As you search for the right living options for yourself or someone you care about, you may find yourself wondering about the differences between assisted living and skilled nursing care. The biggest difference between the two is the level of care provided and who provides that care.
Assisted living and skilled nursing communities are both long-term care options that provide a range of supportive medical, personal and social services for people who can no longer meet their own basic living needs for extended periods of time.
Essentially, in assisted living communities, residents receive assistance with activities of daily living (ADLs), while still handling most activities on their own. In a skilled nursing community, residents receive constant nursing care and need assistance with most, if not all, ADLs.
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 providing needed assistance with ADLs such as (but not limited to) bathing, dressing, grooming, toileting assistance and medication management. Staff is available round-the-clock to provide help when needed.
In an assisted living community, residents reside in an apartment-style residence that may be private or semi-private. 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/entertain in their own apartment, 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 bring their own furniture and belongings, creating a true home-like environment.
Assisted living communities focus on providing a healthy social environment with a calendar full of life enrichment activities; however, residents have the freedom to set their own schedule and to pursue whatever interests and hobbies they desire. Most assisted living communities also make transportation available to enable residents to stay active in the community and to attend church services, beauty appointments and other outings.
Assisted living communities have scheduled times for licensed nursing services; however, registered nurses (RNs) and/or licensed practical nurses (LPNs) are accessible and on call, although 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.
Skilled Nursing Communities
Skilled nursing communities 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, resident’s care is typically focused on providing rehabilitative services to prepare them to return to their previously independent lifestyle. Approximately 25% of the skilled nursing care population will stay less than three months.
For others, however, a skilled nursing community becomes their long-term and permanent home. These residents receive much-needed assistance with ADLs plus round-the-clock complex 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 semi-private room, and unless they are too ill or incapacitated to do so, they eat their meals in a common dining area. Skilled nursing communities generally have a calendar full of daily scheduled activities. For those who are too incapacitated to make it to the group activities, pastimes and pursuits are brought to their rooms.
Certified skilled nursing communities have licensed practical nurses (LPNs) on duty 24 hours a day. A registered nurse (RN) is on duty for at least eight hours of each day seven days a week. On average, for every 100 resident beds, there are 40 nursing assistants, seven RNs and thirteen LPNs on staff.
Because a skilled nursing community provides medically necessary care and 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.
This chart should make the comparison easier if you’re trying to make a choice between an assisted living or skilled living community.
|Assisted Living Communities||Skilled Nursing Communities|
|Living Accommodations||Accommodations are generally apartment-like; may be private or semi-private.||Accommodations, generally semi-private, are more hospital-like.|
|Meals||Three meals are served in a centralized dining area, usually at no additional cost. Meals may be prepared by a resident in their own kitchen in their apartment.||Three meals are served in a communal dining area at no additional cost.|
|Housekeeping Services||Housekeeping and laundry services are generally included at no additional cost.||Housekeeping and laundry services are provided.|
|Caregiving Services||Caregivers are available around the clock. Someone needing or desiring specialized care or one-on-one care can arrange for this supplemental care through a third party at an additional cost.||Caregiving services provided around the clock. Someone desiring one-on-one care can arrange for this supplemental care through a third party at additional cost.|
|Minor Medical Supervision||Provided||Provided|
|Extensive Medical Care||Not provided||Physician ordered extensive medical care is provided.|
|Medical Personnel Available||Full-time medical personnel are on site or on call.||LPNs on-site at all times. RNs on-site at least 8 hours per day. Physicians on-site or on call 24/7.|
|Assistance with ADLs||24/7||24/7|
|Activities||Various activities are scheduled on a daily basis focused on keeping the residents busy throughout the day. Community activities and field trips are planned.||Less active and less strenuous activities scheduled throughout the day. Activities provided in the room for those who cannot join group activities.|
|Transportation||Transportation to and from doctor’s appointments and other errands is often available.||Transportation to and from doctor’s appointments is often available.|
|Payment Sources||Mostly private pay. Some certified communities accept Medicaid and Medicare. Services may be covered by long-term care insurance and Veterans benefits.||Services, which are medical in nature, are covered by Medicare, Medicaid, Veterans Benefits and most long-term insurance policies in certified facilities|
|Average Price Range||Between $2,500 – $4,000 per month. Memory care will run substantially higher.||In 2016, a private room averaged $253 per day and a semi-private room averaged $225 per day. Monthly, that’s $7,590 and $6,750, respectively. Memory care will run substantially higher.|
|Scheduled Activities||Calendar of activities, often offering community activities and field trips||Calendar of activities, not as “active” as assisted living|
|Other Names for These Communities||Assisted Care Communities and Personal Care Homes||Nursing Homes, Convalescent Care, Nursing Centers, Long Term Care Facility|
Some assisted living and skilled nursing communities may also have specialized memory care units, often a dedicated wing within the facility, to provide for the specialized care needed with 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.
Assisted living communities provide a home-like environment and encourage residents to live as independently as possible but have staff available to provide assistance with ADLs as needed. Residents aren’t closely monitored, but someone is always close by when needed.
In a skilled nursing community, medically intensive care is provided for those individuals who have complex or chronic medical needs, severe pain, permanent disabilities or those who are recovering from injury, illness or surgery. They are less private and more institutional in nature.
Assisted living communities encourage independence and provide less medical care; whereas, skilled nursing communities are more restrictive but provide more medically intensive care.
At the end of the day, the care needs of the senior will determine which type of community is most appropriate for their given situation. When you’ve narrowed your option down to assisted living or skilled nursing, and you’ve narrowed your choices down to a few communities within that option, tour the communities. Be sure to ask as many questions are you need to in order to feel comfortable with your final decision. Be sure to ask each community about the services they offer and what services come with additional costs.