Written by: Lewis Smith · Medically reviewed by: Stephanie Hager, LPN · Updated September 2026
Families comparing senior care in the Lowcountry run into three words that seem interchangeable and are not: assisted living, care home, and nursing home. The confusion is not carelessness. Each state licenses these settings differently, national websites describe them in generic terms, and South Carolina uses a name for assisted living that almost nobody outside the industry recognizes.
In South Carolina, assisted living is licensed as a community residential care facility (CRCF) by the SC Department of Public Health. “Care home” is everyday language for the same thing. A nursing home holds a different license for a different level of need, meaning ongoing skilled nursing and medical care. The practical divide is not age or frailty. It is whether someone needs help with daily living or clinical care around the clock.
What South Carolina calls assisted living
South Carolina does not license anything called an “assisted living facility”. The legal category is a community residential care facility, or CRCF, licensed by the SC Department of Public Health.
The state defines a CRCF as a facility that provides room and board and, unlike a boarding house, provides or coordinates a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older, not related to the licensee within the third degree of consanguinity.
Strip the legal language and it means this: a place where someone lives, receives meals and housing, and gets help with the parts of daily life that have become difficult. Care is coordinated and continuous. It is not medical treatment. So when a South Carolina community advertises assisted living, it holds a CRCF license, and you can ask for its license number and check it.
Is a "care home" the same as assisted living?
In the Lowcountry, usually yes. “Care home” is not a license category in South Carolina. It is simply how families talk. When someone searches for care homes in Charleston or Summerville, they are almost always looking for a CRCF.
The reason to check rather than assume is that the phrase travels. In some parts of the country it is used loosely for nursing homes, and sometimes for small private residential arrangements that may hold a different license or none at all. One question settles it: what license does this community hold, and can I see it?
What a nursing home is, and how it is different
A nursing home, more precisely a skilled nursing facility, is licensed to deliver ongoing medical and skilled nursing care. That means registered nurses on duty around the clock, clinical oversight, wound care, IV therapy, complex medication regimens, and rehabilitation after a serious hospitalization.
The distinction is not how much help someone needs. It is what kind. A resident who needs assistance with every activity of daily living but is medically stable belongs in assisted living. A resident who is comparatively independent but requires daily skilled nursing intervention belongs in a nursing home. Families often guess wrong on this the first time, because they measure by how worried they are rather than by what the clinical need is.
| Setting | What it is for | Typical South Carolina cost |
|---|---|---|
| Assisted living (CRCF) | Help with daily living, in a residential setting, for medically stable residents | $5,350 a month, $64,200 a year |
| Memory care | Assisted living in a secured setting, with dementia-trained staff | Generally above the assisted living median |
| Nursing home | Ongoing skilled nursing and medical care, in a clinical setting | $108,405 a year, semi-private room |
| In-home care | Paid help delivered at home, by the hour | $71,786 a year, non-medical |
Assisted living in South Carolina costs roughly 40% of what a semi-private nursing home room costs. Cost figures come from the CareScout 2025 Cost of Care Survey. Placing someone in skilled nursing who does not need skilled nursing is an expensive mistake, and a harder daily life for them.
One caution about quoted rates. Many communities publish a base rate and then add level-of-care fees as needs increase, which means the figure discussed at move-in is often not the figure paid a year later. Our guide to what all-inclusive assisted living pricing includes sets out the difference between the two models.
Who pays: Medicare, Medicaid and OSS in South Carolina
Medicare does not pay for long-term room, board or personal care in assisted living or in a nursing home. It can cover a limited, short-term skilled nursing stay for rehabilitation after a qualifying hospital admission, which is a rehabilitation benefit rather than long-term care coverage.
South Carolina’s Community Choices Waiver is a Medicaid home and community based services waiver, administered by SCDHHS Healthy Connections. It can cover Residential Personal Care delivered inside a licensed CRCF. What it does not cover is room and board. That distinction is the one families most often miss.
Optional State Supplementation (OSS) is state-funded and is explicitly not Medicaid, despite being administered alongside it. It applies only in licensed CRCFs, and the resident must occupy an authorized OSS slot, so a community can hold a CRCF license and still have no slot available. For a fuller treatment of the funding routes families use, including VA benefits and long-term care insurance, see how to pay for assisted living in South Carolina.
Which level does your parent actually need?
