If you are searching for which one might be best for you or a loved one, you may question – What is the difference? Which is the best option?
The biggest difference between these two options is the level of care provided and who provides that care.
What are Daily Living Activities (ADLs)?
These are activities such as bathing, dressing, grooming, bathroom assistance and medication management. Both assisted living and nursing homes provide staff that are available 24/7 to provide help when needed with nursing homes providing more consistent daily management.
Assisted living facilities or communities – Residents handle most of their daily living activities (ADLs) on their own, and may receive assistance if needed. These communities provide care for those adults or seniors who can no longer safely live at home by themselves but are still responsible enough to maintain some daily living activities. They do not need a constant level of assistance as a nursing care facility would provide. If one would need nursing services, these are normally available by appointment or on call with medication managed by a nurse or licensed medical technician. If other intensive programs are needed like physical therapy, then options can include outside healthcare professionals such as home health who can be scheduled to come to the home to provide the needed therapy as many times needed.
Residents usually have downsized and live in apartment-style homes that are private or semi-private. These facilities try to provide a home-like environment with each home is equipped with the same amenities as a regular apartment: living and dining room, small kitchen and bath. Residents usually move in with their own furniture and personal belongings.
A common dining area for all residents is available, as well as, an option to socialize and have a healthy meal prepared for them. Other recreational areas are common for opportunities to socialize with other residents for a sense of community engagement while having the security of staff to help if an emergency arises. These facilities are great as they provide a wide calendar of activities that residents can choose to pursue their own interests or hobbies desired. These facilities provide transportation services in community vans that can take trips out in town for community outings, church gatherings or other appointments.
Skilled Nursing Home Community – These facilities are for residents that require more constant assistance of skilled nursing care for most of their ADLs. These are skilled facilities with 24/7 nursing care for those needing specialized medical care daily or in a skilled setting. Nursing homes can be temporary or long-term. They can be short term after a hospital stay, surgery or other decline in health following a more critical hospitalization. Many short term care nursing homes focus on rehabilitation and returning to a previous home. For other patients, they may need long-term care of ADLs and more strict medical supervision. This may include maintaining a feeding tube, respiratory therapy, IV medications, clinical services, therapies or hospice care.
Rooms are shared with another resident. Meals are provided in a common dining area with other residents unless they are unable to do so. Nursing homes have daily scheduled activities as well to help promote a healthy socialization with other residents. Caregivers or LPNs will bring activities or hobbies to the room if they are unable to attend group activities.
“Certified skilled nursing communities have licensed practical nurses (LPNs) on duty 24 hours a day. A registered nurse (RN) is on duty for at least eight hours of each day seven days a week. On average, for every 100 resident beds, there are 40 nursing assistants, seven RNs and thirteen LPNs on staff.” (1)
Since nursing homes or communities provide a higher skill of nursing care, all medical care is supervised by a licensed doctor. The cost of care is covered by Medicare and Medicaid and most long-term care insurance policies.
How do you Choose Between Assisted Living and Skilled Nursing Home Community?
Choosing the best fit can be difficult depending on the situation that occurred that made this decision necessary. One of the main areas to consider is when the adult or senior is no longer safe to live on their own. What type of care do they medically need is another question to consider?
The following chart comes from SeniorLiving.org and has a clear comparison to help determine the best fit.
| Assisted Living Communities | Skilled Nursing Communities | |
| Living Accommodations | Accommodations are generally apartment-like; may be private or semi-private. | Accommodations, generally semi-private, are more hospital-like. |
| Meals | Three meals are served in a centralized dining area, usually at no additional cost. Meals may be prepared by a resident in their own kitchen in their apartment. | Three meals are served in a communal dining area at no additional cost. |
| Housekeeping Services | Housekeeping and laundry services are generally included at no additional cost. | Housekeeping and laundry services are provided. |
| Caregiving Services | Caregivers are available around the clock. Someone needing or desiring specialized care or one-on-one care can arrange for this supplemental care through a third party at an additional cost. | Caregiving services provided around the clock. Someone desiring one-on-one care can arrange for this supplemental care through a third party at additional cost. |
| Minor Medical Supervision | Provided | Provided |
| Extensive Medical Care | Not provided | Physician ordered extensive medical care is provided. |
| Medication Management | Provided | Provided |
| Medical Personnel Available | Full-time medical personnel are on site or on call. | LPNs on-site at all times. RNs on-site at least 8 hours per day. Physicians on-site or on call 24/7. |
| Assistance with ADLs | 24/7 | 24/7 |
| Activities | Various activities are scheduled on a daily basis focused on keeping the residents busy throughout the day. Community activities and field trips are planned. | Less active and less strenuous activities scheduled throughout the day. Activities provided in the room for those who cannot join group activities. |
| Transportation | Transportation to and from doctor’s appointments and other errands is often available. | Transportation to and from doctor’s appointments is often available. |
| Payment Sources | Mostly private pay. Some certified communities accept Medicaid and Medicare. Services may be covered by long-term care insurance and Veterans benefits. | Services, which are medical in nature, are covered by Medicare, Medicaid, Veterans Benefits and most long-term insurance policies in certified facilities |
| Average Price Range | Between $2,500 – $4,000 per month. Memory care will run substantially higher. | In 2016, a private room averaged $253 per day and a semi-private room averaged $225 per day. Monthly, that’s $7,590 and $6,750, respectively. Memory care will run substantially higher. |
| Scheduled Activities | Calendar of activities, often offering community activities and field trips | Calendar of activities, not as “active” as assisted living |
| Other Names for These Communities | Assisted Care Communities and Personal Care Homes | Nursing Homes, Convalescent Care, Nursing Centers, Long Term Care Facility |
Additional consideration for those with cognitive impairments: Both types of facilities may have a dedicated wing specializing in memory care that will have advanced security measures for leaving the facilities, monitoring equipment, as well as, protective measures, such as, living arrangements without stoves or kitchens. Contacting and interviewing facilities to determine the best fit for medical needs would be the next step to review services and procedures.
Which to Choose?
It depends on the level of care needed and which type of living environment would the resident be best suited. When the type of facility is determined, the process will become easier as then you can contact communities within that service area and tour the community. You would be able to get a feel for the level of medical care provided, review the amenities and services, and ask any questions to see if the facility may be a good fit for you or a senior loved one.