Assisted Living vs. Nursing Homes

As seniors age, they often start to need assistance with daily tasks that they used to find easy, and their need for various medical interventions may also accelerate. Sometimes, their needs exceed what can safely be handled independently at home, leading seniors and their families to seek residential care options.

Many seniors find a home in either an assisted living facility (ALF) or a nursing home (Skilled Nursing Facilities/SNFs). These types of communities can help seniors stay safe by ensuring that assistance is available around-the-clock. Currently, over 811,000 seniors are residing in almost 30,000 different assisted living communities across the United States. There are over 15,000 nursing homes in the U.S., giving seniors and their families tens of thousands of senior living options from which to choose.

With so many different communities, it can be hard to find the right home for yourself or a loved one. Complicating matters further is the fact that many people confuse the different types of residential care. Though many people refer to ALFs and nursing homes interchangeably, they serve very different care needs and offer dramatically different lifestyles, despite some overlap of their services. Below you can learn about who can benefit from each type of care and how to know which one is best for yourself or your loved one.

Assisted living communities offer a wide range of services and amenities. Most services and amenities offered aim to help residents maintain their health, hygiene, and safety, and minimize their need to drive or do household chores.

In ALFs, available services often include:

• Ambulation: Limited help with mobility, including help getting around the facility safely and help transferring (such as help going from chair to bed). Seniors in assisted living cannot be bedridden/fully immobile.
• Meals and More: Full meal services, including nutritious prepared meals in a group dining hall and hands-on help with eating, for those who need it. Many communities offer specialty meals for those with dietary restrictions.
• Maintenance Services: Full housekeeping services, including laundry help, room cleaning, maintenance, organizational help, and more. Residents are never responsible for any landscaping work or external maintenance.
• Hygiene and Grooming Help: Help with a range of hygiene and grooming needs, including assistance with using the toilet/with incontinence, assistance with showering/bathing, dressing, oral care, hair, skin, and nail care, and more.
• Scheduling, Transportation, Technology: Help with a variety of skills such as scheduling and accessing transportation, using computers and tablets, making phone calls, re-ordering prescriptions, and other miscellaneous tasks. The exact limits of help with such tasks will vary by location. Help with the process of paying bills may even be offered in some cases.
• Exercise, Activity, and Entertainment: A wide variety of services aimed at improving socialization, physical fitness, and overall quality of life, including gardening, group classes, fun competitions, religious services, parties, and support getting access to books, hobby materials, and entertainment.
• Limited Health Monitoring: Limited help managing health needs, such as assistance arranging medical appointments, keeping up with one’s medication schedule, and monitoring things like weight, blood pressure, and changes in physical and mental abilities. Since staffers are reachable around the clock, they can also assist a senior or call for first responders if a fall or other health emergency occurs.

In ALFs, on-site amenities often include:

• Suites: Apartments for each senior or couple, usually including a kitchenette for resident convenience.
• Beauty Services: Beauty parlors and barbershops for hair care, nail care, or cosmetic and spa services
• Activity Areas: Gyms, fitness studio rooms, pools, hot tubs, walking paths, or garden areas designed to aid seniors in staying physically active
• Faith Amenities: Chapels or other areas for religious services that may accommodate different faiths at different times.
• Indoor Communal Spaces: Dining rooms, libraries, lounges for TV and games, cafes/bistros, and other common areas to facilitate relaxation, comfortable group dining, and socialization. Comfortable furniture and pleasant decor are typically used throughout all rooms.
• Parking: Designated parking spaces provided for residents who keep their cars.
• Safety Features: Physical safety features such as railings and fire alarms and security items such as video cameras, security keypads, alarms, and/or periodic parking lot patrols.

When it’s truly suited to a senior’s needs, assisted living can reduce the risks of injuries and help prevent premature mental and physical impairments. However, it’s not the right choice for everyone.

In broad terms, seniors who are a good fit for an ALF need care that is:

• Intermittent: Residents need help with tasks like ADLs throughout the day, but they don’t need it at every moment. Constant supervision or assistance is not required, so services are rendered intermittently by staffers in a way that’s tailored to the individual.
• Co-operative: Residents have a reasonably stable cognitive function and physical health, and they can follow directions, make choices, and take a fairly active role in their own lives even as they receive assistance. They are neither bed-bound nor are they suffering from advanced dementia.
• Non-medical: Residents are likely to have some medical conditions, but they are able to or would be able to manage well with medication, smart lifestyle choices, personal care help, and periodic doctor visits. They do not require daily, 24/7, or otherwise frequent medical attention in their place of residence, nor do they need to use complex medical machinery that they cannot operate themselves.

Seniors needing care that doesn’t fit the descriptions above are unlikely to be accepted into an assisted living facility and/or to have their needs met there. If you need less care, then an independent living facility or occasional in-home care may be better. If you need more care, you may need to look into a nursing home instead. However, if intermittent, co-operative, non-medical care sounds like a good fit for you, an ALF may be perfect. Below you can learn more about some common traits of seniors in ALFs. If the below statements apply to you or your loved one, assisted living will likely meet your needs.

• You like to do as much as possible for yourself yet struggle to safely, thoroughly, or consistently perform some ADLs (dressing, bathing, grooming, toileting/managing incontinence, eating, etc.).
• You struggle to keep up with or safely complete yard work, home maintenance, errands, and/or household chores (including healthy meal preparation).
• You may or may not still own a car and drive, but you want or need to have the option of transportation provided by others.
• You may need help with medication management, scheduling appointments and transportation, and other relatively complex tasks.
• You may struggle with loneliness and isolation, and you desire to live in an interesting, active, social environment.
• You are not having your needs fully met at home or in an independent living community.

