Assisted Living vs. Nursing Home: Which One Do You Need?

Assisted living facilities and nursing homes are two types of senior care that people often confuse. If you’re looking for a senior living solution that best meets your needs, how can you know which one is right for you? Here, we describe each care type and offer expert insights that can help you consider which could be best for your situation.

What is a nursing home?

A nursing home, also known as a skilled nursing facility, is a residential long-term care facility that provides ongoing skilled nursing care and extensive personal care support. This type of facility is a step down from hospital care, providing the highest level of personal and medical care of all the types of senior living.

An individual can temporarily stay in a nursing home for short-term rehabilitation after hospitalization for an illness, injury, or surgery before returning home or to their senior care community. They might also live there permanently as a long-term care resident. Whether the person is a short-term patient or a long-term resident depends on the individual’s needs and if the facility is licensed to offer care for the duration they need.

• Short-term patient example: A senior who has recently had hip surgery might need acute medical monitoring, pain management, and inpatient therapy services at a skilled nursing facility for a few weeks to regain the strength and confidence to return home.
• Long-term resident example: In contrast, a senior who needs ongoing skilled care due to a chronic medical condition and significant personal care needs might be a long-term resident in a nursing home. A nursing home could be their best environment because it provides 24/7 skilled nursing services and high level of personal care support. Other facilities in the individual’s area might not offer the care services they need.

Depending on the context, you may hear these facilities referred to as “nursing homes” or “skilled nursing facilities.” The former is a more conversational term, while the latter is a more technical term. Both names refer to a facility that can meet the same types of needs.

Features of nursing homes

Nursing homes have many features and service offerings that help support the ongoing needs of their residents and patients. Features and services might include:

• On-site physical, occupational, and speech therapy for rehabilitation (short-term residents) and restorative therapy (long-term residents), which helps them maintain their mobility and access support for their physical needs.
• Prepared meals served three times daily in a social and safe dining room. Residents typically have a choice on their menu, and those with prescribed special diets will receive those as well. A registered dietitian works closely with the physician, speech therapist, and chef to ensure residents receive the best diet for their needs and challenges.
• Around-the-clock nurses and certified nursing assistants (CNAs) to provide care, offer assistance, and respond to emergencies.
• Events and activities, including excursions into the greater community, scheduled daily and on weekends.
• Housekeeping, laundry, and transportation services.
• Shared spaces, which might include an enclosed courtyard and garden, a library, a living room, and a private dining room.
• Mostly semiprivate rooms, meaning two people share the same room. Each person has their own bed and furnishings, and there is a privacy curtain separating one person’s area from the other. Some private rooms may be available as well.

The nursing home environment

Due to the extensive medical and health services that nursing homes provide compared to other styles of senior care, they have more of a clinical feel. However, facility operators understand that residents want to feel at home regardless of how much skilled care they receive, so nursing home facilities often incorporate as many homelike attributes as possible. You’ll often find art hanging on the walls and cohesive color schemes between the bedding, window treatments, art, and wall colors to create an aesthetically pleasing environment. Staff commonly decorate during special days and holidays to create a joyful atmosphere, and daily activities foster a sense of community among residents and staff.

Nursing home employees

Nursing homes employ licensed nursing professionals who staff the resident and patient floors to administer medications, monitor vital signs, and perform other skilled nursing services. Nursing assistants (who may be called personal care aides or another licensed term that the facility’s state uses) are also on staff in these facilities. They help residents with activities of daily living (ADLs), like bathing, dressing, feeding, transferring, and ambulating. 

Other professionals, such as physical, occupational, and speech therapists, work at nursing homes. They work with short-term patients temporarily staying at the facility for rehabilitation. They may also work with long-term care residents to assist them in maintaining their mobility or to assess their needs. 

What is assisted living?

Assisted living is a type of senior care facility designed to meet the needs of seniors who require some support with personal care tasks. These facilities staff personal caregivers around the clock to help residents with ADLs as needed. 

Not only do assisted living communities help residents with ADLs, but they also strive to make residents’ lives maintenance-free through in-house housekeeping, laundry services (which may come at an extra fee), and other services. 

Features of assisted living

Assisted living communities are all unique; however, some services, amenities, and features are common in these types of senior living residences, including:

• An active social calendar with events, excursions, and activities held throughout the days and evenings. This calendar is curated by an on-staff activity or recreation professional, and you might see events like chair yoga, art workshops, trips to the theater, and happy hour socials.
• Convenience services, such as weekly housekeeping visits, laundry services, and even transportation to and from popular spots in the community, like grocery stores, banks, and medical offices. The facility may include some or all of these ancillary services in their basic monthly room and board fee, but you should inquire about them. For example, laundry services may cost a flat fee per load but may include a caregiver delivering the laundry to your apartment and putting the clothing away in your dresser for you.
• Nutrition services. Every state sets its own requirements about how many meals per day assisted living communities must provide their residents. Often, you’ll find that communities serve chef-prepared meals multiple times daily in a social dining room setting. Most assisted living menus offer a variety of choices so that residents can choose something that sounds good to them on that day, at that time. Residents are encouraged to eat with their peers for healthy socialization. Some communities provide room service if requested, but it may come with an additional delivery cost.
• Medication management services so that residents do not need to worry about keeping track of their own medications and schedules. Instead, nurses and caregivers take over this responsibility and work closely with residents and their primary care physicians to ensure they notice any side effects or other issues with prescription or over-the-counter medications. Usually, residents can choose from tiers of medication services and pay only for the services they need. From verbal reminders only to administration of medications, residents can select the level of service they need and pay accordingly.
• Personalized assistance with ADLs, such as grooming, bathing/showering, dressing, eating, ambulation, or toileting. Caregivers provide the type of assistance each resident needs to remain as independent as possible, such as verbal cueing, setting up supplies, or providing hands-on assistance.
• Living quarters. These vary from one facility to the next, but you’ll often find studio, one-bedroom, and two-bedroom apartments. Depending on the facility’s apartment layouts, the apartments may have kitchenettes and private full bathrooms. Multiple communal areas for relaxing and dining can be found throughout the building.

