Assisted Living vs. Nursing Home Care


As a family caregiver you may find yourself limited in the level of care you can offer your aging loved one. It’s not uncommon for caregivers to find at some point that they can no longer provide the emotional, physical or social support their loved one needs and deserves on a daily basis. But, deciding where the next best place for them to go is can be difficult. Here’s a few things to consider about assisted living facilities and nursing homes (also known as skilled nursing facilities).

Know What They Don’t Offer

While assisted living facilities are supervised communities that offer services such as meals, social activities, and assistance with activities of daily living (e.g. bathing and dressing), one focus at these communities is to provide a healthy social environment so that elders don’t become socially isolated.

“Assisted living by definition is a lesser level of care [than a nursing home] and typically a more home-like environment often looking like an apartment. It is for someone whose prior living arrangement is no longer adequate,” says Jan L. Welsh, an Aging Life Care Manager and owner of Special Care for Older Adults, in Cincinnati, Ohio.

Because assisted living communities are considered non-medical facilities and are not licensed by Medicare or Medicaid to provide skilled care, they are not required by law to have a licensed nurse on staff. Even if a nurse is employed by the assisted living facility, which is often the case, the nurse cannot give residents hands-on skilled nursing care, which is defined by the federal and state governments and includes dressing wounds, administering insulin and oxygen, and more.

Assisted living facilities do not have the same safety or administrative requirements as a skilled nursing facility, and they are prohibited from providing any types of care they are not licensed to give.

“Some assisted living programs offer enhanced services, so you can receive a similar level of care that a nursing home would offer, as long as the family can pay for the services in addition to the room and board,” says Nancy E. Avitabile, who, like Jan, is an Aging Life Care Manager and owner of Urban Eldercare, LLC???, a care management practice based in Manhattan. “With this option, as the person becomes more immobile and eventually bedbound he or she could continue living there.”

Is Skilled Care a Must?

Nursing homes are set up like hospitals and staffed with registered nurses, licensed practical nurses, and certified nursing assistants who are licensed to provide skilled care. Skilled nursing facilities are regulated by the Department of Health and can bill Medicare and Medicaid for skilled nursing care, so they must comply with many complex legal regulations and requirements. For elders who need round-the-clock supervision, or who may need that level of monitoring in the near future, a nursing home may be the best option.

“When a caretaker can no longer provide what’s needed for their loved one, for instance, if the person needs ongoing dialysis or is bed-bound or needs a ventilator, those are appropriate times to consider nursing home,” says Avitabile.

While a senior’s health will inevitably decline over time, knowing which type of care your loved one will need in the future is hard to predict, adds Avitabile.

One thought is that your loved one may choose an independent living community first, then assisted living and then move to a nursing home when more advanced care is needed.

“That order works well for some people, but some people don’t necessarily have to enter assisted living even if they’re chronically ill,” says Avitabile. “We get conditioned to think that ‘OK, now my parent is older and becoming more frail and they can’t fully take care of themselves so now let’s move to assisted living.’ That’s not always the next step. Sometimes it’s less expensive to have an elder stay in their home and provide services for them there.”

Welsh adds that sometimes a person’s health actually improves when they are placed into a facility because they are in a more stable or healthy environment and at other times it declines. If a person was missing medications or eating poorly, those things can be easily stabilized in a nursing (or assisted living) environment. On the other hand, if the facility care is less than the care the person was receiving at home, or the person has a difficult time adjusting, they can go downhill quickly, she notes.

Major Factors for Nursing Home Placement 

Determining whether a loved one should move into a nursing home will be based on several factors unique to each individual. However, Welsh says the following are major indicators:

  • Increase in falls and wandering around dangerously
  • Medication management becomes complicated
  • Incontinence
  • Family fears the risks of being responsible for the aging loved one
  • When aging loved ones become victims of phone, mail or door-to-door scams
  • Sudden change in health (particularly diabetes, stroke, etc.) and independence of the aging person
  • Diagnosis of dementia or Alzheimer’s disease
  • The senior’s personal preferences, whether expressed in Healthcare Power of Attorney documents or based on prior life style

Think Long-Term

Before deciding on a long-term residence, think about the long run.

“Moving is stressful. Moving an older adult who then decides they don’t want to be there is incredibly stressful for them. If you’re interested in a place, after looking at several and meeting with staff, I’d suggest having your loved one stay for a weekend, or at the least a whole weekday to get a sense of how it is day to day,” notes Avitabile.

Besides the health and lifestyle care your loved one will need, Avitabile says consider the following before making a decision:

  • Cost
  • Flexibility
  • Proximity to family
  • How easily your loved one will acclimate in the environment
  • How easily your loved one connects with new faces and other people

No matter where your loved one lives, Avitabile says to keep the following in mind. “It’s very important that family finds ways to engage with the elder and arrange for visitors,” she says. “You can’t assume anything. Nursing homes have improved over the years, but the more present family members, aging care coordinator or caregivers are, the more the nursing home is aware that other people are looking out for your loved one.”


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