Assisted living runs $4,000–$7,000/month in Nashville. Here's a practical guide to every funding source families actually use — including TennCare Medicaid, VA benefits, and long-term care insurance.
Most families assume they'll figure out the finances after they find the right community. That's backwards. How you pay affects which facilities you can even consider — some don't accept Medicaid at all, some have 18-month waiting lists for Medicaid beds, and the VA benefit requires specific documentation that takes months to gather.
This guide covers every legitimate funding source available to Nashville-area families, what each one actually covers, and how to access it. Start here before you tour a single facility.
Before diving into funding sources, know what you're actually paying for. Nashville-area assisted living averages roughly $4,500–$5,500 per month for a base rate — but that's almost never the final number.
| Area | Base Monthly Rate | With Care Add-ons |
|---|---|---|
| Brentwood / Franklin | $5,000–$7,500 | $6,000–$9,000+ |
| Downtown / Midtown Nashville | $4,500–$6,200 | $5,500–$8,000 |
| Hendersonville / Mt. Juliet | $3,800–$5,200 | $4,500–$6,500 |
| Antioch / Bellevue | $3,200–$4,800 | $4,000–$6,000 |
| Madison / Donelson | $3,000–$4,500 | $3,800–$5,500 |
Important: "Base rate" usually covers room, meals, and basic services. Medication management, incontinence care, mobility assistance, and extra safety supervision are often billed separately — sometimes adding $800–$2,500/month to the quote you received. Always ask for the full care cost estimate based on your loved one's specific needs before comparing facilities.
At $5,000/month, assisted living costs $60,000 per year. At $7,000, it's $84,000. For context, the median Tennessee senior has about $180,000 in total assets. Without a funding strategy, most families exhaust savings within 3–4 years — and many haven't planned for what comes next.
The most common starting point for most families
The majority of assisted living residents start as private-pay — meaning they use their own savings, Social Security, pension income, and investment accounts to cover costs. This is the default if no other funding is in place.
Social Security averages around $1,700–$2,200/month for most seniors. That covers roughly a third to half of a typical Nashville assisted living bill. The rest comes from savings and other assets. The key question families face: how long will the money last, and then what?
If your loved one has limited assets, start the TennCare CHOICES application now — not after savings run out. The application process alone can take 45–90 days, and some programs have wait lists.
Tennessee's Medicaid waiver for assisted living and home care
Tennessee's CHOICES program (Community Choices) is the Medicaid waiver that can cover assisted living costs for qualifying seniors. It's one of the most important — and least understood — funding sources available to Nashville families.
CHOICES pays for personal care services in assisted living — help with bathing, dressing, medication reminders, meals, and supervision. It does not cover room and board (housing costs), so residents must still contribute their own income toward those costs. In practice, most of a person's monthly income (Social Security, pension) goes toward the facility, and CHOICES picks up the care services portion.
To qualify for CHOICES Group 2 (assisted living), you must be:
Married couples: If one spouse enters a facility and the other stays home, the at-home spouse (the "community spouse") can retain significantly more assets — currently up to $154,140 (the "community spouse resource allowance" for 2025). The at-home spouse also keeps income up to $3,853.50/month. Consult an elder law attorney before spending down assets — there are legal strategies to protect more.
Many families have too many assets to qualify immediately. The legal process of repositioning assets to meet Medicaid eligibility is called "spend-down." This is legitimate and widely used — but doing it wrong (or within the 5-year lookback period) can trigger penalties. Tennessee looks back 5 years at all asset transfers. Gifts, payments to family members, or transfers for less than fair market value during that window can result in months of Medicaid ineligibility.
Do not transfer assets to children or other family members without consulting an elder law attorney first. Well-intentioned asset transfers made to "protect" assets from Medicaid often trigger exactly the penalties families were trying to avoid. Tennessee's 5-year lookback is strictly enforced.
Call TennCare Connect at 1-855-259-0701 or apply online at tn.gov/tenncare. You can also visit your local Department of Human Services office. Applications typically take 30–90 days. Get started before a crisis — you cannot apply retroactively once savings are gone.
