Long-term care options for older adults are more varied than ever. But deciding which option is best for yourself or a loved one can be complicated. A good place to begin is by deciding what level of care is right for your circumstances.
In this article, we’ll explain the differences between nursing homes and assisted living facilities and how to decide which one is the right choice.
Assisted living is primarily a
To clarify the distinction, here’s a summary of some key differences between the two:
| Assisted living | Nursing home | |
|---|---|---|
| Medical services | Residents are generally in good health but receive medical care tailored to their needs. This may include medical transportation, medication administration, and dementia care. | Residents with chronic illnesses receive 24/7 medical care and assistance, including rehabilitation services like physical therapy. |
| Living space | Individual or shared apartments with kitchens, bedrooms, and living rooms that may or may not be furnished, and may include common areas. | These feature individual or shared rooms with en-suite bathrooms and may include common areas. |
| Daily assistance | This is not covered by Medicare; it may be covered by some long-term insurance policies and Medicaid in some states. | This includes the same types of assistance as in assisted living, but in a more extensive capacity, often involving around-the-clock care. |
| Recreation | This typically offers a wide range of opportunities for physical exercise, creative expression, and socializing, as well as religious services and volunteering options. | Can also include recreational activities, but these may be more limited or may require staff supervision. |
| Meals | Residents can cook in their kitchenettes, eat in community dining rooms, or order meal delivery for a fee. | This includes assistance with daily activities like bathing or getting dressed and services like laundry and housekeeping for those who want them. |
| Median annual Cost | Relatively expensive at $64,200 in 2024 | Significantly pricier than assisted living: Semiprivate room: $111,325 Private room: $127,750 |
| Insurance coverage | This is not covered by Medicare; may be covered by some long-term insurance policies and Medicaid | This is not covered by Medicare; it may be covered by some long-term insurance policies and Medicaid in some states. |
The kind of facility that’s right for you or your loved one will depend on your health and how much help is needed with daily activities.
Here are a few questions to help you decide which kind of facility is best suited to you or someone in your care:
- How much help do you need to take care of daily activities like bathing, dressing, and using the restroom?
- Do you need medical care for serious health conditions?
- Are you able to prepare your meals?
- How do you plan to pay for the care you need?
Once you’ve decided which type of facility best meets your needs, you’ll need to explore individual facilities to find a good match.
As you compare facilities, keep these questions in mind:
- Is the facility licensed by a state agency?
- Has the facility been audited or inspected by any healthcare agency, and are the reports available?
- Do the residents seem happy and well cared for?
- What medical professionals are on staff, and what’s their availability?
- What’s the ratio of residents to staff members?
- What’s the staff turnover rate?
- What’s the procedure for handling a medical emergency with a resident?
- Can people receive visits from their doctors or home healthcare providers?
- Which services are included in the basic cost and which are offered at an extra charge?
- Who gives people their medications?
- Is transportation provided to doctor appointments?
- How close is the facility to your family and friends?
- What kind of recreational activities are offered?
- Do residents go on community outings?
- Can residents bring their own furnishings?
- Are bathrooms shared?
- Is the facility affiliated with a particular faith tradition?
- Can you review a copy of the contract so you understand the policies, procedures, and costs carefully?
- Does the facility offer both assisted living and skilled nursing if needed?
If possible, visit facilities more than once. Talk with friends, neighbors, colleagues, medical professionals, and local organizations that serve older adults to get a sense of which facilities provide the best care in your area.
When to move from assisted living to a nursing home
If you or your loved one is currently in assisted living, these are some key signs that it may be time to switch to a nursing home environment:
- worsening health and medical needs
- difficulty with daily activities
- increased cognitive challenges
- frequent falls
If independent living is the goal, you may find it more appealing or more cost effective to use home health aides or assistants to help care for an older adult at home.
Another increasingly popular option is shared housing, in which older adults live together or with a younger person. This may help keep down housing costs while also staving off loneliness and isolation.
Board-and-care homes (also called adult family homes) may be an option for those who want companionship but don’t need extensive medical care.
Board-and-care homes are smaller residential settings where several older adults live in a single home with a caregiver on site.
Deciding when to transition from independent living to an assisted living or skilled nursing facility isn’t easy. Understanding the options in your area is a good place to begin.
Assisted living facilities may be a good choice if you’re in fairly good health but need help with some daily activities. A nursing home may be better if you need 24-hour medical care along with basic services.
Once you’ve identified the type of facility you need, examine the options in your area to find one that fits your budget, meets your needs, and provides the services you need.