The Arbor Company Senior Living Blog

The Facts: Assisted Living vs. Nursing Home Care

Jan 21, 2016 10:00:00 AM / Wanda Moen Wanda Moen


You’ve spent years helping Mom or Dad cook and clean and get to appointments, and now it’s clear -- your beloved parent needs more support than family, friends or even home care services can provide. Despite this clarity, you may feel confused about what step to take next. Should your family be looking at nursing homes,  or would assisted living do the trick?

For many seniors, assisted living actually can provide just the right amount of support and independence—however, for an elder with a severe mental and/or physical condition, a nursing home just might be the better choice.

Nursing Homes in a Nutshell

Also known as a skilled nursing facility, a nursing home provides the highest level of care  outside of a hospital. Nursing homes deliver 24-hour care to frail elderly people with complex medical conditions who need a high level of hands-on assistance and monitoring. Residents may be confined to bed, have total incontinence and/or tube feeding.  A licensed physician supervises each patient’s care, a nurse is always on the premises, and other medical professionals, such as occupational, physical or speech therapists, are also on hand. Many nursing homes have medical equipment normally found in hospitals, such as x-ray machines or electronic bed. In addition, these facilities often offer short-term rehabilitation services where an adult of any age can stay before returning home after a medical operation or procedure.

A nursing home is the right choice for someone whose medical needs require full-time nursing care or who must have access to services and facilities more like the hospital than home.

However, if needs are more minimal--such as a requirement for assistance with activities of daily living (ADL) like bathing, dressing, or toileting, or if there is need for simple care such as physical therapy and medication management but little more--a nursing home is unlikely to be the best fit.

Assisted Living in a Nutshell

An assisted living community might be a terrific match for someone who may have some health problems and needs help, say, with bathing or dressing, but are independent in the main. Although medical services are not as extensive as nursing homes, they do deliver services like medication and continence management. At most assisted living communities, a licensed nurse completes a comprehensive individualized assessment for each resident, and nursing staff are onsite or accessible 24 hours a day.  Geriatricians and other healthcare professionals, such as dentists or chiropractors, will often see clients on-site, and some assisted living communities have started to offer physical or occupational therapy while still others run wellness rooms supervised by licensed nurses. As well, a number of communities offer specialized memory care units for those with cognitive difficulties.

Like nursing homes, assisted living communities deliver personal care assistance as well as light housekeeping and laundry, and both come with communal dining halls that serve three meals a day including special meals for those with medical conditions like diabetes. In addition, both types of residential alternatives are equipped with safety systems like emergency pull cords.

Download The Complete Guide to Assisted Living

Who They Serve

Assisted living communities and skilled nursing facilities both serve seniors, but they each have a very different purpose.

An assisted living community is a good choice for a senior who needs additional support with activities of daily living (ADLs) and is looking for somewhere to live long-term. These may include dressing, showering, other grooming, or toileting. Assisted living communities also provide socialization opportunities and an event calendar with many activities that make it easy to get out and about.

Some assisted living communities also offer memory care services for those with Alzheimer’s disease or other forms of dementia. In fact, there are specialized assisted living communities that exclusively serve seniors with memory care.

By contrast, a skilled nursing facility is designed for those who have complex medical needs, from pain management to post-stroke rehabilitation. Residents in skilled nursing facilities typically need help that goes beyond ADL care. Like assisted living, skilled nursing facilities provide an event calendar and specialized dining choices.

Many residents of skilled nursing facilities are not planning on a long-term stay, although some do. Skilled nursing offers medical support for residents who need to get better before they are able to return to their home or move to an assisted living community.

Staff and Specialty Care

Assisted living communities provide 24-hour care, usually from nurses and other certified caregivers. They also provide a full complement of dining, housekeeping, maintenance, and other ancillary staff throughout the day.  

In addition to nurses and aides, skilled nursing facilities typically have on-site providers for physical, occupational, and speech therapy.  Caregiver ratios are lower due to the increased needs of residents. Skilled nursing facilities may have an onsite doctor or other clinician, as they are designed to provide medical care first and foremost.

Size and Lifestyle

On average, nursing homes are twice as big as assisted living communities (108 units versus 54). Assisted living residents are often housed in studio or one-bedroom apartments with kitchenettes while those in nursing homes usually live in shared or single rooms. Assisted living communities also have a homier feel to them than nursing homes. Both types of senior living options do offer recreational activities, although those in assisted living are typically offered a wider variety of options (think: arts and craft activities, trips to the theatre, or gardening or book clubs, to name a few).

Another big contrast is around autonomy and independence. Some assisted living residents drive their own cars, cook some of their meals and come and go freely. This would be out of the question for nursing home residents, who cannot leave their home unless they are assisted.


Finally, one big difference between nursing homes and assisted living communities is cost. According to the U.S. Department of Health & Human Services, in 2010, the average cost for a private room in a nursing home was $6,965 per month, more than twice the cost of a one-bedroom assisted living apartment, which averaged at $3,293 per month.

Keep in mind, though, that nearly all nursing homes are certified to participate in Medicare or Medicaid financial assistance programs, or both. Many states cover some assisted living communities under Medicaid, however, the amount of coverage and eligibility requirements vary widely and many communities are not covered at all. Note that assisted living communities are governed by state regulations, which fluctuate from state to state, while nursing homes are federally regulated.

Have more questions about the differences between nursing homes and assisted living communities? Leave a comment below and let us know!

Download the Everything You Need to Know About Independent Living guide

Topics: Assisted living, Nursing Home Alternatives

Wanda Moen

Wanda Moen

Wanda is the Vice President of Sales for The Arbor Company.

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