For most Tennessee families, the question isn’t whether to move a parent into care — it’s when, what kind, and how to pay. Each of the four major settings exists at meaningful scale in Tennessee, and the differences among them matter more than the marketing brochures typically suggest.
Tennessee’s four care settings
In-home care
The setting most older adults prefer and many can use until late in life. Tennessee has a robust private-pay home-care market and TennCare CHOICES Group 2 and Group 3 for residents who qualify for Medicaid-funded in-home support. Private rates run $25–$35/hour for personal care, $40–$55/hour for skilled nursing. 24/7 in-home care costs $13,000–$22,000 per month at full coverage — usually more than skilled nursing.1
Common mistake: assuming Medicare will pay for in-home aide hours. It won’t. Medicare covers short-term skilled home health after a hospital stay; it does not cover long- term custodial care at home.
Assisted living
Tennessee licenses two related but distinct settings:
- Assisted-Care Living Facility (ACLF). Apartment-style residential facilities providing housing plus help with activities of daily living. Most modern large assisted-living communities in Tennessee fall under this licensure.
- Residential Home for the Aged (RHA). Smaller settings (often resembling adapted homes) that provide a less-medical level of care than ACLFs but still offer help with daily activities.
Median statewide cost is around $4,200–$4,500/month, but variance is significant: Nashville and the surrounding Williamson/Sumner County communities routinely run $4,800–$5,800, while rural East and West Tennessee communities sometimes fall under $3,800.
Memory care
Memory care is specialized assisted living for residents with Alzheimer’s or other dementias. The differences from general assisted living: secured units to prevent elopement, higher staff-to-resident ratios, and programming designed for cognitive impairment. Tennessee memory care typically costs $1,000–$1,800/month more than general assisted living at the same property — figure $5,200–$7,500/month for average Tennessee markets, higher in Nashville.
Skilled nursing (SNF)
Skilled nursing facilities provide 24-hour medical supervision and the highest level of non-hospital care. Two broad use cases: short-term rehabilitation (covered by Medicare for up to 100 days post-hospital) and long-term custodial care (paid by TennCare CHOICES for those who qualify, otherwise private pay). Tennessee has approximately 300 licensed nursing homes. Costs run $7,500–$9,500/month for semi-private rooms, $8,500–$10,800 for private.
Cost-of-care in Tennessee by metro
Genworth’s 2024 Cost of Care Survey shows meaningful variation across Tennessee.2 Approximate monthly costs (2024 data, rounded):
- Nashville-Davidson.Home health $4,800–$5,400, assisted living $5,000–$5,800, nursing home semi-private $9,200–$10,200.
- Memphis.Home health $4,200–$4,800, assisted living $3,800–$4,500, nursing home semi-private $7,800–$8,800.
- Knoxville.Home health $4,200–$4,800, assisted living $4,000–$4,500, nursing home semi-private $8,200–$9,000.
- Chattanooga.Home health $4,200–$4,700, assisted living $4,000–$4,500, nursing home semi-private $7,800–$8,800.
- Tri-Cities (Johnson City/Kingsport/Bristol). Home health $3,800–$4,400, assisted living $3,500–$4,200, nursing home semi-private $7,500–$8,500.
- Rural East / West Tennessee.Home health $3,800–$4,400, assisted living often $3,500–$4,000, nursing home semi-private $7,200–$8,400.
How to evaluate a Tennessee facility, in practice
- Visit twice, including once unannounced. Different shifts, different days. The Tuesday-afternoon tour version of a facility is not the Saturday-evening version.
- Read the most recent state inspection report. Available free through the Tennessee Department of Health Health Care Facilities portal. Pay attention to deficiencies cited, plan-of-correction history, and any pattern over multiple years.
- Check Medicare’s Care Compare star rating for nursing homes. Look at the overall rating and the three sub-ratings (Health Inspections, Staffing, Quality Measures). A 5-star overall with a 2-star Health Inspection is a different facility than a 5-star with a 5-star Health Inspection.3
- Confirm license tier matches projected needs. For ACLFs, ask which services they’re licensed to provide and under what conditions a resident would be required to transfer out. A facility that can’t accommodate increasing care needs forces a difficult move later.
- Get the contract in writing before deposit. Tennessee assisted-living and nursing-home contracts are often negotiable on terms (rate-increase frequency, discharge conditions, refund policies). Have an elder-law attorney or geriatric care manager review the contract before signing.
- Verify staffing levels. Care Compare publishes payroll-based staffing data for nursing homes. Compare facility-reported staffing to actual reported hours.
Memory care: when the move makes sense
The signal that an assisted-living resident may need to transition to memory care isn’t a specific cognitive score — it’s typically one of:
- Repeated elopement attempts (wandering outside the facility)
- Inability to participate in standard assisted-living programming
- Behavioral symptoms (sundowning, aggression, paranoia) that general staff can’t safely manage
- Loss of safety awareness around stairs, stoves, or medications
Most Tennessee communities with both general assisted living and memory care keep the resident on the same campus during the transition, which reduces relocation stress. Choosing a property with both at the outset is a common Tennessee strategy.
Nursing-home quality oversight in Tennessee
Tennessee nursing homes are regulated under Tenn. Code Ann. Title 68, Chapter 11, with oversight by the Tennessee Department of Health, Health Care Facilities Division.4 Three quality signals to check before selecting an SNF:
- Medicare’s Care Compare Star Rating. Available at medicare.gov/care-compare for every Medicare- certified facility. The overall rating combines three sub-ratings; checking each sub-rating separately is more informative than the overall.
- Tennessee Department of Health inspection reports. State-specific inspection and complaint data available through the tn.gov/health portal.
- Long-Term Care Ombudsman. The Tennessee Long-Term Care Ombudsman office (1-877-236-0013) can provide information on resident complaints and facility patterns.
Paying for care — the four sources
Most Tennessee families fund long-term care from some combination of:
- Private savings and retirement income. The first source for most families, sometimes the only source.
- Long-term-care insurance. If purchased early enough (typically before age 60), can cover meaningful portions of assisted-living and nursing-home costs.
- Veterans Aid & Attendance benefit. Wartime-era veterans (or surviving spouses) with care needs may qualify for a monthly VA benefit that can be applied toward care costs.
- TennCare CHOICES. Medicaid is the largest payer for long-term institutional care in Tennessee, but requires meeting strict financial and medical-eligibility criteria. See the Tennessee Medicaid guide.
For the financial-planning side — how to plan for these costs, when Medicaid is an option, and what the spend-down process looks like — see the Tennessee Medicaid guide.