Key Takeaways:
- Assisted living and nursing care are two different care levels.
- Assisted living is designed for seniors who are able to maintain some level of independence but need help with daily tasks, such as bathing, grooming and dressing.
- Nursing home care, on the other hand, is for two other groups of seniors: those who cannot live alone and need round-the-clock care for chronic conditions, and those requiring short-term care after a hospital stay.
There's an ever-growing need for senior care options. Across the country, 70% of those currently age 65 or older will need some kind of long-term service or support during the remainder of their lifetime, according to a U.S. Department of Health and Human Services report.
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But the unique care needs of your elderly loved one won't fit neatly into a box. Your dad might have trouble remembering to take his medications, but he has no issues using the restroom. A recent shoulder injury might make it taxing for him to get dressed and perform daily hygiene, but he's able to move around with his walker just fine.
When comparing these diverse needs to the available options for senior care, it can be hard to parse the differences among facilities, including the levels of care provided.
“The lines are hazy. You often find residents in assisted living that should be in a nursing home, and vice versa. If Mom and Dad require a nurse more times than not, use that as a benchmark to consider a nursing home," advises Anthony Cirillo, a North Carolina-based health, aging and caregiving expert and president of The Aging Experience, a company that provides consulting, keynote speaking and products for the senior living industry and older adults. "Don't bear the burden yourself."
In this article, we outline key aspects of assisted living communities and nursing homes to help you better understand which one may be the best fit.
What Are Assisted Living Facilities?
Assisted living is a long-term care option for seniors who may need some assistance with activities of daily living, such as bathing, dressing or grooming, or with daily nonmedical needs, including:
- Cooking
- Day-to-day housekeeping duties and chores
- Laundry
- Social enrichment activities
- Medication management
- Transportation to medical appointments or stores
Assisted living residents have to meet certain standards to live there to ensure they don't exceed the amount of care the community can provide.
Assisted living communities in New York, for example, require residents to be able to walk 150 feet on their own or with mobility equipment.
"If the person cannot meet these standards, then they are more likely going to be placed in a nursing home," says Roxanne Sorensen, an aging life care specialist and owner of Elder Care Solutions of WNY in Buffalo, New York.
Assisted living communities may also have the following features:
- Separated apartments, though some may require residents to share a room with one companion
- Access to common areas, like dining areas, living spaces and activity centers
- Gardens or outdoor walking areas
- Three meals a day
- 24-hour supervision
- Housekeeping
- On-site social events
- Accommodations for pets
Touring a few assisted living communities will give you an idea of which amenities are offered in your area and how much they may cost.
In addition, assisted living facilities may offer secured sections of the building to care for residents with memory loss. These residential settings tend to be much more attractive than the traditional nursing homes that care for those with Alzheimer’s disease and other forms of dementia.
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Nursing Homes vs. Assisted Living
When comparing assisted living options with nursing homes, nursing homes accommodate residents with more advanced care needs.
These residents often have chronic conditions or a lack of mobility, and the services available at these facilities can help residents keep their health stable. Because residents may struggle with health issues and cannot live alone, a move to a nursing home is usually more permanent. These moves are also typically family decisions.
Nursing care facilities offer:
- A higher level of daily physical care, security and supervision than assisted living
- More staff support than assisted living, especially nurses and nursing assistants
- Increased ability to offer skilled nursing tasks, like managing wounds, catheters or IV lines
- A mix of care levels, from short-term post-hospital stays to long-term custodial care and skilled nursing needs
Some elderly adults may just need a short-term stay after a hospital discharge. For example, after having a stroke, some seniors may need a few days of intensive therapy but then are safe to go back to independent living. In these cases, many nursing homes or skilled nursing facilities accommodate these short-term skilled nursing stays. Frequently, moves to an SNF are after a hospital discharge and recommended by a physician.
Differences Between Assisted Living and Nursing Homes
The differences between assisted living and nursing homes will vary depending on each individual community.
Seven key differences between assisted living and nursing homes may include:
1. Level of medical staff and security
Nursing homes offer a higher level of care, so more nurses, therapists and specialists will be on the premises. Physicians might also round more often than they would at an assisted living community.
2. Cost
Both types of care homes for the elderly charge a monthly fee.
However, many facilities are moving away from the traditional flat rate.
"They are moving toward a fee-for-service structure," Sorensen says. "It makes it difficult for families to plan financially as you can’t predict what level of care your loved one will be in two years."
Due to nursing home residents requiring more extensive care, the cost of nursing homes is usually higher and can be expensive.
"I have found over the last 10 to 20 years that fewer people are able to afford that level of care," says Howard S. Krooks, an elder law attorney practicing in Florida, New York and Pennsylvania with Cozen O'Connor.
