At some point, you or a loved one might need more regular or full-time care than you can handle at home. There are numerous long-term care solutions out there, including nursing homes and assisted living.
To decide which is right for your specific situation, start by identifying what level of care is needed. This guide untangles the differences between assisted living and nursing homes, the levels of care they each offer, who they're best for, and how to know when it's time to consider one.
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 run like retirement communities with added healthcare support; however, they don't always provide extensive or round-the-clock medical care.
In assisted living, 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.
Want to learn more about assisted living? Watch the video below. Jeff Hoyt, our editor-in-chief, will walk you through everything you need to know.
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 priority needs. 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: 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 increasing feelings of sadness or isolation.
- Withdrawal: The senior'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 reasons it might benefit you, such as:
- Safety: Daily activities are getting more challenging to manage, but you don't need full-time care. Assisted living facilities can offer as little or as much help as you need with basic tasks of daily life.
- Community and socialization: Good facilities provide a rich social fabric that can improve life and connection immensely for isolated older adults. 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 actually 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 those with chronic illnesses, injuries, or 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. Roughly 84 percent of nursing home residents are age 65 or older.1
People often use the term “nursing home” interchangeably with “skilled-nursing facility” (SNF), but they're two different things. SNFs provide broader 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 every day, but most nursing homes do not have doctors on staff 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, but 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 conditions getting worse
- Increases in falling, sprains, or broken bones
- Trouble managing money: money is being misplaced, overspent, or finances are overwhelming
- Cleanliness: 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?
In general, assisted living is for people who might 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||Nursing Home|
|Medication Management||Assisted living facilities offer medication management, but most charge an additional fee.||Nursing homes administer medication to residents daily.|
|Mobility Assistance||Residents are expected to be fairly mobile, including walking (with a cane or walker), getting in and out of bed, and getting up and down from chairs. Limited assistance is available.||Residents have more access to assistance. Nursing homes are a better choice for wheelchair-bound people, or people with chronic injuries, because of this assistance.|
|Frequent Medical Care||Some, but not all, have on-site medical staff.||Residents have more access to rehabilitative care and frequent medical assistance.|
|Access to Doctors||Residents are often able to keep their own doctors and travel to appointments.||Residents generally use in-house or visiting medical staff.|
|Privacy||Residents have their own private rooms and choose their level of social interaction.||Residents live in more hospital-like conditions, with little privacy.|
|Housekeeping: Cleaning, Laundry, Etc.||Housekeeping is included in assisted living. Laundry is often an additional charge.||Cleaning and laundry are included.|
|Pets||Many assisted living facilities allow pets.||Nursing homes do not allow pets.|
|Entertainment & Activities||Assisted living facilities have daily activity programming, and organize trips outside of the home.||Nursing homes offer in-home activity programming.|
|Living Accommodations||Private apartments or rooms, or sometimes semi-private shared apartments as a more affordable option. Residents are often able to bring in their own furniture and decorate. Couples generally stay together.||Single rooms or shared rooms, generally with furniture from the facility.|
|Ability to Cook||Many assisted living facilities offer apartments with kitchens, where you'll still be able to prepare any meals you choose to.||Nursing homes leave the cooking to the kitchen staff and all meals are prepared for residents. Often, if you're not feeling up for eating in the common dining room, staff will deliver a meal to your room.|
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.2 The average cost for a nursing home ranges from $6,844 to $7,700 per month,3 while assisted living is around $3,628 per month, on average. 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, there are other payment options available, including veterans benefits and long-term care insurance. The National Council on Aging offers a Benefits Checkup website, where you can easily find out 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, it will often be covered by Medicare or Medicaid. 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 you'll be happiest is such an important decision. It's also one that you shouldn't make alone. Talk to your family, your doctors, the staff, and other residents at places you're considering. Remember: you'll be happiest at the place that makes you feel the most comfortable, safe, and well taken care of.