Choosing Between Assisted Living vs. A Nursing Home

September 3, 2020

Differences Between Assisted Living & Nursing Homes?

The main difference between a nursing home and assisted living facility is the level of medical services available. Nursing homes provide round the clock care and monitoring, while assisted living communities have a nurse on staff, but that person is not available 24-7.

Given a choice, many families will say that they prefer for their loved one to go into assisted living, not a nursing home. It can also be hard to know when it is time to consider a nursing home. However, when safety becomes a concern, there may not be a choice. If you can approach the decision with a strong sense of advocacy and care, the transition will be successful for everyone.

What is Assisted Living?

Assisted living communities are growing in popularity, and for good reason. Assisted living is senior group living that takes the worry out of household maintenance, meal preparation, and housekeeping.

Some assisted living communities are large, and others have a more home-like atmosphere.  Most have memory care units attached to accommodate people with dementia who can no longer reside safely in assisted living.

Assisted Living Communities are Best for:

Assisted living helps people if they need it, with bathing, grooming, medication management, and health services.  Amenities such as movies, games, trips, hair salon, book clubs, and other activities are standard in most communities. Most assisted living communities allow residents to come and go as they please as long as staff is notified.

As the population ages, many assisted living communities are accepting more medically frail residents. Each state has guidelines regarding who can and cannot be allowed into a community. Still, it is not uncommon to see residents in assisted living with walkers and other mobility devices.

What is a Nursing Home?

A nursing home is the highest level of care outside of a hospital. There are some other services a nursing home provides:

  • Injections and IV fluids and antibiotics
  • Respiratory therapy
  • Wound care
  • Diabetic care
  • Care for repeated infections
  • Two-person transfers
  • In-house physician services
  • Ability to manage residents who have significant cognitive impairment

Many, although not all nursing homes have a more institutional feel. Some rooms are shared if finances are a concern or if there are no single ones available. Nursing homes rely on a flat rate Medicaid reimbursement, which can lead to cutting costs by combining people in rooms.

Similarities Between Assisted Living & Nursing Homes

Nursing homes, like assisted living, offer medication management, all meals, housekeeping, transportation, and life enrichment activities. Many nursing homes are also secure with a code system to get in and out of the front door.

The Criteria for Admission to Assisted Living

The states determine criteria for admission to assisted living, but oversight varies since there is no universal federal standard. Several states have these requirements:

  • A resident has to be able to evacuate the community during an emergency.
  • If a resident requires two people to assist them with transfers, they may be asked to go to a nursing home.
  • Nursing and aide needs are not to exceed what the staff or nurse can provide.
  • Symptoms of dementia are not so severe that they should be managed in memory care or a nursing home.

Most assisted living communities have a nurse who assesses an individual to make sure they meet the criteria. The other consideration for admission is if the resident can afford assisted living.

The Criteria for Admission to a Nursing Home

States determine admission criteria to a nursing home.Generally speaking, to be admitted, you must have the following:

  • A skilled nursing need such as assistance with catheter care, injections, and intravenous medications, etc.
  • Help with activities of daily living such as grooming, dressing, bathing, and transfers.
  • A negative tuberculous and COVID-19 test.

Most people who reside in nursing homes qualify for Medicaid. That being the case, your loved one must meet the Medicaid criteria for your state to be admitted to a nursing home.

Who Pays for Assisted Living?

Many people think that Medicare pays for assisted living. It does not. Medicare only pays for skilled nursing (short term rehabilitation) and home health. Assisted living is paid privately, and the amount is dependent upon the state and sometimes the area of the state where you live.

According to Genworth, the median cost for care in assisted living in 2019 was $4051 a month. Your price could be lower or much higher, depending on several factors. One of those factors is how much care you require. Many communities have a base rate and then add on monthly fees depending on the level of care you need.

The only other payor source for assisted living is if you have a long term care policy. Long term care policies vary widely in terms of the daily coverage amounts, and most have an elimination period.

Who Pays for a Nursing Home?

Nursing homes are more expensive than assisted living because of the level of medical support they provide. Genworth estimates in 2019, the median cost of a semi-private room was $7513 a month. A private room was $8517 a month.

As you can see, nursing home care is costly. Unfortunately, many people deplete their estates paying for care and have to qualify for stateMedicaid to continue to pay the cost of a nursing home. Each state determines Medicaid eligibility, but generally, income must not exceed $2349 a month with assets around $2000.

The only other way to pay for a nursing home is through along term care insurance policy. You can learn more about how much nursing homes cost in our other guide.

When to Move From Assisted Living to a Nursing Home

How and when to move a loved one from assisted living to a nursing home can be one of the more difficult decisions you will make.Sometimes, an assisted living executive director or nurse will request that your loved one move. The bottom line in making this decision is safety. Here are some reasons it might be time to move your loved one to a nursing home:

  • Your loved one’s medical requirements exceed the care that assisted living can provide. In other words, there is a need to access nursing care around the clock.
  • Severe dementia contributes to wandering, aggression, or self-harm.

Two people need to assist your loved one with transfers to and from bed or a chair.

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