Assisted Living vs. Nursing Homes: Costs and Types of Care

What Is Assisted Living?

Assisted living refers to senior communities where residents can get help with daily activities but still maintain some independence. Each community typically houses between 25 and 120 individuals in separate apartments, while common areas are shared.

The care provided ranges from custodial care to significant levels of assistance with bathing, dressing, and toileting. People receiving higher levels of care should expect to pay more. Some assisted living communities provide transportation to nearby healthcare facilities or have medical personnel occasionally visit on-site, but they do not offer the 24/7 skilled nursing care that residents receive at nursing homes.

Assisted living communities also cater to unique niches. There are assisted living facilities with specific religious affiliations or gourmet meal plans, as well as facilities that allow pets, specialize in memory care, or are located in highly desirable locations.

To learn more about assisted living, read our guide: What Is Assisted Living?

Who Can Benefit From Assisted Living?

Assisted living is best for seniors who are mostly independent. These older adults may have pain or mobility issues that make everyday chores difficult, so having services such as laundry, cleaning, and on-call staff can greatly improve their quality of life. Residents can also benefit from a sense of community provided by other seniors.

What Are Nursing Homes?

Nursing homes provide seniors with the highest level of care available outside a hospital. They offer health-care services fulfilled by skilled medical professionals, and most residents require daily custodial services such as meals, personal hygiene, and medication administration. Residents are typically housed in single or shared rooms, and a skilled nursing staff is on site 24/7.

Some people spend only short stints in nursing homes while they recover from surgical procedures or serious illnesses, but most older adults who move into a nursing home remain there permanently as a result of their continuous need for care. Both short- and long-term residents commonly have access to physical and occupational therapists who are either on staff or visit on a regular schedule.

Who Can Benefit From Nursing Homes?

Nursing homes are ideal for older adults who are no longer safe living independently, often as a result of overall declining health, serious physical or memory diseases, debilitating pain, or other limitations. In many cases, seniors who reside in nursing homes need additional help with the most basic types of mobility.

Older adults who have recently undergone major surgical procedures or suffered serious physical damage may also benefit from a short stay in a nursing home, which will provide the intensive care required for recovery.

Differences Between Nursing Homes and Assisted Living

Assisted living facilities and nursing homes both provide senior living options, but the level of care, services provided, living environment, and cost vary between the two.

Care Provided

Assisted living solely provides assistance with nonmedical services meant to make older adults’ lives easier. The services can be as minimal as help with household chores, laundry, and meal preparation or as extensive as aiding with eating and toileting. Assisted living facilities do not, however, provide medical care. Residents who need to visit a doctor typically attend off-site appointments, but some assisted living communities have partnerships with medical providers who periodically visit the facility.

Nursing homes provide the highest level of care available outside a hospital, including both custodial and medical care. Patients routinely need round-the-clock supervision by nurses or licensed caregivers, and many need assistance with the activities of daily living, such as bathing and eating. Nursing homes — unlike assisted living communities — also provide medical care, so residents are evaluated by a physician on a regular basis. The physician then consults with on-site staff about the care for each individual. Residents also have access to on-site physical, speech, and occupational therapy, and some facilities provide dental care. Nursing homes are also required by federal law to have a registered dietician on staff.

Costs

Assisted living and nursing home costs vary based on location and amenities offered, and your personal cost is also affected by the level of care you or your loved one require. Nursing homes are more expensive than assisted living facilities by an average of approximately $4,000 per month, but you are more likely to receive financial aid to cover the cost of a nursing home.

The average price tag for a month at an assisted living facility in the United States is $5,350. For nursing homes, the average cost ranges from approximately $8,669 to $9,733 per month, depending on whether you select a semi-private or private room.

Financial Assistance

For the average American, the cost of assisted living and nursing home care may seem astronomical. Fortunately, there are many financial-assistance options that can minimize the bill for senior care.

Financial assistance for assisted living and nursing home care typically comes from the same sources. The portion of care covered and requirements for assistance vary, however, and funding for nursing care tends to be easier to secure than aid for assisted living.

Medicaid

In 41 states, older adults can receive financial assistance through Medicaid for the cost of custodial care in an assisted living facility. Medicaid may not cover the cost of assisted living room and board, however, depending on the state in which you live.

