Assisted living vs. nursing home: Tips for choosing the right care

When it comes to deciding between assisted living and a nursing home for yourself or a loved one, there are a wide variety of factors to consider. First and foremost, you’ll want to consider the level of care and support that’s offered at both. 

“While assisted living and nursing homes both provide care, they’re designed for different needs,” explains Donzella Burton, a Maryland-based assisted living executive who goes by The Assisted Living Coach. “Assisted living is for seniors who need some help with daily tasks but [who] still want to maintain independence. Nursing homes, on the other hand, are for individuals who need more intensive, 24/7medical care.”

From price points to what you can expect from daily living, here’s everything you need to know when it comes to the difference between nursing homes and assisted living.

What is assisted living vs. nursing home care?

Assisted living communities primarily support folks who currently need or anticipate needing help with daily activities in the future, but are still relatively independent, explains Shelly Sun Berkowitz, founder and executive chairwoman of BrightStar Care. “Nursing homes “ provide comprehensive medical care for those with complex health conditions requiring continuous supervision.”

Here’s a quick overview of each.

Assisted living communities

Assisted living is a long-term residential option for older adults that combines housing with medical, nursing, personal and other supportive services. Residents typically have their own room or suite, with a bathroom and kitchenette, but typically eat their meals communally in a dining room. 

The key focus of assisted living, it’s important to note, is socialization. (More on this shortly.)

Nursing homes

Nursing homes offer on-site, around-the-clock care. Staffed with medical professionals, such as registered nurses and licensed practical nurses, nursing homes follow a medical care model, with nurses working alongside a physician, who serves as the medical director of the home.

While there are opportunities to socialize, the primary focus of nursing homes is providing medical care for older adults who need it. Nursing homes provide a number of resources that assisted living facilities do not, such as physical, speech and occupational therapy, as well as rehabilitation. These are required services in nursing homes, according to Heidi White, a professor of medicine at the Duke University School of Medicine in Durham, North Carolina.

Cost of assisted living communities vs. nursing homes

Assisted living is almost always less expensive than nursing homes, according to Macie Smith, a licensed social worker and gerontologist with Synergy Home Care. The reason being, older adults receive less care and support in assisted living communities than they do in nursing homes. 

According to Genworth and CareScout, the average annual cost of an assisted living community in the U.S. is $70,800, whereas a semi-private room in a nursing home is $111,325 (a private room is $127,750).

That being said, their payment models differ.

“Assisted living is mostly paid out-of-pocket, though some long-term care insurance policies may help,” Smith says. “Nursing homes are more expensive, but Medicaid may cover long-term stays if eligibility is met. Medicare may cover short-term stays for rehabilitation, but not long-term care.”

To learn more about coverage and payment options, check out:

7 practical ways to pay for long-term care

Assisted living facility vs. nursing home: living arrangement differences

When it comes to the space you or your older loved one will call home, the key difference is thatursing homes have a more medical feel than assisted living, explains Smith.

“Assisted living offers private or semi-private apartments in a home-like setting to promote a feeling of independent living,” she says. “In most cases, those in assisted living can also utilize outside, additional services from home care providers when needed. This can include companion care and personal care when warranted.” 

Nursing homes are usually in a more clinical setting, Smith adds, often with shared rooms and communal areas.

In assisted living communities, residents may have private or semi-private bedrooms and/or apartments with their own bathrooms and a kitchenette. In a nursing home, residents often have a shared room with a hospital-like setup.

Burton notes that while nursing home rooms may offer some personal touches, “they’re often more functional than private.”

How do services compare?

There’s some overlap in terms of the services offered at each, but generally, assisted living puts an emphasis on independence and socialization, whereas nursing homes focus on medical care. 

Basic services offered at an assisted living facility generally include:

• Assistance with daily life activities, including bathing, dressing, taking medication.
• Daily meals.
• Housekeeping and laundry.
• Exercise programs.
• Recreational activities.
• Social services.
• Medical, health, therapeutic services (physical, speech and occupational).
• Transportation arrangements.
• Security.

Some basic services provided by a nursing home may include:

• Room and board.
• Meals, including nutrition care.
• Medical and diagnostic services.
• 24-hour skilled nursing care.
• Access to a pharmacy.
• Medication disbursement and monitoring.
• Assistance with dressing, bathing, going to the bathroom, eating.
• 24-hour emergency medical care.
• Social activities.
• Social services, including counseling.
• Therapies, including physical, speech, occupational.

