It can be a difficult and emotional choice to start looking for care outside the home for an aging loved one. You’ll need to consider 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.
Here’s what you can expect from assisted living vs. nursing home facilities, the key differences and similarities, costs and tips on how to choose the best care option for your loved one.
What is assisted living?
Assisted living, or a residential care center, is a long-term residential option for older adults that combines housing with medical, nursing, personal and other supportive services under one roof. Residents typically have their own room or suite, with a bathroom, but take meals communally in a dining room.
Assisted living is a model of care for older adults that is primarily centered around socializing. Facilities may offer 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.
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
Who can benefit from assisted living?
Assisted living is for seniors who are independent but benefit from support when it comes to doing daily activities in a safe environment. 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.
What is a nursing home?
Nursing homes are regulated by the federal government and offer around-the-clock, 24/7 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.
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.
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.
Find assisted living
Who can benefit from a nursing home?
Several health and medical issues may indicate that an older adult is a candidate for a nursing home. These might include:
- Being in the late stages of Alzheimer’s or dementia and feeding, changing, bathing and moving them may require access to medically-trained staff full-time.
- The person has any medical condition that is difficult to manage at home.
- There are more frequent accidents and injuries at home. Falls and other injuries may be a sign that a nursing home is the best fit.
Join Care for free
Assisted living vs. nursing homes: Key differences and similarities
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 | |
| 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. |
Comparing costs of assisted living and nursing homes
Nursing homes typically cost more due to the constant care offered. The average national cost is $8,669 per month for a semi-private room, and $9,733 for a private room.
Some nursing homes may offer something called short-term, post-acute care, where the first 21 days are paid for by Medicare, says Charlene Harrington, Professor Emeritus at the Department of Social and Behavioral Sciences at the University of California San Francisco’s School of Nursing. 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.
By comparison, assisted living generally costs less because seniors receive less care and less support is required. $5,350 is the average monthly cost nationwide for one bedroom. But 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.
Unless you’re on Medicaid, you’ll have to pay for assisted living out of pocket, says Harrington. “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,” she adds.
Find nursing homes
How to choose the best care option between assisted living vs. nursing homes
“It’s not a decision that can be made primarily on cost, because [assisted living and nursing homes] 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.”
A few key steps to take to determine which facility model is right for your older loved one, according to White:
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 nursing home or assisted living facility for your loved one 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. And get a sense of who will be caring for your loved one. “Check to see how many staff people are available to provide care,” suggests Harrington.
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.
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.)
The bottom line, according to Harrington: “A lot of consumers try to pick the facility closest to their home, and that’s not always the best way to do it. The most important thing is to pick one that provides high-quality care.”
