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What Is The Difference Between Nursing Homes And Assisted Living?

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Updated January 5, 2021
At some point during your caretaking for an elderly parent, you may come face to face with the truth: your loved one cannot live on their own anymore. Depending on their abilities, they might need to move into a skilled nursing facility (SNF) or an assisted living facility (ALF).

But what exactly is the difference between a nursing home and assisted living?

The main difference between nursing homes and assisted living facilities is the type and amount of medical care and services provided to their senior residents. Nursing homes are generally intended for seniors who required long-term care, need monitoring and/or medical care either 24/7 or most of the day. Whereas seniors in assisted living facilities are more independent and may only require occasional assistance (or none at all).

Whether your aging parent or senior loved one is living in the same home they’ve lived in for years or they are in an independent living community – if they are having problems caring for themselves or simply want the security of being monitored daily then the decision may have to be made to move to an assisted living community or a skilled nursing home.

There are multiple key differences between skilled nursing facilities and assisted living facilities. This table below will show you what they are.

Nursing HomesAssisted Living Facilities (ALF)
Residents live in their own private room or they share a room with one other person.Residents have their own private suite or apartment.
Nursing home residents are generally unable to perform their own personal care and activities of daily living such as bathing, dressing, preparing meals, etc.Residents are able to perform their own activities of daily living and have access to a main dining room where usually two meals are provided.
Medication management is provided by the nurses.Many ALF’s can provide medication management if it’s requested.
Medicare generally pays for a portion of nursing home stays for 100 days . Then Medicaid may kick in to continue paying.Neither Medicare or Medicaid pay for assisted living. Long-term care insurance may be used.
Are generally large facilities with the look and feel of a hospitalCan be large buildings with a slight home like feel or they can be smaller private residential homes that house a handful of residents.
Provides 24 hour round the clock care and emergency call systems.Provides 24 hour round the clock care and emergency call systems.
Provides recreational activities.Provides recreational activities and may offer outings to local events.
Generally able to provide extensive medical care and medical services.Does not provide medical care to it’s residents.
Many skilled nursing homes are able to provide rehabilitation services such as speech therapy, occupational therapy and physical therapy.Generally do not provide rehabilitation services to their residents.
Provides transportation to and from doctor’s visits.Normally provides transportation to and from doctor’s visits, grocery stores, etc.

All nursing homes and assisted living facilities have multiple levels of care so when interviewing the places you are considering – make sure to understand what they are able to provide at each stage of care that your senior loved one may require.

You can read more about the different levels of care here.

If someone needs daily therapy, IV medication, or artificial respiration (i.e, a ventilator), for instance, skilled nursing is better equipped to meet the need.

For the person who wants or needs help with simpler tasks, assisted living may be the answer.

Is Assisted Living Cheaper Than A Nursing Home?

Assisted living is not necessarily cheaper than a nursing home. It all depends on the location (what state it’s in), the type of facility and the amount and type of care you (or your senior loved one) requires.

According to – the average cost of nursing home care in 2020 was somewhere between $89,297 and $100,375 per year.

Also, per, the average cost of an assisted living facility (as of 2018) is about $4,000 per month which comes out to about $48,000 per year.

So clearly, for older adults who can care for themselves – assisted living communities are a better financial choice.

How Do I Choose A Nursing Home Or Assisted Living Facility?

Choosing between a nursing home and assisted living facility for a senior loved one should not be taken lightly. Many family members or caretakers are in the position of trying to choose between placing their elderly loved one in a nursing home or an ALF. It’s not an easy decision but the more information you have on hand – the easier it can be.

If you are leaning towards moving a loved one into assisted living or a nursing home, how do you know which is best for them?

In this case, it’s not a matter of preference. The type of facility that is best suited for them really depends on their medical needs and the level of daily care your senior requires.

Here are some questions that will help you decide between the two:

1) Does Your Senior Have Dementia Or Alzheimer’s? Although you might not think so, both dementia and Alzheimer’s patients can do well in assisted living facilities as opposed to a nursing home. Again, this depends on their level of cognitive impairment, but some seniors may live in a memory care unit while still retaining some independence through assisted living.

