Assisted Living vs. Skilled Nursing

Assisted Living Communities

Assisted living communities provide care to older adults who can no longer safely live at home by themselves; however, assisted living residents don’t require the higher level of care a skilled nursing community provides. Assisted living communities encourage residents to live as independently as possible, while also providing needed assistance with ADLs such as (but not limited to) bathing, dressing, grooming, toileting assistance, and medication management. Staff is available around the clock to provide help when needed.

In an assisted living community, residents live in an apartment-style residence that may be private or semiprivate. Each apartment typically has a living area, dining area, small kitchen, and private bath. Although residents can choose to prepare their own meals and dine or entertain in their own apartments, centralized dining areas are typically available.

Large common areas are the norm, offering unlimited opportunities for socialization and providing residents with a feeling of community. Residents can often bring their own furniture and belongings, creating a truly homelike environment.

Assisted living communities focus on providing a healthy social environment with a calendar full of life-enriching activities; however, residents have the freedom to set their own schedules and pursue whatever interests and hobbies they desire. Most assisted living communities also make transportation available so residents can stay active in the community, attend church services, go to beauty appointments, and make other outings.

Assisted living communities have scheduled times for licensed nursing services; however, registered nurses (RNs) and/or licensed practical nurses (LPNs) are on call 24/7 when they aren’t onsite. They may or may not always be present. Medications are administered by a nurse or licensed medical technician.

Although assisted living communities don’t provide for medically intensive needs, they may partner with other healthcare professionals, such as home health agencies and hospice, to provide for a resident’s needs. For example, if outpatient therapy is needed three times a week, a home health agency can come into the community to provide therapy (e.g., physical, occupational, or speech therapy), or hospice agencies can come in to provide end-of-life care.

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Skilled Nursing Communities

Skilled nursing facilities provide 24/7 skilled nursing care for individuals requiring specialized medical care or daily therapy services in a skilled-care setting. Although sometimes temporary, a stay in a skilled nursing community could be likened to a long-term hospital stay.

Skilled nursing services are often provided for short-term stays following hospitalization, surgery, injury, or some other significant decline in health, such as a heart attack or stroke. During these temporary stays, care is typically focused on providing rehabilitative services to prepare them to return to their previously independent lifestyle.

For others, a skilled nursing community becomes their long-term home. These residents receive much-needed assistance with ADLs, plus round-the-clock medical care and supervision. This medically intensive care is provided by professionally licensed personnel. Residents often have complex medical conditions with high care needs requiring routine skilled nursing services, such as:

• Wound care
• Ventilator care or respiratory therapy
• IV medications
• Feeding tube
• Advanced-stage pressure ulcers (bed sores)
• Physical, speech, and/or occupational therapies
• Pharmaceutical, radiology, and laboratory services
• End-of-life or hospice care

Residents typically share a semiprivate room, and they eat their meals in a common dining area unless their medical conditions inhibit them from doing so. Skilled nursing facilities generally have a calendar full of daily scheduled activities. Activities are brought to rooms for those who are too incapacitated to make it to the group events.

Certified skilled nursing facilities have LPNs on duty 24 hours a day. An RN is on duty for at least eight hours each day, seven days a week. For every 100 resident beds, there are 40 nursing assistants, seven RNs, and 13 LPNs on staff, on average, though each state sets its own minimum requirements for staff-to-patient ratios that may be lower. For example, in Florida, the state requires a minimum of one licensed nurse per 40 residents and 3.6 hours of daily facetime (combined certified nursing assistants and licensed nursing staff) per resident.2

Because a skilled nursing facility provides medically necessary care that is supervised by a licensed physician, the cost of care is covered by Medicare and Medicaid and most long-term care insurance policies.

Choosing Between Assisted Living and Skilled Nursing Communities

Finding the right living arrangement can seem overwhelming at times, especially when a precipitating event has made it necessary, which is often the case. When it’s no longer safe to live independently, many people find themselves wondering which option is best for themselves or someone they care about. In these cases, they often find themselves comparing assisted living and skilled nursing.

The chart below compares assisted living and skilled living facilities to help you make an informed decision.

Some assisted living and skilled nursing facilities may also have specialized memory care units within the facility to provide the specialized care needed for advanced cognitive difficulties. These units often provide advanced security measures, such as secured entrances/exits and additional surveillance equipment. Memory care apartments generally do not have kitchens.

Deciding Between Assisted Living and Skilled Nursing

Assisted living communities provide a homelike environment and encourage residents to live as independently as possible, but they still have staff available to provide assistance with ADLs as needed. Residents aren’t closely monitored, but someone is always close by, just in case.

In a skilled nursing facility, medically intensive care is provided for individuals who have complex or chronic medical needs, severe pain, permanent disabilities, or are recovering from injury, illness, or surgery. These facilities are less private and more institutional in nature.

Assisted living communities encourage independence and provide less medical care. On the other hand, skilled nursing communities are more restrictive and provide more medically intensive care.

At the end of the day, a senior’s care needs will determine which type of community is most appropriate for their given situation. When you’ve narrowed your options down to assisted living or skilled nursing, tour several communities in your area. Be sure to ask as many questions as you need to in order to feel comfortable with your final decision. Remember to ask each community about the services they offer and which services come with additional costs.