Assisted living vs. nursing home services

Each community is different, but here’s an overview of what you can expect at each:

	Nursing home	Assisted living
Services offered	Bathing, feeding, laundry, getting dressed, using the bathroom, transportation, turning in bed, etc.	Preparing meals, recreational activities, transportation, help with medication, etc.
Level of care	24-hour nursing care; short-term care and long-term care.	Does not offer around-the-clock care.
Rules and regulations	Regulated by the Federal government; laws do not vary by state. Certified to provide services to people with Medicare and Medicaid.	Governed by individual states; laws vary by location.
Living arrangements	Shared and private rooms; small and large homes; total of 1.7 million beds nationwide.	Shared and private rooms; small and large assisted living facilities; some may have as few as five beds or as many as several hundred beds.

Regulations and staffing

Nursing homes are heavily regulated at both federal and state levels with regular inspections and strict requirements, explains Berkowitz. “They must maintain specific staff-to-resident ratios and have registered nurses on-site at all times,” she continues. “Certified nursing assistants provide most direct care under nursing supervision and facilities must have medical directors and regular physician oversight.”

On the other hand, assisted living regulations vary by state, with “less stringent oversight than nursing homes,” notes Berkowitz. 

In general, staffing requirements are lower at assisted living, with fewer licensed medical professionals required. 

“Most direct care is provided by resident assistants or caregivers with basic training,” says Berkowitz. “A facility might have only one nurse overseeing several residents, with limited physician presence.”

Admission criteria

Per Burton, Berkowitz and Smith, the following criteria must be met in order to be admitted to either an assisted living community or nursing home. 

Assisted living typically accepts residents who: 

• Need assistance with several activities of daily living. 
• Can transfer with minimal assistance (moving from bed to chair, etc.) 
• Have stable medical conditions that don’t require daily nursing.
• Can communicate their needs (or have family support).
• Don’t present serious safety risks to themselves or others.
• Can afford the costs (as many don’t accept Medicaid).

Nursing homes admit residents who: 

• Require 24/7 skilled nursing care. 
• Have complex medical needs requiring regular monitoring. 
• Need extensive assistance with mobility or are bedridden. 
• Have advanced dementia or severe cognitive impairments. 
• Require rehabilitation after hospitalization. 
• Need specialized care like wound treatment or IV therapy.

Smith adds that admission to a nursing home often requires a doctor’s referral, along with an assessment to determine the level of care needed.

How to decide between assisted living and a nursing home

To determine whether a nursing home or assisted living is the right choice, you’ll want consider your own or your loved one’s medical needs and level of independence, Smith says, adding that this can help you pinpoint exactly how much support is required.

If you or your loved one can still manage most daily activities, like bathing or taking medication, with some help,assisted living might be a better fit, says Burton. But Iif constant medical attention is required, a nursing home would be more appropriate.”

In addition to taking stock of the situation on your own, here are a few other steps to consider taking:

Consult with medical professionals. Talk with your or your loved one’s physician, nurse practitioner or physician’s assistant about care needs so you know what to look for.

Visit the space. By doing this, Smith notes, you’ll get a better understanding of what goes on and how daily life unfolds. 

Have a meal in the dining hall. White recommends this as a good way to meet others living at the facility, as well as their family members. This will help you get an overall feel.

Find your local Area Agency on Aging. These are important clearinghouses for patients and families. The purpose of this public or private nonprofit agency is to help you find an appropriate nursing home or assisted living facility for your loved one at a regional and local level.

Research. If you’re leaning toward exploring nursing homes, Medicare offers a searchable website called Nursing Home Compare, where you can find and analyze nursing homes in your area. (This tool is not available for assisted living facilities, as they are maintained by individual states.)

Work with an assisted living community or nursing home on an assessment. Know that ahead of making a move, an assisted living facility will conduct an assessment to ensure you are making an appropriate choice, and a nursing home will want detailed medical information to determine if an admission is appropriate.

In addition to care needs, Berkowitz notes that it’s also important to consider personal preferences, financial resources and potential future needs. “I always remind families that this decision isn’t necessarily permanent — needs change and transfers between levels of care aren’t uncommon.”

Families also ask

When is it time for assisted living? Struggling to stay on top of household chores and personal hygiene are among a few reasons to start considering assisted living. 

When is it time for a nursing home? A number of factors, including fall risk and cognitive impairments, may mean it’s time for a nursing home. 

How to choose the right nursing home? In addition to geographic location preference, consider word of mouth, along with accreditations and more. 

Additional reporting by Rachel Murphy