Senior citizens have many options from which to select when looking for senior living facilities. From the available options, assisted living facilities and nursing homes are the most popular. Some people believe the two to be similar, but there is a visible difference in the types of senior living facility when it comes to activities, types of services, living accommodations, staff, and payment options. Before selecting a suitable option for your loved one, you should understand the key differences between assisted living facilities and nursing homes.
In this article, we provide a detailed comparison of assisted living facilities and nursing homes.
Assisted Living vs Nursing Home: Overview
Nursing homes are facilities where elderly people can live when they require full-time nursing care (24 hours) that they cannot get at home or at any other senior living facility. Nursing homes are the next level down from hospitals.
Most of the residents in nursing homes have substantial difficulties with Activities of Daily Living (ADLs); therefore, they need help with the majority of ADLs. This is the reason nursing homes house senior citizens who have serious health issues. A general physician’s order is compulsory before patient admission to nursing homes. Each state is responsible for controlling and licensing nursing homes to provide care for the elderly. Only registered or licensed nurses may provide assistance in nursing homes.
On the other hand, assisted living facilities usually cater to relatively independent senior citizens who are generally healthy, but require a hand with a few routine tasks. Assisted living facilities fall between self-governing independent living communities that accommodate active seniors, and the nursing homes that offer medical care 24/7. The care provided in assisted living is somewhere between the care provided in a nursing home and that provided in an independent living community. Additionally, inhabitants of assisted living communities consider the services offered to be wellness-promoting surroundings that endorse individuality and high-quality life in senior years.
Assisted Living vs Nursing Home: Services
Residents of assisted living receive help with daily tasks, including:
- Bathing & toileting
- Self-care, such as grooming
- Food preparation and feeding
Some of these facilities have resident nurses or on-site clinics that oversee medical care, such as the administration and management of medication.
Assisted living facilities also assist in other activities, such as grocery shopping, finance management, and transportation. Senior citizens living in such a facility can also get medical services via proper channels, such as going to medical appointments with nurses.
Beyond these ADLs, senior citizens can take part in community-based activities. Examples of these activities may include:
- City tours
- Shopping trips
- Movie nights
- Fitness or exercise classes
- Dancing sessions
- Yoga classes
- Book clubs
- Social events
- Religious gatherings
Usually, assisted living facilities feature public areas where residents can socialize and communicate with each other. Some of these facilities are pet-friendly, whereas pets are not allowed in nursing homes.
Even though assisted living facilities do not have licenses to provide medical services, nowadays, some have specialized centers, such as memory care units, where they assist elderly inhabitants who have memory deficits.
Some assisted living facilities even make it possible for senior citizens to age in place by offering retirement services in retirement communities. These aim to help the elderly with their ever-changing needs throughout retirement.
Staff members who work in assisted living facilities also try to offer life enrichment to fulfill the physical, emotional, and spiritual needs of senior citizens. They make sure that the elderly community members are content and happy with their lives.
In comparison to an assisted living facility, a nursing home operates very differently. A nursing home includes not only personal care services, but also medical treatments. Most of the residents in nursing homes come directly from the hospital where they were being treated for a disease, or having surgery.
Staff at nursing homes can provide care for various cases, such as seniors who have broken hips or bones because of a fall, or people who are recovering from a major disease and depend on wheelchairs or walkers for mobility. Senior citizens in nursing homes can also receive physical, speech, and occupational therapy sessions.
A few nursing homes include a special care unit for the elderly, such as memory units for people with Dementia or Alzheimer’s disease, similar to the memory care services provided by assisted living facilities.
Here are a few reasons why senior citizens may stay in nursing homes:
- Wound care
- Nutrition management
- Respiratory treatment
- Intravenous medication administration
Unlike in assisted living facilities, fun activities and excursions are not provided in nursing homes. Inhabitants in nursing homes are usually physically or cognitively unable to participate in such activities.
Additionally, nursing homes offer less freedom to residents, as compared to assisted living. This is because of safety and security concerns. The senior citizens in nursing homes are more confined to their quarters, and kept under the supervision of skilled nurses or staff members.
