What’s the Difference Between Nursing Homes and Assisted Living?

US News & World Report’s recent article entitled “Nursing Homes vs. Assisted Living” explains that a big question is determining what type of facility is the best fit. According to the National Institute on Aging (NIA), long-term care residences include:

• Assisted Living Facilities
• Nursing Homes
• Board and Care Homes; and
• Continuing Care Retirement Communities.

We will look at the major differences among these options.

Assisted Living. Assisted living and nursing home facilities are different in many ways. One big difference is in how to pay for them. Some assisted living facilities do not accept Medicaid and are private pay only. Medicaid does cover nursing home care because states must do so under federal law. That’s the only way some can cover the cost in many instances.

Otherwise, the primary difference is in the level of care each can provide. Assisted living is for those who need some help with daily care, but not as much as what a nursing home has to offer. These facilities are for those who can still take care of themselves, but could use a bit of help with daily activities such as:

• Housecleaning and laundry
• Household chores and cooking
• Bathing
• Medication management; and/or
• Transportation to medical appointments or stores.

The residents use any or all of the services offered and pay for the level of care they are receive. However, the more care, the higher the cost. Assisted living residents typically have their own private apartments and share common areas, like the dining room and community rooms. Most offer three meals a day for those who don’t want to cook, 24-hour supervision and security and socializing and recreational events with other residents. Many assisted living communities even permit pets.

Nursing Homes. Nursing homes are also called “skilled nursing facilities” and provide a higher level of daily care—especially medical care that assisted living facilities aren’t equipped to handle. Along with the same help for daily living that assisted living communities provide, a nursing home can offer:

• Nursing care
• Rehabilitation services, such as physical, occupational and speech therapy
• Help getting dressed or in and out of bed
• Frequent or daily medical management for chronic conditions; and
• Some facilities specialize in memory care for patients suffering from Alzheimer’s disease or other forms of dementia.

Board and Care Homes. Also called “residential care facilities” or “group homes, ” these are small homes of 20 or fewer residents living in private or shared rooms. Similar to assisted living facilities, these places can provide personal care and meals but no nursing or medical care.

Continuing Care Retirement Communities. Also called “life care communities, ” they offer different levels of service in one location, like independent housing, assisted living, and a skilled nursing facility all in one place. Residents can begin at one level of care and transition into higher care, as needed.

How to pay for care is another common misunderstanding, because unless you have long-term care insurance, assisted living is paid out of pocket. For a skilled nursing facility, if you are hospitalized and discharged to a care facility, Medicare will pay a set amount for a certain time. The responsibility for payment then goes back to the resident.

The rules to qualify for MassHealth/Medicaid are complex. It is best to speak with elder law attorney who can apply these rules to the mixture of your individualized assets and the time frame for the need for skilled care. While it is always best to preplan for long-term care, an experienced elder law attorney can assist you or your loved one in becoming eligible and/or applying for MassHealth.

Reference: US News & World Report (November 52, 2020) “Nursing Homes vs. Assisted Living”