It can be a difficult and emotional choice to start looking for care outside the home for an aging loved one. As the primary decision-maker, there are two main factors to take into consideration: the level of care needed and what it will cost. Whether your aging relative needs a lot of help with basic daily tasks or simply needs a constructive, active environment, nursing homes and assisted living can both be successful living and care arrangements. And knowing the differences between assisted living vs. nursing home can help you decide what’s best for your family.
Nursing homes are regulated by the federal government and offer 24/7 care. Assisted living facilities are designed for individuals who do not require 24-hour care, and the facilities are controlled by individual states. “A lot of it hinges on the payment, because a lot of people can’t afford to pay privately for care,” says Charlene Harrington, Professor Emeritus at the Department of Social and Behavioral Sciences at the University of California San Francisco’s School of Nursing.
According to Harrington, some nursing homes may offer something called short-term, post-acute care, where the first 21 days are paid for by Medicare. Long-term stays at nursing homes — or beyond the first 21 days — are not subsidized by Medicare and are paid for privately, by the individual. Assisted living facilities also require that residents pay out of pocket for services.
Assisted living vs. nursing home: breaking it down
Choosing the right type of care for your loved one ensures that their needs are met without going over budget. Here’s a breakdown of assisted living vs. and nursing home.
|
Nursing Home |
Assisted Living | |
|
Cost | Typically costs more due to the constant care; average national cost is $7,908 per month for a semi-private room, and $9,034 for a private room.* | Generally costs less because less care and support is required; $4,500 is the average monthly cost nationwide for one bedroom.* |
|
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. |
*Source: Genworth Cost of Care 2021
Nursing homes: more hands-on care
Nursing homes offer around-the-clock care to roughly 1.3 million residents in the U.S., according to the latest data from the Centers for Disease Control and Prevention (CDC). These facilities are staffed by professional nurses, like registered nurses and licensed practical nurses, and they follow a medical care model. The nurses work alongside a physician, who serves as the medical director of the nursing home. A nursing home is also staffed by an administrator and director of nursing. These staff members oversee and provide consultative input regarding the care that is provided in that facility.
Resources provided on site
Nursing homes provide on-site resources that assisted living facilities do not. This includes 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.
“Comparatively, assisted living facilities do not generally have that level of sophistication of professional services, especially from nurses and physicians,” says White. “That’s not to say they might have a registered nurse on staff, but it’s possible they don’t.”
“Comparatively, assisted living facilities do not generally have that level of sophistication of professional services, especially from nurses and physicians.”
HEIDI WHITE, PROFESSOR OF MEDICINE, DUKE UNIVERSITY
Nursing homes and rehabilitation
Older adults may seek the care of a nursing home upon leaving the hospital, when they’re in need of rehabilitation. Rehabilitation covered under Medicare benefits is not provided in assisted living facilities, according to White.
“You can only get that kind of care in skilled nursing facilities, and only for a limited period of time in which you are receiving services and making overall improvements in your functioning and your capabilities,” White says. “Some care in nursing homes is covered by limited periods of time by Medicare benefits, but many people who go to nursing homes for rehabilitation may not rehabilitate to a place where they can function in a stable manor within their previous living situation. Therefore, they may need long-term care in a nursing home.”
Nursing homes and long-term care
Long-term care in a nursing home provides a higher level of care, also known as custodial support, which provides assistance with the personal activities of daily living, such as using the toilet, bathing, dressing and feeding. As a result of such attentive care, nursing homes typically cost more than assisted living facilities. The latest data from Genworth says the national average for long-term care in a nursing home is $7,908 a month for a semi-private room and $9,034 a month for a private room. The cost for care will fluctuate depending on the services the person needs, as well as what part of the country they live in.
“Seniors don’t always have a lot of resources, so they spend down,” Harrington says. “They usually only have enough money for three to six months on private pay, and then they may be eligible for Medicaid, but they have to meet the state’s Medicaid requirements — usually two or three limitations in activities in daily living.”
