If you have a loved one who can no longer “age in place,” meaning they can no longer live independently in their own home, you may be wondering what the next step should be. While you’re having the assisted living vs. nursing home debate, read on to learn about the differences between the two so you can make the best choice for the senior in your life, or perhaps even for yourself.
What Is a Nursing Home?
A nursing home provides a higher level of medical care of the two senior living options. Closest to a hospital setting, a nursing home is a senior residence that offers a high level of attentiveness to the people who live there.
Nursing homes typically have skilled nurses and other aides available at all hours of the day and night, with physicians who call for routine appointments and more urgent situations. Medical care is provided at a nursing home, as well as various types of therapy, and residents can get assistance with virtually every aspect of their lives, from using the restroom to eating.
Residence at a nursing home is usually permanent, although some nursing homes offer rehabilitation facilities for seniors who may need temporary full-time help, such as after surgery or a stroke, until they can return to a less intensive level of care.
Nursing homes go by a number of different names, including:
- Old folks’ homes
- Old people’s homes
- Senior homes
- Rest homes
- Care homes
- Convalescent homes
- Skilled nursing facilities
Some nursing homes offer double rooms for couples who wish to continue living together. Others have single rooms or joint rooms for same-sex residents who have no partner.
Additionally, some nursing homes offer what is known as custodial care, which is considered non-skilled care. This is for people who cannot feed or dress themselves, such as people with Alzheimer’s, but who don’t need extensive, high-skilled nursing care.
Nursing homes can also offer palliative care, which is care designed to help relieve the pain and suffering that accompanies chronic health conditions. Palliative care does not cure health problems, it simply makes it easier for people to live with their respective conditions, such as arthritis.
What Is Assisted Living?
Assisted living offers less care than a nursing home but it is a step up in care from living independently. Some assisted living centers are basically residential complexes that offer seniors extra help with things like housekeeping, transportation, and 24/7 assistance with emergencies. Others offer additional services, such as:
- Personal care
- Recreational activities
- Spiritual activities
- Linen service
- Assistance with medications
- Social services
Often assisted living facilities offer tiers of care so seniors can add more care as they need it over time. The idea is to have seniors live as independently as possible with just as much help as they need. Assisted living typically offers more privacy than nursing homes. Many assisted living residents remain involved in community activities, unlike nursing home residents.
Some assisted living residences are affiliated with or even adjacent to nursing homes to provide a long continuum of care for seniors, who may eventually transition from assisted living to a nursing home when they need more care.
Also, some assisted living facilities provide memory care for people with dementia and Alzheimer’s. While these residents don’t need the skilled care of a nursing home, they do require close supervision and need to live in a place where they can’t wander or accidentally harm themselves.
Unlike nursing homes, which may be covered by insurance or Medicaid, assisted living is usually paid for privately. The monthly fee for assisted living is typically determined by the level of care provided as well as by the amenities the facility offers, such as classes, trips, swimming pools, on-site shopping, and specialty dining.
Like nursing homes, assisting living facilities are almost always accredited through appropriate agencies, depending on the state, by licensure, certification, or registration.
When Is a Nursing Home the Right Choice?
Nursing home residents can perform few tasks themselves and need assistance with most aspects of their lives. What is known as Nursing Home Level of Care (NHLOC) is often used as a set of criteria to decide if a senior should reside in a nursing home. Nursing Home Level of Care may also be referred to as:
- Level of Care (LOC)
- Nursing Facility (NF)
- Nursing Facility Clinically Eligible (NFCE)
- Skilled Nursing Level of Care (SNLOC)
- Level of Care Determination (LOCD)
While NHLOC varies from state to state, it’s important to know the distinction for your location because it may affect reimbursement for programs like Medicaid. It can also help you in your assisted living vs. nursing home decision.
Broadly speaking, NHLOC criteria include elements such as the following:
- Medical care: residents require equipment such as catheters, intravenous (IV) drips, or ventilators.
- Cognitive care: residents are unable to process certain information, such as with advanced Alzheimer’s and dementia.
- Behavioral care: residents may be incapable of controlling their emotions and may have mood swings or verbal outbursts.
- Functional care: residents cannot perform basic life functions, like dressing, eating, or using the bathroom.
An elderly person’s physician or primary health care provider may recommend nursing home care, knowing the person meets the NHLOC requirements for your area. If you aren’t sure, you can ask a geriatric specialist to help make the determination.
In general, it’s better to err on the side of too much care than too little when thinking about a senior who can no longer live independently. That could mean a nursing home, or it could mean an assisted living facility with high levels of help and supervision.
What are some reasons your senior in question may do better in a nursing home rather than in an assisted living situation?
The senior needs medical equipment typically found in a hospital.
While seniors can live with oxygen tanks and other self-monitored equipment in an assisted living facility, if they need equipment that you would usually see in a hospital room, a nursing home is probably a better option. This includes:
- Heart monitors
- IV bags and pumps
- Traction devices
- Suction devices
- Feeding tubes
Skilled nursing care is required daily.