2) Is The Senior Willing To Accept Help? If your senior understands that they can no longer perform daily activities and do everything for themselves (but can still do some things) and thus welcomes help, then assisted living is the right choice.

That said, when seniors need help but are resistant, a nursing home would likely be more appropriate. An elderly person in this state probably wouldn’t be able to care for themselves, so they’d need someone consistently available to provide this care when necessary – even if the senior doesn’t want it.

Here’s how to talk to an elderly parent about assisted living.

3) Does The Senior Have Mental/Behavioral Problems? If a senior’s lack of self-care stems from behavioral problems related to dementia or other cognitive deficits, mental health issues, or even physical pain, then a nursing home is the best choice for them. They can then receive the kind of extensive care they require.

4) Can The Senior Get Around Themselves? If your loved one has no problem getting around on their own, then they can probably do most things in their suite or apartment at an assisted living facility. It’s those seniors who struggle to get out of bed and move around who are much better off in a nursing home.

Read more about How To Choose The Right Nursing Home.

When To Move From Assisted Living To A Nursing Home

Making the decision on when to move from an assisted living facility to a nursing home is usually a group effort by family, caregivers and the physician. Transitioning from one senior housing to another is not easy but if your senior loved one’s condition requires it – then it may be necessary.

If your senior is set up in an assisted living facility now, things may not remain as they currently are forever. Their physical, mental, or behavioral health may degrade past even the highest level of care offered in assisted living.

At this point, it’s time to consider moving them to a nursing home instead. There, they can receive the around-the-clock monitoring and attention that someone in their condition would require.

Our article, When To Put An Elderly Parent In A Nursing Home, has more helpful information to guide you through this next step.

In that article we discuss 6 reasons that anyone would be admitted into a skilled nursing home.

  1. They are alone with no family or friends to care for.
  2. The person’s physical and/or cognitive disabilities are too difficult for a family or friend to manage.
  3. They do not have the funds to pay for a private caretaker to come to their home either part time or full time.
  4. They require 24 hour medical care due to their cognitive and/or physical disabilities.
  5. Family dynamics are too dysfunctional to provide care for the older adult.
  6. It’s a temporary placement for rehabilitation.

Books You May Find Useful

Navigating Assisted Living: The Transition into Senior Living

How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets

Other Senior Living Options

In this article we went over the differences between two popular (and common) housing options for seniors – but I want to also inform you that there are other senior living options as well that may suit the needs of your senior loved one. The list includes:

  • Granny Pods
  • Active Adult Communities aka Senior Living Communities
  • Tiny Home Retirement Communities
  • RV Retirement Communities
  • Senior Villages
  • Senior Co-Housing
  • Residential Care Homes
  • Continuing Care Community

It’s important to know that you are not necessarily forced to choose between just an ALF and a nursing home. These days – there are multiple different senior housing communities to select from.

You can read more about these senior living options here.

Frequently Asked Questions

Who can help me to make this decision and to choose a facility?

A geriatric care manager is your best source of information to not only help you assess which type of facility would be best suited for your senior loved one but also to choose which ones may fit your needs.

What questions should I ask when choosing an assisted living facility?

There certainly are specific questions that you should be asking when you go in to “interview” the assisted living facility. You can read about the 34 questions we recommend that you ask by clicking here.

Can you still have a social life in an assisted living facility?

Yes – residents in an ALF have their own apartment or suite and can certainly entertain guests. These living quarters generally have a small kitchenette, a living area, a bedroom, and a bathroom and oftentimes a screened-in outdoor porch.

Did We Answer Your Question About The Differences Between Nursing Homes And Assisted Living?

If your senior can no longer live on their own, you may be trying to choose between moving them into assisted living or a nursing home.

While some adult children might think they can choose either/or, that’s not the case. Now that you know more about both facilities, you can make an educated choice about which is the best care option for your senior.

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