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 nursing home or assisted living facility. Having more than one option can be confusing.
What is the difference between a nursing home and assisted living?
- Nursing homes are for seniors who need monitoring and care. In assisted living, they’re more independent.
- Those in assisted living may live in a suite or apartment. In a nursing home, the senior has only a room (which may be shared with another resident).
- Medicaid or Medicare may pay for the senior’s stay at a nursing home, but not for assisted living.
If you’re on the fence about whether a nursing home or an assisted living facility would be best for an older adult, this is the article for you. In it, we’ll discuss which option is costlier and whether the senior needs to qualify to get in. We’ll even talk about how to choose between a nursing home and assisted living, so keep reading!
Are There Different Levels Of Assisted Living Or Nursing Home Care?
One thing to be aware of is that there are different levels of care in both nursing homes and assisted living facilities. These levels are dependent on your senior loved one’s individual physical and cognitive needs.
Basically, there are three levels of assisted living. This is due to the somewhat more relaxed regulations that govern assisted living, especially when compared to nursing homes, which have stricter rules.
These levels are:
- Low assisted living care
- High assisted living care
- Memory care
If a senior is in an assisted living facility, it is assumed they have at least a decent degree of mobility. Their behavioral problems are minimal, even if they may have dementia or Alzheimer’s. The person is also receptive to help, but can take care of themselves to a degree.
Low Assisted Living Care
For a senior to enter the lower level of care in an assisted living facility, they must be quite healthy.
They can walk or use a wheelchair or another assistive device. They can speak, their memories are clear, and they can do many things for themselves, just not everything. For example, maybe they can’t shower by themselves or tie their own shoes anymore.
For these seniors, a nurse or medical professional would be available to assist them, on an as needed basis. This medical professional would also administer medications and do basic tests like blood sugar monitoring.
High Assisted Living Care
Seniors that need high-level care at an assisted living facility may struggle to walk or get around. They can do even fewer things for themselves, such as going to the bathroom, showering, or dressing. While the early signs of Alzheimer’s or dementia may have begun to manifest, these seniors do not yet qualify for memory care.
A senior who needs high level assisted living care may be more likely to slip and fall, they might have chronic pain, or they could otherwise need more frequent monitoring.
Those seniors with dementia, Alzheimer’s, or another cognitive condition that affects their memory would need their own level of care from a facility that focuses on memory care.
Everything around the memory care programs are designed to give the person autonomy while making them feel like they can’t fail, even if their memory isn’t as sharp as it once was.
According to WebMD.com, “Nursing homes offer the most extensive care a person can get outside a hospital.”
Although there are different categories of nursing homes and these often vary from state to state, they boil down to three main levels of care:
- Intermediate care
- Skilled nursing care
- Rehabilitation care
With intermediate care, the senior generally needs some type of medical care along with 24-hour supervision. They also need help with activities of daily living (ADLs), such as getting dressed, taking medication, bathing, and/or toileting.
Skilled nursing care is for seniors who need help with ADLs and who also have medical concerns that require professional nursing intervention (example: intravenous feeding or IV medications, or help taking care of a colostomy bag).
WebMD notes that, “Skilled care also includes services provided by specially trained professionals, such as physical, occupational, and respiratory therapists.”
Rehabilitation care is for those recovering from an illness, an injury or who need help with a disability. The person would usually only live in one of these facilities temporarily while they receive short term care.
Do You Have To Qualify For Assisted Living Or A Nursing Home?
A senior “qualifies” for assisted living due to their inability to completely take care of themselves. A more formal, written qualification is needed to move them into a nursing home and might be obtained through a doctor’s assessment or via a physical or occupational therapist.
Before you begin applying to assisted living facilities for the senior in your life, do know they must qualify for entry. The rules aren’t super strict, but it is necessary that your senior require assistance with their Activities of Daily Living (ADLs).
If your senior struggles with two or more of their ADLs, they should meet the requirements to get into assisted living.
The guidelines to qualify for admittance to a nursing home vary from state to state. In general there are criteria to meet, such as the senior’s physical and cognitive impairments, any medical and behavioral concerns (wandering, aggression, impulsiveness), and their ability to accomplish ADLs.
Additionally, they must need:
- Continuous, daily supervision
- Services on an in-patient basis
- The services to be ordered by a physician
Can You Be In A Wheelchair In Assisted Living?
If your senior primarily uses a wheelchair to get from Point A to Point B, would that prohibit them from entering an assisted living facility? In most cases, no, but the policy may differ from one facility to another.
