Assisted Living vs. Nursing Home Care: How They Differ

Terminology

The "assisted living vs. nursing home" topic is best understood when you know what each term means. It also helps to know the other terms that are frequently used for the same types of senior care options. To that end, here are basic definitions that begin to clarify the difference between nursing home and assisted living options.

An assisted living facility (ALF) is a place where seniors or adults with disabilities live semi-independently and receive limited help with certain day-to-day activities. Assisted living communities tend to provide various hospitality and personal care services, 24-hour emergency response protocols, and regular opportunities for recreation and social interaction. The exact levels of care and types of services that are offered vary from facility to facility and often depend on state regulations. Other terms that are sometimes used when referring to assisted living include:

• Assisted care
• Residential care
• Supportive housing
• Supported living
• Adult foster care (in facilities with no more than four residents)

A nursing home is a place where residents who cannot live independently receive extensive and ongoing care due to old age, disabling medical issues, or other kinds of physical or mental conditions that require continuous monitoring or supervision. Nursing homes tend to provide more frequent and comprehensive personal care services than what you will find in assisted living facilities. They also provide easier access to skilled nurses. In some cases, people use the following terms when describing nursing home care:

• Long-term care
• Extended care
• Rest home
• Care home
• Intermediate care home

A skilled nursing facility (SNF) is a specific type of nursing home (or a special unit within a nursing home) that focuses on providing services that can only be carried out by registered nurses (RNs) or licensed practical or vocational nurses (LPNs or LVNs). Skilled nursing facilities are mostly intended for people who need short-term medical care or rehabilitative services outside of a hospital following surgery or other serious medical treatments. Examples of skilled nursing care procedures include:

• Giving injections
• Inserting catheters
• Using aspiration devices
• Inserting IV feeding lines
• Treating widespread skin diseases
• Applying dressings to infected wounds
• Assessing and educating patients
• Planning, managing, and evaluating patient care

Personal care (also known as custodial care) is assistance that doesn't require the skills of a registered or licensed nurse. That's why personal care is a stronger focus within facilities that provide assisted living (vs. skilled nursing facilities, which have a stronger focus on skilled care for medical conditions). Examples of personal care services include:

• Helping residents eat, bathe, get dressed, or go to the bathroom
• Administering routine oral medications, ointments, or eye drops
• Applying creams for minor skin problems
• Repositioning residents in their beds
• Changing dressings for non-infected wounds
• Helping residents walk, get around in wheelchairs, or stay mobile through other means
• Assisting with routine maintenance of bladder catheters or colostomy bags
• Supervising residents who have dementia

Common Types of Residents

When it comes to weighing nursing home versus assisted living options, it's essential to understand who is best served by each type of facility. That way, you can feel more confident in your decision-making while potentially avoiding a costly or unnecessary move later on.

Assisted living is usually suitable for people who:

• Are open to the idea of getting assistance
• Can benefit from a more socially engaging living environment
• Are able to walk or use mobility devices on their own
• Need a limited amount of supervision or personal care assistance
• Are lucid or have only mild cognitive problems
• Want or need to be free of the responsibilities of home ownership

Nursing home care is often necessary for people who:

• Need daily medical care and/or a lot of personal care assistance
• Aren't able to walk or get around in other ways without help
• Are too sick or frail for home care
• Need round-the-clock supervision or monitoring
• Have severe problems with incontinence
• Are likely to need frequent visits to the hospital
• Have moderate to severe cognitive problems
• Have complicated medical, emotional, or mental conditions
• Resist when being given assistance
• Display problematic behaviors

To break down the differences between assisted living and nursing home residents even further, check out the following demographic comparisons based on Centers for Disease Control and Prevention (CDC) data from 2014. The first number represents the percentage of assisted living residents who fall into a particular demographic, and the second number represents the percentage of nursing home residents in that same demographic.