Nursing Home vs. Assisted Living: Activities
Nursing homes are organized around medical care and treatment, while assisted living facilities usually offer social and community-based activities for residents. Nursing homes are focused on the medical health of residents, while assisted living facilities not only focus on medical care, but also promote emotional and mental well-being through activities.
Assisted living facilities may offer group outings, social gatherings, mental exercises, physical exercises and dance classes, playing cards or other games, and book clubs, among others. Some exclusive, high-end assisted living facilities even go further, by hiring coordinators who handle age-appropriate events for residents. Their job is to entertain senior citizens in a way that actively engages them in their interests and hobbies.
Participation in activities is voluntary. However, staff members usually try to encourage all residents to engage in activities, as participation helps with issues like loneliness and isolation, which can contribute to depression, anxiety, and a myriad of other ailments.
Assisted Living Facilities vs Nursing Homes: Admittance Requirements
A suitable candidate for an assisted living facility is an individual who can handle their daily activities on a moderate level, and requires little to moderate assistance with ADLs. The goal of assisted living is to assist retirees with support and care, while maintaining their independence and privacy.
Assisted living facilities do not admit people under fifty-five years of age; the focus is on caring for the elderly population. Research has revealed that there are more women than men in assisted living facilities, as women tend to outlive men of the same age.
Some elderly people living in assisted living communities may be suffering from memory disorders, such as dementia or Alzheimer's disease. However, this is not a requirement for admittance to an assisted living facility. Any of your loved ones are welcome, even if they only need minimal assistance with ADLs or with medication.
Nursing homes, on the other hand, are specifically designed for those who need full-time medical assistance. The requirements for admission to a nursing home are injury, severe illness, or a medical health condition that causes a person to be bedridden and incapable of handling things alone. Therefore, a suitable candidate for a nursing home is a senior who requires 24/7 care and supervision by trained medical staff. There is no age limit when it comes to admission to a nursing home. People of any age can receive admission to a nursing home, as these facilities aim to provide medical services to anyone. However, most inhabitants of nursing homes are senior citizens.
Assisted Living Compared to Nursing Homes: Accommodations and Facilities
Both nursing homes and assisted living facilities offer the elderly a secure environment. Nursing homes often provide shared bedrooms, which limit privacy. These rooms are structured similarly to shared hospital rooms. On the other hand, assisted living facilities usually provide an independent living space, such as a residential apartment, where senior citizens can live alone. Upon their arrival to an assisted living facility, seniors can choose the living quarters or rooms that suit them best. Seniors can choose between a studio apartment with a single bed, or shared apartment.
Assisted living facilities are similar to HOSTELS for senior citizens. Seniors can choose their favorite type of room, and can bring pets and other possessions.
Senior couples can also stay together in an assisted living facility. As the residents are given independence in their living choices, they can decorate or change the furnishing of their new living space according to their wishes, and make it feel like home. Their rooms have bathrooms and kitchen facilities. Emergency medical help is also available 24/7 in an assisted living facility.
There are many different types of assisted living homes. Large assisted living homes look similar to retirement communities in that they usually have rooms or full apartments for their residents. There’s then a common dining hall as well as living and recreational areas. Many large assisted living centers have outdoor recreational areas as well. These larger assisted living facilities provide seniors with more privacy when they need it. Caregivers will come by during the day as scheduled, and there is always assistance close by should the resident need it.
There are also small, private assisted living facilities, often referred to as board and care facilities. These facilities are located in small residential units, usually with less than 10 residents. The caregivers live on site, and seniors either have their own bedroom or share with one other person. These facilities also have rooms you would find in a traditional home, such as a kitchen, living room, and dining room, but usually with modifications for seniors with mobility issues. Although they don’t provide as much privacy as a larger assisted living facility, these units, which are also referred to adult foster care homes in some states, as well as personal care homes in others, provide a real feeling of living at home. Each resident gets as much independence as they need, while still having a personalized care plan available to them if they need it. These houses are usually conveniently located in residential areas, and are designed to be cozy and comfortable. This is in contrast to larger assisted living facilities, which sometimes can feel a bit cold or impersonal.