Not all facilities accept TennCare CHOICES — many higher-end communities in Brentwood and Franklin are private-pay only. When touring, specifically ask: "Do you accept TennCare CHOICES? How many CHOICES beds do you have? Is there currently a waitlist?" Facilities that accept CHOICES must go through a certification process and often have a limited number of Medicaid beds available.
For wartime veterans and their surviving spouses — one of the most underused benefits in senior care
The VA's Aid & Attendance benefit is a pension enhancement that pays a monthly cash benefit to wartime veterans (or their surviving spouses) who need help with daily activities. It can be used for assisted living, memory care, home care, or any other qualifying care.
| Recipient | Maximum Monthly Benefit | Annual Maximum |
|---|---|---|
| Veteran (single) | $2,358 | $28,296 |
| Veteran with dependent spouse | $2,795 | $33,540 |
| Surviving spouse of veteran | $1,513 | $18,156 |
| Two veterans (married) | $3,748 | $44,976 |
Surviving spouses qualify too: If your parent is the surviving spouse of a wartime veteran — even if they were never in the military themselves — they may qualify for Aid & Attendance. This benefit is dramatically underused because families don't know it exists. A surviving spouse receiving $1,513/month in A&A gets $18,156/year toward care costs.
In 2018, the VA introduced a 36-month lookback period for asset transfers — similar to Medicaid's. Asset transfers made within 3 years of applying may result in a period of ineligibility. The maximum penalty period is 5 years.
Contact the Tennessee Department of Veterans Services at (615) 741-2931 or visit a regional VA office. Free assistance with the application is available through the American Legion, VFW, and DAV — veteran service organizations can submit claims on your behalf at no cost. Avoid companies that charge fees to apply for VA benefits; accredited VSOs do this for free.
Applications take 6–12 months on average. Start as early as possible. The benefit is retroactive to the month of application once approved, so don't delay.
Nashville VA Medical Center: Located at 1310 24th Ave S, Nashville, TN 37212. Phone: (615) 327-4751. The social work department can help connect veterans with benefits and facility placement resources.
For families whose loved one purchased a policy years ago
Long-term care insurance is a policy purchased in advance (typically in one's 50s or 60s) that pays a daily or monthly benefit toward qualifying long-term care costs. If your loved one has a policy, it may cover a significant portion of assisted living costs. If they don't have one, this section doesn't apply — you cannot purchase LTCI once care is needed.
Many families don't know their loved one purchased LTCI years ago. Search through old files, bank statements (look for annual premium payments), and safe deposit boxes. Check with former employers for group coverage. The National Association of Insurance Commissioners has a life insurance policy locator that can help find lost policies.
Most LTCI policies require two "benefit triggers" to start paying: the insured must need help with 2 of 6 activities of daily living (bathing, dressing, eating, continence, toileting, transferring), OR have a cognitive impairment such as dementia. The assessment is usually done by a nurse from the insurance company. Keep records of your loved one's care needs — documentation matters.
Tennessee Partnership Program: Tennessee offers a "Medicaid Partnership" LTCI program — policies that qualify under this program let you protect additional assets equal to the amount the policy paid out, before Medicaid eligibility kicks in. Worth asking a Tennessee elder law attorney about if you're in the planning phase.
For many families, the house is the biggest asset. If your loved one owns a home, selling it can generate substantial funds — and it's often the right decision when the person is moving into assisted living and won't be returning home. Nashville home values have appreciated significantly; even a modest home in Davidson or Williamson County may yield $250,000–$450,000+ after selling costs.
Medicaid note: If TennCare CHOICES is anticipated in the future, consult an elder law attorney before selling the home. Tennessee has an estate recovery program — if Medicaid paid for care, it can file a claim against the estate after death for the amount paid. However, proceeds from a home sale during life do not automatically go to Medicaid. The rules are complex and specific to each situation.
A Home Equity Conversion Mortgage (HECM) lets a homeowner 62+ access equity without selling. The loan is repaid when the home is sold or the owner moves out. For assisted living specifically, this has a major limitation: the loan becomes due when the borrower no longer lives in the home as a primary residence. If your loved one is moving to assisted living permanently, a reverse mortgage typically isn't the right tool — the house would need to be sold to repay it.
