Nursing Home vs. Assisted Living: How to Tell Which Is Needed
They can look similar from the outside, but nursing homes and assisted living serve different needs, are regulated differently and are paid for differently.
Families often start by asking which option is “better”. The more useful question is which one matches the care your loved one needs now and is likely to need over the next year.
What each one provides
Nursing homes (skilled nursing facilities) provide 24-hour care from licensed nurses and nurse aides, with physician oversight. They care for people who need help with most daily activities, have complex medical needs, or are recovering from a hospital stay with therapy and skilled nursing.
Assisted living combines housing with help for daily activities such as bathing, dressing and managing medications, in a more residential setting. Residents are generally expected to be fairly independent, and on-site nursing is usually more limited than in a nursing home.
How they are regulated
Nursing homes that accept Medicare or Medicaid must meet federal standards, are inspected regularly by state agencies on behalf of the Centers for Medicare & Medicaid Services (CMS), and receive the CMS star ratings and public inspection reports shown in this directory. Assisted living is licensed and regulated by each state, without a federal rating system, so the information available to families varies widely by state.
How they are paid for
- Medicare can cover a short skilled nursing stay after a qualifying hospital stay, but it does not pay for assisted living or for long-term custodial care in either setting.
- Medicaid pays for long-term nursing home care for people who qualify. Many states also use Medicaid waiver programs to cover some services in assisted living, but usually not room and board, and availability is often limited.
- Private funds and long-term care insurance pay for most assisted living.
Signs a nursing home may be the better fit
- Needs help with most daily activities, including moving from bed to chair or using the toilet.
- Needs nursing care around the clock, such as frequent monitoring, complex medications or wound care.
- Is recovering from a hospital stay and needs daily therapy or skilled nursing.
- Has advanced dementia with care needs an assisted living community says it cannot meet.
Signs assisted living may be enough
- Is mostly independent but needs reminders, medication help or some personal care.
- Is safe for periods of time without staff in the room.
- Would benefit most from social activity, meals and a safer setting than living alone.
Get a professional assessment
A physician, hospital discharge planner or geriatric care manager can assess care needs and recommend a level of care. Ask any community you are considering what would make your loved one need to move. Assisted living communities can ask residents to leave when needs exceed what they provide, so it helps to know that threshold before moving in.