• Age 65 or over: 93 percent vs. 85 percent
• Age 85 or over: 53 percent vs. 42 percent
• Women: 70 percent vs. 67 percent
• Need help walking or getting around: 29 percent vs. 91 percent
• Need help eating: 20 percent vs. 58 percent
• Need help bathing: 62 percent vs. 96 percent
• Need help getting dressed: 47 percent vs. 92 percent
• Need help going to the bathroom: 39 percent vs. 88 percent
• Need help getting in and out of bed: 30 percent vs. 85 percent
• Have diabetes: 17 percent vs. 32 percent
• Have depression: 23 percent vs. 49 percent
• Have had falls: 21 percent vs. 17 percent
• Have Alzheimer's disease or other dementia: 40 percent vs. 50 percent

As you can see, many assisted living facilities welcome residents who have early- to middle-stage dementia, including people with Alzheimer's disease. When those residents require 24-hour supervision (for their own safety and the safety of others), they often need to move into nursing homes that have special memory care units.

Another interesting thing to keep in mind is that a person who turns 50 today now has a 53- to 59-percent chance of needing nursing home care at some point during the rest of his or her life. So you or your loved ones are definitely not alone in experiencing the challenges that often result from getting older. Residential and nursing care has become a normal part of life for a huge segment of the population.

Typical Living Spaces

Everyone wants a comfortable living environment. That's why most assisted living facilities and nursing homes strive to create warm, homelike atmospheres where residents can socialize and accommodate visitors. However, beyond that shared goal, these two types of senior living options tend to have some very recognizable differences when it comes to the actual living spaces they offer.

Assisted living facilities:

• Tend to feature private or shared apartment-style units or studios
• Often feature units with small kitchens
• Generally give residents a lot of freedom in decorating their spaces
• Provide communal dining rooms
• Provide a lot of shared recreational space
• Serve about 28 residents each day, on average, according to CDC

Nursing homes:

• Mostly offer shared or private hospital-style rooms
• Sometimes provide a little less freedom when it comes to decorating
• Provide communal dining and living areas
• Tend to offer less recreational space
• Serve about 88 residents each day, on average, according to CDC

In both types of facilities, the staff are usually trained to value residents' privacy and knock before entering shared or private rooms. And, although it is still relatively uncommon, some assisted living facilities allow their residents to have pets. Even a few nursing homes around the country now allow certain kinds of residents to have easy-to-care-for pets.

Care Services

Needing or wanting some level of personal care assistance is generally the main factor that drives seniors or their families to explore assisted living and nursing home options. But the care-based services that are offered in each type of facility can vary greatly. So, what is the difference between assisted living and nursing home care?

In general, assisted living facilities:

• Provide some help with personal care activities such as bathing and dressing
• Help manage and give out basic medications
• Are designed for helping residents avoid injury
• Offer round-the-clock staffing in case of emergencies
• Don't provide nursing or medical care (unless licensed to do so)
• Are limited in what they can do for residents who display behavioral problems

In contrast, nursing homes:

• Provide some help with personal care activities such as bathing and dressing
• Manage and administer a full range of medications
• Regularly monitor the medical conditions of residents
• Provide certain kinds of medical treatments, when necessary
• Frequently have more on-site emergency medical equipment
• Are better able to handle residents who have behavioral issues

Despite the general differences above, the line between assisted living and nursing home care continues to blur in many regions. That's because some assisted living facilities are licensed to provide certain types of nursing services. And some of today's most progressive nursing homes now aim to provide high levels of care in appealing living environments that more closely match what you can get with assisted living.

To get a better idea of the types of care services offered at each type of senior living facility, look at the following comparisons based on CDC data. For each type of service, the first number represents the percentage of assisted living facilities in the U.S. that offer it. The second number represents the percentage of nursing homes offering the same kind of service.

