Elder care planning, which includes long-term care planning (LTC), is something many people think about as retirement closes in. However, too many people just keep thinking about it and don’t act. One reason for a delay in planning may be the belief that long-term care means “ending up in a nursing home”. While the majority of individuals will receive care at home – at least for a while – at some point a decision to move on to facility care may become necessary. One common concern is, what is the difference between assisted living vs. nursing home care?
It’s no wonder people are confused. Nursing homes have been called numerous things over the past half century. I remember watching old movies with my mother, and seeing scenes of elderly people who lived in a “home for the aged”. My mother was the guardian of her uncle, my great-uncle Oscar, who had no children of his own to help him. We would go visit him at the “rest home”, which is what nursing homes were often called back in those days. Today, these facilities are generally referred to as nursing homes or skilled nursing facilities (SNF).
What is the “official” difference between nursing homes vs. assisted living? In a nutshell:
- Nursing homes provide medical and personal care in a medical environment
- Assisted living primarily provides personal care in more of a residential environment.
Differences also center around medical services, living space, help with activities of daily living, social activities, meals, and cost. We will compare the differences between these two types of facility care.
Nursing homes still carry a stigma with many as being a place where individuals go towards the end of their life when they can no longer take care of themselves – with little to do except watch television in their room and wait for a visitor or for the next mediocre meal to be served. Fast forward to the 21st century, and we find the nursing homes of today have come a long way! In addition to patients who need both medical and personal care on a 24/7 basis – nursing homes are also now short-term rehabilitation facilities where individuals are cared for following surgery, illness, or injury. Services may include physical therapy, occupational therapy, and speech therapy.
- Cost – varies by state, but on a national average, a semi-private room runs around $93,000 a year, and a private room costs around $106,000 annually1
- Living space – is similar to a hospital room. Whether private or semi-private, each room has its own bathroom – and limited storage for clothing and personal possessions.
- Meals – are served in a dining room atmosphere for those who are able. Meals can also be served in room.
- Medical Services – are offered 24/7. Nursing home care is for individuals who need consistent medical attention as well as daily help with personal care and activities of daily living. Short-term patients needing rehabilitation after surgery, suffering a stroke, or other conditions receive help with personal care, activities of daily living (ADLs), and are provided with any therapy they may need.
- Help with ADLs – In addition to medical care, patients receive help with (ADLs) such as bathing, dressing, and toileting.
- Social Activities – may include book clubs, arts and crafts, pet therapy, religious services/studies, musical events, etc.; designed to keep residents engaged.
Assisted living was developed in the 1980s specifically to provide care in a residential environment where individuals would remain safely independent, retain their dignity, and be treated as residents – not as patients. Residents have private quarters with doors that lock and 24-hour staff to handle medical emergencies.
In the past, individuals who could no longer remain at home to receive care had no other option but nursing home care. That is exactly why my Mom’s uncle, my great-uncle Oscar resided in a nursing home. How wonderful it would have been for him to have had the option of care in assisted living.
- Cost – varies by state but is generally about half the cost of nursing home care. The national average for a one-bedroom unit is around $52,000 a year.1 Studio units are also available at less cost.
- Living space – is a personal residence. Residents bring their furniture and possessions and can create an environment that feels like home.
- Meals – are served in a dining room, usually with a choice of meals from a menu. Meals can also be served in room. In addition, units generally come with a kitchenette, allowing those wishing to have more meal options to prepare food in their unit.
- Help with ADLs and cognitive impairment – Residents receive help with activities of daily living such as bathing and dressing. In addition, many assisted living facilities now have dedicated memory care units that help residents with dementia-related conditions remain in a community setting longer.
- Medical Services – assisted living is not designed for individuals needing daily medical care, however services such as daily medication management are available. Registered nurses are on staff 24/7 for intermediate needs, and there are staff doctors available several days a week.
- Social Activities – are more robust in assisted living facilities than in nursing homes. In addition to book and card clubs, arts/crafts, lectures, religious services/studies, musical events, and movie nights – there may be occasional field trips for able residents.
Determining which care service a person needs may simply be a matter of how much medical assistance the individual requires. Assisted living provides options that can extend independence, social interaction, and dignity, as well as the comforts of home living with your own furniture and possessions.
Many years before needing care for dementia, my mother told me to never get rid of her favorite pair of yellow chairs. She had them for nearly 60 years and recovered them four times! Unlike her Uncle Oscar, my mother was fortunate enough to have the option of assisted living and taking her favorite possessions with her. She passed away peacefully on her own sofa in her one-bedroom unit, also furnished with that pair of yellow chairs. My mother is gone now – but I still have those chairs.