If a senior needs a nurse throughout the entire day, an assisted living situation is probably wrong for them. A nursing home can offer registered and other nurses for things like wound and oncology care. The resident doesn’t have to request these services. As in a hospital, the health care providers decide what needs to be done.
Skilled nursing help is also used by temporary nursing home residents after major surgery, such as a hip replacement, or when they are recovering from certain incidents, like a stroke or heart attack. This is a more reasonable and economic approach when the patient can’t live at home alone for a time and when a hospital bed is too costly or needed for more critical patients.
The resident requires skilled therapy.
Although some assisted living facilities offer therapy, when a resident needs serious occupational, physical, or speech therapy, a nursing home is the best bet. Like skilled nursing help, skilled therapy can be long term or it can be temporary to help someone after an event like a stroke.
The older person has limited mobility along with other limitations.
There are certainly many people with limited mobility living happily in assisted living facilities. However, when a senior has lost mobility and also meets some of the other criteria listed in this section, a nursing home can offer the help they need.
Advanced dementia or Alzheimer’s is present.
Assisted living can provide help for dementia and Alzheimer’s residents when they still have other functions intact. But when a senior citizen needs full-time memory care, especially if other health concerns are present, a nursing home is usually the safer of the two alternatives.
Cognition is limited.
When a senior’s cognition has declined significantly, it’s challenging to live in an assisted living situation that requires some level of independence. For seniors with cognitive deficits, a nursing home is usually the best option.
There has been a serious decline in mental health and self-censoring.
Assisted living facilities are typically very community oriented. An older person who has frequent outbursts and who can’t self-censor their language and behavior is usually a better fit for a nursing home. Sometimes this behavior is independent of other health concerns but it also sometimes accompanies dementia.
The senior requires help with most daily functions.
While assisted living does provide help with many life functions, seniors who can no longer bathe themselves or who need help dressing and feeding themselves may get better help from a nursing home. With seniors for whom daily living tasks like housekeeping and cooking are their only problems, assisted living is often a better choice. But for seniors who need help with daily living in conjunction with other health problems, a nursing home is going to better meet their needs.
When Is Assisted Living a Good Option?
Assisted living is the perfect option for a senior who is more independent than not and who can appreciate the community aspects of the facility. Because assisted living facilities don’t have the hospital-like level of nursing care onsite that a nursing home does, they are best suited for seniors who don’t need that constant care. Here are some scenarios when seniors typically do well in assisted living.
A senior still enjoys privacy for daily living.
Assisted living affords more privacy than a nursing home because of the level of care offered. Also, most units are more like private apartments where services come in as needed and extra features like security cameras and call buttons add a layer of safety.
The resident doesn’t have any debilitating health issues.
As mentioned above, if a senior needs long-term, 24/7 skilled nursing, a nursing home is the best fit. However, a senior who isn’t bedridden and doesn’t need daily hospital-type equipment may do better in an assisted living situation.
An older person still has most of their cognitive function, usually with limited dementia.
Assisted living facilities are best for seniors who have retained good cognitive function and have limited dementia, unless they are in a dedicated memory care facility. Because of the independence provided by assisted living, seniors need to be able to make their own decisions, understand what’s going on around them, and not be a danger to themselves through forgetfulness or confusion.
The resident still desires to be active in the community.
A wonderful aspect of assisted living is that it lets older adults stay active in their communities. For the senior who is still involved in worship, clubs, and other outside activities, assisted living allows them to continue those activities while still getting extra help around the home and added security.
The senior can spend time on their own unsupervised.
Unless they are in a memory facility, seniors in assisted living are typically able to spend time on their own. They may receive help with meals, getting dressed, or taking their medications, but they don’t need constant supervision like in a nursing home.
Because of the gray areas involved in the assisted living vs. nursing home decision, many assisted living facilities today strive to provide the greatest continuum of care possible so that seniors can prolong their time outside of a nursing home. For example, some offer independent living that’s almost like staying at a resort, with included meals, light housekeeping, happy hours, and fitness clubs, plus extra on-site security and medical alert devices.
Seniors can then transition to greater levels of assisted living as needed. This gives them a feeling of aging in place and doesn’t involve the disruption of moving and making new friends. Today, older adults in their 50s or 60s can start with independent living and stay in the same facility for 20 years or more, knowing that increased care is available when they are ready for it. Only seniors who require the most intensive levels of care need to transition to a nursing home.
If you would like more information about assisted living to see if it’s a good option for you or a loved one, contact Park Terrace Senior Living today. We can give you a tour of our Phoenix residence, which includes both independent living and assisted living. We combine the best of vacation living with a permanent residence and community for older adults and have streamlined everything for super ease and comfort. Check out our refreshing take on senior living. We offer everything you need and more!