According to Genworth Financial's 2023 Cost of Care survey, the average monthly cost for an assisted living community is $5,350. A private room in a nursing home averages $9,733 per month.
3. Insurance coverage
Medicare will pay for certain types of short-term nursing care, like rehabilitation after a knee replacement. But Medicare does not cover long-term nursing home or assisted living care.
Medicaid covers nursing home care, but it may only cover assisted living services depending on facility policies and the state residents are living in. Because Medicaid is a joint federal and state public health insurance program administered by individual states, coverage for assisted living services varies.
4. Social atmosphere
All senior care homes will have some type of social scene. However, as assisted living residents require less direct care than nursing homes, the social atmosphere is often elevated. Activities, such as senior fitness or music classes, are geared toward individuals who are able to move around on their own and communicate.
5. Spatial layout
Assisted living communities may have more common areas and room for their residents to walk around. There are often more private rooms or suites, whereas nursing homes may have smaller and shared rooms.
6. Federal regulations
Nursing homes are subject to more government oversight by both the state and federal governments to ensure quality. The federal Centers for Medicare and Medicaid Services oversees nursing homes. Assisted living communities are subject to state regulations.
To compare the quality of nursing homes, you can visit Medicare Nursing Home Compare, which CMS runs.
You can also look at U.S. News' Best Nursing Homes ratings. For 2024, U.S. News evaluated more than 15,000 nursing homes on a variety of indicators of quality.
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7. Independence offered to residents
Assisted living communities allow their residents more independence than nursing homes. Because assisted living residents don't have as many medical conditions, they will have more freedom to leave the facility to go to community events or visit with family outside the premises. Nursing home residents are also allowed to leave, but they may require more assistance and planning to do so.
Similarities Between Nursing Homes and Assisted Living
Despite having some differences, there are a few key similarities between assisted living and nursing homes.
Three similarities between nursing homes and assisted living include:
1. Use of the same building
A facility may refer to its senior care home as a nursing home, but it may offer various levels of care. They could have a mix of nursing home care, assisted living or even memory care offered in the same location.
"Each facility chooses which areas to add to their building, such as a one-person assist area, two-person assist area and so on," Sorensen says. "Each building is different."
2. Round-the-clock on-site medical staff
Unlike independent senior living communities, nursing homes and assisted living communities will each have medical staff on-site at all times.
3. Availability of community areas
Even nursing care facilities with residents who require a lot of care will have common areas for them to dine, visit with family or even just to offer a change of scenery. This differs from a hospital, where patients typically cannot access spaces outside their rooms.
Assisted Living vs. Nursing Home: Which Is the Best Fit?
Choosing nursing homes versus assisted living can feel daunting.
Here are a few circumstances to keep in mind:
- Do you anticipate your or your loved one's care needs will change quickly? If that's the case, you may want to choose a facility that offers both nursing home care and assisted living.
- What do medical providers have to say? A medical provider can perform something called a functional assessment, which helps determine how much care your loved one needs. They'll also have insight regarding any chronic conditions, like how quickly they see your loved one's chronic kidney disease progressing, for example.
- How much medical care do you need? If you only need help with a few daily activities, like getting out of bed in the morning and having your food prepared for you, assisted living is a viable option.
Other questions you may have could include:
- Is assisted living better than a nursing home? Neither is a better option than the other. It depends on individual needs. A nursing home may be a poor choice for someone looking for lots of social activities and who doesn't need a lot of medical interventions. However, assisted living may not be a fit for someone who needs extensive help caring for themselves.
- Who is the best fit for assisted living? Assisted living is the best fit for someone who can communicate on their own. They also should be able to do most of their daily care independently, like brushing their teeth or changing their clothes. It's OK if they need some help with specific tasks, like a steadying hand to help them move from bed to wheelchair, or if they have a minor injury or condition that prevents them from being fully independent. Most assisted living communities automatically include some activities of daily living in their basic plan, then charge more for others, like laundry or medication management.
- Who is the best fit for a nursing home? A nursing home is the best fit for someone who needs moderate to extensive care to perform their daily activities. They may also require skilled nursing tasks, like wound care, catheter care or IV medications.
Overall, the decision of choosing between assisted living and nursing homes should be made with the senior, their family and their medical team.
Bottom Line
In summary, nursing homes and assisted living care may take place in the same building sometimes, but they are not the same level of care.
Nursing home care is for those who need more daily care and assistance. Assisted living is a more independent type of senior living, but it still offers some medical oversight.
Enlist the help of a professional, such as a geriatric physician or a geriatric care manager, to guide you in making an informed decision on how to choose assisted living versus a nursing home. Medical professionals can assess the needs of each potential resident using a scale to measure the activities of daily living. The more assistance needed, the higher the level of care – and cost – required.