Nursing home facilities are similar to larger assisted living facilities in that they have common dining and living spaces, but typically each resident has just a room instead of a full apartment unit. These rooms do provide some privacy, but because of patient’s medical needs, they are a bit more open so that doctors and nurses can monitor them as needed. Despite this, nursing homes allow their residents to personalize their spaces and make them as comfortable as possible for residents.
Nursing homes offer all kinds of medical support, such as skilled nurses, trained medical staff, and medical equipment to help residents in case of emergency. As mentioned, there are fewer activities related to social or community-based events, and so the facilities are not designed for activities. In an assisted living facility, on the other hand, there are spaces for gardening, book reading, and socializing. There are expansive dining halls where seniors can have their meals while socializing with their peers.
Nursing Homes vs Assisted Living Facilities: Staff
There are certified and licensed staff members in both assisted living and nursing homes. In assisted living facilities, certified caregivers look after the seniors, while in nursing homes, skilled nurses are always there to help with medical emergencies. Other personnel in an assisted living facility may include directors, administrators, housekeepers, admission coordinators, dining staff, nurses, aides, and volunteers.
In nursing homes, the staff teams up closely with doctors, nurses, and other medical professionals, like dieticians, physical therapists, and licensed nursing assistants. They all aim to provide regular medical help to the residents. There are services around the clock for residents in a nursing home, provided by these professionals. Other staff members in a nursing home may include custodians, maintenance crew, helpers, maids, and groundskeepers.
As the level of medical care in a nursing home is greater than that in assisted living, physicians and nurses in nursing homes make regular rounds to ensure the residents are in good health. Nursing homes also provide visiting pharmacists, who pay monthly visits to ensure proper medication practices.
Assisted Living vs Nursing Home: Stay Duration
With the extensive services provided by assisted living, residents may end up staying for years in these facilities. Some communities make it easy for residents to receive continued care services as they age, so that they can spend the rest of their lives there. These communities are a combination of assisted living, independent living, and even nursing homes, and are thus called continuing care retirement communities.
People who live in nursing homes typically do not stay there for more than a year, as medical care is the purpose of staying there. As soon as residents’ conditions improve, they transition back home, or one of the other senior living options. A longer stay is not the norm in a nursing home; however, residents with severe medical conditions requiring full-time, life-long care to stay there for a longer period.
Assisted Living Communities vs Nursing Homes: Social Life
Socialization is an important part of everyone’s life, but it is particularly essential for elderly or senior citizens. As people age, they need extra love and companionship. Assisted living facilities provide opportunities for socialization by organizing outings to shopping malls, parks, museums, and other attractions. They also offer transportation services, which enable residents to go to the doctor, go grocery shopping, and run other errands. Assisted living homes offer a variety of activities and social opportunities for their residents to help keep them occupied in retirement. Staying social is great for both physical and mental health, so residents are usually encouraged to participate in at least one of the many activities that are available. There are many regular clubs and activities that happen on site, focusing on specific hobbies, sports, or interests, and assisted living homes may take their residents off-site to enjoy appropriate community events. Additionally, they may bring in movies and live performances for their residents. Family and friends can visit as desired, depending on the individual senior’s health and ability level. Some facilities allow more independence, so seniors can leave to visit others or have others visit them very easily. Others have stricter security policies that require advance notice or planning. This is usually dependent on what the senior needs help with or feels comfortable with. In assisted living, there is a focus on the senior making their own decisions when they are able to. Residents of assisted facilities often engage in social gatherings, like book clubs, organized events, and group meals. Some facilities may even offer yoga and exercise classes for residents to maintain their good health.
Alternatively, inhabitants of nursing homes usually stay inside their rooms, unless they need medical assistance. Since residents of nursing homes are not particularly active, nursing homes do not offer the same types of activities as assisted living facilities. However, nursing homes do offer activities designed to improve physical well-being, such as exercise and therapy sessions. In nursing homes, every effort is made to keep seniors occupied and comfortable, but there is less freedom and fewer choices when it comes to daily activities. This is for the safety of the residents there. However, there are still plenty of things to do that are available there to keep residents entertained. Usually if a senior has a hobby that they still enjoy from earlier in life, staff will make an effort to help them continue to enjoy it. There are some opportunities for socialization, but these are more limited than at an assisted living facility to prevent seniors from getting overwhelmed. Seniors can have family and friends come visit them as approved by the facility staff. They can also leave to visit family if they are able, but this has to be approved by the medical staff.
