Almost every family we meet in Great Falls arrives using the two terms as if they mean the same thing. They do not. Assisted living and nursing homes are separate categories in Montana law, licensed by different processes, staffed to different standards, paid for in completely different ways, and built for people at genuinely different points in life.
Getting the distinction right matters, because choosing the wrong one costs families money, time, and sometimes a second move at the worst possible moment. Here is the honest version - including the times when a nursing home, not a place like ours, is the right answer.
The short answer
A nursing home - properly called a skilled nursing facility - is a medical institution. Licensed nurses are on duty around the clock, and the care model is built around medical treatment and rehabilitation.
Assisted living is a residential setting. It is a home where people live, with 24-hour supervision and help with the activities of daily living: bathing, dressing, medications, meals. Health care services are layered in only to the extent the facility's license category allows.
One is a place you go to be treated. The other is a place you go to live.
Side by side
The differences that matter most to families, in one view:
| Assisted Living | Nursing Home (Skilled Nursing Facility) | |
|---|---|---|
| What it is | A residential home where people live and receive personal care | A medical facility built around 24-hour licensed nursing care |
| Who licenses it | Montana DPHHS, Office of Inspector General, Licensure Bureau | State licensed and federally certified by CMS against 42 CFR Part 483 |
| Nursing coverage | 24-hour supervision and assistance; a registered nurse is required only at Category B and above | Licensed nursing 24 hours a day, plus an RN at least 8 consecutive hours a day, 7 days a week |
| Typical resident | Needs help with daily activities, but is not consistently and totally dependent in four or more of them (Category A) | Needs skilled nursing or rehabilitation that cannot safely be delivered outside a medical setting |
| What it feels like | A house - living room, kitchen table, private bedrooms | A clinical setting, often with shared rooms and nursing stations |
| Median cost (2025) | $5,295/month in the Great Falls metro area | No Great Falls figure is published; Montana median is $8,973 semi-private, $9,581 private |
| Does Medicare pay? | No - Medicare does not pay for long-term custodial care | Only short-term: up to 100 days per benefit period, after a qualifying 3-day inpatient hospital stay |
| Does Medicaid pay? | Montana's Big Sky Waiver may pay for services - never for room and board | Yes - nursing facility care is an institutional Medicaid benefit that includes room and board |
| Length of stay | A long-term home | Often short-term rehabilitation; long-term stays are typically Medicaid-funded |
How Montana draws the line
Montana law defines an assisted living facility as a congregate residential setting that provides or coordinates personal care, 24-hour supervision and assistance, activities, and health-related services (MCA 50-5-101). These homes are licensed and inspected by the Montana Department of Public Health and Human Services, through the Office of Inspector General's Licensure Bureau.
Nursing homes are held to a different standard entirely. Montana's own rule for skilled nursing facilities does not write separate state standards - it requires compliance with the federal Conditions of Participation at 42 CFR Part 483. Under those federal rules, a certified nursing home must provide nursing services 24 hours a day, designate a licensed charge nurse on every tour of duty, employ a registered nurse at least 8 consecutive hours a day 7 days a week, and have a full-time director of nursing.
That is the structural difference in a sentence: a nursing home is required to have licensed nurses on duty around the clock. An assisted living home is required to have supervision and assistance around the clock - which is not the same thing, and should not be sold to you as if it were.
Montana's four assisted living categories - and why they matter to you
This is the piece most families have never heard, and it is the single most useful thing to walk into a tour knowing. Montana does not license every assisted living home the same way. There are four categories, and the category determines who a home is legally allowed to accept and keep.
- Category A - the baseline. Residents need physical assistance with at least one activity of daily living, but may not be consistently and totally dependent in four or more of them. Residents may not require physical or chemical restraint or confinement in locked quarters, may not have a stage 3 or stage 4 pressure ulcer, may not have a gastrostomy or jejunostomy tube, and may not require skilled nursing on a continued basis, except for the administration of medications.
