Assisted Living Facility vs. Nursing Home: What’s the Difference?

As people grow older, they may start to need help with day-to-day tasks. Things that were once simple and quick may take extra effort – and might even put their wellbeing at risk.

For family members or close friends of these older individuals, now might be time to consider alternatives to living at home. Two alternatives to living at home are assisted living facilities and nursing homes. But how do people decide which is the right one?

For advice on distinguishing between the two and making a choice, we asked Salman Khan, MD, a geriatric physician with Rochester Regional Health.

Assisted living and nursing homes

An assisted living facility is a place where residents can maintain social independence while receiving help with day-to-day responsibilities such as room cleaning, laundry, dining services, and dispensing medications.

Assisted living facilities offer varying levels of independence, ranging from simple check-ins and provided services to memory care units for residents with dementia or Alzheimer’s disease.

Nursing homes are available for those who need more care than an assisted living facility can provide. If a person can’t be at home or their family can’t take care of them at home, it may be appropriate to move into a nursing home.

The degree of care for nursing home residents builds on what is offered at most assisted living facilities, providing for more complex medical needs. Memory loss, physical dysfunction, urinary incontinence, and falls often lead to nursing home care.

“The biggest challenge in these situations is a person’s loss of independence. Most people moving into assisted living or nursing homes come from a house or apartment, and it can be hard to face the reality that they cannot safely remain in their home,” Dr. Khan said.

Similarities

Basic Assistance: Both assisted living facilities and nursing homes offer help with everyday activities for people who need it. While the degree of care differs, services can include room cleaning, laundry, and physical, speech, or occupational therapy.

Food: Assisted living facilities and nursing homes each provide three meals a day for residents. In New York, residents at an assisted living facility need to eat in a common area at least once a day as a welfare check.

Differences

Independence: Assisted living facilities offer a higher degree of independence for residents compared to nursing homes. Some people live in a room alone, while others have a roommate. There are social gathering spaces, on-site laundry, parking, and other amenities available.

Nursing homes focus more on caring for the medical needs of residents while continuing to promote social and physical independence at an individual’s highest possible level.

Cost: Assisted living facilities cost around $3,800 per month in the Rochester area, according to the 2021 Genworth Cost of Care Survey. Nursing homes cost considerably more due to the increased level of care provided for residents – coming in at approximately $10,000 per month in the Rochester area, according to the New York State Department of Financial Services.

Some of these costs can be offset with financial assistance through insurance, Medicare, or Medicaid – depending on the individual.

Supervision and Medical Assistance: Nursing homes tend to have a higher degree of hands-on care compared to assisted living facilities. Providers offer more supervision with a physician, PA, or NP onsite to help with any medical needs, while assisted living facilities have providers who come by as needed at least once a week. Most nursing homes have more medical resources as compared to assisted living facilities, simply because the residents’ needs are often greater.

Making a decision

There are several conversations that can help determine whether a person should remain at home, or consider moving into one of these facilities.

Providers will use a PRI (patient review instrument) assessment tool to determine what a patient’s physical, mental, and cognitive abilities are so they can better decide which services they need. Assisted living facilities and nursing homes will often include a PRI assessment in determining if someone can live at their location.

Questions about moving can be directed to social workers with ElderONE and Rochester Regional Health primary care offices. Social workers are often the ones who can best direct individuals toward the resources they need. Organizations such as the Alzheimer’s Association, Lifespan, and Finger Lakes Caregivers Institute also provide resources about next steps.

Most, if not all, assisted living facilities and nursing homes also allow prospective residents and their loved ones to take a tour.

“Making the choice between an assisted living facility and a nursing home means understanding the level of care that a person needs,” Dr. Khan said. “Our long-term care staff will give you as much information as you need to help you make the right decision about where they need to go.”