When Is It Time to Move From Assisted Living to Nursing Home Care?

Every stage of life comes with its own set of challenges, and late adulthood is no exception. As you age, you must come to terms with the fact that your body is changing. For example, you may move a little slower or have more aches and pains than usual. Your mental processing speed also declines, so it takes a bit longer to make important decisions.

Some changes increase the risk of loneliness and social isolation. You may have trouble hearing other people talk, walking on uneven surfaces or seeing your surroundings. These challenges make it more difficult to socialize and maintain strong connections with friends, family members and neighbors.

At some point, you may decide to sell your home and move to an assisted living community. Although these communities provide plenty of support for seniors, they don’t provide around-the-clock medical care. Therefore, you may have to make the difficult decision to transition from assisted living to a skilled nursing facility, also known as a nursing home.

To help you navigate this decision, we created this guide explaining the main differences between assisted living and skilled nursing. It also includes a list of seven signs that it may be time to consider moving from assisted living to a nursing home that you can use to guide your decision. 

Assisted living is a type of housing for seniors who need assistance with activities of daily living (ADLs). Feeding yourself, walking independently, getting dressed and maintaining control of your bladder and bowels are some of the most basic ADLs. As you get older, you may develop arthritis, chronic back pain, osteoporosis or another health problem that makes it a little more difficult to perform these activities.

Assisted living helps by giving you access to trained staff members who can help you overcome your limitations. Every assisted living community also provides meals, recreational activities and other services to help you stay healthy and socially connected. These communities are for seniors who need a little help but don’t require 24/7 medical care.

Nursing homes provide around-the-clock medical care, making them well-suited to older adults with complex medical needs. For example, a skilled nursing facility may offer swallowing therapy to someone who has trouble eating and drinking. Nursing homes also have licensed staff members available to administer injections, provide wound care and manage chronic diseases. This setting is usually reserved for people with serious medical problems or cognitive impairments.

Assisted living communities offer the following services and amenities to help residents preserve their health and independence:

• Medication reminders: As you get older, it becomes a little more difficult to remember your daily medications. If you move to assisted living, staff members may remind you when it’s time to take your pills or self-administer injections.
• Assistance with ADLs: Assisted living communities have trained staff members available to help you with basic ADLs. For example, if you have an arthritis flare that makes moving around difficult, a caregiver can help you walk to the dining room for lunch.
• Recreational activities: Every assisted living community offers recreational activities to keep residents engaged and make it easier to build relationships with each other. Popular activities include movie nights, field trips to local museums and educational events.
• Monitoring: Staff members keep an eye out for changes in your physical and mental health, which may help you avoid serious complications.
• Medication assistance: Assisted living communities have staff members available to help you self-administer your medications. For example, if you have trouble opening blister packs, a caregiver may be able to open them for you, ensuring that you don’t miss any doses.
• Transportation: Many communities provide transportation to local parks, museums and other attractions. It’s also common for assisted living communities to transport their residents to medical appointments.

Nursing homes offer a nursing facility level of care, which is a combination of services designed for people who can’t care for themselves independently without putting their health or safety at risk. These are some of the most common services and amenities available in these facilities:

• Physical therapy: You may need physical therapy if you have weak muscles, chronic pain or difficulty moving around. Nursing homes provide this type of therapy to relieve pain and help residents improve mobility.
• Occupational therapy: Occupational therapy helps older adults regain some independence. It’s also useful for managing chronic health conditions, especially when those conditions interfere with your ability to perform basic ADLs.
• Personal care: Staff members provide hands-on personal care to residents who aren’t able to perform certain ADLs on their own. For example, an aide may comb your hair or shave your beard.
• Medication administration: Nursing homes have nurses and other staff members available to give injections, administer intravenous medications and dispense oral medications.
• Speech therapy: Dementia, stroke and other medical conditions may interfere with your ability to speak clearly or swallow safely. Speech therapy addresses the symptoms, protecting you from serious complications.
• Specialized nutrition services: Although assisted living communities can accommodate a wide range of nutritional needs, they’re not ideal for seniors who need tube feedings or liquid diets. Nursing homes offer custom nutritional plans for each resident.

Assisted living communities and nursing homes provide different services and amenities and are suited for different needs. Assisted living is for seniors who can perform most tasks independently, while nursing homes are for older adults who require a nursing facility level of care.

Although nursing homes offer social and recreational activities, each activity is designed for participants who have trouble performing ADLs on their own and require 24/7 supervision to keep them safe. For example, an assisted living community may arrange to take residents on a bus tour of a national park. This type of activity isn’t suitable for seniors with serious medical or mental health conditions.

The table below provides an overview of the major differences between assisted living communities and nursing homes.

Now that you understand the differences between an assisted living community and a nursing home, it’s natural to wonder how you’ll know when it’s the right time to make the transition.

Everyone’s situation is a little different, but there are some signs indicating that you may need a nursing facility level of care. If you experience any of the following, seek professional advice from a doctor and ask your loved ones to help you look for a nursing home that fits your needs.

Arthritis, heart disease and other medical conditions don’t prevent you from moving to assisted living. As your medical needs become more complex, however, you may need more care than an assisted living community can provide. For example, if your arthritis is so severe that you can’t walk more than a few steps, you may benefit from the physical therapy available in a nursing home.

As you get older, you lose muscle mass. It’s also common for older adults to develop low blood pressure, gait abnormalities and other problems that make it more difficult to maintain balance. Frequent falls may be a sign that it’s time to move to a nursing home, as every fall puts you at risk of fractures and other serious injuries.

Assisted living staff can remind you to take your medications or provide assistance with medication self-administration. However, they can’t give you injections or run medications through an IV. If you need a complex medication regimen to maintain your health, a nursing home may be a better fit for your needs.

Assisted living communities offer a wide range of activities, some of which require balance and coordination. For example, your community may offer exercise classes or field trips to local attractions. If your health has declined to the point that you can’t participate in these activities, consider moving to a nursing home.

Some assisted living communities have memory care units, designed for residents with dementia and other forms of cognitive decline. If your community isn’t one of them, you may need to move to a nursing home. It may also be time to move to a nursing home if you have memory loss combined with a serious medical diagnosis.

If you’re in and out of the hospital, you may need around-the-clock medical care to prevent your symptoms from worsening. Assisted living communities don’t provide this type of care, so it may be time to move to a nursing home.

Your assisted living community should be able to accommodate some dietary restrictions, such as the need for less sodium or saturated fat. However, assisted living isn’t for residents who have significant dietary restrictions. Consider moving to a nursing home if you need meals customized according to your nutritional needs.