At first glance, terms like senior living, assisted living, and nursing home facilities can easily sound interchangeable. However, these terms may only share one thing in common: differing levels of care. Surveys show that most people say that they want to age in place—meaning they want to stay at home.
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Aging in place is possible, but it can depend on a myriad of changing care needs. As people age, their care needs can evolve and become more detailed and expensive. Preparing for care as you age is possible if you have discussions with your family about what would be most reasonable and what to do if your plan changes.
Part of that includes understanding what kind of care you can get as you age.
Assisted Living vs. Nursing Home Facility: Type of Care Received
The line between assisted living and nursing home care has started to blur over the last few years. Ten years ago or more, most assisted living communities looked more like independent retirement communities, with more active, independent seniors.
According to the U.S Census Bureau, “By 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that one in every five residents will be [of] retirement age…and older people are projected to outnumber children for the first time in U.S. history.”
As the aging population increases, so do the infirmities associated with aging and the care needed to support older adults. Assisted living communities have grown across the country in an effort to capitalize on the growing need for the different types of supportive care. It is not that unusual to see many of the residents in assisted living communities in wheelchairs, jazzys, and walkers. These same assisted living communities are meeting the demand of consumers who can’t stay at home, but don’t want to go to a nursing home.
However, there are a few distinctions between assisted living and nursing home care:
Assisted living communities are more independent, with some featuring separate apartments with full kitchens. They can include lots of amenities, including activities, a hair salon, gym, transportation, meal service, and housekeeping. The ambiance in many assisted living communities feels very upscale with libraries, movie theatres, and common rooms.
Some may even feature on-site physician services. This is becoming more popular and available in assisted living, ultimately reducing the need for going to an outside provider.
In addition, nurses may also be on-site with their availability limited to Monday through Friday except in rare cases.
On the other hand, nursing homes are built with 24-hour nursing care in mind to meet almost any medical need. Other types of therapy like physical and occupational therapy services depend on whether a patient is paying either through private means, using a long-term care insurance plan, or via Medicaid.
Nursing homes typically have more than one patient to a room, and in some cases they share a bathroom as well. Amenities are limited. Although all of the resident’s medical needs are taken care of, activities will be minimal. Gyms are for rehab only and not personal use. There are no theatres and few common rooms or libraries.
Assisted Living vs. Nursing Home Facility: Admissions Process
The admission processes for assisted living and nursing home care can be very different, but they do share some basics.
Assisted living admissions process
As with any application, you’ll want to contact the assisted living community that interests you.
It is important to review the costs of care, including the additional costs for specific types of care, and sign the contract.
In order to gain admission, a nurse will conduct an evaluation to make sure that any medical conditions you or your loved one may have can be handled on-site. For example, if your mobility is impaired and you require two people to assist you, an assisted living community may deny your admission.
A cognitive assessment is also considered as part of the admissions process. If someone has significant dementia, an admissions coordinator may recommend memory care instead of assisted living. Most assisted living communities have memory care available on-site in a different location in the community. Memory care units are locked, secure units to contain wandering.
Nursing home admissions process
With nursing home admissions however, it is dependent on each state’s Medicaid criteria. Medicaid is typically the primary source of payment for nursing home care, so many patients must meet a minimum level of care that is specified by their state’s Medicaid. In other words, in order to meet the requirements to receive Medicaid, you must have medical conditions that require 24-hour care at a nursing home facility.
Like an assisted living community, a nurse will conduct a functional assessment. They may also request supporting medical documentation from primary care physicians or other doctors.
In the end, admission is dependent on who pays. If it is Medicaid, many states require that Medicaid eligibility is in place before admission. If it is private pay, you sign a contract on an agreed daily amount. If long-term care insurance will be paying a portion of the daily rate, it is usually up to the resident to apply for that benefit.
Assisted Living vs. Nursing Home Facility: Paying for Care
Understanding how to pay for assisted living and nursing home care is essential to your long-term care plan. Most people think that Medicare pays for assisted living, but it does not. Medicare also does not pay for nursing home care except in the case of short-term rehabilitation services.
According to Genworth, the median cost of assisted living across the country in 2019 was $4051 a month. Prices could be much higher or somewhat lower, depending on where you live and the care you need. Assisted living can be paid for in three different ways:
- Private pay. Private pay from income and assets is the primary way to pay for assisted living. assisted living is paid. Most communities have a “base rate” per month and then have tiers of care that are added on top of the base rate. These costs can be determined by the following:
- How many medications need to be dispensed.