- Category B - adds health care. A Category B home may serve residents who need skilled nursing or other services for more than 30 days for an incident, or more than 120 days a year, and may keep residents who are consistently and totally dependent in more than four activities of daily living. It requires a practitioner's written order for admission and a health care assessment renewed quarterly. Category B homes must employ or contract with a registered nurse to provide or supervise nursing service.
- Category C - secured memory care. This category serves residents whose severe cognitive impairment renders them incapable of expressing needs or making basic care decisions, including those who might leave without regard for their own safety. Montana rule requires direct care staff in the secured unit at all times residents are present, plus dedicated dining and activity space.
- Category D - a small, specialized secured setting for individuals assessed by a practitioner or adjudged by a court to be a danger to themselves or others. A Category D facility may not have more than 15 residents.
Ask which category, and ask early
When you tour any assisted living home in Montana - ours included - ask which license category it holds. It tells you, in one answer, whether that home can care for your parent as their needs change, or whether you will be moving them again in a year.
You can verify any Montana facility's license yourself through the state's public licensed-facility search, filtering by license type and Cascade County. It is free, it is official, and it takes about a minute.
What it costs here
In the 2025 CareScout Cost of Care Survey - the long-running industry benchmark, formerly published by Genworth - the median cost of assisted living in the Great Falls metro area was $5,295 per month. That is genuinely local data, and notably it runs below the Montana statewide assisted living median of $6,075 per month.
Nursing home care in Montana costs substantially more: a statewide median of $8,973 per month for a semi-private room and $9,581 per month for a private room. Statewide, that puts a semi-private nursing home room roughly 48 percent above the cost of assisted living.
One honest caveat on the local numbers: CareScout does not publish a Great Falls figure for nursing homes - there were not enough survey responses in this metro area, so the survey reports it as unavailable. Any site quoting you a precise Great Falls nursing home price is not getting it from this survey. We would rather tell you the data does not exist than invent it.
Two more cautions worth carrying into any budget conversation. A median is a midpoint, not a quote - the assisted living figure reflects a one-bedroom unit averaged across basic to more substantial care, and it excludes one-time community or entrance fees, which the survey tracked separately. And memory care and higher levels of acuity typically cost more than the published median.
Who pays - and the part that surprises families most
If you take one thing from this page, take this: Medicare does not pay for long-term care. Medicare's own coverage page for long-term care is labeled 'Not Covered - You pay all costs,' and states that because most long-term care is non-medical, Medicare and most health insurance, including Medigap, do not pay for it - whether it is delivered at home, in the community, in an assisted living facility, or in a nursing home.
What Medicare does cover is a short, skilled episode in a nursing facility. In 2026, after a qualifying inpatient hospital stay of at least 3 days in a row, Medicare Part A covers days 1 through 20 at $0 per day once the $1,736 deductible is met, then charges $217 per day for days 21 through 100. From day 101 onward you pay all costs, and coverage is capped at 100 days per benefit period.
The trap inside that rule is the word inpatient. Time spent in the emergency room or under observation status does not count toward the 3-day qualifying stay, even if your parent was in the hospital overnight. If a hospital stay may lead to rehabilitation, ask the hospital directly, and in writing, whether your parent is admitted as an inpatient or is under observation. Note too that Medicare Advantage plans and certain Accountable Care Organizations may handle the 3-day rule and the day 1 through 20 copays differently, so check the specific plan.
Medicaid works the other way around. Nursing facility care is an institutional Medicaid benefit, and that bundled payment includes room and board. Montana Medicaid pays for nursing facility care for eligible members, with the resident's own income applied toward the cost of care and Medicaid covering the remainder.
For assisted living, Montana's Big Sky Waiver - a Section 1915(c) home and community-based services waiver - can pay for services delivered in an adult residential or assisted living setting for people who qualify financially and who meet the level of care required for nursing facility placement. What it cannot do is pay room and board; federal rules prohibit HCBS waivers from covering it. So the waiver may help with care, while the family covers rent and meals. Two practical notes: DPHHS reports the waiver currently has a waiting list, and screening and referrals run through Mountain-Pacific Quality Health.