If your loved one has a whole or universal life insurance policy with cash value, there are options:
Be cautious of life settlement companies. While life settlements are legitimate, they are frequently the subject of high-pressure sales tactics and scams targeting seniors. Only work with licensed Tennessee life settlement brokers and get multiple offers.
This is the most common misconception in senior care financing: Medicare does NOT pay for assisted living. This surprises many families who assumed it would.
| Service | Medicare Coverage |
|---|---|
| Assisted living room & board | ❌ Not covered |
| Assisted living personal care services | ❌ Not covered |
| Memory care | ❌ Not covered |
| Short-term skilled nursing (post-hospitalization) | ✓ Up to 100 days if qualifying stay |
| Home health care (medically necessary) | ✓ Limited, with doctor's order |
| Doctor visits at assisted living | ✓ Part B covers physician services |
| Prescription drugs | ✓ Through Part D |
| Physical therapy at facility | ✓ Part B covers qualifying therapy |
Medicare does pay for medically necessary services — like physician visits, therapy, and some medications — that occur at an assisted living community. It just doesn't pay the facility itself for housing and personal care. This is an important distinction: Medicare may cover an individual's healthcare costs even while they live in assisted living.
Medicare Advantage (Part C) plans offered through private insurers sometimes include limited supplemental benefits for in-home personal care or adult day services. A few plans are beginning to cover some non-medical care support. Check your loved one's specific plan details — benefits vary significantly by plan and provider.
Most Nashville families use a combination of funding sources. Here's how to think about sequencing them:
This is not the area to rely on general-practice attorneys. Elder law attorneys specialize in Medicaid planning, VA benefits, and estate planning for seniors. The National Academy of Elder Law Attorneys (NAELA) has a directory. Tennessee-specific resources include the Tennessee Commission on Aging and Disability at (615) 741-2056.
Free resource: The Tennessee State Legal Services Association provides free or low-cost legal help to seniors who qualify by income. Call 1-800-342-1202. They can provide basic Medicaid and benefits guidance.
Yes. Social Security income goes directly toward the cost of care. If the total monthly Social Security is $2,200 and assisted living costs $5,000, the remaining $2,800 comes from savings or other sources. If your loved one is on TennCare CHOICES, most of their income goes to the facility as the "patient pay amount" and TennCare covers the care services.
Not while they're alive. Tennessee's estate recovery program can file a claim against the estate after the person dies if Medicaid paid for care — meaning the home's value may go toward repaying TennCare rather than to heirs. However, there are protections: if a spouse still lives in the home, or certain dependent relatives reside there, estate recovery may be deferred or waived. An elder law attorney can help structure assets to minimize this.
Vietnam veterans qualify as wartime veterans for Aid & Attendance purposes (Vietnam War period: Aug 5, 1964 – May 7, 1975). As long as he served at least 90 days of active duty with one day during that period, received an honorable or general discharge, meets the care need criteria, and is within the net worth limit ($155,356 in 2025), he may qualify.
Under standard Medicaid rules, an individual must spend down to $2,000 in countable assets. However, "countable assets" excludes the primary home (if intending to return), one vehicle, household goods, and burial funds. A married couple has significantly more protections. Legal strategies like annuities, certain trusts, and care agreements can legitimately restructure assets while remaining within the rules. Consult an elder law attorney — doing this wrong can result in penalties.
Plan on 45–90 days for a straightforward application. Complex asset situations, missing documentation, or facility coordination issues can extend it longer. You cannot pay for the care retroactively if savings are exhausted while waiting — start the process well before a financial crisis occurs.
Yes — but the number of Medicaid-accepting beds at a given facility is often limited. Many communities start residents as private-pay and then allow them to transition to Medicaid if they spend down, provided a Medicaid bed is available. Confirm this policy explicitly before signing a contract. Ask: "If my parent runs out of money, will they be able to stay if they qualify for TennCare CHOICES?" Get the answer in writing.
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Browse Assisted Living Communities Browse Memory CareThis guide is for informational purposes only and does not constitute legal, financial, or medical advice. Medicaid rules, VA benefit amounts, and income limits change annually. Consult a licensed Tennessee elder law attorney and a VA-accredited claims agent for advice specific to your situation. Information current as of 2025.