As we age, we often need more help and supervision in our daily lives. This can lead to a need for long-term care facilities such as nursing homes or assisted living facilities. However, it can be difficult to determine which type of long-term care facility is best for you or your loved one.
On the surface, assisted living facilities and nursing homes may seem similar. They're both residential facilities designed to provide long-term care.
However, their similarities stop there. Assisted living facilities and nursing homes provide different services and levels of care for those with varying care needs.
At LTC News, we want to help everyone understand the world of long-term care. We collaborate with experts to offer accurate and up-to-date educational resources.
Understanding the differences between nursing homes and assisted living facilities is crucial when considering long-term care options for yourself or a loved one. This article will explain what each type of facility is and help you determine the best choice for you or your loved one based on your specific needs and preferences.
What Is an Assisted Living Facility?
Assisted living facilities are residential communities for individuals who need long-term care. They're less institutional than traditional long-term care facilities. They cater to those who don't need a substantial amount of help or supervision each day.
These communities provide housing and personalized care, primarily focusing on helping with activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Common ADLs include bathing, eating, transferring, continence, dressing, and toileting. Common IADLs can include but aren't limited to housekeeping, meal prep, and transportation.
These care services help residents focus more on their interests and comfort instead of their care needs, leading to more fulfillment in life.
What Does Housing Look Like in an Assisted Living Facility?
Assisted living facilities offer two primary living arrangements: private apartments or private rooms. These living spaces have amenities like any standard apartment, including bathrooms and kitchens.
Most assisted living facilities allow a spouse who may not need care to live with their partner within the assisted living facility.
Residents are free and encouraged to personalize and furnish their units. The goal is to help their new apartment feel like home. Residents also have full access to on-site amenities outside their apartments, which we'll discuss below.
What Services and Amenities Do Assisted Living Facilities Offer?
Assisted living facilities offer various services that support residents in their daily lives. These services typically revolve around:
Outside of long-term care services, assisted living facilities recognize the importance of quality of life. Many assisted living facilities offer amenities to promote social engagement, relaxation, and convenience.
These amenities can include:
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Communal dining spaces
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Fitness centers with exercise classes
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Libraries
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On-site beauty services
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Gardens or outdoor spaces
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Recreational areas or game rooms
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Access to religious services
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Transportation to outings
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Wi-Fi and cable TV
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Organized events like parties or group trips
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Educational workshops
Many facilities also provide beauty salons and transportation services. Facilities with more luxurious amenities may charge a higher price.
Memory Care Units Within Assisted Living Facilities
Many assisted living facilities also include a memory care wing. This wing caters to those with cognitive impairment, usually those in the beginning stages of Alzheimer’s disease or dementia. These units provide more supervision and are designed with cognitive decline in mind to prevent wandering and confusion among residents.
Services inside memory units in assisted living facilities may include additional services and modifications designed specifically for those with dementia or Alzheimer's disease.
Some key aspects of supervision available in a memory care wing include:
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Specially trained staff. Staff in memory care wings understand the unique challenges and behaviors associated with dementia. They're equipped to provide compassionate and effective care to those in need.
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Enhanced safety measures. Memory care units need to be secure to prevent wandering and ensure each resident's safety. Other safety measures may include secured entrances and exits and monitoring systems.
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Structured environment. Memory care units are easy to navigate. They often have clear signage and a simple layout to reduce confusion and agitation among residents.
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Personalized care plans. Each resident has a care plan tailored to their specific needs, abilities, and preferences. This ensures each person receives the appropriate level of care and support.
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24/7 supervision. Staff are available around the clock to assist residents with daily activities, monitor their well-being, and respond to emergencies.
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Therapeutic activities. Various activities can help stimulate memory and enhance cognitive function. These activities can also help fulfill social needs, which is crucial for individuals with cognitive impairment.
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Regular health assessments. Memory care units perform regular assessments to monitor their resident's memory progression. These assessments help the staff accurately adjust their residents' care plans.
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Support and education for families. Memory care wings often offer resources, support groups, and educational programs for residents' families. This can help families understand dementia and how to support their loved ones best.
Who Are Assisted Living Facilities For?
The National Center for Assisted Living's (NCAL) 2018 study reported 818,000 individuals in assisted living facilities that year. About 94% of these individuals were aged 65 or older.
The same study found that most residents did not need 24/7 skilled nursing care. However, they did find that about 64% of residents needed help with bathing, and about 50% needed help with walking.
