someone may need long-term care for months or years, and the amount and type of help often changes over time.
The settings where long-term care is provided
In-home care: help provided in a person's own home, ranging from non-medical assistance with daily tasks to skilled home health care ordered by a doctor. Medicare-certified home health agencies also carry CMS quality ratings.
Community and adult day services: programs such as adult day centers, meal programs, and transportation that support people who live at home.
Assisted living and residential care: housing that combines a place to live with help for daily activities and, often, some health services. These settings are licensed and overseen at the state level and are not part of the CMS five-star nursing-home rating system.
Continuing care retirement communities (CCRCs): campuses that offer several levels of care — independent living through skilled nursing — in one place.
Skilled nursing facilities (nursing homes): settings that provide 24-hour skilled nursing care and supervision. These are the facilities CMS rates and that this site summarizes.
Settings at a glance
It helps to compare the settings on the same three questions: who it typically suits, who oversees it, and whether it carries a CMS star rating you can look up.
In-home care — suits people who can stay safely at home with some help; non-medical care is largely unregulated at the federal level, but Medicare-certified home health agencies are federally overseen and do carry CMS quality ratings. Adult day and community services — suit people at home who need daytime structure or support; overseen largely at the state and program level; not CMS star-rated. Assisted living / residential care — suits people who need help with daily activities but not 24-hour skilled nursing; licensed and overseen by states; not part of the CMS nursing-home rating system. Continuing care retirement communities — suit people planning for changing needs over time; a mix of oversight by level; the skilled-nursing level is CMS-rated. Skilled nursing facilities (nursing homes) — suit people who need 24-hour skilled nursing and supervision; federally certified and inspected; these are the facilities CMS rates and that this site summarizes.
A framework for deciding which setting to research first
The settings can blur together, so it helps to work from the person's actual needs rather than from a building type. Ask four questions in order.
First: how much help is needed with activities of daily living — bathing, dressing, eating, toileting, transferring? Occasional help points toward in-home or community support; help with several ADLs most days points toward assisted living or skilled nursing.
Second: is skilled medical or nursing care required — wound care, IV medication, complex conditions, or recovery after a hospital stay? If yes, the choice narrows to skilled home health or a skilled nursing facility. If it is mainly personal-care help, non-skilled settings may fit.
Third: is the need round-the-clock, or only at certain times? A need for overnight supervision or 24-hour nursing points to a facility; daytime-only needs can often be met at home or through adult day programs.
Fourth: how might the need change over the next few years? If it is likely to increase, a setting that can step up care — a CCRC, or a facility that offers both short-term rehab and long-term care — can avoid a disruptive move later.
Only once those answers point to a setting does comparing specific providers make sense. When that setting is a nursing home, the public CMS data is where the comparison starts.
Long-term care vs. short-term (post-acute) care
Not all care in a nursing home is long-term. Many people enter a skilled nursing facility for a short, time-limited stay to recover after a hospitalization — for example, rehabilitation after surgery, a stroke, or a serious illness. This is often called post-acute or short-term rehab care.
Long-term care, by contrast, is ongoing support for people who need help over a long period. The same facility can provide both, which is why it helps to be clear about which kind of care you are looking into when you read a facility's record.
How long-term care is typically paid for
Long-term care is paid for through several sources, and the rules are set by official programs rather than by this site. Medicare generally does not pay for ongoing long-term (custodial) care; it covers limited, medically necessary skilled care — for example, a capped number of skilled nursing facility days after a qualifying hospital stay, under specific conditions.
Medicaid is the largest single payer of long-term care in the United States and can cover nursing-home and other long-term services for people who meet income, asset, and needs requirements that vary by state.
Other sources include paying privately out of pocket, long-term care insurance, and — for eligible veterans — certain benefits through the U.S. Department of Veterans Affairs.
Eligibility and coverage details are specific and change; confirm them with official sources such as Medicare.gov, your state Medicaid agency, and your local Area Agency on Aging. This site does not provide financial or benefits advice.
Where nursing homes and CMS ratings fit
Skilled nursing facilities are the part of long-term care that provides 24-hour skilled nursing care, and they are the facilities the Centers for Medicare & Medicaid Services (CMS) rates through its Care Compare program. SeniorCareRating.com organizes those public CMS records — overall and component star ratings, staffing, health-inspection findings, and federal penalty records — exactly as CMS reports them.
These ratings cover certified nursing homes only. In-home care, adult day programs, and assisted living are overseen through different systems and are not part of the CMS nursing-home five-star ratings. Medicare-certified home health agencies have their own separate CMS quality ratings.
Using CMS data when a nursing home is the right setting
If long-term care in a nursing home is what you're evaluating, public CMS data is a useful starting point: compare a facility's overall rating alongside its health-inspection, staffing, and quality-measure components, and review its inspection and federal-penalty records.
Two things shape how to read that record. Compare facilities within the same state — CMS grades the health-inspection rating against other facilities in that state, so identical stars in different states do not represent the same bar. And because the same building commonly serves both long-stay residents and short-stay rehabilitation patients, CMS reports several quality measures separately for each; read the set that matches the kind of stay you are planning for.
CMS data can lag current conditions, so treat it as one factual input among several. Confirm anything important directly with the facility, and verify current details on the official CMS Care Compare site and with your state survey agency.
Where to learn more
Official sources describe long-term care options, eligibility, and how they are paid for in far more detail than a single page can. Medicare.gov covers what Medicare does and does not pay for. The federal long-term care guidance that used to sit at LongTermCare.gov is now published by the Administration for Community Living at acl.gov/ltc — a different HHS agency from CMS, which is why it covers the settings the CMS ratings do not. Your state Medicaid agency sets the Medicaid rules where you live, and the Eldercare Locator at eldercare.acl.gov will identify your local Area Agency on Aging.
This site organizes public CMS nursing-home data and does not provide personalized care, medical, or financial guidance.