Assisted Living versus Nursing Home: Cost and Expenses
A cost comparison of nursing homes and assisted living indicates that nursing homes are much more expensive than assisted living facilities. According to last year's survey, the average cost for a stay in a nursing home was more than $7,440 per month for a shared room; the cost is nearly $1000 more for a private room. On the other hand, assisted living services cost approximately $4000 each month nationwide.
There is a huge difference in expenses between these senior living options. This is because nursing homes offer extensive medical care, which is costly – employing medical staff, such as doctors, nurses, physicians, pharmacists, physiotherapists, and medical helpers, is expensive.
However, the cost of nursing homes is still less than that of hospitals. So, nursing homes are still sometimes a cost-effective solution for patients with severe injuries, acute illnesses, and post-surgery care needs. These patients will be in a hospital-like environment that can provide care for many special needs.
Nursing homes usually use building models similar to hospitals. There is typically an option of paying daily for semi-private or private rooms, just like in hospitals. If the resident requires additional services or supplies, these will cost extra.
Now, let's examine assisted living expenses in detail. Most of these facilities use an all-inclusive cost method. For example, a resident will receive a single bill per month, covering rent, meals, housekeeping, transportation, medical services, recreational activities, and any other services used that month.
Tiered pricing is also an available option in assisted living facilities, in which residents pay according to their needs. For example, someone who needs no additional help beyond recreation and entertainment services will pay less than someone who requires a high level of assistance with ADLs.
There are a few assisted living facilities that disregard the aforementioned billing methods and use a flat billing rate per month. So, the residents of these facilities will pay for basic services at a fixed price, and can enjoy other services at an additional cost.
Assisted Living and Nursing Homes: Payment Methods
In most cases, Medicare and Medicaid do not cover the expenses of assisted living facilities. However, many states have started multiple waiver programs to help seniors with low income afford the expenses of senior living facilities.
On the other hand, nursing homes are mostly licensed, and their services are billable to Medicaid, Medicare, and health insurance companies. A resident can also pay with private funds.
To cover the expenses of nursing homes, many people use long-term care insurance programs. The federally-funded Medicare can only pay the bills of people who qualify, based on limited income or assets. Other restrictions on Medicare coverage of nursing home residency include:
- Limited time period
- Medicare-certified nursing homes only
- A licensed doctor must order the necessary medical care
- Nursing home care must follow an in-patient hospital stay of more than 3 days
In contrast, the state-funded Medicaid covers the nursing home expenses of people who qualify only on a financial basis. Qualified people have:
- Limited funds
- Below average income
- Not enough assets or property
To qualify for Medicaid coverage, one must reside in a nursing home that is Medicaid-certified. The requirements to get Medicaid coverage vary from one state to another in terms of paying nursing home expenses. After approval, there is no restriction on the duration of stay or on payments.
Veterans can choose between various services of nursing homes. Options include community-based services, VA-owned facilities, and state veteran’s homes. These options have different eligibility, admission, and payment requirements.
Benefits and Downsides of Assisted Living:
There are many benefits to staying in an assisted living facility for seniors. The biggest benefit is that it offers flexible care options that can be personalized for your unique needs. Seniors are presented with a wide variety of amenities, and work with their caregivers to determine what they need help with throughout the day. Being able to maintain some privacy and independence helps seniors live as full a life as possible and enjoy their favorite activities until later in life, but there’s a very helpful sense of security in knowing that help is available when you need it.
Another benefit of staying in an assisted living facility is that you are in a healthy environment that can actually prevent your conditions from getting worse in many cases. Seniors in an assisted living facility receive healthy food and live in a clean environment. They also receive reminders to take medication regularly and get help exercising and treating chronic pain when necessary. There are opportunities to socialize with others and try new activities, which is very beneficial for mental health. By taking these preventative measures, seniors can confidently live longer, happier lives.
