Assisted Living vs Nursing Home
The main difference is that the level of medical care isn't the same between nursing homes and assisted living. Assisted living facilities may have a nursing staff and a health clinic. However, the primary focus of assisted living is to help residents with activities of daily living.
Taking the next step in your living situation, whether that's moving to an assisted living facility or a nursing home, is never easy. You might choose a move like this because it would be nice to have help around the house – or maybe your family wants you to have that help. Maybe you're recovering from an injury or an illness. Some people choose to move because they live alone and would be happier spending time with people every day. Some need more care than they can get at home.
Every person's reason for choosing elder care is different, but one thing is true for everyone: there are many questions in this decision process, and finding the answers requires research, patience and an open mind. Don't feel overwhelmed! There are many resources to help you make this decision. In this article you'll learn about two different but similar kinds of elder care that are often confused: assisted living and nursing homes.
According to the Centers for Disease Control (CDC) , in 2014, there were over 15,000 nursing homes and 30,000 assisted living facilities in America – so it's important to ask the right questions to find the place you'll be happiest and most comfortable and soon calling home.
Get informed with the help of our side-by-side guide, talk to people you trust, and rest easy knowing you've chosen the perfect option for yourself.
What's the Difference?
People will often use the terms “assisted living” and “nursing home” interchangeably, but the two are very different. Let's take a look at how they line up:
Assisted living facilities are for people who can still take care of themselves for the most part. They might need (or just enjoy having) some assistance with cooking, daily household tasks like cleaning and laundry, and personal care like showering – but it's like ordering from a menu… you choose what you want help with. Monthly pricing for this kind of housing is based on the level of assistance you want or need. In general, as a resident of an assisted living facility, you would live in a private living space (like an apartment or condo), and have a private bathroom and kitchen. Couples are generally able to live together. Sometimes these places allow you to have your own car, and almost all of them provide rides to bring you where you need to go like the doctor or the store. You'll also enjoy a high level of socialization, with organized trips to museums, movies and more.
Nursing homes offer a higher level of daily care, including everything from help getting dressed to using the restroom to getting in and out of bed. You might choose to live in a nursing home if you need frequent or daily medical care, or if your ability to get around has lessened and you feel more secure having people check in on you frequently. Often, family caregivers might choose a nursing home when they feel they can't care for their loved ones well enough anymore. While this type of living situation offers less independence, you'll feel really well taken care of with round the clock care.
How Much Help Do You Need?
The main factor in choosing assisted living or a nursing home is how much help you need every day. Caregivers determine that level of help by measuring your Activities of Daily Living (ADLs). Those are daily things like eating, toileting and walking. The number of assisted ADLs you need determines your level of care and the cost for it. Assisted living facilities include a small number of ADLs in the base monthly cost. Anything else you need help with – like laundry or medication reminders – is usually an additional cost. Often, family members will help out to save on ADL fees by doing things like taking laundry home to wash. Nursing homes include more ADLs in their monthly cost. Let's look at the Activities of Daily Living to see which you might need help with:
- Medication Management – Your ability to remember to take medication on your own. If you can easily manage your own medications, assisted living facilities will generally leave them with you to handle yourself. Assisted living facilities can manage your medication for you, but that is generally not included in basic care and is an additional charge. Nursing homes generally manage all medications for residents.
- Eating – How easily you can feed yourself? Some assisted living facilities offer help with eating a meal, but assume residents can easily eat on their own. Nursing homes give more help with eating when it's necessary. All elder care housing provides three meals a day and snacks. If you still enjoy cooking, you can usually do that in your private kitchen in assisted living.
- Personal Hygiene – Your ability to easily take care of your own hygiene. Assisted living facilities can help with showering, oral care or grooming, but those are generally added charges. Nursing homes include more hygiene help in their basic level of care.
- Continence – How easy it is for you to use the restroom, including changing incontinence products. Assisted living facilities charge for assistance with adult incontinence, and for help changing sheets outside of the regular schedule. Many residents of nursing homes need assistance using the restroom and are able to receive that help.
- Mobility – Walking, getting in and out of bed, or getting up and down from chairs. In an assisted living facility, they generally assume that you can get around easily, even an ease of mobility is necessary, even if you use a cane or a walker. In nursing homes, there's more help available with getting around. A nursing home is usually a better choice for someone in a wheelchair.
Can You Still Have a Social Life?
Of course! One of the biggest benefits to moving to an elder care facility is being part of a community. Assisted living facilities offer organized outings to fun places like museums, attractions and shopping malls. They also provide you with transportation to doctors appointments, and to do errands like grocery shopping. In an assisted living facility, residents feel as though they're able to maintain their own independence, sometimes with the ability to drive their own cars.
Residents of nursing homes generally stay on property unless they're leaving with family or need medical assistance – but in that case, activities come to you. Both nursing homes and assisted living facilities have daily activities ranging from fitness and craft classes to movie nights, performances from visiting musicians and wine and cheese happy hour.
What About People with Specialized Medical Concerns?
Many people move to elder care when they need help dealing with an illness or an injury. If it's the kind of medical concern that you'll recover from, rehabilitative services help you transition from the hospital back into your life. The benefit to nursing home care is that many offer rehabilitative services, so you're able to get back to normal as quickly as possible.
For people with advancing memory loss, there are memory care facilities that cater to advanced Alzheimer's and Dementia patients. Because they're designed specifically for people with compromised memory, they are safe spaces for people to feel like they're living independent lives while still being cared for 24 hours a day.
How Do You Pay for It?
Most assisted living facilities are considered “custodial care” by the government, and require out-of-pocket payment. They're not covered by Medicare or Medicaid. However, there are other 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.
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 coverage of nursing home care. Medicare has detailed information on coverage. Medicaid's website also has resources for comparing nursing homes and exploring coverage options.
Which is the Right Choice for Me?
Assisted living is ideal for someone who still has the desire and ability to be somewhat independent, but may need assistance with ADL's.
Nursing homes are ideal for those who may need more care than an assisted living community can provide. Those living with a health complication or who have limited mobility might want to consider a nursing home.
|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.|
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.|
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.|
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, talk to your doctors, talk to 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.