Medicaid is the most common form of financial assistance for assisted living care. To qualify, your monthly income may not exceed a threshold set by each state. Many people have too much income to qualify for Medicaid long-term-care benefits, but there’s still hope. Some states allow seniors to qualify for Medicaid by putting their extra monthly income in a trust.

If you qualify for Medicaid and a doctor has deemed nursing home care medically necessary, the program will cover most of your nursing home costs, including room and board. There are charges it won’t cover, however, including those unrelated to your medical care.

Medicare

If a physician prescribes nursing home care following a major surgery, injury, or illness, Medicare will cover up to 100 days each benefit period. That includes 100% of the cost for the first 20 days and 80% of the price for Day 21 through Day 100.

Medicare will not cover assisted living, but some Medicare Advantage plans cover the cost of personal (custodial) care.

Other Financial Assistance

Other common financial-assistance possibilities for both assisted living and nursing homes include veterans’ benefits; Social Security and state-funded senior programs; friends and family; and long-term care or life insurance policies.

When to Move From Assisted Living to a Nursing Home

Older adults who start out in assisted living occasionally develop additional medical needs the facility cannot meet. In contrast, nursing homes were created to fill most of the complex medical needs that arise during older adulthood and provide the custodial care also offered in assisted living facilities.

Transition can be taxing — both physically and emotionally — so many older adults may hesitate to make a move if an assisted living facility does not directly ask them to find another home. Nevertheless, a move may be necessary.

It may be time to move from assisted living to a nursing home if you or your loved one meets one or more of the following conditions:

• You have complex medical needs that require frequent attention by a certified health-care professional (frequent infections, injections, use of IVs, need for wound redressing, heart failure, severe diabetes, serious respiratory issues, etc.).
• You have been diagnosed with a degenerative condition, and it has progressed significantly.
• You have a memory disorder and have begun to wander, experience disorientation and confusion, or act aggressively toward care staff or other residents.
• You are bed-bound without the assistance of another person.
• You can no longer pay for assisted living but are covered by insurance for nursing home care.
• You struggle to swallow or require a highly specialized diet.
• Your assisted living community is falling short of your most basic needs.

How to Choose Between Assisted Living and a Nursing Home

Your loved one’s needs may seem to fit both assisted living and nursing home residency, and you’ll have to make a decision between the two. How do you decide which type of care will best meet your family member’s needs? Consider the following:

Medical Needs

Consider your loved one’s overall health and the frequency of medical attention they need. If they have a chronic condition, do they still manage it well on their own or do they need a nurse to check in on a regular basis? If they forget things, can it be attributed to normal cognitive decline or do they have a serious memory disorder that may require 24/7 supervision? Do they have a degenerative condition that has begun to get worse? Is incontinence a perpetual struggle, or do they simply have an occasional accident?

Level of Personal Care

Review your loved one’s personal or custodial-care needs. If they need help in only a few areas, such as household chores, cooking, and bathing, then an assisted living community will likely fit their needs. If they need assistance with multiple activities of daily living (dressing, eating, bathing, etc.), it may be time to consider a nursing home even if they don’t have additional medical conditions. Assisted living staff can help with medication management, so missing a couple doses here and there doesn’t automatically qualify your loved one for nursing home residency.

Mobility

Mobility is a significant factor to consider when choosing between an assisted living community and a nursing home. If your loved one is bedridden or has entirely lost the use of one side following a stroke, for example, a nursing home is likely their best choice. On the other hand, an individual who uses a wheelchair, has little trouble with daily living activities, and manages chronic conditions well has a high chance of success in assisted living.

Cost

If your loved one does not qualify for financial assistance and can meet the health and mobility requirements for an assisted living community, a nursing home may be your best — or only — bet. An average $4,000 per month price difference between assisted living and nursing homes adds up quickly. On the other hand, if your loved one has Medicaid and meets medical qualifications for a nursing home, you are far more likely to have most of the costs covered at a nursing home than in an assisted living community.

Other financial-assistance options, such as insurance, retirement funds, veteran benefits, and senior organizations, may also have their own stipulations about whether they will help pay for assisted living instead of a nursing home.

Every situation is unique, and you will want to weigh the needs of your loved one against costs — and the importance of each — when making your final decision. To learn more about senior living environments, read our helpful guides:

• Alternatives to Assisted Living
• Guide to Seniors Condos
• Medicare and Medicaid Coverage of Assisted Living
• Medicare and Medicaid Coverage of Nursing Homes
• How Much Money Do You Need to Retire?
• What Is a Caregiver?