When Dan and his wife, Erin* realized they needed to consider supervised care for his father, Gene who was showing signs of memory loss and reduced mobility, they weren’t sure where to begin. Searching online, they found plenty of options for older adult living within a 2-hour drive of their home. But they were overwhelmed by the information. In particular, they didn’t objectively understand the difference between nursing home care and assisted living care.

Though not a widely researched topic, surveys have shown that Dan and Erin are not alone in their confusion: Whether as a matter of marketing or geographic preference, different names are often used to describe types of residential care for older adults. For example, nursing homes may also referred to as long term care facilities, skilled nursing facility, or homes for the aged. 

In reality, there are two broad categories of care settings for older adults: 

• nursing homes 
• assisted living communities

Understanding the differences between a nursing home and an assisted living community can make the process of choosing elder care less stressful and more reassuring for your family.

What type of care is provided at a Nursing Home?

Nursing homes are legally permitted to provide extensive, 24-7 nursing and medical care under the supervision of a practicing physician and medical specialists. This care is somewhat similar to (but more extensive than) hospital care and can include:

• near-constant monitoring of individuals who have significant physical and/or cognitive impairment and serious medical conditions
• round-the-clock nursing care
• assistance with personal hygiene, toileting, dressing, cleanliness of room 
• various types of physical rehabilitation / therapy (speech, hearing, cognitive)
• social-emotional therapeutic services
• meals are provided according to the medical needs of each patient, similar to a hospital stay
• visitation hours are not open-ended but are similar to hospital visiting hours
• recreational and social programs are limited and may not be provided at all depending on a person’s health condition(s)

Importantly, families need to understand that nursing home care is a custodial arrangement in which the medical staff are the custodians of care for the older adult. In a custodial arrangement, the room to which your loved one is assigned is not their private, personal space. Medical staff and other personnel may enter the room at any time of the day or night.

The length of an individual’s stay at a nursing home can be a short-term (several weeks) or long-term (months or years). Some individuals may transfer into and out of nursing home care based on reoccurrence of medical symptoms/complications that cannot be sustained in hospital care.

What type of care is provided at an Assisted Living Community?

An assisted living community describes older adult care found on a continuum and often referred to as Continuing Care Retirement Communities (CCRC). These communities are licensed to offer different levels of healthcare and wellness care to support the quality of living for older adults as their needs change over time, including physical, medical, social and emotional, and spiritual needs. 

Older adults who reside within an assisted living community are considered independent to the extent that they are capable of participating in and, at the least, partially managing their basic daily living needs within their private living quarters. The extent of assistance needed is a determining factor in cost to reside at an assisted living community. 

Assisted Living Communities provide a wide array of services based on iwhat is needed by a resident. Services can include:

• Meals provided and/or restaurants on site
• Recreational areas indoors and out
• Entertainment and enrichment programs
• Concierge services
• Shared common areas for activities
• 24-hour medical staff accessible to all residents regardless of level of independence
• Personal hygiene assistance (dressing, bathing)
• Medication reminders
• Housekeeping
• Laundry 
• Transportation 
• Security 

Assisted living communities focus on preserving an older adult’s well-being and uphold a resident’s right to personal privacy, autonomy, and dignity while promoting community and family involvement.

Assisted living centers do not employ a custodial arrangement. Rather, the older adult’s living space (usually an apartment style set-up) is considered a private residence. As such, an older adult enters the community as an active and independent resident who needs minimal assistance, but should their health decline in a way that prevents truly independent living, the community provides a transition to stepped-up care. This can include receiving help with daily living activities, physical rehabilitation and adaptations in their same living space – or transitioning to more medically intensive long-term care services such as Memory Care or skilled nursing (with appropriate permits as required by law).

In the broadest sense, nursing homes focus strictly on medical care – from short-term rehab to long-term ongoing medical care. Assisted living is focused on supporting the evolving health and wellness needs of older adult residents for the duration of their “golden years”.

How do I know if my aging parent needs placement in assisted living or a nursing home?

Foremost, the type of care an aging parent needs will be determined by their medical needs, as indicated by their healthcare provider. Additionally, the extent to which they require help managing their health and personal business, is a significant factor in deciding type of care for an aging family member: 

• What is the extent of their physical or cognitive impairment? Is it short or long-term?
• Can they manage their medication regiment on their own? 
• What is their medical prognosis?
• If their condition is likely to worsen over time, which means the care they need now will change in months or years, can you step in to help? 
• Will the facility they start out at be able to provide care for changing needs or will you need to relocate them to a different type of facility?

Choosing the Right Care for an Aging Parent

Ultimately, Dan and Erin had many conversations with Gene’s physicians to understand Gene’s functional limitations now and would things would likely be in the months and years ahead, with his failing memory a top concern. They also used an eldercare mediator to help explain to Gene the reasons why he could not remain at home alone. Together, they toured several assisted living communities with a preference for those with social programs and wellness activities that aligned with Gene’s friendly nature, but most importantly with progressive stages of memory care and on-site physical therapy for when his medical conditions further decline.

Even an older adult who is mostly independent in their self-care, today, will encounter times when their healthcare needs become too extensive for living on their own. You may want to choose an older adult community like Everbrook Senior Living, which provides transitional care to support your loved one as their health and wellbeing changes over time. 

Resources

Connecticut Assisted Living Association Resource Guide

How to Choose Assisted Living or Nursing Home

National Institutes of Health: Residential Facilities, Assisted Living, and Nursing Homes 

Helpful Guidance for Managing Older Adult Long-Term Care

Eldercare Locator
Ph: 800-677-1116
This email address is being protected from spambots. You need JavaScript enabled to view it. 

You can also call or search online for your local Area Agency on Aging or Department of Human Services.

*Names changed to protect identity