Veterans have one more avenue. VA Aid and Attendance is a monthly payment added to a VA pension for those who need another person's help with daily activities such as bathing, feeding, and dressing. For the rate year running December 1, 2025 through November 30, 2026, the maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents - about $2,424 a month - and $34,488 with one dependent; for a surviving spouse with no dependents it is $18,697. The net worth limit for that period is $163,699. Two things families routinely misunderstand: the actual payment is the maximum rate minus countable income, so very few receive the full amount, and VA pays the veteran or survivor directly as cash, not the facility.
Everything else is private pay. Nationally, assisted living is funded predominantly from personal income and savings, supplemented by long-term care insurance, veterans' benefits, and - for a limited number of qualifying people - Medicaid waiver services.
The nursing homes in Great Falls
As of the most recent federal provider data, there are four Medicare and Medicaid certified nursing homes in Great Falls: Benefis Senior Services - Eastview, Benefis Senior Services - Grandview, Benefis Senior Services - Westview, and Park Place Transitional Care and Rehabilitation.
We are not going to rank our neighbors. If skilled nursing is what your family needs, the right tool is Medicare's own Care Compare, which publishes current five-star ratings, health inspection results, staffing data, and penalties for every certified nursing home. Those ratings are updated regularly, so check them fresh rather than trusting any number printed on a website - including this one.
When a nursing home is the right choice
There are situations where assisted living is not the answer, and a good home will tell you so plainly.
Montana rule says it directly: assisted living is not appropriate for individuals incapable of responding to their environment, expressing volition, interacting, or demonstrating independent activity - the rule gives the example that someone in a persistent vegetative state requiring long-term nursing care should not be placed in an assisted living facility. There is also a practical safety standard: a resident who is ambulatory only with mechanical assistance must be able to self-evacuate without an elevator or lift, reach an adjacent fire-separated section, or reach an approved area of refuge.
In plain terms: if your loved one needs daily skilled nursing, wound care at the level of an advanced pressure ulcer, tube feeding, or medical monitoring that only licensed nurses can provide around the clock, a skilled nursing facility is the safer and more appropriate setting. Recovering from a hospital stay with intensive rehabilitation is also squarely nursing-home territory - and it is the one scenario where Medicare helps pay.
Assisted living is the right fit for the much larger group in the middle: people who cannot safely live alone anymore, but who are not sick enough to need a hospital-like setting, and who would be diminished by living in one.
Your rights if someone says your parent has to move
Families are rarely told this, so we will. Montana rule requires an assisted living facility to give 30 days written notice before an involuntary move-out, and it limits the reasons: that the resident's needs exceed the level of daily living services the facility provides; that behavior repeatedly and substantially interferes with other residents after prudent intervention; severe cognitive decline beyond what the license category allows; a complex, unstable, or unpredictable medical condition that cannot appropriately be treated in assisted living; a significant change in condition after outside treatment; nonpayment; or facility closure.
That notice must state the reason, the effective date, possible discharge locations, the right to appeal to the department, and the name, address, and telephone number of the state long-term care ombudsman. The resident has a right to a fair hearing. Shorter notice is allowed only in a medical emergency, when there is immediate danger, or when residency has been under 30 days.
If you receive a notice that leaves out the ombudsman's contact information, that is a real problem with the notice - and a reason to call the ombudsman yourself.
Where BeeHive Homes of Great Falls fits
We are assisted living, and we say so clearly. Across eight residential-style homes on our campus at 2320 15th Ave S, we offer assisted living at Sage and Clover, memory care at Linden, Mesquite, Maple, Pine Tree, and Huckleberry, respite care for families who need a short-term break, and specialized traumatic brain injury care at Fireweed.
