Assisted Living or Nursing Home: Learning the Differences and Deciding What's Best

Years ago, most of us referred to senior living facilities as nursing homes – a term that is no longer used within the industry but is still common among the general public. 

The fact is that there are significant differences between assisted living and skilled nursing (the term that has replaced nursing home) facilities.  These are important distinctions that seniors and caregivers should understand as they begin examining future living options, and fall primarily into the categories of level of care, atmosphere, costs and payment options.    

Level of care

The first difference between skilled nursing and assisted living facilities is the level or type of care that is licensed and provided.  Typically, residents of skilled nursing facilities have serious physical or mental health issues, can no longer live alone and require round the clock care.  Skilled nursing communities are licensed to administer necessary medical care and offer 24-hour onsite nursing staffing, standard staffing levels and 24-hour supervision. 

Residents of assisted living communities, by contrast, are more independent and are encouraged to socialize.  Facilities often offer individualized levels of personal care assistance including medication management and assistance with bathing and dressing.  Nursing staff may be available most of the day and on call afterward.  Residents have access to social activities, 24-hour supervision and transportation.  Services will vary by facility and cost.

Atmosphere, costs and payment

Living space is another difference between the two types of communities.  While a nursing home offers private and semi-private rooms of a more institutional or hospital appearance, assisted living facilities are generally more comfortable and homelike, with some offering common entertainment areas and gardens as well as amenities that include computer access, “country stores” and snack shops.  Residents live in private apartments that include their own furnishings, if they so desire.  In both types of facilities, however, meals are provided in a central dining area. 

Because of the higher level of care provided, skilled nursing communities are significantly more expensive than assisted living, although eligible residents can pay for skilled nursing with Medicare, Medicaid or long term care insurance.

Although Medicaid may pay in some instances for qualified assisted living residents, most pay privately for their care, supplemented by long term care insurance if applicable.  One often overlooked payment option is the Aid & Attendance program, provided by the U.S. Department of Veterans Affairs, which helps offset the cost of rent in assisted living communities for veterans and their spouses.