What are the differences between Assisted Living and a Nursing Home?

It is important to understand the differences between an assisted living residence and a nursing home before choosing which environment is the right fit for you or your loved one. It is best to pick a senior living community that matches a person’s current needs and can also accommodate needs that evolve over time.

If you or a loved one has a progressive illness, such as Parkinson’s disease, Alzheimer’s disease, or another chronic and debilitating medical condition, choose an environment that offers a transition plan so a secondary move may not be necessary. The transition plan should include increased services and support, and/or allow for a simple relocation to another floor or building within the same complex. Moves for seniors can be stressful and strenuous on all family members, so minimizing major moves is key to everyone's emotional well being.

In general, an Assisted Living environment provides services for a person who requires some but not full assistance. In other words, this person is semi-autonomous and is able to manage some of their activities of daily living and/or domestic tasks but may need help with other activities.

Activities of daily living include:

  • Bathing
  • Grooming
  • Dressing
  • Toileting
  • Getting in and out of bed
  • Walking around the home
  • Feeding oneself

Domestic tasks include:

  • Housekeeping
  • Grocery shopping
  • Laundry
  • Meal preparation
  • Money management
  • Medication management.

Assisted living communities offer support with activities of daily living and domestic tasks and may be included as part of the monthly rental or on an á la carte basis. There will usually be a central dining room from which a person can choose a meal plan. Meal plans can vary from one to three meals daily. Some communities offer “tickets” that can be used for any meal, so the resident has flexibility. These communities usually offer a small kitchen and bathroom in each room, although there may be shared rooms as well. Some units are small apartments with a second bedroom.

Many assisted living environments have small grocery stores, hairdressers, activities (movies, exercise, art, social club) and some even have a small bank depot. All of these services are available at an additional charge. Many assisted living communities have a health center which offers nursing visits or pharmacist visits.

The rental rate for an Assisted Living community is determined by the number of services needed. For example, if your loved one has mild memory loss and only needs medication management services and meals, that would be offered at one rate. But if this your loved one begins to need, for example, two supervised weekly showers six months later, that will usually require another service level and the monthly rate would increase. Once toileting care is required, or if there is a persistent memory problem that leads the staff to have to redirect your loved one to their room or dining room — or their safety is at risk due to wandering — memory care may be indicated.

A nursing home is needed when a person is fully dependent on others for most or all of their activities of daily living and domestic tasks. Usually, the fee for a nursing home includes full time care and support. However, if a person has specific needs, such as a lift for getting in/out of bed as they are fully bed/wheelchair bound, or their behavior is such that more supervision is needed, the nursing home may charge additional fees. Usually, there are doctors and nurses available for regular visits (additional fee may apply), but you should be allowed to have your own physician continue to follow you. In addition, protective undergarments, medication and personal supplies will not be included in the rate.

If your loved one has severe memory problems and requires 24 hour supervision, he or she needs the full support of a nursing home, unless an assisted living facility has a secured floor. Regardless, if your loved one suffers from disorientation, confusion and short term memory problems make sure that the environment in which he or she lives provides a secured method of getting in/out of the building or on/off the floor (codes for elevator, bracelet, etc.).

If you need additional advice in choosing the proper level of care, consult with your doctor, a geriatric care manager or social worker to evaluate your needs. Senior living communities with progressive levels of care can also help you with this decision.


Written by Stephanie Erickson

Stephanie Erickson, MSW, PSW, LSCW is a clinical social worker licensed in California and Quebec who specializes in working with seniors and their families. She is currently writing a book which encourages family discussions and offers tips on how to proactively design your aging experience. Erickson has provided training and consultations to financial institutions, community groups and professional organizations, and has been a guest on CJAD Radio, Issues Today Radio, and the Alzheimer’s Speaks radio show. Erickson has developed various worksheet packages and webinars to assist current caregivers and families proactively.

Erickson Resource Group