When someone you love is no longer safe at home — whether after a hospital stay or due toa gradual decline — the next decision can feel overwhelming. Home care? A nursing home? A rehab facility? In many cases, the question becomes one of home care vs. nursing home, and sometimes even nursing home vs. rehab, depending on the situation. People use these terms loosely, and the overlap can be genuinely confusing.
The good news is that once you understand what each of these involves, the picture gets a lot clearer. This guide breaks down all three options so you can figure out which one fits your loved one’s situation right now when comparing home care vs nursing home in NYC.
What Is Home Care?
Home care is exactly what it sounds like: professional support provided in the home, on a schedule that fits the person’s needs. It ranges from a few hours of help a week to round-the-clock coverage, depending on what’s required. For families considering a home health aide in the Bronx, understanding how in-home support works can make it much easier to determine whether remaining at home is both safe and realistic-a key factor in the broader home care vs. nursing home decision.
What services can be provided in-home?
Home care covers more ground than most people realize. Depending on what your loved one needs, services can include:
- Personal care and daily support. A home health aide helps with bathing, dressing, meal preparation, mobility, and medication reminders — the everyday tasks that become difficult when recovering from surgery. In many cases, a home health aide in the Bronx provides consistent daily assistance, allowing older adults to recover or age in place without relocating to a facility.
- Skilled nursing. For those who need medical oversight at home, a registered or licensed practical nurse can visit on a scheduled basis to manage wound care, medications, and complex health conditions. This is often where families compare skilled nursing vs. rehab or rehab vs. home care; therapy intensity is usually the deciding factor.
- Therapy. Physical, occupational, and speech therapy can all be provided at home following a hospitalization or health event, without the patient needing to travel to a clinic.
How much supervision does home care provide?
Home care is not continuous, unless around-the-clock coverage is specifically arranged. A typical home care plan involves scheduled visits from an aide or nurse, with family members or the client themselves managing in between. This works well when a person is medically stable, and the primary need is support rather than supervision, one of the core distinctions in the home care vs. nursing home conversation.
Who is home care right for?
Home care tends to work best for people recovering from a procedure or illness and progressing steadily, people managing a chronic condition who need consistent daily support, and older adults who want to remain at home with some degree of family involvement. It’s also important that their living situation — perhaps with modifications — can safely accommodate their care needs.
If you’re not sure whether home care is the right fit for your loved one’s situation, an in-home care assessment is a good way to get a clear picture before making any decisions.
What Is a Nursing Home or Skilled Nursing Facility?
A nursing home (also called a skilled nursing facility, or SNF) is a residential care setting that provides 24-hour nursing supervision and personal care. In the discussion of home care vs. nursing home, the defining difference is continuous residential oversight vs. scheduled in-home support. In essence, nursing homes are primarily designed for long-term care: people who can no longer live safely at home and need ongoing medical oversight and daily assistance. Here’s what that looks like in practice:
24/7 nursing supervision
Skilled nursing facilities have nursing staff on site around the clock, including registered nurses, licensed practical nurses, and certified aides. Physicians visit regularly but are not continuously present. The phrase “skilled nursing facility vs. nursing home” is often used interchangeably, as both refer to residential facilities providing comprehensive medical supervision. This level of supervision makes a skilled nursing facility the appropriate setting for people whose medical needs are complex, unpredictable, or require consistent professional monitoring.
Long-term care environment
When most people picture a nursing home, they’re picturing long-term custodial care — a permanent or semi-permanent residence for someone who can no longer live safely at home. The facility handles all aspects of daily life: meals, personal care, activities, and ongoing medical management. For families in New York City, these costs are among the highest in the country, which makes understanding Medicaid eligibility an important part of the conversation.
When does a nursing home make sense?
Long-term nursing home placement is typically appropriate when someone requires ongoing medical supervision that can’t be provided at home, when cognitive decline has progressed to the point where independent living poses a genuine safety risk, or when the physical demands of care exceed what family members or home aides can realistically manage.
What Is a Rehab Facility?
A rehab facility is focused on short-term recovery. The goal is to help someone regain strength, function, and independence after a medical event — and then return home. Unlike a nursing home, a rehab stay has a defined endpoint.