Assisted living facilities can be a good option for seniors who need some assistance with their daily lives but do not need the substantial level of institutional care provided by a nursing home.
Here are some examples of the types of people who might live in an assisted living facility:
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An individual who needs hands-on or stand-by assistance with some activities of daily living.
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An individual who is still relatively independent but needs help with cooking and cleaning.
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An individual with mild dementia who is still able to walk and talk but needs supervision and medication management.
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An older couple that is still mostly independent but who wants to live in a community with other people their age and know that help is available if something happens or they fall.
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A spouse of an individual who needs help with ADLs or supervision and wishes to live with them even though they are fully independent.
What Is a Nursing Home?
A nursing home, also known as a skilled nursing facility, is a residential care facility that provides 24-hour medical services, supervision, and help with activities of daily living to older or disabled individuals.
These facilities often support those with significant health care needs or those who cannot care for themselves independently. People often move into nursing homes when they can't get the care they need at other facilities or through other long-term care services.
Staff at a nursing home consists of a dedicated team of professionals, including licensed nurses, therapists, and other healthcare experts. They're responsible for administering medications, performing medical procedures, and offering rehabilitation services.
Nursing homes help residents with personal care tasks, such as bathing, dressing, and eating. Additionally, they offer social activities and amenities to enhance their residents' quality of life. The result is a safe and supportive environment tailored to each person's unique needs.
What Does Housing Look Like at a Nursing Home?
Nursing home residents usually have a choice between private or semi-private rooms. Each room has essentials like a bed, chair, and personal storage. Private rooms are generally more expensive than shared rooms.
Most nursing homes don't provide kitchens within the rooms. Instead, residents may eat in dining halls or receive a meal service provided to their room.
What Services and Amenities Do Nursing Homes Offer?
Nursing homes offer various care services to meet their residents' needs. They focus on providing comprehensive and flexible care for everyone to ensure comfort and a high quality of life.
Services can include but aren't limited to:
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24/7 or round-the-clock nursing care
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Medication management
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Help with activities of daily living
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Physical, occupational, or other therapies
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Wound care
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Chronic condition care management
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Specialized memory care for dementia or Alzheimer's
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Rehabilitation care
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Skilled care
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Supervision
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Meal services
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Transportation
Nursing homes are equipped with various tools and equipment designed to assist staff in providing optimal care for older seniors and individuals with substantial disabilities. Some of the key equipment includes:
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Hospital beds. Each room has an adjustable bed that can be easily raised or lowered, ensuring comfort and safety for residents, particularly those with mobility issues.
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Hoists and lifts. These are mechanical devices used to help lift and transfer residents from one place to another, reducing the risk of injury for both the resident and the caregiver.
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Wheelchairs and walkers. Wheelchairs and walkers can help residents move more freely around the facility. They promote independence while ensuring safety.
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Bathing equipment. Each nursing home has specialized bathtubs and shower chairs designed to make bathing easier and safer for residents with limited mobility.
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Communication devices. These tools include call buttons and intercom systems that enable residents to call for assistance quickly.
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Monitoring systems. These devices track residents' vital signs and alert staff to potential health issues.
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Safety rails and guardrails. These safety measures are all around the facility, particularly in bedrooms and bathrooms, to prevent falls and injuries.
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Pressure relief mattresses. These are specially designed mattresses that help prevent bedsores and provide comfort for residents who spend extended periods in bed.
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Assistive eating devices. These are modified utensils and tools to make eating easier for residents with limited dexterity or strength.
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Physical therapy equipment. These items include exercise balls, resistance bands, and other tools to help maintain or improve residents' physical abilities.
Nursing homes were also designed with the community in mind. Many of these homes offer amenities to encourage residents to interact with others and live life fully. Amenities can include but aren't limited to:
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Recreational spaces for socializing and activities
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On-site beauty services
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Outdoor gardens or courtyards
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Access to religious services
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Transportation to outings
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Wi-Fi and cable TV
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Organized events like parties or group trips
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Exercise classes
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Educational workshops
It's also worth mentioning that nursing homes have a much more institutional feel to them than assisted living facilities. Some amenities may also be limited compared to assisted living facility options.
Who Are Nursing Homes For?
According to the Centers for Medicare & Medicaid Services (CMS), there are approximately 1.4 million nursing home residents in the United States as of 2023. This number has been declining in recent years as more people choose to receive long-term care in their homes or assisted living facilities.