Assisted living vs. nursing home: How to know which kind of care is right for you

Multiple factors influence the decision of whether a person is best suited for an assisted living facility or a nursing home. Many of these factors relate to the individual, such as: 

• The individual’s need for skilled nursing care. Do they have no skilled nursing needs, intermittent skilled nursing needs, or ongoing needs?
• The individual’s need for help completing ADLs. Do they require no assistance, some assistance, or significant assistance involving one, two, or more caregivers?

Other factors depend on the facility:

• What level of skilled nursing care and types of skilled services does the facility provide?
• Does the facility provide ongoing skilled care or intermittent care only?
• What level of independence does the facility accommodate?
• Does the facility permit residents to hire outside third-party companies to provide additional care?

Every assisted living facility has regulations set by the state in which it is located. Some of these regulations are minimum and maximum requirements, and others allow or disallow facilities to opt in or out of offering certain services or care. To fully understand what assisted living facilities and nursing homes offer in a particular area, it’s best to seek the help of an expert, like a local Oasis Senior Advisor. Individuals interested in a particular facility can also speak with its representative to learn more.

Despite all the nuances, you can get a general idea of the type of care that an individual needs by considering the following aspects.

Is there a need for ongoing or routine skilled nursing care?

Finding an assisted living facility that can meet intermittent skilled nursing needs is not uncommon. Still, it’s much less common for an assisted living facility to staff enough licensed nursing professionals to administer routine skilled nursing care to its residents. Some states allow assisted living facilities to offer some level of skilled nursing care, which leaves it up to the facility whether it staffs licensed nursing professionals to provide ongoing skilled care. 

Therefore, if someone needs ongoing skilled nursing care, it’s important to find out if an assisted living facility in your area can admit someone with your specific needs and provide ongoing care to manage the condition. If assisted living facilities cannot support a person’s ongoing skilled care needs, a nursing home will likely be the best environment to help care for that person.

Paul Doyle, Certified Senior Advisor and owner of Oasis Senior Advisors Fairfield-Westchester, said, “Skilled nursing care at a skilled nursing facility [nursing home] is nurse-driven.” This means that licensed nursing professionals are staffed to administer skilled care routinely to the patients. 

Some states permit the admission or retention of assisted living residents with some skilled care needs under certain circumstances, such as if the resident is receiving hospice care services or can independently manage the care. For example, Florida allows residents to remain in assisted living facilities even if they require 24-hour nursing supervision as long as they are receiving licensed hospice services.

One factor is a person’s need for skilled care; the other is whether any assisted living facilities in the area can meet those needs. If no assisted living facilities can meet those needs, a nursing home may be the best fit.

How much help is needed to complete activities of daily living?

Another factor to consider when determining which type of senior care will best meet a person’s needs is the individual’s need for help completing activities of daily living (ADLs). This term refers to a set of daily tasks fundamental to preserving an individual’s health and survival, including feeding oneself, bathing, dressing, transferring (e.g., moving from bed to a chair), toileting, and ambulating (walking or moving around). Depending on state regulations, additional tasks might be included. 

Some states regulate the number of ADLs a person can require assistance with to qualify for different types of facilities. Others also include the degree to which help is needed, such as the number of caregivers who need to help the individual complete an ADL or whether the individual is independent, partially dependent, or fully dependent on others to complete an ADL.

If a person requires only some assistance with activities of daily living, a nursing home may provide too much support compared to what the person really needs. “In this situation, the care is more preventative. If a person is unsteady in the shower, an assisted living caregiver can stand by to help ensure they don’t fall. Needing this type of assistance alone doesn’t mean that a person needs to move to a nursing home,” Doyle said. 

Seniors who thrive in nursing home care

Your loved one might thrive in a nursing home if they:

• Need ongoing medical services like wound management, pain management, IV management, or intensive therapy services.
• Need hands-on assistance with ADLs due to physical or cognitive limitations. If a person requires help from more than one caregiver to perform ADLs, they may require nursing home care.
• Have a trach or feeding tube or require a level of skilled care that assisted living communities can not provide.

Short- and long-term care in a nursing home can be expensive, so it is imperative to ensure your loved one requires this level of skilled care. 

Seniors who thrive in assisted living

Assisted living residents typically thrive in a community setting thanks to the presence of caregivers and the ease of socializing with their peers. Your senior loved one might succeed in assisted living if they:

• Need help with some activities of daily living.
• Can walk independently or with the assistance of a cane or walker, or can move independently with a wheelchair without needing full assistance or help from more than one caregiver when using it.
• Do not require ongoing medical services, such as daily IV management or wound management.
• Feel lonely or isolated in their home, miss socializing with peers, or want to make new friends.

Most assisted living communities can accommodate fairly significant care needs. Some communities offer specialized services, like secured memory care neighborhoods. In many cases, individuals can be better suited for assisted living communities. Nursing homes are usually best for meeting the needs of someone who has ongoing, long-term skilled nursing needs. 

If you aren’t quite sure what type of senior living care would be best for your loved one now and in the future, speak with your local Oasis Senior Advisor. They can give you recommendations based on your loved one’s needs.

Senior care facility rules and requirements vary based on company-specific policies and state-level regulations. The content above represents common guidelines but may differ from a particular facility’s policies or requirements. To learn the regulations that apply in your state, contact your local Oasis Senior Advisor.