“Seniors don’t always have a lot of resources, so they spend down. They usually only have enough money for three to six months on private pay, and then they may be eligible for Medicaid, but they have to meet the state’s Medicaid requirements…”
CHARLENE HARRINGTON, PROFESSOR EMERITUS, UNIVERSITY OF CALIFORNIA SAN FRANCISCO SCHOOL OF NURSING
Assisted living: Maintaining some independence
An assisted living facility, also known as a residential care center, is a model of care for older adults that is primarily centered around a social model. This particular model of care includes providing recreational activities like yoga, movie nights, card games and other interests. Also included in this model is the overall upkeep of the facility’s appearance, as well as the dining and food services offered.
“These types of services are the focal points of most assisted living facilities,” White says.
Help with daily activities
Assisted living facilities provide assistance with instrumental activities of daily living, such as providing meals and activities and help with medication, as well as a safe living environment. Assisted living facilities do not usually offer support with tasks like bathing, using the bathroom or getting dressed.
“They may provide some assistance in that direction, but not that amount of hands-on assistance that a nursing home provides,” White says. “For this reason, assisted living facilities tend to be cheaper than nursing homes because they provide a different kind — and a different level — of care.”
Costs and accommodations
According to Genworth, the national average for a one-month stay at an assisted living facility is $4,500. The price per room, which is generally paid for out of pocket by the resident, will vary depending on what part of the country the patient lives in and the extent of services they require. White says assisted living in most states covers a wide variety of facilities — such as family care homes, where individuals care for a small number of adults in their home, versus a corporate entity, which provides housing for a larger number of older adults.
“Assisted living homes can take patients who need quite a bit of care, too,” says Harrington. “The problem with assisted living is that you have to pay for it out of pocket, unless you’re on Medicaid already. Some states will not pay for the room and board part, but will pay for the care part so they will help subsidize care in payments.”
“Assisted living homes can take patients who need quite a bit of care, too.”
CHARLENE HARRINGTON, PROFESSOR EMERITUS, UNIVERSITY OF CALIFORNIA SAN FRANCISCO SCHOOL OF NURSING
Because assisted living facilities are regulated by each individual state, the rules and regulations vary greatly. This means that little data is available about individual assisted living facilities — and what data is available is often inconsistent across the board, so it’s best to do your own independent research before making this important decision.
Knowing the best option for your family
As the primary decision-maker, your goal should be to help the staff at the facility get to know your loved one in a timely manner and be a partner in providing the necessary care, according to White. She advises families to look closely at the individual’s needs. Do they require assistance with the activities of daily living, or do they need more hands-on care?
If the person needs help bathing on a regular basis or needs encouragement to finish a meal, then a nursing home providing constant care is likely a better option. People who need less hands-on care but more supervision and structure to their environment are often better served in an assisted living facility.
“It’s not a decision that can be made primarily on cost, because they are based on different models of care,” White says. “Certainly both nursing homes and assisted living facilities try to do some of the other model, as well, but they are fundamentally different facilities.”
Finding and vetting communities
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.
There are several things White suggests families do to properly vet an assisted living facility:
- Consult medical professionals. Talk with your loved one’s physician, nurse practitioner or physician’s assistant about the individual care needs so you know what to look for.
- 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 assisted living facility for your loved at a regional and local level.
- Visit the facility. Schedule a meeting with the people you would be interacting with on a routine basis, such as the administrator or the director of nursing.
- 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.
- Consider the distance. How easily and quickly can you get to the facility to be a presence and an advocate for your loved one should a problem arise? This may be tertiary to your decision, after level of care and cost.
“The most important thing is to pick one that provides high-quality care, and that’s usually the nonprofit facilities, not the for-profit facilities,” Harrington says. “A lot of consumers try and pick the facilities closest to their home, and that’s not always the best way to do it. Remember, don’t be fooled by how the lobby looks. Check to see how many staff people are available to provide care. There’s a lot of quality problems in nursing homes and assisted living facilities. Only a small percent of both have very good care.”
