Differences Between Nursing Homes and Assisted Living Facilities

What's the Difference between Nursing Homes and Assisted Living Facilities?
Both Nursing Homes and Assisted Livings Offer Community Dining. Morsa Images/ Getty Images

Question: What Are the Differences Between a Nursing Home and an Assisted Living Facility?

Many people would be surprised at how these two types of facilities have become more similar than different over the past 15 years, with assisted living facilities accepting residents with more physical, psychiatric, and cognitive problems than they have in the past. About 1.4 million U.S. adults reside in about 15,700 skilled nursing facilities, while there are 36,000 licensed assisted living facilities in the U.S., with more than one million beds.

Nursing homes are typically best suited for people who require significant personal and nursing care: being bed-bound, having fractures or wounds that are not healing, and having multiple medical problems like diabetes, heart disease and congestive heart failure. Nursing homes may also be appropriate for people who need 24 hour care and supervision related to dementia. Only a quarter of nursing home residents can walk without assistance, and nearly two-thirds receive psychiatric medications.

Assisted living facilities are best suited to people with higher levels of functioning and independence who can benefit from social activities, exercise and wellness programs. The main philosophy of assisted living is providing residents with varying levels of choice and independence in a homelike environment.

Costs and Source of Payment

As a residential service with 24-hour care, nursing homes remain the most costly option for long-term institutional care, with fees now approaching and some even exceeding $100,000/year.

Most of those costs are covered by the Medicaid program, contributing to fiscal crises in many states. In contrast, the majority of assisted residents pay from their own financial resources, although 41 states offer waiver programs that allow low-income residents to live in assisted living.

    Regulation and Staffing Issues

    Nursing homes are generally regulated by the federal government, while assisted living facilities are regulated by the states. In a sign that assisted living facilities are caring for more complex residents, at least half of the 50 states have updated their assisted living regulations since 2008. Annual staff turnover remains high in both settings, and while a nurse must be on-site 24 hours per day in a nursing day, in assisted living that may not be the case. Tennessee, for example, requires only that a nurse be available as needed.

    Medication Management

    While in a nursing home it is taken for granted that nurses administer medications, in assisted living facilities things are murkier. In some states the laws are vague regarding which staff members may assist with medications, and nearly half the states permit registered nurses to delegate the administration of oral medications to aides. Residents with diabetes requiring insulin or pain conditions requiring narcotics may not be able to receive these medications from assisted living staff.

    Dementia

    Both nursing homes and assisted living facilities have high rates of Alzheimer's disease and other kinds of dementia: both settings have upwards of two-thirds of residents with dementia or significant levels of cognitive impairment. Sixty percent of nursing home residents with dementia are in the moderate and severe stages, compared with forty percent in assisted living. Because of the high rates of dementia in assisted living, many states now have enhanced standards for the care of assisted living residents with dementia.

    Some facilities have what's called a "memory loss unit" or a "secure dementia program." This type of care is generally designed for those who are in the middle stages of dementia where they would benefit from activities that target that cognitive level. Often, these programs have their entrances and exits secured since some people with dementia wander and are at risk of elopement.

    Sources:
    Centers for Disease Control and Prevention. April 29, 2015. Nursing Home Care. http://www.cdc.gov/nchs/fastats/nursing-home-care.htm

    Centers for Disease Control and Prevention. 2012. Residents Living in Residential Care Facilities: United States, 2010. http://www.cdc.gov/nchs/data/databriefs/db91.htm

    -Edited by Esther Heerema, MSW

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