Nursing Homes vs. Assisted Living

The time may come when your elderly mother, father or other loved one cannot fully care for himself or herself. The adult children may not have the time or resources to ensure their relative’s health and safety. At that point, it may be time for him or her to move into a residential facility that can provide the care and services needed.

But what type of facility is the best fit? According to the National Institute on Aging, long-term care residences include:

— Assisted living facilities.

Nursing homes.

— Board and care homes.

— Continuing care retirement communities.

What are the main differences among these options? That’s worth knowing well before the time comes to make a decision.

[READ: Assisted Living Checklist.]

What Is Assisted Living?

Many people use the terms assisted living and nursing home without understanding that those types of facilities are different in many ways. One crucial difference is in how to pay for them. Some assisted living facilities do not accept Medicaid and are private-pay only, says Howard S. Krooks, an elder law attorney practicing in Florida and New York and past president of the National Academy of Elder Law Attorneys. Medicaid does cover nursing home care as states are required to do so under federal law. That is often the only way some can cover the cost.

“It is so prohibitively expensive” to live in a nursing home, Krooks says. “I have found over the last 10 to 20 years that fewer people are able to afford that level of care,” which can cost up to $11,000 a month in Florida and $16,000 a month in New York.

The main difference, other than cost, is in the level of care each can provide. Assisted living, the NIA says, is for those who require some help with daily care, but not as much as what a nursing home can offer. According to, these facilities are for those who can, for the most part, still take care of themselves but could use a hand with daily activities such as:

— Housecleaning.

— Household chores.

— Laundry.

— Cooking.

— Bathing or showering.

— Medication management.

— Transportation to medical appointments or stores.

The resident can take advantage of any or all of the services offered and pay for the level of care they are receive. The more care, the higher the cost.

Assisted living residents typically have their own private apartments and share common areas like the dining room, gym and community rooms. Most offer three meals a day for those who don’t want to cook, 24-hour supervision and security and opportunities for socializing and recreational with other residents. Many assisted living communities even allow pets.

[Read: Questions to Ask on a Nursing Home Visit]

What Is a Nursing Home?

Nursing homes, explains, are also known as skilled nursing facilities. As that name implies, they are able to offer a higher level of daily care, especially medical care that assisted living facilities are not equipped to handle. Along with the same help for daily living that assisted living communities provide, a nursing home can offer:

— Nursing care.

— Rehabilitation services, such as physical, occupational and speech therapy.

— Aid getting dressed or in and out of bed.

— Frequent or daily medical management for chronic conditions.

Some but not all skilled nursing facilities also offer memory care for patients suffering from Alzheimer’s disease or other forms of dementia.

The NIA says that some people require nursing home care for only a short period, often after being in the hospital, and go home once they recover. But most nursing home residents have physical or mental health conditions that require them to be cared for and supervised for the rest of their lives.

Other Options

The NIA identifies board and care homes and continuing care retirement communities as alternative options.

Board and care homes. Known as residential care facilities or group homes, are small homes of 20 or fewer residents living in private or shared rooms. Like assisted living facilities, these homes can provide personal care and meals, but not nursing or medical care.

Continuing care retirement communities. Sometimes called life care communities, offer different levels of service in one location, such as independent housing, assisted living and a skilled nursing facility all on one campus. Residents can start at one level of care and move into higher care as they require it.

[See: Beyond Bingo: Innovative Activities at Today’s Nursing Homes.]

How Do You Choose?

Elder care professionals can assess the needs of each potential resident using a scale to measure the so-called activities of daily living, which include things like the ability to eat, toilet, maintain personal hygiene and walk. The more ADLs that need assistance, the higher level of care — and cost — is required. Most assisted living facilities automatically include some ADLs in their basic plan, then charge more for other ADLs like laundry or medication management. says that family members can handle some ADLs themselves, like bringing laundry home, to save money.

A mistake many make is not understanding the difference between levels of care, says Anthony Cirillo, a health, aging and caregiving expert and president of The Aging Experience. “Most times, I believe, families will know from a loved one’s physician what level of care they need. When it gets to that level, most often, a skilled nursing facility is needed.”

How to pay for care is another common misunderstanding, Cirillo says: “Unless you have long-term care insurance, assisted living by and large is paid out of pocket. For a skilled nursing facility, if you are hospitalized and discharged to a care facility, Medicare will pay a certain amount for a certain time, then it reverts to the resident. Only when they become destitute can you then consider Medicaid as a payment mechanism. Hand in hand, you need to understand what is available to you. My dad was a veteran so my mom was eligible to receive money toward her care because of that. You need to consult an elder law attorney to work through all this. And it must be an elder care attorney. They know all the nuances.”

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