What’s the Difference Between Assisted Living and Nursing Homes?
Senior living communities today are not the same ones from decades ago. Today, there are multiple senior living solutions for families to choose from, with each one specializing in a certain type of care and support. The most common types of senior living communities are assisted living and nursing homes. These two types of communities are not the same; each brings its own regulations, care, and amenities. Knowing the difference between these two options can help you make a more confident decision for your loved one’s next steps.
Assisted living communities offer supportive daily help while nursing homes provide more acute medical care. This guide will compare services, residents served, costs, assessments, and signs that can help you determine which option is the best fit.
What Is Assisted Living?
Assisted living communities are a residential care option for older adults who can benefit from around-the-clock caregiver support and oversight. Caregivers provide peace of mind in addition to personalized assistance with activities of daily living (ADLs) such as bathing, grooming, dressing, and transferring.
Residents in assisted living settings typically need at least some level of support, whether it is verbal cueing, supply set up, or hands on assistance, with at least one activity of daily living. They are mostly independent but benefit from having additional caregiver oversight and access to amenities like housekeeping, laundry, and dining services.
Most assisted living communities feature apartments (studio, one and two-bedroom options) or semi-private suites. Residents enjoy dining services, activity programming, and shared common spaces like a library, game room, and outdoor patio.
What Is a Nursing Home?
The term nursing home is outdated. Skilled nursing facilities (SNFs) or skilled nursing communities are the term that is most used today to describe this acute care setting. Around-the-clock nurses and caregivers provide skilled care to residents who require more medical interventions. While not a hospital, a skilled nursing facility offers hands-on assistance and medical oversight with skilled care interventions such as wound care management, feeding tube oversight, and pain management.
Residents in a skilled nursing facility can be there short-term for rehabilitation and care after a hospital stay, surgery or procedure, or long-term for acute medical care due to chronic conditions or other serious health needs. Residents have access to nurses and caregivers, as well as onsite physical, occupational, and speech therapy services as prescribed by their physician.
Most SNFs offer private or semi-private rooms, some with private bathrooms. Residents still have access to amenities and resources including housekeeping, laundry, and dining services.
Assisted Living vs. Nursing Home: The Biggest Differences
Level of Medical Care
Assisted living communities are not designed to provide acute medical care. Instead, nurses write care plans that tell caregivers how to support and help each resident with activities of daily living. Medication management can be provided at an additional cost and some communities might have visiting hours for local physicians, specialists, and therapists.
Nursing homes, or skilled nursing facilities, provide around-the-clock medical care and monitoring, including advanced services such as wound care, pain management, and intense inpatient therapy services.
Level of Daily Assistance
Assisted living caregivers are there to provide assistance with activities of daily living. However, most communities do not accept residents who need full support with more than 4-5 ADLs. Instead, assisted living residents are mostly independent who need just a little extra verbal or physical support with 1 or more ADLs.
Nursing home caregivers and nurses can provide more intensive support with ADLs. It is common for skilled nursing residents to require extensive hands-on assistance with multiple ADLs throughout their routine.
Living Environment
Assisted living communities feel more like an apartment or condo building and less like a hospital. Apartments and shared community spaces are cozy and focused on building relationships between residents.
Nursing homes are not hospitals, and their design has come a long way in the past few decades, but can feel more clinical than an apartment building. The environment may feel more loud, busy, or overstimulating simply because of the type of care that is offered there.
Resident Lifestyle
Assisted living communities are designed to enhance independence as well as to create meaningful connections between neighbors. You’ll find lots of shared community spaces for residents to gather, as well as a curated activity calendar based on resident interests.
Nursing homes focus heavily on safety and health, offering residents and family members peace of mind during physical and cognitive decline. While there are certainly activities to enjoy and neighbors to meet, the main focus of a SNF is health and safety.
Typical Cost Difference
Assisted living communities typically bill a monthly fee that is nearly all-inclusive. Additional charges might be added for extra caregiver support or activities. In most cases, assisted living pricing is less expensive than skilled nursing. However, the majority of assisted living communities are private pay and do not accept Medicare or Medicaid.