We recommend getting in touch with each facility you are considering and asking about their wheelchair policy.
Will Assisted Living Help With Toileting?
Perhaps you’re more worried about your senior taking care of their bathroom needs. If they routinely forget toileting, would a medical professional at an assisted living facility help?
Yes, they would – but that would mean your senior needs a higher level of care. In this case, a nursing home might be a better option.
Is A Nursing Home More Expensive Than Assisted Living?
As you debate between a nursing home or assisted living for your senior, one major deciding factor is going to be cost. Which of these two options would be pricier? Let’s compare the two:
According to Senior Living.org, in 2020, a semi-private nursing home room may cost $245 a day. That’s $7,441 a month and $89,297 a year.
If you wanted a private room for your senior to live at the nursing home, you may be looking at costs of $275 a day, $8,365 a month, and $100,375 a year.
The current trend of nursing home pricing is on an upward trajectory:
- For a semi-private room in 2016, you would have spent $82,128 a year. That same year, private rooms cost $92,376 annually.
- It’s believed that by 2028, the annual price of a semi-private nursing home room could be $120,008 and $134,896 for a private room.
These costs are averages (even for 2020). Depending on where in the United States you call home, you may pay less than the average or even more.
States such as Oklahoma and Texas are the cheapest, with semi-private rooms less than $5,000 a month and private rooms under $7,000 monthly.
There are also many states with semi-private nursing home costs that average around $6,000 to $7,000 a month, with private rooms between $5,500 and $7,500. These include Missouri, Arkansas, Illinois, Utah, Iowa, Alabama, Tennessee, and South Carolina.
The 10 most expensive states for nursing home care, according to Senior Living. org‘s most recent data, are:
- West Virginia
- New Hampshire
- New Jersey
- North Dakota
- New York
In any of these 10 states, semi-private rooms start at $10,200 and go up to $12,600, while private rooms are priced at $11,000 – but may cost as much as $13,700 a year. The only exception is Alaska, in which a semi-private room is $27,573 and a private room $29,291 a year.
Remember that, as we mentioned in the intro, if your senior has Medicaid or Medicare, it’s possible for this insurance to kick in on some or even all the costs of nursing home living.
Speaking of Medicaid coverage, Paying For Senior Care.com says, “Practically speaking, if one is seeking Medicaid assistance, they should not begin by taking their loved one to a doctor to obtain a Nursing Home Level of Care designation. Instead, they should start by contacting their state Medicaid office. The state will likely require that a specific group of doctors, therapists or administrators be used to make the determination, and it is unlikely that one’s primary care doctor is included in this group.”
You can find your state’s Medicaid Program contact information here.
Assisted living facilities are on a private payment model, so it’s a lot harder to get estimates compared to nursing homes. Having done some digging, different data from Senior Living.org estimates that 2020 assisted living prices are between $2,000 and $7,000 per month.
As with the nursing home costs above, the prices of assisted living do vary from state to state across the US. The prices are all over the board, so we randomly selected a handful of states to show you the discrepancies. Included are daily, monthly, and annual costs.
- Wyoming: $131 a day, $3,995 a month, and $47,940 a year
- Texas: $116 a day, $3,515 a month, and $42,180 a year
- Rhode Island: $162 a day, $4,931 a month, and $59,161 a year
- Ohio: $118 a day, $3,600 a month, and $43,200 a year
- New York: $136 a day, $4,136 a month, and $49,635 a year
- Nevada: $100 a day, $3,050 a month, and $36,600 a year
- Minnesota: $105 a day, $3,200 a month, and $38,400 a year
- Louisiana: $104 a day, $3,155 a month, and $37,860 a year
- Hawaii: $136 a day, $4,125 a month, and $49,500 a year
- Illinois: $128 a day, $3,898 a month, and $46,770 a year
- Florida: $100 a day, $3,045 a month, and $36,540 a year
- Washington, DC: $220 a day, $6,700 a month, and $80,400 a year
- California: $132 a day, $4,000 a month, and $48,000 a year
- Alabama: $95 a day, $2,900 a month, and $34,800 a year
By comparing averages only, a private nursing home room at $100,375 for 2020 is costlier than an assisted living community, even at $7,000 a month. That would total $84,000 a year.
How Do I Choose A Nursing Home Or Assisted Living Facility?
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 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 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.
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.
When To Move From Assisted Living To A Nursing Home
If your senior is set up in an assisted living facility now, things may not stay this way 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 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.
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.