Understanding the difference between nursing home vs. rehab is important because rehab may take place in a skilled nursing facility, yet the purposes are entirely different.
How a rehab stay works
Most people enter a rehab setting directly after a hospital stay. They no longer need acute hospital care, but they’re not ready to go home yet either — they need more intensive therapy than home care can provide.
There are two main settings where this happens:
- An inpatient rehabilitation facility, or IRF, is hospital-based and offers the most intensive therapy, typically averaging at least 3 hours per day. It’s often recommended after a stroke or major orthopedic surgery.
- The other option is a skilled nursing facility with a rehab unit, which offers therapy at a lower intensity and covers a broader range of recovery needs.
It’s worth knowing that many SNFs run both a long-term care unit and a short-term rehab unit under the same roof. So when someone is referred to a nursing home for rehab, they may be going for a short-term stay with a clear plan to return home, not a permanent placement.
What the therapy schedule looks like
Rehab stays are built around therapy. In an IRF, patients receive multiple daily sessions of physical, occupational, or speech therapy. In an SNF rehab unit, therapy is also provided but at a somewhat lower intensity. In both cases, the focus is on active recovery — getting the person back to their previous state.
When rehab is typically recommended
Short-term rehab is commonly recommended after hip or knee replacement, stroke, serious cardiac events, or major injury. In those early weeks of recovery, daily therapy makes a real difference — and that’s something home care alone can’t always provide.
Nursing Home vs Rehab: Key Differences
Because a nursing home and a rehab stay can happen in the same building, the clearest way to understand the difference is by goal rather than by setting.
Length of stay
A short-term rehab stay is designed to end — typically when the patient has met their recovery goals or plateaued in progress. Long-term nursing home care has no defined end date and is intended to be an ongoing living arrangement.
Therapy intensity
Short-term rehab involves frequent, structured therapy sessions aimed at restoring function. Long-term nursing home care may include some therapy, but the focus shifts to maintenance and daily care rather than active recovery.
Medical oversight
Both settings have nursing staff on site around the clock. The difference is in focus: a rehab stay focuses on achieving specific recovery milestones over a defined period, while long-term nursing home care focuses on managing ongoing, chronic conditions.
Discharge expectations
The defining question is whether the stay is designed to end with a return home. Rehab stays are built around that goal. Long-term nursing home placement generally is not, though some people do eventually transition from nursing home care back to home care as their condition stabilizes.
| Short-term rehab | Long-term nursing home care | |
| Length of stay | Weeks to a few months, with a defined endpoint | No defined end date |
| Therapy intensity | Frequent, structured sessions focused on restoring function | Some therapy may be offered, but the focus is on daily care |
| Medical oversight | Focused on reaching recovery milestones | Focused on managing ongoing, chronic conditions |
| Discharge goal | Return home | Ongoing residential placement, though transitions back to home care are possible |
Home Care vs Nursing Home: Which one is right for your loved one?
Choosing between home care and a nursing home isn’t always straightforward, but a few key factors can help point you in the right direction:
Whether family support is available
When a person is recovering from surgery, illness, or injury and has family members who can be present and involved, home care is often the more practical and preferred option. A home care aide provides the hands-on daily support, while family members fill in around the scheduled visits. This arrangement keeps the person in familiar surroundings and generally supports a more comfortable recovery.
For more on how home care fits into the post-discharge picture, our guide on home health aide support after hospital discharge walks through the transition in detail.
Safety and supervision needs
When someone’s safety at home is genuinely in question, whether due to fall risk, cognitive decline, or a condition that needs round-the-clock monitoring, home care has its limits. A nursing home provides the kind of continuous supervision that scheduled home visits can’t.
Complex medical conditions
Conditions that require complex, ongoing medical management — such as some wound care protocols, IV treatments, or ventilator dependence — may be difficult or impossible to safely manage at home, regardless of how much support you have. A skilled nursing facility is designed for exactly these situations.
What Are the Cost Differences in NYC?
Cost is a real and significant factor in this decision, especially in New York City, where care costs more than almost anywhere else in the country.
