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Assisted Living or Nursing Home?

Mitchell Hollingsworth Assisted Living

This week is National Assisted Living Week. This annual observance encourages communities to celebrate individuals living in assisted living facilities and help to educate the public about long term care. A question we often hear from families inquiring about long term care is a very common one. Does my loved one need an assisted living or nursing home? To answer that question, we need to know more information. Are you choosing long term care because your loved one can no longer take care of their property? Are they having difficulties cooking, cleaning, doing laundry? Did this decision come because children and support family live out of town and cannot help out or cannot afford sitters during the work day? Did the individual simply have a decline in self-care and now has difficulties with ambulating, transferring, and medication management? While you might have heard that an assisted living and a nursing home are very similar, here is what you need to know to understand their differences.

Assisted Living

An assisted living is not a nursing home with fancy furniture. Assisted living facilities offer a housing alternative for older adults who need help with dressing, bathing, eating, toileting, but do not require intensive medical and nursing care provided in nursing homes. Residents usually have their own room or small apartment. Some facilities offer meals, recreational activities, housekeeping, and laundry services. They are not licensed to give medical care. The primary focus is on providing a healthy social environment and preventing social isolation. It takes away the burden of caring for a home, a yard, and other day to day responsibilities. Assisted living facilities can also partner with home health and hospice services to receive nursing care, but it is usually only once a week at minimum. Depending on the facility, costs can run between $25,000- $50,000 a year or $2,000-$5,000 a month. Fees typically pay for the facility and some services. It is important to find out which services are additional costs. Most residents pay for assisted living with their own personal funds or with a long term care insurance policy. There are also causes for eviction in an assisted living. Some of these might include failure of a resident to pay, failure to comply with law, failure to follow facility policy, if the facility determines they can no longer care for changing needs (not being able to get out of bed, not being able to understand and correctly take medications), or if the facility changes its purpose. If your parent or loved one is in fragile health and seems to be steadily declining physically or mentally, be very cautious about choosing an assisted living over a nursing home (also called a skilled nursing facility). No one typically chooses a nursing home first, although the skilled care they deliver is often what is most needed. Assisted living facilities can be wonderful and supportive environments for residents who do not need skilled care.

Nursing Home

Nursing homes are more like hospitals in that they deliver skilled care to frail seniors. They do not have the look and feel of the hospital, but the care provided comes from licensed professionals such a CNA’s, LPN’s, RN’s, MD’s, and physical, occupational, and speech therapists. Nursing home services offer room and board, monitoring of medications, personal care (dressing, bathing, toileting, feeding), assistance with getting around (walker, wheelchair), 24- hour emergency care, social and recreation activities, and so much more. A licensed physician supervises each person’s care and a nurse or other medical professional is always on the premises. Having so many available certified professionals on-site allows the delivery of medical procedures and therapies that would not be possible in other housing. Nursing homes can also partner with hospice services to receive extra individualized end of life care when needed. Nursing homes can be very expensive. Costs can start at $50,000 a year or $4,000- 7,000 a month. About 1/3 of residents pay nursing home costs from their own private funds, while others may have long term care insurance. Most residents, however, pay for their care with money through Medicaid. Medicaid picks up the cost of nursing homes once people have used almost all of their savings. If the resident is married, the spouse is allowed some assets including income, savings, and their home. If your loved one needs to be watched more closely throughout the day or you believe that he or she is likely to need such supervision in the near future as well as assistance with their medication now or in the near future, it is your only and BEST choice. Nurses give hands-on 24 hours a day care, administer around the clock medications, consistently treat wounds, administer oxygen, or other tasks defined by the government as skilled care. Because skilled nursing facilities bill Medicare and/or Medicaid for skilled nursing care, they must comply with many complex legal regulations and requirements.


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