• Nursing services: 59 percent vs. 100 percent
• Mental health services: 52 percent vs. 87 percent
• Pharmacy services: 82 percent vs. 97 percent
• Dental services: 54 percent vs. 88 percent
• Podiatry services: 74 percent vs. 93 percent
• Therapeutic services: 69 percent vs. 99 percent
• Dementia care (as part of a unit within a larger facility): 12 percent vs. 15 percent
• Dementia care (as a stand-alone facility): 10 percent vs. 0.4 percent
• Hospice services: 62 percent vs. 80 percent

Other Kinds of Services

Beyond care-based assistance, senior living facilities also usually provide a nice variety of other support services. They are all intended to help seniors minimize their daily responsibilities while maximizing their sense of well-being. In fact, assisted living facilities and nursing homes often share a lot of similarities in this regard. For example, both options usually provide:

• Regular, nutritious meals
• Laundry service
• Housekeeping services
• Local-area transportation
• Opportunities for social interaction

The main difference is that assisted living facilities generally offer many more recreational activities and local excursions. As an assisted living resident, you may get more chances to take classes related to art, exercise, or other fun areas of interest. Or if you have existing hobbies, you may get to use on-site facilities that allow you to keep pursuing them.

Primary Caregivers

In both assisted living facilities and nursing homes, most full-time employees are nurse aides or assistants. The difference is that nursing homes are much more likely to employ skilled nurses such as registered nurses (RNs) or licensed practical or vocational nurses (LPNs or LVNs). In fact, CDC says that about 99 percent of all nursing homes in the U.S. employed at least one registered nurse in 2014 (compared to about 40 percent of assisted living facilities). To get a better sense of the makeup of caregiving staff, look at the following comparisons based on CDC estimates from the same year.

In assisted living facilities:

• 82 percent of full-time employees were aides (compared to 64 percent in nursing homes).
• 11 percent of full-time employees were LPNs or LPNs (compared to 22 percent in nursing homes).
• 6.5 percent of full-time employees were RNs (compared to 12 percent in nursing homes).

Cost and Payment Methods

According to Genworth, in 2016, the national median cost was $6,844 per month for a shared room in a nursing home (vs. assisted living costs of $3,628 per month). For a private room in a nursing home, the cost was $7,698 per month. So, although costs vary from facility to facility, assisted living usually costs quite a bit less than nursing home care.

But looking at cost alone doesn't provide the full picture. That's because how you pay for services may play a larger role in determining your options. For example, many seniors rely on Medicare and Medicaid, but those government programs don't always provide the necessary coverage.

When it comes to assisted living:

• Most residents (or families) pay out of their own pockets.
• Some people are covered through private long-term care insurance.
• Many former military members (and/or their spouses) are able to pay using veterans benefits.
• Some states provide Medicaid coverage if you meet certain eligibility criteria.

When it comes to nursing home care:

• Most residents, if they are eligible, pay for it with Medicaid.
• Some people pay for it out of pocket or with private long-term care insurance.
• Under certain conditions, some patients receive temporary coverage through Medicare.

Medicare Part A, which is a federal government program, will temporarily cover the costs of care in a skilled nursing facility (SNF) under specific conditions. Medicare.gov says that, in order to qualify, a patient must have spent at least three days in the hospital prior to his or her stay in an SNF. Medicare will then fully cover the costs of care for the first 20 days in the SNF. After that, Medicare will continue to pay a portion of the costs for up to a total of 100 days. (During that time, a patient will need to pay a copay of over $160 per day.) When Medicare coverage runs out, the patient must cover all costs of care in the SNF.

In contrast, Medicaid is often used to pay for extended stays in nursing homes (and, less commonly, in assisted living facilities). Medicaid is a joint program of the federal government and individual state governments. Each state gets to set its own eligibility criteria for Medicaid benefits. As a result, the rules about long-term care coverage vary from state to state.

In general, however, a long-term care resident can often qualify for Medicaid coverage if he or she meets a few basic conditions. First, the long-term care facility must be licensed by the state and accept Medicaid payments. Second, the resident must have proof from his or her doctor that the long-term care is medically necessary. Finally, the resident may have to prove that his or her income and financial assets fall below a specific state-mandated threshold.

In 2014, about 95 percent of nursing homes were certified or authorized to participate in Medicaid (compared to about 47 percent of assisted living facilities), according to CDC. As a result, about 63 percent of all nursing home residents in the U.S. used Medicaid to help pay for their care (compared to about 15 percent of assisted living residents).