Skilled nursing facility vs nursing home vs assisted living

At some point, support from family, friends, and local programs may not be enough. People who require help full-time might move to a residential facility that provides many or all of the long-term care services they need.

Facility-based long-term care services include: board and care homes, assisted living facilities, nursing homes, and continuing care retirement communities.

Some facilities have only housing and housekeeping, but many also provide personal care and medical services. Many facilities offer special programs for people with Alzheimer's disease and other types of dementia.

What Are Board and Care Homes?

Board and care homes, also called residential care facilities or group homes, are small private facilities, usually with 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals and have staff available around the clock. Nursing and medical care usually are not provided on site.

What Is Assisted Living?

Assisted living is for people who need help with daily care, but not as much help as a nursing home provides. Assisted living facilities range in size from as few as 25 residents to 120 or more. Typically, a few "levels of care" are offered, with residents paying more for higher levels of care.

Assisted living residents usually live in their own apartments or rooms and share common areas. They have access to many services, including up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities. Exact arrangements vary from state to state.

What Are Nursing Homes?

Nursing homes, also called skilled nursing facilities, provide a wide range of health and personal care services. Their services focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.

Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require constant care and supervision.

To look for and compare nursing homes in your area, see Medicare's Nursing Home Compare. Also get tips for choosing a nursing home.

What Are Continuing Care Retirement Communities (CCRCs)?

Continuing care retirement communities (CCRCs), also called life care communities, offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, and skilled nursing care all on one campus. Healthcare services and recreation programs are also provided.

In a CCRC, where you live depends on the level of service you need. People who can no longer live independently move to the assisted living facility or sometimes receive home care in their independent living unit. If necessary, they can enter the CCRC's nursing home.

There are many sources of information about facility-based long-term care. A good place to start is the Eldercare Locator at 1-800-677-1116 or https://eldercare.acl.gov. You can also call your local Area Agency on Aging, Aging and Disability Resource Center, department of human services or aging, or a social service agency.

For information on covering the costs of long-term care, read about paying for care.

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Facility-Based Long-Term Care

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 01, 2017

Assisted living is primarily a residential environment, while nursing homes — also called skilled nursing facilities — are considered medical environments.

To clarify the distinction, here’s a summary of some key differences between the two.

Medical services

Assisted living

In an assisted living facility, residents have access to different levels of medical attention depending on their individual needs.

For example, a facility may provide transportation to doctor appointments or help with taking medications. Some assisted living facilities offer special areas for people with dementia or conditions that affect memory.

In general, people in assisted living facilities are in fairly good health.

Nursing home

In a nursing home, medical care is provided round the clock. A nursing staff helps care for residents with chronic illnesses.

Rehabilitative services such as physical, occupational, respiratory, and speech therapy are provided for those who need them.

Some residents live there long term, and some are admitted for a shorter period of rehabilitation after a hospital stay.

Living space

Assisted living

In an assisted living facility, people often live in individual or shared apartments with kitchens, bedrooms, and living rooms.

Some facilities offer furnished spaces. Common areas invite residents to share meals and activities if they choose.

Nursing home

In a nursing home, people generally have individual or shared rooms with en-suite bathrooms.

Many nursing homes or skilled nursing facilities have common spaces where residents can share meals or participate in activities together.

Assistance with daily activities

Assisted living

If residents of an assisted living facility need help with daily activities, such as bathing or getting dressed, those services are provided.

Laundry, housekeeping, and meal preparation services are available to residents who need them.

Nursing home

In a nursing home, most people need more extensive help caring for their daily needs.

Staff members help residents bathe, dress, use the restroom, and take their medications. Meals are prepared by a kitchen staff, and the staff take care of laundry and cleaning for the residents.

Recreational activities

Assisted living

One of the hallmarks of assisted living facilities is the wide range of activities offered to residents.

Research shows that staying physically active and socially connected is crucial to maintaining the health of older adults.

Most assisted living facilities offer opportunities for physical exercise, creative expression, and socializing. Some also offer religious services and opportunities to volunteer in the community.

Nursing home

In nursing homes, the variety of recreational activities may be more limited.

