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. These scenarios are common: Overall, 70% of people currently age 65 or older will need some kind of long-term care, according to the federal government.

Assisted living facilities and nursing homes, also widely known as skilled nursing home care, are two of the most common types of facilities for long-term care. Assisted living is for individuals who need help with some of the daily activities of living, such as cooking, medication management and housekeeping.

Skilled nursing home care, on the other hand, is for seniors who require a higher level of medical attention, often because they have a serious medical condition, such as dementia or Parkinson’s.

A skilled nursing care facility can provide an array of medical services, including:

— A feeding tube.

— Respiratory therapy or ventilator care.

— Wound care.

— Pharmaceutical, lab and radiological services.

— Intravenous medications.

How do you determine 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 interchangeably, without understanding that these types of facilities differ in many ways.

The main difference, other than cost, is in the level of care each can provide, says Roxanne Sorensen, owner of Elder Care Solutions of WNY in Buffalo, New York, a case management consultancy. She’s also an aging life care specialist, which is a “health and human services specialist who helps families who are caring for older relatives,” according to the Aging Life Care Association.

Assisted living is for people who need some help with daily care, but not as much as what nursing homes offer. It’s for individuals who can still take care of themselves, but could use a hand with daily nonmedical needs and activities such as:

— Bathing or showering.

— Cooking.

— Day-to-day housekeeping duties and chores.

— Laundry.

— Medication management.

— Transportation to medical appointments or stores.

Some assisted living residents have their own apartments, while others share a room. Residents typically have access to common areas like the dining room, gym and community rooms.

Most offer three meals a day for those who prefer not to cook, 24-hour supervision, security and housekeeping services. They also typically provide opportunities for socializing and recreational activities with other residents. Many assisted living communities even allow pets.

What Is a Nursing Home?

Nursing homes are also known as skilled nursing facilities. As that name implies, they’re able to offer a higher level of daily care, especially medical care that assisted living facilities aren’t equipped to handle.

Nursing homes would be more appropriate for seniors who need round-the-clock medical care for conditions such as dementia or the effects of a major stroke.

Along with the same kind of help with daily living activities that assisted living communities provide, a nursing home can offer:

— Skilled nursing care. This would include medically-necessary care that an only be provided by skilled or licensed medical personnel. Examples include: intravenous injections, wound care and catheter care.

— Rehabilitation services, such as physical, occupational and speech therapy. These services are needed by people who’ve suffered a stroke, broken bones or had a traumatic brain injury; and individuals who have undergone back surgery, open-heart surgery or had a hip or knee replacement.

— Aid getting dressed, or moving 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.

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.

One crucial difference is in payment options. It’s important to sort out what Medicare and Medicaid will pay for regarding assisted living versus nursing home care.

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

What Does Medicare Cover?

Medicare is a federal health insurance program for people age 65 and older, certain younger individuals with disabilities and people with end-stage renal disease. No version of Medicare, such as Medicare Advantage and Medigap, pays for assisted living.

To pay for assisted living, you can purchase a long-term care policy through a private insurance company.

The majority of long-term care insurance policies allow you to use them to pay for:

— Adult day care.

— Assisted living.

— Hospice care.

Memory care.

— Nursing home care.

Many people purchase long-term care insurance between their mid-50 and mid-60s. Insurance companies typically screen individuals for eligibility. Each policy has its own eligibility criteria, Sorensen says.

“There are policies that require a full medical exam and may even want to review your medical records,” she says. “Other policies may only do a phone interview and do a prescription check to see what medications the person is taking.”

Some insurers may check with the Medical Information Bureau — which maintains a database of medical and nonmedical information (such as dangerous hobbies) that its members use in to try to mitigate risk and lower costs. Such a check may show if you’ve been turned down for any other policies.

Conditions that may preclude someone from being eligible for a policy include:

— Oxygen therapy use.

— Wheelchair dependency.

— Knee or hip replacements.

— Use of a cane.

— Alzheimer’s disease.

Average annual premiums could range from $1,700 for single man who’s 55, to $3,100 for a 65-year-old single woman with health issues, according to the AARP. Couples who purchase this kind of insurance pay less per individual.

The original Medicare plan doesn’t pay for most nursing home care. It does provide limited coverage for medically necessary skilled care at a nursing home, or in your home. It also provides coverage for short-term skilled care for an injury or illness, under certain conditions.

Some nursing homes have contracts with Medicare Advantage or other Medicare plans. Ask your plan about nursing home coverage.

What Does Medicaid Cover?

Medicaid is a federal program, funded jointly by states and the federal government, that provides health coverage to nearly 77 million people, including:

— Low income adults.

— Children.

— Pregnant women.

— Elderly adults.

— People with disabilities.

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 with the firm Cozen O’Connor. He’s a past president of the National Academy of Elder Law Attorneys.

Medicaid, on the other hand, 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. “With costs continuing to escalate year after year, it is crucial to have a plan in place to meet your long-term care needs.”

COVID-19 Protocols

Whether you or your loved one is considering a assisted living or a skilled nursing home, it’s a good idea to learn about the facility’s protocols for protecting residents, staff and visitors.

Whether its assisted living or a nursing home, it’s important that the facility adhere to COVID-19 guidelines from the Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services and local health departments.

Ask if the facility offers COVID-19 vaccines for residents and staff. Also, inquire as to when and how updates about changes in COVID-19 procedures and policies are shared with residents and their families. Good communication is important.

Other Options

When it comes to long-term care facilities, the National Institute on Aging 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, these are small homes of 20 or fewer residents living in shared or private 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 assistance needed, the higher level of care — and cost — is required. Most assisted living facilities automatically include some activities of daily living in their basic plan, then charge more for others, like laundry or medication management.

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.

“Choosing between types of care is difficult,” he says. “Don’t bear the burden yourself. Consider that hospital clinicians and discharge planners often are unfamiliar with the different services and target populations of assisted living communities and nursing homes.”

Cirillo suggests enlisting a geriatric physician and a geriatric care manager to help you navigate through the different long-term care choices. “The lines are hazy. You often find residents in assisted living that should be in a nursing home and vice-versa. If Mom and Dad need more than custodial care and require a nurse more times than not, use that as a benchmark to consider a nursing home.”

More from U.S. News

11 Red Flags to Look for When Choosing a Nursing Home

24 Gift Ideas for Nursing Home Residents

8 Early Signs of Dementia

Nursing Homes vs. Assisted Living originally appeared on

Update 02/08/22: This story was published at an earlier date and has been updated with new information.

More from WTOP

Log in to your WTOP account for notifications and alerts customized for you.

Sign up