We expect our loved ones to be able to enjoy their golden years retiring, working on passion projects or getting into new hobbies.
“No one sits around and says, ‘OK, I’m ready for a nursing home.’ It’s normally that broken hip or stroke that comes out of nowhere that throws our life into a black hole,” says Roxanne Sorensen, an aging life care specialist and owner of Elder Care Solutions of WNY, a care management consultancy in Buffalo, New York.
Loved ones are left scrambling to find facilities, figure out how to afford the cost of care without losing all their life savings and then accept what a new version of life looks like, Sorensen adds.
But the unique care needs of your older loved one may not fit neatly into a box, and it can be hard to parse the differences among facilities, including the levels of care provided. Learn about when to consider assisted living versus a nursing home and what the differences are.
[READ: Identifying the Right Time for Senior Care.]
Nursing Homes vs. Assisted Living
Nursing homes and assisted living communities both provide essential care for seniors, but they cater to different levels of need, says Jude Tenorio, RISE program manager at Foundation for Senior Living in Phoenix.
“Nursing homes typically serve individuals with more complex medical conditions who require round-the-clock medical supervision, while assisted living communities focus on providing a more independent lifestyle with support for daily activities like bathing, dressing and medication management,” Tenorio explains.
[READ: When to Move From Assisted Living to a Nursing Home]
Assisted living
Assisted living is a long-term care option for seniors who may need some assistance with:
— Activities of daily living, such as dressing, bathing or grooming
— Cooking
— Day-to-day housekeeping duties and chores
— Laundry
— Social enrichment activities
— Medication management
— Transportation to medical appointments or stores
[READ: Assisted Living Categories and Levels, Explained]
Nursing homes
On the other hand, nursing homes accommodate residents with more advanced care needs.
Nursing care facilities offer:
— A higher level of daily physical care, security and supervision than assisted living
— More staff support than assisted living, especially nurses and nursing assistants
— Increased ability to offer skilled nursing tasks, such as managing wounds, catheters or IV lines
— A mix of care levels, from short-term post-hospital stays to long-term custodial care and skilled nursing needs
Some older adults may just need a short-term stay after a hospital discharge. For example, after having a stroke, some seniors may need a few days of intensive therapy but then are safe to go back to independent living. In these cases, many nursing homes or skilled nursing facilities (SNF) accommodate these short-term skilled nursing stays. Frequently, moves to an SNF occur after a hospital discharge and are recommended by a physician.
Differences Between Assisted Living and Nursing Homes
The differences between assisted living and a nursing home will vary depending on each individual community.
“Even after many years, the lines are hazy. You often find residents in assisted living that should be in a nursing home, and vice versa,” says Anthony Cirillo, a North Carolina-based health, aging and caregiving expert and president of The Aging Experience, a company that provides consulting, keynote speaking and products for the senior living industry and older adults.
Six key differences between assisted living and nursing homes include:
1. Level of medical staff and security
Nursing homes offer a higher level of care, so more nurses, therapists and specialists will be on the premises. Physicians might also round more often than they would at an assisted living community.
2. Cost
Because nursing home residents require more extensive care, the cost of nursing homes is usually higher and can be expensive.
Sorensen says a fee-for-service structure is more common in assisted living facilities, and nursing homes are more often a flat rate. The fee-for-service structure is based on the level of care needs of your loved one. Sorensen adds that if an older adult enters the facility not needing assistance upon admission, but a year later needs assistance with dressing, toileting or bathing, the fee-for-service facilities will now require an additional cost on top of the base rate.
“This can make financial planning complicated, as we can’t predict how our loved one’s care needs are going to increase,” she explains.
According to Genworth Financial’s 2024 Cost of Care survey, average monthly costs in an assisted living facility are $5,900, whereas a private room in a nursing home averages $10,646 per month. Sorensen says in New York state, a nursing home can cost $18,000 a month. She recommends allocating a minimum of half of the individual or couple’s assets for their care when estate planning.
3. Insurance coverage
Medicare, the federal health insurance program primarily for those age 65 and older, will pay for certain types of short-term nursing care, like rehabilitation after a knee replacement. But Medicare does not cover long-term nursing home or assisted living care.
Medicaid, a joint federal and state public health insurance program administered by individual states, covers nursing home care. However, Medicaid coverage for assisted living services varies depending on facility policies and the state residents live in.
4. Social atmosphere
All senior care homes will have some type of social scene. However, as assisted living residents require less direct care than nursing homes, the social atmosphere is often elevated. Activities, such as senior fitness or music classes, are geared toward individuals who are able to move around on their own and communicate.
5. Federal regulations
Nursing homes are subject to more government oversight by both the state and federal governments to ensure quality. The federal Centers for Medicare & Medicaid Services oversees nursing homes. Assisted living communities are subject to state regulations.
