Nursing homes are licensed under 10 NYCRR Part 415, Nursing Homes - Minimum Standards, a distinct regulatory chapter focused on skilled, medically intensive care. Assisted Living Residences are licensed under 10 NYCRR Part 1001, and can only exist as an additional certification on top of an already-licensed Adult Home or Enriched Housing Program, themselves licensed under 18 NYCRR Parts 487 and 488.
The distinction that matters
These aren't just different rule numbers; they reflect genuinely different care models and levels of medical intensity. Nursing homes under Part 415 are built for skilled nursing and rehabilitative care, typically for people with more significant medical needs than assisted living is designed to serve, and Medicaid coverage for nursing home stays runs through the long-term-care Medicaid pathway, distinct from ACA Medicaid, once private funds are exhausted, at a statewide median cost of $511 per day for semi-private or $550 per day for private, per CareScout's 2025 survey. Assisted Living Residences under Part 1001, layered onto an Adult Home or Enriched Housing base license, are generally for people who need help with daily activities but not full-time skilled nursing care, at a lower statewide median of $225 per day. Families comparing the two should search both facility types on NYS Health Profiles, which maintains separate search tools for Adult Care Facilities and Nursing Home Profiles, reflecting this same underlying regulatory split.
