Assisted Living vs. Nursing Home

What Is Assisted Living?

Assisted living consists of a residential community equipped to help people with daily life and routine self-maintenance when needed. Ranging in size from a few dozen to a few hundred residents, they often operate like retirement communities with added healthcare support; however, they don’t always provide extensive or round-the-clock medical care.

In assisted living facilities, people typically have their own rooms (shared and private) or apartments. They can gather in common areas for dining or recreation. Most facilities include room and board, medication management, and housekeeping. They also provide bathing and bathroom help as needed, social and leisure activities and emergency care. Different facilities offer different levels of service, benefits, and expertise. Some even combine with independent living residences to form hybrid communities so you can move from one to the other more easily when needed.

When Is It Time for Assisted Living?

Assisted living comes in a broad spectrum of forms designed to help seniors age in place for longer. For some, it’s a way to downsize into a new home for the long term. For others, it’s a way to maintain independence, even though they need some help with daily self-care. Ultimately, focus your decision on the most vital needs in your life. Below are six signs that it might be time to consider assisted living:

• Increase in injuries: You or your loved one is falling or sustaining injuries more frequently.
• Worsening health conditions: For example, the person has diabetes, arthritis, or macular degeneration.
• Cleanliness: The individual is experiencing difficulty keeping the house clean or maintaining personal hygiene.
• Depression and loneliness: You or your loved one is experiencing increased feelings of sadness or isolation.
• Withdrawal: The person's engagement with people or activities is declining.

Other Reasons to Consider Assisted Living

While you might not need assisted living yet, there are still a few more reasons it might benefit you, such as:

• Safety: Daily activities are increasingly challenging, but you don’t need full-time care. Assisted living facilities can offer as little or as much help as you need with the basic tasks of daily life.
• Community and socialization: Good assisted living facilities provide a rich social fabric that can improve the quality of life and interpersonal connections for older adults who feel isolated. Even if you’re not isolated, becoming part of a supportive community can significantly enhance your quality of life as you age.
• Maximizing independence: Assisted living aims to help people live as independently as possible. If you need some help but don’t need 24/7 care, assisted living can foster more independence than living at home.

What Is a Nursing Home?

Nursing homes are long-term residences that focus more heavily on medical assistance for older adults with chronic illnesses or injuries, or those who need round-the-clock care. Many people turn to nursing homes when they need more consistent medical help than assisted living provides, but it’s not always permanent. Some residents are only there for recovery and need weekly dialysis or intensive physical therapy. That said, roughly 84 percent of nursing home residents are age 65 or older, many of whom intend to stay for the long term.2

People often use the term “nursing home” interchangeably with “skilled nursing facility” (SNF), but they’re two different things. SNFs provide medical services for more acute needs, such as terminal illness or 24-hour care for Alzheimer’s. Medicare- and Medicaid-certified nursing homes require a licensed nurse to be on the premises at least part of the day, but most nursing homes do not have doctors available for specialized care.

Typical nursing home services include:

• Custodial care: bathing, eating, dressing, and using the toilet
• Medication management
• General mobility (sitting down and up)
• Transport throughout the residence
• Skilled nursing care, e.g., physical, occupational, or respiratory therapy
• 24-hour supervision and emergency care
• Social and recreational activities

For a closer look at nursing homes, watch the video below!

When to Move From Assisted Living to a Nursing Home

The decision to move into a nursing home is a very individual and personal one. For many, it means a marked loss of independence, which most people understandably resist. Many factors affect the choice to transition to a nursing home, from emotional readiness to proximity, services, and cost, it often comes down to safety. Look for these signs that may indicate it’s time for the next level of care:

• Terminal or chronic illness needing 24/7 supervision or care
• Debilitating or worsening emotional disorders or dementia-related conditions
• Multiple medical conditions at once or worsening conditions
• Increases in falling, sprains, or broken bones
• Trouble managing money; money is misplaced, overspent, or financial responsibilities have become overwhelming
• Difficulty keeping up with house cleaning and personal hygiene
• Declining mental acuity, increased memory loss, confusion, or disorientation
• Depression, increasing feelings of isolation or withdrawal from people and activities

What Is the Difference Between Assisted Living and a Nursing Home?

Assisted living is generally for people who need help with daily tasks. Nursing homes are for people who need a higher, more consistent level of care, often round-the-clock. Both assisted living facilities and nursing homes offer some of the same essential services, but studying the differences below can help you decide which type of care you need.

Assisted Living vs. Nursing Home Costs

Both long-term facilities are expensive, but nursing homes can be more than double the cost of assisted living.4 In 2024, the median cost for a nursing home ranges from $8,929 to $10,025 per month, depending on the room type, while the median for assisted living is around $5,511 per month.5 So how can you pay for hefty assisted living or nursing home costs?

How to Pay for Assisted Living

Most assisted living facilities are considered “custodial care” by the government and require out-of-pocket payment. Medicare and Medicaid don’t cover them. However, other payment options are available, including veterans benefits and long-term care insurance. The National Council on Aging offers a Benefits Checkup website, where you can easily determine which benefits you're entitled to. For more information on assisted living and ways to pay, head to our assisted living costs guide.

How to Pay for a Nursing Home

If a nursing home adheres to national and state licensing requirements, Medicare or Medicaid will usually cover it. Original Medicare covers up to 100 days of skilled nursing coverage, and Medicare Advantage offers supplementary nursing home care coverage. Medicaid's website also has resources for comparing nursing homes and exploring coverage options. Our nursing home costs guide offers more details on ways to pay for nursing home care.

Picking the place where you'll be happiest is a critical decision. It's also one that you shouldn't have to make alone. Talk to your family, doctors, the staff, and other residents at places you're considering. As you think about your options, remember that you'll be happiest where you feel most comfortable, safe, and well taken care of.