- The number of times someone needs help with bathing and dressing.
- If the person needs someone to accompany them to the dining room for each meal.
- If the person needs help toileting.
- Long-term care insurance. Long-term care insurance policies vary in terms of how much they pay each day. Strict criteria must be met first, and there is usually an elimination period. A typical period may be 90 days, where you have to pay out of pocket first. Once the benefit kicks in, the daily rate can offset the cost of assisted living.
- Medicaid waiver programs. Medicaid Waiver programs are federal programs run by the states. Criteria for acceptance into the program and the application process is complicated. The program’s purpose is to keep people in their assisted living community rather than move them to a nursing home once they qualify for Medicaid. Not every assisted living community is a contracted Medicaid Waiver location.
With nursing homes, the costs can skyrocket depending on where you reside as well as other other care needs. In 2019, Genworth calculated that the median cost for a shared room in a nursing home was $7513 a month. Despite the higher costs, nursing homes can be paid for in four different ways.
- Medicaid. Medicaid pays nursing homes a flat monthly rate for each resident and all of the care that person needs has to be covered under that rate.
- Long-term care insurance. As with assisted living, a long term care policy will defray the daily cost of care by providing a daily cash benefit. Plans range widely in terms of their benefit amount.
- Private pay. Some people will pay privately if they don’t qualify for Medicaid and/or do not have a long term care policy. Private pay amounts may be based on the Medicaid rate or could be negotiable depending on the location.
- Veterans Affairs nursing homes. It is possible for qualified veterans and their spouses to apply to a VA nursing home at a reduced cost. The criteria are complicated but worth exploring if you think you might qualify.
Assisted Living vs. Nursing Home Facility: Who Are They For?
While many people would prefer to age in place or maintain some independence as they age by residing in an assisted living facility, there may be times when a nursing home is the safest option.
There are also times when nursing home care might be necessary. When looking at one or the other, it is important to think about what you or your loved one are looking to get in the long run.
When to consider assisted living
Family caregivers may supplement care with additional in-home care options, but sometimes the costs and tasks may be too much to manage. Here are some other reasons why assisted living may be for you or your loved one:
- Preparing meals. Assisted living communities provide all meals in a group dining area.
- Intermittent nursing. You may exhaust your home health care financial aid, and require more consistent nursing.
- Socializing. Some people feel isolated and lonely in their homes.
- Exhausted family caregivers. There comes a time when the burden of caregiving is no longer sustainable.
- In-home caregiving becomes unviable. Some states may not allow in-home caregivers to perform any kind of medical tasks.
- Detailed medication instructions. Some medications may only be administered by nurses or require more medical knowledge.
When to consider nursing home care
Like with assisted living, there will come a time where you may have to make a decision regarding the appropriate level of care needed for you or your loved one. If you’re still waffling over nursing homes versus assisted living, here are some reasons to keep in mind:
- Complex medical needs. You or your loved one may require 24-hour care that cannot be met at home or in assisted living.
- Assistance with walking or transportation. When someone needs more than one person to help them get around.
- High costs of care. When someone depletes their financial assets and can no longer pay for in-home care.
- Cognitive or behavioral issues. When someone has behavioral issues that can’t be managed in assisted living.
- Assistance with eating. You or your loved one may need monitoring when it comes to eating because of swallowing problems.
Deciding on Assisted Living vs. Nursing Home Care
While no one wants to have to decide on an elevated care plan that involves them leaving home, it may be the safest method to ensure continued care.
By preparing for any and all options up ahead, you can ease any difficulty your family may face. Keeping your options open and being realistic about care can enable you to make a decision when the time comes.
If you're looking for more information on care for aging adults, read our guides on the best senior care and alternatives to assisted living.
- “Older People Projected to Outnumber Children for First Time in US History.” United States Census Bureau, www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html.
- “What is Nursing Home Level of Care and it’s Importance to Medicaid Eligibility.” American Council on Aging, www.medicaidplanningassistance.org/nursing-home-level-of-care.
- “VA Nursing Homes, Assisted Living, and Home Health Care.” U.S. Department of Veterans Affairs, www.va.gov/health-care/about-va-health-benefits/long-term-care.