- Is there a medical need that requires a licensed nurse daily, such as wound care, injections or complex clinical monitoring? That points to skilled nursing.
- Is the difficulty with daily living rather than medicine, such as bathing, dressing, medication reminders and meals? That is assisted living.
- Is there cognitive decline with a safety dimension, such as wandering or leaving appliances on? That points to memory care, which is assisted living in a secured setting.
- Is this recovery from a hospital stay rather than a permanent change? That is transitional care, and it does not have to become a permanent decision.
- Is the person medically stable but no longer safe alone? Assisted living, almost always.
If the honest answer is “we are not sure”, a good community will assess before admitting rather than after. Ask for the assessment first.
Where Lowcountry families look
The South Carolina Alzheimer’s Disease Registry recorded 125,538 South Carolinians living with diagnosed Alzheimer’s or a related dementia as of 2022. Locally the demographics explain the demand: Census Bureau QuickFacts puts Charleston County at 19.5% aged 65 or older, with Dorchester County at 17.2% and Berkeley County at 16.2%.
Stratford Place is a family-owned community in Goose Creek with 28 suites across one campus and two levels of care: assisted living at 97 Bridgetown Road and memory care at 95 Bridgetown Road. Pricing is all-inclusive, with no level-of-care fees added as needs change, and nursing staff are on site around the clock.
Frequently asked questions
A community residential care facility, or CRCF, is what South Carolina officially calls an assisted living community. The SC Department of Public Health licenses a CRCF as a place that provides room and board and, unlike a boarding house, provides or coordinates a degree of personal care for a period of time in excess of 24 consecutive hours for two or more persons, 18 years old or older, who are not related to the licensee. If a South Carolina community advertises assisted living, it is licensed as a CRCF.
In South Carolina, usually yes. “Care home” is everyday language rather than a license category, and locally it almost always refers to a CRCF. It is still worth confirming, because some people use the phrase loosely for a nursing home or for a private residential arrangement. Ask which license the community holds and the answer settles it.
Assisted living fits someone who needs help with daily living, such as bathing, dressing, medication, meals and housekeeping, but who does not need continuous skilled nursing. It is a residential setting rather than a clinical one, it usually costs substantially less, and it preserves far more independence. A nursing home is the right answer when the need is ongoing medical and skilled nursing care that an assisted living license does not permit.
Medicare does not pay for long-term room, board or personal care in either setting. It can cover a limited, short-term skilled nursing stay for rehabilitation following a qualifying hospital admission, which is a different thing from long-term nursing home residence. Assisted living, including room and board, is not a Medicare benefit at all.
Some will, and the mechanism matters. South Carolina’s Community Choices Waiver can cover Residential Personal Care delivered inside a licensed CRCF, but it does not cover room and board. Optional State Supplementation is a separate program that helps low-income residents with basic living costs in a licensed CRCF holding an authorized slot, and it is state-funded rather than Medicaid. Eligibility, income limits and slot availability all apply, so ask a specific community what it accepts.
The most common one families run into is cost escalation they did not plan for. Many communities quote a base rate and then add level-of-care fees as needs increase, so the monthly figure agreed at move-in is not the figure paid a year later. Ask for a written breakdown of what the quoted rate includes, and what triggers an increase, before signing anything.
Related reading
- Assisted living and memory care in Charleston, SC
- Assisted living and memory care in North Charleston, SC
- Assisted living and memory care near Mount Pleasant, SC
- Assisted living and memory care in Summerville, SC
- Assisted living near Moncks Corner, SC
- Assisted living vs in-home care: when bringing help in stops working
Still not sure which level of care fits?If you would like help working out where your loved one belongs, schedule a tour of Stratford Place in Goose Creek, SC, or call (843) 300-1951. We will tell you honestly if the answer is somewhere other than here. We serve families across Goose Creek, Summerville, Charleston, North Charleston, Mount Pleasant, and Moncks Corner. |
Sources & references
- South Carolina Department of Public Health, Community Residential Care Facility licensing: sc.gov
- South Carolina Department of Health and Human Services, Community Choices Waiver and Optional State Supplementation: gov
- CareScout 2025 Cost of Care Survey: com
- Alzheimer’s Association South Carolina, state Registry prevalence: org
- S. Census Bureau QuickFacts: census.gov
This article is for general education and is not a substitute for legal, financial or medical advice. Licensing rules and program eligibility change, so confirm current details with the relevant state agency.
