How much does a nursing home cost — and why?

Nursing-home care is the single largest health cost most families never budget for. The national median is $9,581 a month for a semi-private room and $10,798 for a private room — roughly $115,000–$130,000 a year — and it is higher in the Northeast and on the West Coast.

Those are the national medians from the CareScout (Genworth) 2025 Cost of Care Survey (surveyed July–November 2025), the same table behind the cost figures on every facility and state page here — so this guide and the rest of the site cannot drift apart. A median is the middle of a wide range: your state matters more than the national number, and the cost-of-care planner uses your state's own median.

Why it costs so much

You are paying for 24-hour skilled nursing, not just room and board. Staff wages are the biggest line item, which is why staffing levels and cost track together. Real estate, food, therapy, and regulatory compliance make up the rest. Facilities owned by large chains or investors sometimes carry extra costs (management fees, rent to a related company) that don’t reach the bedside — one reason ownership is worth checking.

The number that actually matters: multi-year cost

The monthly figure understates the real exposure, because a stay lasts an average of one to three years and costs rise with inflation. Two years of private-room care at today’s prices is over $259,000, and prices climb 3–5% a year. The cost-of-care planner projects the full multi-year number for your state, and the “will my money last?” calculator shows how many years of it your savings cover.

What each payer covers

Medicare does not pay for long-term custodial care — only short rehab stays. Long-term costs fall to private savings, Medicaid once assets are spent down, long-term-care insurance if bought years earlier, and VA benefits for eligible veterans. See how families actually pay for the full picture.

The tax deduction almost nobody mentions

Nothing on this page reduces the bill. This does, and it is routinely missed: nursing-home care is often deductible as a medical expense — and not just the nursing part. If a principal reason for being in the home is to get medical care, the whole cost counts, room and board included. The IRS says it in one sentence: “You can include in medical expenses the cost of medical care in a nursing home, home for the aged, or similar institution… This includes the cost of meals and lodging in the home if a principal reason for being there is to get medical care.” If the reason for being there is personal, meals and lodging don’t count — but “you can, however, include in medical expenses the part of the cost that is for medical or nursing care” (IRS Publication 502, Medical and Dental Expenses ↗).

Against a six-figure annual bill, that is not a rounding error. The mechanics, and where families lose it:

• You have to itemize, and only the excess counts. The deduction is for medical expenses above 7.5% of adjusted gross income, claimed on Schedule A (26 U.S.C. § 213(a) ↗). On a $115,000 nursing-home year that floor is cleared almost immediately — a bill this size is frequently the thing that makes itemizing worth it for someone who has taken the standard deduction their whole life.
• A child paying the bills may be able to deduct them. This is the part that surprises people, including some preparers. For the medical deduction specifically, the usual gross-income test for claiming a parent as a dependent does not apply — § 213(a) reaches a dependent “determined without regard to” that test. Pub. 502 puts it plainly: you can include medical expenses you paid for someone who “would have been your dependent except that” they had too much gross income, or filed a joint return. A parent with a pension and Social Security too large to be your dependent can still be your medical dependent. You do still have to be providing over half their support.
• Several siblings splitting the support can still get it — but only one of you. Under a multiple support agreement, where nobody individually pays over half, the sibling designated as providing more than half can include what they paid. Watch the trap in the IRS’s own example: if your siblings reimburse you for their shares, you deduct only your share, and they deduct nothing. If instead they cover the non-medical support and you pay the medical bills yourself and unreimbursed, you can include the full amount. Same money, same family, very different tax result — decided by who writes which check.
• Assisted living and memory care can qualify too, by a different door: “qualified long-term care services” are deductible medical care (§ 213(d)(1)(C) ↗) when they are required by a chronically ill individual and “provided pursuant to a plan of care prescribed by a licensed health care practitioner.” Chronically ill is the same certification the LTC-insurance world runs on — unable to perform at least two activities of daily living for at least 90 days, or requiring substantial supervision due to severe cognitive impairment (§ 7702B(c)(2) ↗). Note what that requires you to have: a practitioner’s certification and a plan of care. Get them at the time, not from a doctor’s memory in April.

Two honest limits. First, this is the shape of the rule, not your return — the dollar thresholds move every year, this interacts with who claims whom, and a facility bill that is partly medical and partly personal is a judgment call worth paying a CPA to make. Second, a deduction is not a refund: it reduces taxable income, so what it’s worth depends on your bracket and on your having tax to offset. That said, of everything on this page, it is the item most likely to be sitting unclaimed — and unlike the rest of eldercare finance, you get three years to amend a return you already filed.

Compare real facilities

Advertised prices are rarely public and rarely honest. What is public is each home’s inspection record, staffing, and fines — and its operating economics from Medicare cost reports. Compare facilities side by side before you compare price quotes.

This guide is general information, not medical, legal, or financial advice. Rules vary by state and change over time. For personalized, unbiased help, your Area Agency on Aging and your state’s Long-Term Care Ombudsman are free.