Many nursing homes offer art classes, choir, cooking classes, animal therapy, educational courses, and mentally stimulating games for residents to enjoy.

Exercise activities are often supervised by physical therapists who focus on helping residents gain strength, improve mobility, and prevent falls.

A 2018 research review showed that these supervised physical activity sessions have important health benefits for residents of long-term care homes.

Meals

Assisted living

In an assisted living facility, residents may cook for themselves in their kitchenettes or take meals in community dining rooms.

Some facilities offer meal delivery services for a fee. Dining rooms may stay open all day or may serve meals at set times throughout the day.

Nursing home

In a nursing home, dieticians prepare meals for residents. Depending on their personal wishes and mobility, residents may be served in their own rooms or in a communal dining room.

Personal aides are usually available to help residents who have difficulty eating on their own.

Cost

The American Health Care Association has reported that the cost of nursing home care is roughly double the cost of assisted living residence.

For residents paying out of pocket, the annual cost of a semi-private room in a nursing home is around $89,000, while an assisted living facility costs approximately $48,000 a year.

Insurance coverage

Medicare does cover some costs of a nursing home or skilled nursing facility if you need to be there to recuperate from a health condition, surgery, or injury.

But you typically have to cover some costs yourself if your stay extends beyond 20 days.

Medicare usually does not pay for assisted living or for help with custodial care (help with the activities of daily living).

Some state Medicaid programs pay for assisted living or nursing home care, but the rules vary in each state. Some states may require Medicaid beneficiaries to spend their funds before Medicaid begins paying for services.

According to Medicare.gov, some people invest in long-term care insurance policies to cover their costs, but the specific benefits vary in each plan.

Some policies only cover care in a nursing home while other policies include at-home care and assisted living facilities.

Before you purchase a long-term care policy, be sure to read the provisions carefully so you understand in advance what is and isn’t covered.

The kind of facility that’s right for you will depend on your health and how much help you need with daily activities.

Here are a few questions to help you decide which kind of facility is best suited to you or someone in your care:

• How much help do you need to take care of daily activities like bathing, dressing, and using the restroom?
• Do you need medical care for serious health conditions?
• Are you able to prepare your meals?
• How do you plan to pay for the care you need?

Once you’ve decided which type of facility best meets your needs, you’ll need to explore individual facilities to find a good match.

As you compare facilities, keep these questions in mind:

• Is the facility licensed by a state agency?
• Has the facility been audited or inspected by any healthcare agency, and are the reports available?
• Do the residents seem happy and well cared for?
• What medical professionals are on staff, and what’s their availability?
• What’s the ratio of residents to staff members?
• What’s the staff turnover rate?
• What’s the procedure for handling a medical emergency with a resident?
• Can people receive visits from their doctors or home healthcare providers?
• Which services are included in the basic cost and which are offered at an extra charge?
• Who gives people their medications?
• Is transportation provided to doctor appointments?
• How close is the facility to your family and friends?
• What kind of recreational activities are offered?
• Do residents go on community outings?
• Can residents bring their own furnishings?
• Are bathrooms shared?
• Is the facility affiliated with a particular faith tradition?
• Can you review a copy of the contract, so you understand the policies, procedures, and costs carefully?

If possible, visit facilities more than once. Talk with friends, neighbors, colleagues, medical professionals, and local organizations that serve older adults to get a sense of which facilities provide the best care in your area.

If independent living is the goal, you may find it more appealing or more cost-effective to use home health aides or assistants to help care for an older adult at home.

Another increasingly popular option is shared housing, in which older adults live together or with a younger person. This may help keep down housing costs, while also staving off loneliness and isolation.

For people who want companionship but don’t need extensive medical care, board-and-care homes (also called adult family homes) may be an option.

Board-and-care homes are smaller residential settings where several older adults live in a single home with a caregiver on site.

Deciding when to transition from independent living to an assisted living or skilled nursing facility isn’t easy. Understanding the options in your area is a good place to begin.

Assisted living facilities may be a good choice if you’re in fairly good health but need help with some daily activities. A nursing home may be better if you need 24-hour medical care along with basic services.

Once you’ve identified the type of facility you need, take a closer look at the options in your area to find one that fits your budget, meets your needs, and provides the services that are right for you.