Hourly home care costs
Home health aide services in New York City typically range from the high-$20s to the high-$30s per hour, depending on the agency and level of care. For someone who needs 40 hours of support per week, that typically comes to roughly $4,500 to $6,000 per month — significantly less than facility-based care.
Skilled nursing facility costs
A semi-private room in a New York City skilled nursing facility often costs more than $14,000 per month. Private rooms run higher. For families paying out of pocket, the costs add up quickly. Medicaid can cover nursing home costs for those who qualify, but New York’s eligibility rules are specific and worth understanding before making any decisions.
Short-term rehab coverage and Medicare considerations
Under Original Medicare, short-term rehab in a skilled nursing facility typically requires a qualifying three-day inpatient hospital stay. (Medicare Advantage plans may follow different rules, so it’s important to confirm coverage details in advance.)
Coverage is substantial for the first 20 days, then steps down with a daily co-pay from day 21 through day 100. After 100 days, Medicare coverage ends. Home care services can also be covered by Medicare when a physician certifies medical necessity, and the patient meets homebound criteria.
What NYC Families Should Consider
Beyond the clinical factors, New York City creates its own set of practical realities that affect which care setting makes the most sense.
Apartment living and accessibility
Many New York City apartments — particularly in older buildings in the Bronx, Brooklyn, and upper Manhattan — weren’t built with mobility limitations in mind. Walk-up stairs, narrow doorways, and small bathrooms can make home care more complicated and sometimes require modifications before care can safely begin. A skilled nursing or rehab facility eliminates these barriers, which is worth considering when making the decision.
For NYC families weighing their options by borough, home care options in the Bronx and Brooklyn can help you understand what’s available locally. Options like working with a home health aide in the Bronx can help address common mobility challenges in walk-up buildings or smaller apartments.
Transportation and therapy access
Outpatient therapy requires regular attendance at appointments, which is manageable for some patients and genuinely difficult for others. If a person’s condition makes regular travel hard, in-home therapy or a facility-based setting may be more realistic than outpatient care.
Family availability and caregiver support
Home care works best when there is some family involvement — not necessarily full-time, but enough to provide a safety net between aide visits. Families who are spread across the city, working full-time, or managing multiple responsibilities may find that a facility setting provides more reliable coverage than a home care arrangement that depends on their regular availability.
Frequently Asked Questions
What is the difference between home care and a nursing home?
Home care provides professional support in the person’s own home on a scheduled basis — personal care, nursing visits, and therapy as needed. A nursing home is a residential facility that provides 24-hour nursing supervision and full-time personal care for people who can no longer live safely at home. The key differences are setting, the intensity of supervision, and whether the person can manage safely at home with support. For those who prefer to remain at home, hiring a home health aide in the Bronx can provide structured support without requiring residential placement.
Is rehab the same as a nursing home?
Not exactly. Rehab is focused on short-term recovery — helping someone regain function after a surgery, stroke, or illness, to return home. Long-term nursing home care is for people who can no longer live safely at home and need ongoing support indefinitely.
People sometimes confuse the two because they often happen in the same building (many skilled nursing facilities have dedicated rehab units alongside their long-term care residents). Either way, the distinction comes down to the goal of the stay, not where it happens.
When should someone choose rehab instead of home care?
Rehab is generally the right choice when intensive daily therapy is needed to regain function (such as after a major surgery, stroke, or serious injury) and when that level of support can’t realistically be provided at home. Home care is often the better fit when someone needs consistent daily assistance — whether they’re recovering steadily or simply managing the challenges of aging or a chronic condition.
Does Medicare cover rehab or home care?
Medicare covers rehab and home care, but the rules are different for each:
- Skilled nursing facility rehab requires a qualifying three-day hospital stay. The first 20 days are fully covered, and days 21 through 100 come with a daily co-pay. After day 100, coverage ends.
- Inpatient rehabilitation facility (IRF) stays are covered when the patient requires intensive therapy and can tolerate at least 3 hours of therapy per day.
- Home health services, including skilled nursing and therapy, are covered when a physician certifies medical necessity, and the patient meets homebound criteria.
None of these benefits is unlimited, so it’s worth discussing the specifics with the hospital discharge team or a care coordinator.