Charleston Senior AdvisorWhat separates assisted living from a nursing home in South Carolina?
Daily skilled nursing: a CRCF provides room, board and personal care but may not admit or keep someone who needs the continuous daily attention of a licensed nurse, while a nursing home provides 24-hour licensed nursing, therapy and medical oversight.
Regulation 60-84 spells out the conditions a CRCF cannot take on, such as IV therapy, sliding-scale insulin, stage 2 or worse pressure ulcers and tube feeding the person cannot manage alone (Section 801.C). If any of those apply, a nursing home is the setting the state expects.
How are they regulated and rated differently?
Both are licensed by DPH, but nursing homes are also certified and inspected for Medicare and Medicaid, so CMS publishes star ratings, inspection results, staffing and fines for them; assisted living has no CMS ratings at all.
For a CRCF the public record is the DPH license, the Alzheimer's unit flag, enforcement orders and inspection reports available on written request. For a nursing home, Care Compare adds a large body of federal data. DPH lists 19 licensed nursing homes in the three counties with 2,115 licensed beds, and CMS rates 18 of them, 9 at four or five stars overall (Care Compare data as of October 1, 2026).
Which costs more?
A nursing home: CareScout's 2025 South Carolina medians are about $9,034 a month for a semi-private room and $9,612 for a private room, against about $5,350 for assisted living.
The payment picture differs more than the price. Medicare covers up to 100 days of skilled nursing after a qualifying hospital stay, and Medicaid pays for long-term nursing home care for eligible residents. For assisted living, Medicare pays nothing toward rent or care, and public help is limited to OSS and Community Choices in participating buildings.
Can someone with serious health needs still live in assisted living?
Often, if the needs are manageable with personal care, routine medication help and outside services: home health can provide short-term nursing for up to 14 consecutive days, and hospice can serve residents through the end of life.
The limits are total dependency in all daily activities lasting more than 14 days, dangerous behavior the building cannot control, and the need for a nurse's continuous daily attention (Section 801.D). When those appear, the facility must arrange a move within 30 days.
How should a Charleston family decide?
Ask the discharging physician or a geriatric care manager which tasks need a licensed nurse and how often; if the answer is daily skilled care, look at nursing homes, and if it is help with bathing, dressing, medications and safety, look at assisted living.
Campuses with both licenses, which exist in Mount Pleasant, on James Island and in Summerville, reduce the risk of choosing wrong. Our facility pages note when a CRCF and a nursing home share an address.
Side by side
| Assisted living (CRCF) | Nursing home | |
|---|---|---|
| Nursing | Personal care; short-term nursing up to 14 days | 24-hour licensed nursing |
| Ratings | No CMS ratings | CMS stars, inspections and staffing |
| 2025 SC median | About $5,350 a month | About $9,034 a month semi-private |
| Medicaid | OSS or Residential Personal Care in participating buildings | Long-term care for eligible residents |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