Nursing homes tend to bill at a daily rate and the monthly bill can far exceed an assisted living bill. However, SNF services can be covered by Medicare, Medicaid, and other third-party payors.
Services Commonly Offered in Assisted Living
Assisted living communities highlight a maintenance-free lifestyle with access to services and amenities that are designed to enhance independence, socialization, and wellness. While each assisted living community is unique and offers services based on resident preference, it is common to find these types of services in an assisted living community:
- Caregiver assistance with bathing, dressing, grooming, toileting, and medication management (sometimes at an additional cost)
- Dining services which includes 3 meals served in a social restaurant setting
- Regular housekeeping visits and laundry services
- Social events, outings, fitness classes, and wellness programming
- Possible add-on care such as memory care, therapy, or limited nursing support depending on the community
Services Commonly Offered in Nursing Homes
Skilled nursing facilities also offer a maintenance-free lifestyle and access to services that support safety, health, and overall wellness. Again, each community is different, but common services can include:
- 24/7 skilled nursing and medical supervision via nurses and caregivers
- Rehabilitation services such as physical, occupational, and speech therapy
- Wound care, injections, specialized diets, and complex medication administration
- Full support for meals, feeding, transfers, continence, and mobility needs
Who Is a Good Fit for Assisted Living?
It can be difficult to determine if assisted living is the best fit for you or your senior loved one. However, there are some qualities that might point to assisted living being your next best step:
- Your loved one is generally independent with most ADLs, but might need a little support with a few
- Your loved one has expressed feeling overwhelmed with housekeeping tasks and home maintenance
- Your loved one has expressed they feel lonely or isolated at home
- You or your loved one feel anxious about what will happen if there is a fall or medical emergency while they are home alone
- Your loved one wants to downsize their home, meet new friends, and stop worrying about making meals daily and tidying up the house
Who Is a Good Fit for a Nursing Home?
If your loved one meets any of these points, they could be a good candidate for short or long term support in a skilled nursing facility:
- Your loved one has a chronic condition that affects their physical mobility
- Your loved one lives with chronic, unmanaged pain
- Your loved one requires skilled care interventions such as wound management, pain management, IV medications, or feeding tube care
- Your loved one has been in the hospital after an illness, injury, stroke, or surgery and needs a supportive environment to heal and recover
- Your loved one is not safe at home due to their medical condition or future prognosis
Assisted Living vs. Nursing Home Assessments
When you begin to look at assisted living and skilled nursing communities, the professionals there will need to assess your loved one in order to determine they are the right candidate for that type of care. Assisted living communities typically focus on assessing ADLs, mobility, and other supportive care needs. Skilled nursing facilities will assess those as well as taking a comprehensive medical history and medication/treatment review.
Admission Requirements: How They Differ
In general, assisted living communities require that residents need assistance with fewer than 4-5 ADLs. Full assistance with any ADL can be a disqualifier depending on the ADL, resident, and community.
A nursing home is more equipped to handle residents with higher care needs. They can and will accept residents who require moderate to full assistance with ADLs.
A physician can recommend a senior living solution, but it is still imperative that the community assess and accept the resident prior to making the move.
How Costs Compare
Assisted living communities charge a monthly fee that is nearly all-inclusive. Additional costs can include expenses for additional care or support, activities, or other supplies. Therapy services offered at the community are considered outpatient services and will be billed separately through the therapy provider.
Nursing home pricing is typically billed daily for short-term residents and monthly for long-term residents. The costs are nearly all-inclusive with additional expenses for private rooms, certain activities and supplies. Skilled care services at nursing homes can be covered under Medicare, Medicaid, and other third-party payors like private insurance.
When understanding the true cost of each option, be sure to compare all fees and add-ons, not just base pay. In addition, ask community staff how you can offset the pricing through insurance, VA benefits, or other solutions.
Medicare, Medicaid, and Insurance Considerations
Assisted living is not covered by Medicare. While some assisted living communities accept Medicaid, the majority do not. Those communities that do often have long waitlists, so if that is your plan, ensure you are looking for communities sooner rather than later.
