Here’s a hypothetical but not atypical situation: Walter is an 83-year-old male who enjoys his time in an assisted living community. The staff help him manage his medications, aid him in getting into his wheelchair in the morning, and he takes pride in participating in the social activities there.
After a bout of pneumonia, however, he becomes weaker and never fully regains his strength. He needs more help than just getting out of bed, and he has to start taking several new medications. Realizing his needs exceed what his assisted living facility can provide, Walter and his family make the joint decision to move him to a nursing home.
As Walter’s situation illustrates, there often comes a time when your loved one needs more hands-on, intensive long-term care. Here are some factors influencing the decision-making process of moving a loved one from assisted living to a nursing home.
[READ: Nursing Home Requirements: Who’s Eligible?]
What’s the Difference Between Assisted Living and a Nursing Home?
There are a few key differences between assisted living and nursing homes.
Assisted living is like staying at a hotel with concierge services. With assisted living, older adults have their own space in a shared corridor and have access to help when needed, but they are fairly independent.
In general, assisted living works well when a person can do most things for themselves, adds Dr. Gerda Maissel, a New York City physician certified in physical medicine, rehabilitation and patient advocacy and the president and founder of My MD Advisor, a patient advocacy service.
“For example, a senior who can get from here to there on their own, even if that means using a walker or a scooter. Or they can take their own medications, even if someone has to set up their pills in a weekly pill box,” she explains.
Nursing homes, on the other hand, are like a cozy version of an extended stay at the hospital. The focus shifts from maintaining independence to ensuring that complex medical needs are addressed, and staff provide more hands-on daily care. Residents of a nursing home will have much more contact with nurses and nurse aides than residents of an assisted living community have.
Here are some of the key differences between assisted living and nursing homes:
Signs It’s Time to Move From Assisted Living to a Nursing Home
“Fortunately, many assisted living communities are more able to support individuals aging in place,” says Mallory Grivner, a licensed clinical social worker in Blue Bell, Pennsylvania, and the owner of Thrive Counseling and Wellness, a counseling practice that focuses on senior care needs. “But at times, the need to move is undeniable.”
Here are four signs it might be time to move from assisted living to a nursing home.
1. Needing around-the-clock medical care
If your loved one requires 24/7 care, it may be an indicator that they need more consistent care than assisted living can provide.
Knowing that nursing homes have staffing ratios and infrastructure to allow more hands-on support with emergencies, daily care, mental health and chronic conditions can provide peace of mind to both you and your loved one.
[READ: Mental Health Resources for Seniors]
2. Frequent hospitalizations
Frequent hospitalizations indicate that your loved one’s medical conditions are becoming more complex.
This might be after an illness, injury or surgery when a seniors need short-term nursing home care, also known as subacute rehabilitation, Maissel says. Or, they may need new long-term nursing home care because their health now requires ongoing hands-on care and supervision.
After each hospital discharge, it’s likely that your loved one has new needs, such as:
— Additional medications, such as IV medications or injections
— Nursing interventions, such as monitoring vital signs or blood sugar or providing catheter care
— Therapy, such as physical therapy, occupational therapy or speech therapy
A nursing home level of care will allow your loved one to adequately recover from hospital stays and provide necessary interventions to manage their chronic conditions.
3. Cognitive decline
People who suffer from cognitive impairments often experience a decline in their condition that makes it difficult for them to live safely in an assisted living setting, says Shebna N. Osanmoh I, a psychiatric nurse practitioner at SavantCare in Los Altos, California.
“Most of the time, people suffer from severe cognitive impairments caused by Alzheimer’s disease, dementia or due to other neurodegenerative conditions,” he adds.
Osanmoh I says signs of cognitive decline that may indicate it’s time to move from assisted living to a nursing home include:
— Risky behaviors, such as wandering or forgetting to turn off a faucet
— Increased confusion or disorientation, such as forgetting basic details about themselves like their name or address
— Agitation, such as paranoia or aggressive acts toward staff members or family
— Declining communication abilities, such as trouble expressing emotional or physical needs
Nursing homes provide the type of continuous care needed to support residents who are experiencing cognitive decline. Many also provide memory care, a specific type of care to support those with Alzheimer’s disease and other types of dementia. (Assisted living communities may also have a memory care unit, but the level of care provided is lower than that of nursing home care; more on that below.)