We are not a skilled nursing facility, and we do not pretend to be one. Our nursing support serves in a non-medical capacity, and in a medical emergency our team calls 911 immediately. If your loved one's needs move beyond what assisted living can safely provide, we will tell you honestly and help you plan the transition rather than stretch past our license.
What we do offer is the thing a nursing home structurally cannot: a real home. Small houses, familiar caregivers, private rooms, home-cooked meals at a shared table. For the many families whose parent needs help but not hospitalization, that difference is everything.
If you would like to talk it through - even if you are not sure which kind of care you need - call us at (406) 205-4516. We are glad to help families sort this out, including the ones who end up somewhere other than here.
The whole comparison on one page
If it helps to have all of this in one place - to save, print, or send to a sibling weighing the same decision - here is the full comparison in a single graphic.
Great Falls and Montana resources
These are the people to call, and none of them are selling you anything:
- Cascade County Aging Services / Area VIII Agency on Aging, 1801 Benefis Court, Great Falls - (406) 454-6990. Your local aging and disability resource center for options counseling and referrals.
- Long-Term Care Ombudsman for Cascade County, through North Central Independent Living Services - (406) 788-6423, or NCILS at (406) 452-9834. Free, confidential advocacy for residents of licensed facilities.
- Montana State Long-Term Care Ombudsman - (406) 444-3285, or toll-free (800) 332-2272.
- Montana SHIP, free unbiased Medicare counseling - (800) 551-3191.
- Montana DPHHS Licensure Bureau, which licenses assisted living facilities and nursing homes - (406) 444-2676.
- Big Sky Waiver screening and referrals through Mountain-Pacific Quality Health - (800) 219-7035 or (406) 443-4020.
- Medicare - 1-800-MEDICARE (1-800-633-4227), or Care Compare online for nursing home ratings.
- Great Falls VA Clinic, 1400 29th Street South - (406) 771-5800. For Aid and Attendance questions, VA benefits at 1-800-827-1000.
- Alzheimer's Association 24/7 Helpline - (800) 272-3900.
Sources & further reading
- Montana Code Annotated 50-5-226 - Placement in assisted living facilities - the A, B, C, and D category criteria
- Montana Code Annotated 50-5-101 - Definitions - statutory definition of an assisted living facility
- Montana DPHHS - Administrative Rules for Assisted Living Facilities (ARM 37.106, Subchapter 28) - categories, secured units, evacuation standard, and 30-day discharge notice rules
- Montana DPHHS - Long Term Care facility rules (ARM 37.106, Subchapter 6) - Montana adopts the federal standards for skilled nursing facilities
- 42 CFR 483.35 - Nursing services - the federal 24-hour nursing and RN coverage requirements
- Montana DPHHS - licensed facility search - verify any Montana facility's license and category
- Medicare.gov - Long-term care coverage - Medicare does not pay for long-term custodial care
- Medicare.gov - Skilled nursing facility care - the 3-day inpatient rule and 2026 cost structure
- Federal Register - CMS CY2026 deductible and coinsurance amounts - the 2026 $1,736 deductible and $217 daily coinsurance
- Medicaid.gov - Institutional Long Term Care - why nursing facility payment includes room and board and other services may not
- Montana DPHHS - Big Sky Waiver Program - eligibility, covered services, and current waiting list status
- VA.gov - Aid and Attendance benefits - eligibility
- VA.gov - Veterans Pension rates - rates effective December 1, 2025 through November 30, 2026
- CareScout (formerly Genworth) Cost of Care Survey - 2025 median costs; Great Falls metro and Montana statewide
- Medicare Care Compare - nursing home ratings and inspections - current ratings for the four certified nursing homes in Great Falls
- Montana DPHHS - Long-Term Care Ombudsman - free advocacy for residents and families
This page is general information for families, not legal, medical, or financial advice. Program rules, costs, and availability change - please confirm current details with the agencies listed above or with our team.