Not all seniors living in ALFs will check yes to all of the above items, but they will typically need help in multiple areas. Admission policies will vary by facility, so you’ll want to ask for detailed information on services and admission standards. Additionally, keep in mind that some assisted living communities offer “respite care,” that is, the option for short-term stays (perhaps a week) so that a senior’s caregivers can go on vacations or just take a break from their unpaid work during a stressful time.

Nursing Home services are overwhelmingly focused on the medical needs of seniors and those who are disabled, but they also offer ADL services that are essential for wellness.

Services frequently found in SNFs include:

• Medical Care: Wound care, infection control, other medical services provided by nursing staff, including help with the use and maintenance of specialized medical equipment such as catheters, ostomy bags, feeding tubes, and more.
• Medication Management and Administration: General pharmacy services, comprehensive medication management, and administration of specialty drugs such as those delivered through IV.
• ADL Assistance: Help with eating, dressing, bathing, moving/transferring, and mostly non-cosmetic grooming.
• Rehabilitation: Physical therapy, occupational therapy, speech therapy, psychiatric treatment, and a wide variety of other specialized rehabilitative services
• Social Services: Access to/cooperation with social workers as needed.
• Transportation: Help with/arrangement of transportation to hospitals, doctors, dentists, and other appointments for vital health services not rendered on-site.
• Select Activities: Some social activities and celebrations, though typically not frequent.

Nursing homes can be very nice, but they are typically not built with amenities that compare to those in assisted living. Because the focus in these communities is on medical care, there usually aren’t things like pools, fancy restaurant-style dining, or other amenities and services that could be considered luxuries.

A nursing home is an excellent fit for someone whose complex or constant medical needs disqualify them from living in an assisted living setting. Their needs go beyond assistance with personal care, transportation, and similar services and require regular hemp from trained medical professionals.

If you answer “yes” to any of the following questions, you’re likely a good candidate for nursing home care:

• Are you going to have surgery that will require an intense recovery period?
• Are you temporarily or permanently dealing with a severe mobility reduction and/or are you bedbound?
• Have you had multiple falls at home?
• Do you require the constant or frequent use of a medical device that you cannot operate at home/independently?
• Do you need a specific, frequent therapy that you cannot access in your current living situation?
• Do you require frequent hospitalization?
• Do you need help with wound care and infections?

It may help you see the care options in nursing homes and assisted living side by side. As the table below illustrates, some services are offered in both settings, but overall the needs accommodated are very different. Note that an asterisk (*) indicates that this feature may vary significantly depending on the specific community.

Nursing home care costs significantly more than assisted living. Medical staffing and facilities simply cost far more than personal care, so even when nursing homes cut “luxury” amenities, they still need to charge more for their services. In the United States, assisted living costs an average of $4,300 per month, while a shared room in a nursing home costs an average of $7,756 per month. Below, you can see how these costs add up over one year.

Annual Assisted Living vs. Nursing Home Costs:

As you can see above, living in a nursing home can easily cost twice as much as living in an assisted living community, even if you opt for a semi-private room. However, seniors should keep in mind that they’re more likely to get insurance coverage or government assistance for nursing home care. This is particularly true if the nursing home stay will be temporary. Below, you can see how different types of insurance cover assisted living and nursing homes.

Choosing to leave your home or your independent senior community for a higher level of residential care is always a difficult decision, but it can improve your life dramatically. As you try to decide between a nursing home and an assisted living community, ask yourself: do I only need personal care assistance, or do I need personal care help plus medical care?

If you’re having difficulty determining the best type of care for you, make a list of your current care needs or things you’re having trouble with at home. Does your list clearly show whether or not you need more than just housekeeping, ADL assistance, and social programs? You may wish to ask family, friends, or in-home caregivers to add anything to the list that you missed. Compare your current needs and abilities to what you know about assisted living communities and nursing homes’ services and amenities.

If figuring out which level of care suits you seems complicated, you’re not alone. You can call a Caring Family Advisor at (800) 973-1540 for personal guidance, free of charge. Your Family Advisor can help you determine which type of care is right for you or your loved one and connect you with the local communities that best meet your care needs and budget. While finding a new place to call home can be a challenge, a Family Advisor can guide you through the process and make it as stress-free as possible.

• “Facts & Figures” AHCA & NCAL, 2020, https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx. Accessed 24 Mar 2021.
• No title. CMS, https://www.cms.gov/research-statistics-data-and-systems/research/mcbs/downloads/2008_appendix_b.pdf. Accessed 24 Mar 2021.
• Stramowski, Alana. “Assisted Living Receives High Marks for Residents’ Quality of Life.” Senior Housing News, 29 Aug 2016, https://seniorhousingnews.com/2016/08/29/assisted-living-receives-high-marks-residents-quality-life/. Accessed 24 Mar 2021.
• “2020 Cost of Care Survey.” Genworth Financial, 12 February 2021. https://www.genworth.com/aging-and-you/finances/cost-of-care.html. Accessed 24 Mar 2021.
• “What Long-term Care Insurance Covers.” LongTermCare.gov, 18 Feb 2020, https://acl.gov/ltc/costs-and-who-pays/what-is-long-term-care-insurance/what-long-term-care-insurance-covers. Accessed 24 Mar 2021.
• “Skilled nursing facility (SNF) care.” Medicare, https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care. Accessed 24 Mar 2021.
• “Nursing Facilities.” Medicaid, https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/nursing-facilities/index.html. Accessed 24 Mar 2021.
• “Home & Community-Based Services 1915(c).” Medicaid, https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html. Accessed 24 Mar 2021.