There are a few downsides to assisted living. The biggest downside is that there isn’t medical care on site. This can be inconvenient for seniors struggling with chronic conditions. Many seniors experience a middle ground during their elderly years where they experience chronic physical or mental symptoms and need some assistance, but aren’t quite ready for full-time nursing home care yet. This means that while they are in assisted living, they will still have to travel offsite to see their doctor, which can be stressful.
The other downside to assisted living is that residents are living away from their families. This can be difficult if they lived with their families before or spent lots of time with them. Because seniors in an assisted living home have more independence and are healthier than seniors in a nursing home, they are more likely to be aware of this, and it can make the adjustment process difficult. To make this transition easier, be sure to take time to visit your loved one in their assisted living home during the moving process.
Benefits and Downsides of a Nursing Home:
For seniors who are struggling with chronic health conditions, a nursing home is the best way to get 24/7 care. The biggest benefit of nursing homes is that medical staff are available to help manage problems whenever they occur, which prevents medical conditions from getting worse and helps seniors live longer. This means that seniors and their families won’t have to worry about finding care in an emergency, because trained medical staff will be ready to help and solve the problem. Seniors also have access in a nursing home to extensive medical resources, which can reduce pain and keep mental functioning as high as possible.
The safe and secure environment of a nursing home is also very advantageous for seniors with disabilities. Nursing homes near you will typically be very well-lit, and they have accessible showers and elevators for seniors using mobility devices. While many assisted living homes also have these features, there is an extra focus on them in nursing homes, where a higher percentage of the population needs disability assistance. This can give you the peace of mind you need when transitioning into a nursing home, or if you have a loved one that is making this big move.
The biggest downside of living in a nursing home is that there isn’t as much privacy or independence as you would have in an assisted living home nearby, or if you were living on your own. This can be frustrating for seniors at times, particularly if they are feeling homesick or craving somewhere cozier and more intimate. When choosing a nursing home, look for somewhere that makes an effort to create a comfortable, cozy atmosphere. This will mitigate some of this problem and help your senior feel more comfortable. Another downside to living in a nursing home is that it isn’t as social as living in an assisted living facility. It’s important for seniors to have social interaction throughout the day for their mental health and happiness. Taking time to visit your loved one while they are in a nursing home can help them feel better and more comfortable.
Should you choose assisted living or nursing home?
Senior citizens are assets of society, as they have contributed their entire lives to improve our society. There are many senior living options, such as assisted living, in-home care, nursing homes, retirement communities, retirement homes, and many more. The most common among all the senior living options are assisted living facilities and nursing homes. Knowing the difference between these two options is crucial when it comes to choosing a suitable home for your loved one.
In this comprehensive article, we have provided a detailed comparison of assisted living facilities and nursing homes, in terms of their services, costs, facilities, staff, accommodation options, payment methods, and duration of stay. Now, it is your responsibility to examine both options and determine the appropriate one for your senior.
If you are still unsure and cannot choose between assisted living facilities and nursing homes, then search for top assisted living facilities near you or nursing homes near you. We recommend visiting our website and looking at the current best options in senior living.
We recommend spending time visiting potential senior living options. Talk with the management, directors, staff members, and the residents about the facility. This will give you a clearer picture, and make it easier to decide which senior living option is better for your loved one.
About the Author:
"Assisted Living vs Nursing Home - Comprehensive Guide" is authored by Anisha Rao, MPP, Healthcare Consultant, Certified Lean Six Sigma Green Belt Healthcare Professional. Anisha holds a Master of Public Policy from the University of Maryland, Baltimore County, as well as a Bachelor of Arts in Health Administration and Public Policy, a Bachelor of Arts in Psychology, and a Minor in Management of Aging Services. Anisha has extensive experience in Healthcare Services and Aging issues, including dementia care, senior health, and nursing home care. Anisha is passionate about ensuring seniors receive the best care possible and empowering seniors to become more involved in their care planning decisions.