The core difference
A nursing home (skilled nursing facility) is a health facility licensed by the California Department of Public Health, with licensed nurses on duty around the clock. A board and care home is a residential care home licensed by the Department of Social Services, with caregivers who help with daily living but do not provide ongoing skilled nursing.
Side by side
| Board and care home | Nursing home | |
|---|---|---|
| Licensed by | Department of Social Services | Department of Public Health |
| Care | Personal care, supervision, medication help | 24-hour skilled nursing and rehab |
| Setting | A house, usually six or fewer residents | A medical facility, often shared rooms |
| Typical cost | $3,000 to $6,000 a month (California statewide range, 2026) | About $315 a day for a semi-private room (national median, 2025) |
| Medicare | Does not pay | Short-term skilled stays after a qualifying hospital stay of at least three days as an admitted inpatient |
| Medi-Cal | Care services in some homes, not room and board | Can cover long-term stays when medically necessary |
What Medicare covers in a nursing home
After a qualifying hospital stay (at least three days as an admitted inpatient; observation days do not count), Medicare Part A can cover up to 100 days of skilled nursing care per benefit period while skilled care is needed. Days 1 to 20 have no coinsurance, and days 21 to 100 cost $217 a day in 2026. Medicare does not cover long-term custodial care in either setting.
Who needs a nursing home
- Daily skilled nursing: complex wound care, IV medications, feeding tubes managed by nurses, ventilators.
- Intensive rehab after a hospital stay.
- Medical needs that change hour to hour.
Who usually does better in board and care
- People who need help with bathing, dressing, toileting, transfers and medications, but not daily nursing.
- People living with dementia who are calmer in a quiet house.
- People on hospice, in a home with a hospice waiver.
- People finishing rehab who are not ready to live alone.
Many families move a parent from a nursing home to a board and care home once rehab ends. The care is more personal, and the cost is usually far lower than private pay in a nursing home.
Sources
- Medicare.gov, Skilled nursing facility care coverage
- CMS, Medicare deductible, coinsurance and premium rates for 2026
- CareScout, 2025 Cost of Care Survey results (March 2026)
- California Care Compass, California senior care costs 2026
- Nolo, When California's Medi-Cal will pay for a nursing home, assisted living, or home care