“Assisted living is less regulated, so there are fewer data points to check to validate objectively. Skilled nursing, on the other hand, is under a star rating from Medicare,” Cirillo says.
Especially given the volatility in the current market with a new presidential administration, families choosing a high-quality senior living option for their loved one need to be vigilant because the tendency so far is for less regulation overall, he adds.
6. Independence offered to residents
Assisted living communities allow their residents more independence than nursing homes. Because assisted living residents don’t have as many medical conditions, they will have more freedom to leave the facility for community events or to visit with family outside the premises.
Nursing home residents are also allowed to leave, but they may require more assistance and planning to do so.
Similarities Between Nursing Homes and Assisted Living
Despite some differences, there are a few key similarities between assisted living and nursing homes.
Three similarities between nursing homes and assisted living include:
1. Use of the same building
Although a facility may refer to its senior care home as a nursing home, it may offer various levels of care. The facility could have a mix of nursing home care, assisted living or even memory care offered in the same location.
2. Round-the-clock on-site medical staff
Unlike independent senior living communities, nursing homes and assisted living communities each have medical staff on-site at all times.
3. Availability of community areas
Even nursing care facilities with residents who require a lot of care have common areas for them to dine, visit with family or even just to offer a change of scenery. This differs from a hospital, where patients typically cannot access spaces outside their rooms.
Assisted Living vs. Nursing Home: How to Decide
Choosing between a nursing home and assisted living can feel daunting, but you aren’t alone.
Many families honestly don’t know where to start, Sorensen says: “The first assumption is their loved ones need a nursing home because that is the language we know. But that person might only require an assisted living facility.”
Here is an at-a-glance table to guide your decision between an assisted living facility vs. a nursing home.
| Factor | Assisted Living | Nursing Home |
| Entry requirements | Your loved one needs some help with activities of daily living (ADLs) but is mostly independent. Having medical supervision close by is helpful, but your loved one doesn’t need 24/7 oversight. | Your loved one needs up to full assistance with ADLs. This includes if two or more people are required to be able to move, lift or transfer your loved one. “If Mom and Dad require a nurse more times than not, use that as a benchmark to consider a nursing home,” Cirillo advises. |
| Cost | $5,900 per month national median price, according to Genworth Financial | $9,277 national median price for a semi-private room, and $10,646 national median price for a private room |
| Medical and nursing care | Nursing staff assist with medication management. Basic health monitoring, such as daily vital signs, is also provided. | Full-time care for complex or comorbid conditions is offered. This includes administering medications that might be given through an injection or IV line. More frequent condition monitoring is also provided. |
| Ancillary services | Outpatient or contracted therapy, such as speech therapy, occupational therapy or physical therapy. | On-site therapy often includes speech, occupational and physical therapy. Dementia care and palliative care and hospice are also typically offered. |
| Mobility requirements | Most residents move unassisted or use walkers, canes or wheelchairs. | Residents may use walkers, canes or wheelchairs, but some residents may also require hospital beds or Hoyer lifts. |
| Staffing ratios | Lower resident-to-staff ratio due to higher level of independence. | Higher resident-to-staff ratio due to increased care needs. |
Here are a few additional circumstances to keep in mind:
— Changing needs. Do you anticipate your or your loved one’s care needs will change quickly? If that’s the case, you may want to choose a facility that offers both nursing home care and assisted living.
— Provider recommendations. What does your medical provider have to say? A medical provider can perform something called a functional assessment, which helps determine how much care your loved one needs. They’ll also have insight regarding any chronic conditions, like how quickly they see your loved one’s chronic kidney disease progressing.
— Consider local word of mouth. Cirillo says that your neighbors and friends, as well as those you meet in your social clubs or religious activities, may be able to provide the best recommendation.
— Some facilities incorporate both care levels. Although a facility might be marketed as assisted living or as a nursing home, they might have wings for both levels of care. Each building is different, so some might incorporate amenities from both care levels. While nursing homes are more likely to have a Hoyer lift, for example, it doesn’t mean all assisted living communities wouldn’t have one. It’s best to tour and talk to facilities to compare.
— Other options. There are options outside of assisted living and nursing homes that could also work for you. You can consider older adult group homes, for example. Cirillo suggests considering independent living supplemented by home care. In fact, that is how he chose care for his mom, who lived to be 94 years old, when he was her caregiver.
More from U.S. News
Hiring an In-Home Caregiver: What to Consider
What Is Life Like in an Independent Living Community?
Understanding the Differences Between Nursing Homes and Assisted Living originally appeared on usnews.com
Update 03/13/25: This story was previously published at an earlier date and has been updated with new information.
