Nursing homes and assisted living in Puerto Rico

In Puerto Rico, many families care for their elders at home until they just can't do it anymore. When that time comes, it helps to know what care settings are called on the island, who oversees them and what help is available. Here is a summary of the essentials.

What care settings are called here

On the island, almost all care settings for older adults (age 60 and older) are licensed by the Departamento de la Familia (Puerto Rico's Department of the Family) under Law 94 of 1977 (Ley 94). The main types are:

• Hogar de cuidado (a licensed care home; the law calls it an institución): a place that cares for 7 or more people 24 hours a day. It's what many people call a nursing home.
• Hogar sustituto (an adult foster home): a family's home that cares for no more than 6 older adults 24 hours a day. It's a small, homey setting, similar to a board and care home in the states.
• Centro de cuidado diurno (adult day care center) and centro de actividades múltiples (multi-activity center): your loved one spends the day in good company and comes home to sleep.

Licenses are issued for up to two years and then renewed. Separately, the Departamento de Salud (Puerto Rico's Department of Health) licenses unidades de cuidado prolongado (long-term care units). These are the closest thing to a nursing home or skilled nursing facility, with nursing care 24 hours a day. The Departamento de Salud also licenses hospices and home health agencies.

How Medicaid helps in Puerto Rico

The island's Medicaid works through Plan Vital, the government's health plan, which is run by ASES (Administración de Seguros de Salud, Puerto Rico's Health Insurance Administration). Eligibility is decided by the Programa Medicaid (Medicaid Program) of the Departamento de Salud.

There is one important difference from the states. According to MACPAC, the federal commission that advises Congress, Puerto Rico's Medicaid has not covered stays in long-term care nursing facilities because of a lack of funding. Since July 2024, it has added home health services and hospice for adults. Always check with your plan to see what benefits your loved one can get today.

If your loved one has Medicare Parts A and B and also qualifies for Medicaid, they may be able to get Medicare Platino, which combines both kinds of coverage on a single card. Keep in mind that Medicare can pay for a short rehab stay in a skilled nursing facility after a hospital stay, but not a long stay.

To apply for or check on Medicaid, call the Programa Medicaid: 787-641-4224, or visit medicaid.salud.pr.gov to find your local office. For questions about Plan Vital, call ASES: 787-474-3300, option 1.

How much care costs in Puerto Rico

CareScout's Cost of Care 2025 survey (done from July to November 2025 and published in March 2026) does not publish data for Puerto Rico. That's why we don't give you a figure for the island.

For reference, the survey's national medians were about $6,200 a month for assisted living and $315 a day for a semi-private room in a nursing home. Prices in Puerto Rico are often different, so ask each home for its rates in writing and ask what they include.

Who to call

• OPPEA (Oficina del Procurador de las Personas de Edad Avanzada): (787) 721-6121. This office defends the rights of older adults. It also serves as the Procurador de los Residentes en Establecimientos de Cuidado de Larga Duración, which is the island's long-term care ombudsman. It has offices in Ponce (787-841-1180), Guayama (787-866-6971) and Mayagüez (787-986-7105).
• Departamento de la Familia, ADFAN: 787-625-4900. Its Programa de Servicios a Adultos (Adult Services Program) offers guidance, support and services for people 60 and older.
• Eldercare Locator: 1-800-677-1116, a free national line to find services for older adults.

Tips for your family

• Check the license with the Departamento de la Familia search tool. You can search by name, region or municipality and see when the license expires.
• Ask about the emergency plan. The law requires hogares de cuidado to have a water tank (cistern) with enough water for several days and a generator or solar panels. This is very valuable during hurricane season, and good homes are proud to explain their plan.
• Plan how you will pay. Because Medicaid usually doesn't cover long stays, talk as a family about savings, pensions or Social Security, and talk to a professional if you have questions.
• Visit at different times of day and talk with the staff.

On hogaresparamayores.com, you can see the licensed care facilities in Puerto Rico. This guide is for information only and does not replace medical or legal advice.