This blog was published on January 21, 2016 and updated on January 20, 2020.
Caring for an ailing senior can be exhausting work that leaves caregivers burned out. As a senior’s needs change, you may find yourself continually adding support services such as in-home aides, daily check-ins, and home modifications. Although these services can improve your loved one’s quality of life, they’re not always enough. When a senior has a progressive medical condition or serious health needs, assisted living or a nursing home may be the best option.
Many families balk at the idea of transitioning Mom or Dad to residential care. They worry that they are abandoning their loved one, or that a senior living community won’t meet the senior’s needs. But the truth is that most seniors experience an improvement in quality of life after moving. Your loved one will have the help and support they need, which may actually increase their independence. You’ll get a break from the stress of caregiving, and your loved one will gain access to new friends and a wide range of activities that are tailored to their needs. For example, a nursing home that specializes in dementia care may offer dementia-friendly activities such as music therapy and simple crafts.
Assisted living is a great option for seniors who need some extra help and support, or who need assistance with tasks of daily living. A nursing home, by contrast, offers more comprehensive support to people with extensive medical needs.
Nursing Homes in a Nutshell
Also known as a skilled nursing facility, a nursing home provides the highest level of care possible outside of a hospital. In fact, many seniors move to a nursing home following a hospital stay. Nursing homes deliver 24-hour care to seniors who have complex medical conditions and need a high level of hands-on assistance and monitoring.
Residents may be confined to bed, be totally incontinent, and/or rely on tube feeding. A licensed physician supervises each patient’s care, a nurse is always on the premises, and other medical professionals, such as occupational, physical, or speech therapists, are also on hand. Many nursing homes have medical equipment that is normally found in hospitals, such as X-ray machines or electric beds. In addition, these facilities often offer short-term rehabilitation services where an adult of any age can stay before returning home after a medical operation or procedure.
A nursing home is the right choice for someone whose medical needs require full-time nursing care or access to services and facilities that are more like the hospital than home. Some families choose to transition to a nursing home after a serious infection, or when a senior is continually in and out of the hospital. Because skilled nursing facilities offer extensive care, they can provide more stability to seniors who might otherwise spend extended periods of time in the hospital. Some nursing homes also deliver hospice services, providing palliative care to seniors who are nearing the end of their senior living journey..
However, if a senior’s needs are more minimal — such as assistance with activities of daily living (ADL) such as bathing, dressing, or toileting, or if a senior needs simple care such as physical therapy and medication management — a nursing home may be too restrictive, and needlessly add costs.
Assisted Living in a Nutshell
An assisted living community might be a terrific match for someone who has some health problems and needs help with bathing or dressing. Many seniors who choose assisted living remain independent aside from a few daily tasks.
Assisted living communities are not hospitals. They can, however, offer some medical services, and may help with diet and nutrition issues as well as incontinence. At most assisted living communities, a licensed nurse completes a comprehensive individualized assessment for each resident, and nursing staff are on-site or accessible 24 hours a day. Geriatricians and other healthcare professionals, such as dentists or chiropractors, will often see clients on-site, and some assisted living communities have started to offer physical or occupational therapy while others run wellness rooms supervised by licensed nurses.
Additionally, a number of communities offer specialized memory care units for those with cognitive difficulties. It’s important to ask about the levels of care the community offers, especially if a senior has a chronic or progressive medical condition that may get worse. Some assisted living communities offer a continuum of care by contracting with skilled nursing companies or offering an on-site nursing home for residents whose support needs change.
Like nursing homes, assisted living communities deliver personal care assistance as well as light housekeeping and laundry, and both offer communal dining halls that serve three meals a day, including special meals for those with medical conditions such as diabetes. In addition, both types of residential alternatives are equipped with safety systems like emergency pull cords.
Whom They Serve
An assisted living community is a good choice for a senior who needs additional support with ADLs and is looking for somewhere to live long-term. These may include dressing, showering, other grooming, or toileting. Assisted living communities also provide socialization opportunities and an event calendar with many activities that make it easy to get out and about.
Some assisted living communities also offer memory care services for those with Alzheimer’s disease or another form of dementia. In fact, there are specialized assisted living communities that exclusively serve seniors with memory care.
By contrast, a skilled nursing facility is designed for those who have complex medical needs, from pain management to post-stroke rehabilitation. Residents in skilled nursing facilities typically need help that goes beyond ADL care. Like assisted living, skilled nursing facilities provide an event calendar and specialized dining choices.
Many residents of skilled nursing facilities are not planning on a long-term stay. Instead, a person might enter a nursing home for 30 days of rehab after a fall. Skilled nursing offers medical support for residents who need to get better before they are able to return to their home or move to an assisted living community. Most residents of assisted living communities, however, move to the community because it’s where they want to spend the rest of their life.
Staff and Specialty Care
Assisted living communities provide 24-hour care, usually from nurses and other certified caregivers. They also provide a full complement of dining, housekeeping, maintenance, and other ancillary staff throughout the day.
In addition to nurses and aides, skilled nursing facilities typically have on-site providers for physical, occupational, and speech therapy. Caregiver ratios are lower due to the increased needs of residents. Skilled nursing facilities may have an on-site doctor or other clinician, because they are designed first and foremost to provide medical care.
Size and Lifestyle
On average, nursing homes are twice as large as assisted living communities (108 units versus 54). Assisted living residents are often housed in studio or one-bedroom apartments with kitchenettes, while those in nursing homes usually live in shared or single rooms. Assisted living communities also have a homier feel to them than nursing homes. Both types of senior living options do offer recreational activities, although assisted living typically offers a wider variety of options (think: arts and crafts activities, trips to the theater, and gardening or book clubs, to name a few).
Another big contrast is around autonomy and independence. Some assisted living residents drive their own cars, cook some of their own meals, and come and go freely. This would be out of the question for nursing home residents, who cannot leave their home unless they are assisted.
Finally, one big difference between nursing homes and assisted living communities is cost. According to the U.S. Department of Health and Human Services, in 2010, the average cost for a private room in a nursing home was $6,965 per month, more than twice the cost of a one-bedroom assisted living apartment, which averaged $3,293 per month.
Keep in mind, though, that nearly all nursing homes are certified to participate in Medicare or Medicaid financial assistance programs, or both. Many states cover some assisted living communities under Medicaid. However, the amount of coverage and eligibility requirements vary widely, and many communities are not covered at all. Even when Medicaid covers an assisted living community, a person might have to meet certain medical criteria before coverage kicks in.
Note that assisted living communities are governed by state regulations, which fluctuate from state to state, while nursing homes are federally regulated.
The care decisions you make will affect your loved one for the rest of their life. They can improve an entire family’s quality of life, reduce bickering, and restore a sense of balance and peace to your relationship. The move to residential care is never a one-size-fits-all decision. Instead, it’s important to review your loved one’s needs, spend time touring each community, and ask many questions. When you find a community that meets your loved one’s needs and feels welcoming and comfortable, act quickly, because many communities have long waiting lists. Your loved one deserves a retirement of peace and support, no matter how their health shifts in the coming years. So take your time, and make a decision that feels comfortable for everyone.