The difference between assisted living and nursing homes

These two living options for seniors have different benefits based on how much care you need.

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Key Takeaways

  • Assisted living and nursing homes both provide long-term care services for senior living

  • Assisted living mainly helps with personal care, and provides a level of independence in a more social setting

  • Nursing home facilities are better suited for people who need extensive medical care

  • Medicare does not help pay for assisted living, but Medicaid can cover long-term nursing care

Most aging seniors in the United States will need some form of long-term care. Some people get in-home care (hiring someone to provide custodial care in your home), while others opt to move to a facility and receive care there. Senior living communities range on a spectrum depending on the level of care (personal and medical) that you will need.

For example, independent living communities, like some retirement communities, may not offer much in the way of either type of care, and simply allow senior citizens or adults of a certain age (usually age 55 and older) to live and dwell in the same development and foster a community.

Assisted living communities, on the other hand, help residents with their activities of daily living, like eating, drinking, and bathing. (These facilities often provide meals, too.) Assisted living may also help with medication management and more, based on the resident’s needs.

If you wanted more extensive medical care, then you might consider a nursing home. Nursing homes can provide more thorough medical attention. They are more similar to hospitals than assisted living communities, which have a less clinical environment.

Both assisted living and nursing homes may offer special services or programs for dementia or Alzheimer's care. They are also both viable senior living options for people with disabilities. We’ll compare assisted living vs nursing homes and see who benefits from each.

Assisted living

The main objective of assisted living is to provide seniors with personal care. Assisted living residents live full-time at the facility and might receive help with daily living activities, like eating, bathing, going to the bathroom, getting dressed, and sometimes taking medication. Assisted living facilities are supervised at all hours by staff members, but not necessarily by skilled nursing care personnel. That means a medical professional may not be on hand to provide immediate medical care.

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Generally, the assisted living communities have different levels of care, based on the resident’s needs. For example, one resident may only need help bathing, while another may also need assistance walking from place to place and more regular checkups. It’s important to compare assisted living facilities in your area to see if their care options meet your needs.

Assisted living aims to give its residents a bit of freedom and encourage socializing. Residents may live in private or shared rooms, in studio or apartment-style housing. There is usually a larger common space to accommodate any recreational activities (like movie nights or bingo) for the greater assisted living community. In some states, assisted living communities might be more commonly referred to as residential care facilities.

Other common assisted living services include:

  • Meals

  • Laundry services

  • Housekeeping services

  • Recreational activities

  • Non-medical transportation

Assisted living benefits seniors who need some personal care, but not medical supervision.

Nursing homes

Nursing homes are best for people who need more extensive medical care. Also known as a skilled nursing facility, a nursing home has registered nurses on hand to provide care at any time of day. Think of the nursing home as a hospital and equally restricted in terms of living space — nursing homes usually house 100 or more residents who may often share rooms, though private rooms are often available at a higher cost. Because the focus of a nursing home tends to be more medical in nature, there may be fewer recreational activities hosted by this type of facility.

Nursing homes aren’t the same as hospice care, which is designed to provide comfort rather than medical treatment in situations when a patient is near the end of life. Some nursing home facilities may offer hospice care.

Seniors who need constant medical attention aren’t the only ones in need of a nursing home. Sometimes a nursing home stay can be temporary, like a three-month stay for patients recuperating from hip surgery. Patients might seek post-acute care and short-term rehabilitation services in a nursing home instead of at a hospital.

Costs: assisted living vs nursing home

The average assisted living costs are $4,051 per month in the United States, according to Genworth’s 2019 Cost of Care survey. The average monthly cost of a nursing home is nearly double that: $7,513 per month for a semi-private room or $8,517 per month for a private room.

In some circumstances Medicaid can help pay for long-term nursing care. Each state also designates and defines a level of care that a nursing home needs for the purposes of Medicaid billing. Medicare does not cover the costs of assisted living because it mainly provides personal care. However, you can get some nursing home coverage through Medicare Part A if it is medically necessary (such as for the rehabilitation services we previously mentioned).

Because senior care living options — not just nursing homes and assisted living, but other care facilities like personal care homes and in-home care — can be very costly, it’s important to plan ahead for your future needs. If you’re young, you can purchase long-term care insurance, which gets prohibitively more expensive the older you get. You can also talk with an attorney who specializes in elder care or elder law about what’s best in your situation.