Nursing homes are primarily for individuals who need constant medical attention, round-the-clock skilled nursing, and custodial care that cannot be effectively provided in other long-term care settings or at home.
Individuals often need this care due to frailty from aging, chronic illness, disability, or cognitive decline. Nursing homes offer a higher level of medical supervision and skilled care than other facilities. They're the ideal and, sometimes, the only viable solution for those with acute care needs.
It's also important to note that many people on Medicaid are forced to receive nursing home care because of the limited availability of other facilities or home care options. Often, those with Medicaid receive nursing home care because it is the only type of care Medicaid covers.
RELATED: Finding A Quality Nursing Home
Differences Between Assisted Living Facilities and Nursing Homes
Assisted living facilities and nursing homes have many differences. Not only do they offer different types of long-term care, but they’re also designed to help people with different care needs. Below, we’ll compare and contrast assisted living facilities and nursing homes.
ONE: Nursing Homes and Assisted Living Facilities Offer Different Levels of Long-Term Care
Possibly, the most important distinction between assisted living facilities and nursing homes is the level of care provided.
Assisted living facilities offer basic long-term care services like help with activities of daily living or help with chores. While staff and care are available 24/7, assisted living facilities are not intended to be used as an option for round-the-clock, continuous, long-term care.
Residents in assisted living settings should be able to maintain some level of independence. However, the option to reach out for or arrange help is always there.
In other words, the staff at assisted living facilities are available 24/7, but care is "on demand" instead of continuous. These facilities encourage residents to live as independently as they can while ensuring a quick response if care is ever needed.
This can look a little different for those living in a memory care unit within assisted living facilities. Often, there's more routine supervision than outside of the memory care wing.
On the other hand, nursing homes offer constant and substantial long-term care services, including therapies or skilled care. Residents are assumed to need full-time care in a more institutional or hospital type of environment. Some may need 24/7 skilled services or supervision.
A good way to look at this difference is with an example. At an assisted living facility, the ideal resident would be someone with care needs who can take care of themselves for the most part. However, they may still need care "on demand," like help going to the bathroom or bathing.
At a nursing home, someone may need care because of a chronic condition or disability requiring substantial care or supervision round-the-clock. This individual may be bedridden, at substantial fall risk, or pose a danger to themselves or others due to cognitive decline.
The nursing home has the resources to offer services for this individual 24/7. In contrast, the assisted living facility would not be able to provide the level of care this person needs.
Before an individual moves into an assisted living facility, a head nurse must evaluate their care needs. Assisted living facilities are not intended to provide constant skilled care or substantial supervision.
If the individual needs substantial care, the assisted living facility would not accept them. They may also direct the individual to an appropriate nursing home or other care facility.
TWO: Different Living Arrangements
Assisted living communities and nursing homes are both residential facilities. However, they offer different living arrangements.
Assisted living facilities offer private apartments or private rooms for residents. Most facilities also allow the spouse of a care recipient to move in with their partner, even if they don't need care.
Residents often have a small kitchenette in their room for those who want to or have the ability to cook small meals on their own. Others can dine at the facility with a restaurant-type menu service (although a limited menu may vary daily).
Some facilities have multiple dining room options, and others may even offer a coffee shop within the facility. Most assisted living facilities also provide recreational areas for events, pursuit of interests, or exercise.
Nursing homes offer less privacy. Most residents live in either a shared or private room within the facility. Most of the time, these rooms do not have their own kitchens or living rooms; they're more similar to hospital rooms than apartments.
Nursing homes are required by law to provide residents with three nutritious meals per day, along with snacks. The meals must meet all the dietary needs of the residents. Nursing homes must also have a registered dietitian on staff to develop and supervise the dining program.
Many nursing homes offer a variety of dining options, including:
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Restaurant-style dining. Residents can choose from a daily menu of fresh items.
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Buffet dining. Residents can serve themselves from a buffet of fresh items.
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In-room dining. Residents can have their meals delivered to their rooms.
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Special diets. Nursing homes can accommodate special diets, such as low-sodium, low-fat, or diabetic.
THREE: Nursing Homes Are More Expensive Than Assisted Living Facilities
In general, nursing homes are more expensive than assisted living facilities. This is because nursing homes offer more specialized services. Therefore, they need more highly trained staff members to ensure high-quality care.