[READ: Dementia Tests: What to Know and How They Work]
4. Requiring full support for activities of daily living
With old age, many seniors become dependent on others for support with their daily activities.
If your loved one can no longer perform multiple activities of daily living (ADLs) without support, it’s time to consider moving from assisted living to a nursing home.
ADLs include:
— Bathing and personal hygiene
— Toileting
— Dressing
— Walking and general mobility
— Eating
Nursing homes accommodate all levels of resident needs and have staff allocated to assist with ADLs.
5. Managing chronic health conditions
As your loved one’s health challenges persist, assisted living may no longer provide them with the level of care they need.
Whether it’s Alzheimer’s disease, dementia, Parkinson’s disease or heart failure, there comes a point where assisted living might not be enough. Facilities specializing in Alzheimer’s memory care or Parkinson’s assisted living can help early on, but advanced stages may require the 24/7 oversight and total care offered in nursing homes.
Here are a few examples that illustrate when a chronic health condition would necessitate moving to a nursing home:
— Advanced Parkinson’s symptoms, such as tremors or freezing episodes, which can make daily mobility challenging, causing frequent falls
— Uncontrolled diabetes, which can lead to frequent infections, requiring intense wound care monitoring and treatment
— End-stage heart failure, which can necessitate weight checks, IV medications and strict fluid monitoring and administration
When chronic health conditions demand attention, nursing homes can provide the higher level of care that your loved one needs.
6. Special dietary requirements
Your loved one may need a special diet to stay safe and healthy. While many assisted living communities are able to accommodate dietary needs and preferences and have multiple dining options, more complex dietary needs may require the resources of a nursing home.
Some of these diets include:
— Tube or enteral feeding diets
— Mechanically altered diets for swallowing difficulties, such as puree or thickened diets, though many assisted living communities may be able to provide these
— Complex diets that require precise control of multiple micro and macro nutrients, such as a renal diet with protein, phosphorus and potassium specifications
When your loved one’s diet is no longer just about nutrition but a part of managing a chronic condition, a nursing home may provide the safest level of care.
7. Need for special medical equipment
It may be time for your loved one to move from assisted living to a nursing home if they need specialized medical equipment and the infrastructure and staff to monitor and use the equipment effectively.
Examples of this kind of medical equipment include:
— Advanced respiratory support supplies, such as tracheostomy supplies
— Hospital-style beds with pressure relief technology for long-term immobility
— Hoyer lifts to transfer residents who cannot transfer without full assistance
Financial Considerations
Grivner says finances are also a major deciding factor in moving from assisted living to nursing homes. Although nursing homes are more expensive, about two-thirds of residents use Medicaid to help cover costs, according to KFF. Many assisted living communities, however, do not accept Medicaid for long-term care. Assisted living is mostly self-pay until finances run out.
The lines between different levels of care of assisted living and nursing homes are not as rigid as one might think, and they are more driven by funding than most people realize, Maissel adds.
“In reality, what I see is that people stay in assisted living as long as possible, often with the support of private aides. When they can no longer afford this, or if they could never afford it, then they go to nursing homes for long-term care through Medicaid,” she explains.
How expensive is assisted living vs. a nursing home? According to Genworth Financial and CareScout’s 2024 Cost of Care survey, assisted living costs a national average of $5,900 per month, while a semi-private nursing home room or private room costs $9,277 and $10,646, respectively.
Consider the finances of your loved one when determining the best senior care option for them.
Explore Top-Rated Nursing Homes With U.S. News & World Report
Moving a loved one to a nursing home can improve their quality of life by providing specialized care and attention. Involve a health care provider in your decision-making process to provide peace of mind, ensure that your loved one’s transition is smooth and that their health needs are adequately met.
To find top-rated nursing homes near you, check out U.S. News & World Report’s Best Nursing Homes. In 2025, U.S. News evaluated more than 15,000 facilities throughout the country and rated most of them in two different areas, short-term rehabilitation and long-term care.
More from U.S. News
Moving a Parent With Dementia to Assisted Living: 12 Tips to Ease the Transition
How to Make the Transition to an Assisted Living Community Easier
Assisted Living vs. Memory Care: The Key Differences
When to Move From Assisted Living to a Nursing Home originally appeared on usnews.com
Update 08/28/25: This story was previously published at an earlier date and has been updated with new information.