Skilled nursing facilities do accept Medicare for those meeting Medicare qualifications (a 3 day qualifying hospital stay and are working toward meeting set care plan goals). However, Medicare only pays up to 100 days per year. Skilled nursing facilities also accept Medicaid but often have a limited number of Medicaid beds, which results in a long waitlist.
Private long-term care insurance might pay for assisted living or skilled nursing, depending on your policy.
Signs It May Be Time to Move From Assisted Living to a Nursing Home
For some seniors, assisted living is not a permanent solution. Increased care needs and significant medical changes can mean a move to a nursing home is the safest option. Your assisted living care team will work with you to move your senior loved one into a skilled nursing option so that the transition is as smooth as possible.
Possible reasons why a move to skilled nursing might be warranted can include:
- Worsening medical needs or increased hospital visits
- More difficulty with multiple ADLs
- Frequent falls, safety concerns, or need for hands-on transfers
- Increased cognitive decline or behavior changes that require closer supervision
- Need for skilled nursing, rehab, wound care, or specialized medical treatment
Questions Families Should Ask When Comparing Both Options
In general, a move to a nursing home is needed when your senior loved one requires extensive medical care and oversight. However, if you are still not sure which would be best for your situation, begin by speaking with your loved one’s physician for their recommendation. They can give you an idea of what to look for now, as well as what you can anticipate in the future.
When touring communities, you can ask questions to help clarify your options such as:
- What level of medical care is available on-site?
- How much help is provided with ADLs?
- What services are included in the base price, and what costs extra?
- Can the community handle changing needs over time?
Common Misconceptions About Assisted Living and Nursing Homes
- Myth: Nursing homes and assisted living are basically the same.
Fact: These are two distinct senior living options that offer different types of care and support.
- Myth: Assisted living is only for very healthy seniors.
Fact: Assisted living communities support independence and quality of life, but many residents there do need some type of assistance with activities of daily living due to challenges that come with aging or chronic conditions.
- Myth: Nursing homes are only for end-of-life care.
Fact: Nursing homes provide acute clinical care that helps residents be as safe and as healthy as possible for as long as possible. Many skilled nursing residents live many years while receiving excellent care.
- Myth: Moving to a higher level of care always means losing independence.
Fact: All senior living communities focus on giving residents as much independence and autonomy as possible.
How to Decide Which Option Is Right
As you begin to determine if assisted living or skilled nursing is best for your loved one, begin by speaking with their physician. Take an inventory of their current care needs while being as realistic as possible for their needs now and what they might be in the future. Once you determine your level of care, you can begin to narrow down your choices to research more.
Assisted Living vs. Nursing Home FAQs
What is the main difference between assisted living and a nursing home?
The main difference between these two senior living solutions is the type of care offered. Nursing homes offer more clinical nursing care while assisted living focuses on support with activities of daily living. A senior with more nursing needs would likely benefit from a skilled nursing community.
Is assisted living cheaper than a nursing home?
In general, yes, assisted living is less expensive than a nursing home. However, nursing home care can be offset by Medicare, Medicaid, and private insurance while most assisted living communities do not accept Medicare or Medicaid.
Can someone move from assisted living to a nursing home later?
Yes, as someone’s needs progress, they can move to a higher level of care in order to remain healthy and safe.
Does Medicare pay for assisted living or nursing homes?
Medicare does not pay for assisted living. It can pay for short-term stays at a skilled nursing facility as long as the resident meets qualifying conditions.
Who qualifies for a nursing home?
Seniors who require more acute nursing care and oversight would succeed in a nursing home environment.
Is assisted living or a nursing home better for dementia?
Assisted living communities can have separate memory care units for residents who are living with dementia but do not require full support with more than 4 activities of daily living. Skilled nursing facilities can have a separate memory care unit, but they do not always, and can support memory care needs for residents who require acute care and oversight.
Learn more about assisted living by visiting a Legend Senior Living residence near you. We’re happy to answer any questions you might have and review your loved one’s needs to determine if they would be a good fit.