Assisted living facilities do not provide the same high-level, continuous care as nursing homes, which means they do not need the same type of staff involved in constant, high-level care.
However, both options can be expensive. In fact, some assisted living facilities with luxurious amenities may cost the same or more than some nursing homes.
Assisted living costs can quickly add up because they charge a "base rate" and add surcharges. The "base rate" is what any assisted living facility resident pays for housing and the basics. The surcharges are based on individual care plans, meaning the overall cost depends on the individual's care needs.
LTC News offers a Cost of Care Calculator to help you research and compare costs in your area. This calculator also allows you to estimate how much care will cost in the future.
RELATED: How Much Does Long-Term Care Cost?
FOUR: Residents Live Vastly Different Lifestyles
Because of the differences in demographics of people at each facility, residents usually lead very different lifestyles.
Assisted living encourages residents to pursue their interests and hobbies as independently as possible. The staff is always available to support residents as needed.
Many facilities offer in-house gyms or activity rooms to accommodate their residents. Buildings may feel more like an apartment complex with amenities than a care facility, which can help residents feel more at home.
On the other hand, nursing homes are mainly concerned with the safety and rehabilitation of residents. Living at a nursing home may feel more institutional than an assisted living facility.
Nursing homes are aware of their residents' disabilities. This is why they try to create catered recreation plans to help their residents pursue their interests and hobbies despite their handicaps.
Activities at a nursing home may focus on socialization, mental stimulation, or supervised physical activity. Staff often monitor residents as they interact to ensure their safety.
FIVE: Individuals Choose These Facilities For Vastly Different Reasons
Many individuals choose or end up in nursing homes and assisted living facilities for different reasons. While both facility types help with long-term care, each facility offers care to varying degrees.
It's also important to note that most long-term care today happens at home. However, there are times when a facility would be desired, better suited, or even required, depending on someone's preferences and their level of care needs.
Many people choose assisted living facilities because they offer socialization and recreational activities. These individuals benefit from ensured safety and the availability of care within these communities.
Assisted living can also act as a good stepping stone for some struggling with a home that's not well-suited to in-home care. Others prefer the social setting assisted living can provide without giving up their independence.
However, nursing homes are a little different. Many people who move into nursing homes may not have any other option for long-term care. They may start receiving care in a nursing home because that is the only facility that can ensure their needs will be met.
Others may move to a nursing home for rehabilitation services, staying for short periods of time instead of as a long-term option. However, some people may require longer terms of rehab, which nursing homes also offer.
While other individuals may suffer from severe cognitive decline or dementia, these families often choose nursing home care for their loved ones. This may be a last resort option when caring for their loved one at home is not enough to meet their needs.
Individuals relying on Medicaid also often receive nursing home care. Many times, Medicaid will only cover nursing home care. This can force those who rely on Medicaid into a nursing home even if they don't technically need that substantial level of care.
RELATED: Factors to Consider When Selecting a Long-Term Care Facility for a Loved One
Recap: What’s the Difference Between Assisted Living Facilities and Nursing Homes?
Choosing a long-term care facility is a personal decision. Whether you're considering options for yourself or a loved one, evaluating care needs, preferences, and budget is essential.
As we discussed, assisted living facilities and nursing homes are both valuable residential resources for long-term care recipients. But this is where their similarities end.
Assisted living facilities specialize in helping those with basic long-term care needs. Individuals who thrive in assisted living environments do so because they don't need constant care. Living arrangements are most similar to apartments, and most residents live a relatively independent lifestyle.
On the other hand, nursing homes are specifically designed for individuals who need constant care and may not have other options. Living arrangements are most similar to hospitals, but residents are encouraged to pursue their interests with supervision or the help of staff members.
If neither option suits your or your loved one's needs, you should consider other facilities or in-home care services. LTC News has many resources for exploring long-term care options. Here are a few resources that could help you in your long-term care journey:
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Finding a Quality Nursing Home – This guide dives deeper into nursing homes and can help you choose a high-quality nursing home that best suits your needs.
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Assisted Living and Memory Care Facilities – This guide explains everything you need to know about assisted living facilities and memory care facilities so you can evaluate if either option will work for you or your loved one.
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How To Pay For Long-Term Care? – This article offers multiple resources and valuable information to help you pay for long-term care. If you’re struggling to manage care expenses, this article may be for you.
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How Much Does Long-Term Care Cost? – This article explains how much long-term care costs and how those costs can vary depending on where you live and how you choose to receive care.
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