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Understanding the Difference Between Assisted Living and Skilled Nursing

Skilled nursing and assisted living are two senior living options for individuals for whom living independently is no longer the safest or most practical option. For those just beginning to see or experience changes in physical or cognitive abilities, these types of communities often get lumped under the generic term of “nursing home.” There are however, important differences in the type of care and services offered at the facilities which serve resident populations with very different needs. 

The following sections highlight the key differences between assisted living and skilled nursing and provide examples of circumstances where each living arrangement may be suitable for an individual in need of assistance or nursing care.

Assisted Living

Assisted living communities offer care to older adults who are either no longer able to live safely at home or for whom maintaining a house is too burdensome. While assisted living communities support residents' independence, they also provide assistance to residents with activities of daily living (ADLs) with including light housekeeping, meal preparation, dressing, and grooming. Depending on a facility’s level of licensure, assistance with healthcare issues can be provided including medication management and certain therapies. Staff in these facilities are available around-the-clock.

“Everyone’s needs and expectations are different,” said Elderwood Director of Operations Assisted Living Facilities Eric Bernard. “When looking for assisted living options it’s important to ensure the licensure at the assisted living can meet your loved ones needs now or potentially in the future. There are different assisted living options ranging from adult home to memory care and enhanced assisted living. Families should look for an assisted living that is eager to learn more about their loved ones needs.”

There is a full calendar of life-enriching activities in assisted living communities. Residents can choose the activities that suit their interests and hobbies. They can also take advantage of transportation to attend church services, appointments, and other events in the community.

Elderwood assisted living communities work with residents to help them age in place. This allows residents of assisted living communities to remain in a comfortable, familiar, and in a homelike setting.

Assisted living also helps assist those with memory care needs, and chronic conditions like diabetes. 

Skilled Nursing

Skilled nursing communities provide specialized medical care and daily therapy services to individuals who require clinical care care 24 hours a day. 

Within a skilled nursing facility, what many refer to as a “nursing home,” there are usually two distinct types of residents – short-stay subacute rehabilitation patients and long-term care residents.

Subacute rehab patients are often there following hospitalizations due to surgeries, injuries, heart attacks, or strokes. These patients are usually continuing their recovery following discharge from a hospital, where the highly specialized acute care provided in that setting is no longer needed, but the patient still requires clinical care and specialized therapies to fully recover and return home. 

In some cases, however, skilled nursing communities become permanent homes for those who will live there long-term. Their complex medical care and supervision needs are most often unable to be met at home. Professionally licensed personnel provide this medical care. Most residents need routine skilled nursing services due to complex medical conditions, including:

  • Care for wounds
  • The need for a ventilator or respiratory therapy
  • IV medications
  • Feeding tube
  • Bed sores (pressure ulcers) at an advanced stage
  • Therapies such as physical therapy, speech therapy, and occupational therapy
  • Pharmaceutical, radiology needs, and laboratory services
  • Hospice care or end-of-life care

“I can’t stress enough to families when looking for skilled nursing care options to ask a lot of questions,” said Elderwood Chief Operating Officer Phil Quillard. “I always suggest going online to look at a facility’s star rating through Medicare.gov. Families should also visit facilities to get a feel for the environment.”

Visiting facilities during high stress times of day can help give families an overall feel of how well a facility is being run. “Visiting during the early morning and late afternoon, which is a very busy time, is a great time to observe the staff and how well they’re interacting and caring for the residents. This is a great indicator for how well a facility is performing, said Qulliard.”

It is typical for residents to either have a single room or a semi-private room. Unless they are incapacitated or ill, they will eat their meals in a communal dining area. Activities are typically scheduled every day in skilled nursing communities. The activities are brought to those who are unable to attend the group activities.

There are LPNs and RNs on duty 24 hours a day in certified skilled nursing communities.

Skilled Nursing vs. Assisted Living

If living independently is no longer safe, many people are left wondering which option is best for them or a loved one. These situations often lead them to compare assisted living and skilled nursing. Based on what we’ve shared, here's a quick breakdown to consider when looking into your options.

Level of Need:

There are distinct differences between assisted living and skilled nursing.

Skilled nursing is better equipped to manage medical needs, regular therapy, IV medications, or the need for a ventilator or other forms of artificial respiration.

Assisted living may be a good option for those who need assistance with regular daily tasks. The following are the most routine needs expressed for assisted living residents:

  • A person's daily routine (eating, bathing, and dressing)
  • Need for companionship
  • Management of medications
  • Keeping track of finances 

The type of community that will admit your loved one will rely substantially on standardized evaluations that ensure individuals can live safely and have the easiest access to the care needed to maintain their health and wellbeing. Keep in mind that the level of care that may be needed right now could change in the future. A person may require skilled nursing temporarily after a medical event and be able to transition into an assisted living environment after rehab. The same is true for someone who is living in assisted living who may experience a need for increasingly complex clinical care – at which time a transition to skilled nursing may be appropriate.

“Many assisted living communities can offer some of the same services as skilled nursing facilities depending on the residents needs and the licensure at the facility.  If a transition to a skilled nursing facility is needed, we can work with one of many skilled nursing facilities in the area to ensure a smooth and safe transition,” said Bernard.

Having medical input from your team of health and family caregivers will guide you in choosing the level of care.

“When transitioning from an assisted living setting to a skilled nursing setting, we have families work with our case managers and social workers to ensure a smooth transition,” said Quillard. “They’ll work with the family and go over options for the appropriate setting.”


Assisted living is considered a residential setting, while skilled nursing is considered a medical setting. An assisted living facility can be an apartment like setting. While skilled nursing usually occurs in a traditional subacute or rehabilitation facility.

To familiarize yourself with the settings and care needed, ask to visit and tour. It’s important to ask questions. 

“Don’t hesitate to ask about level of care and services the facility provides,” said Qulliard. “Also, ask how long the administrator has been there and ask about staff to resident ratio. If you notice anything while on a tour that maybe a concern, don’t hesitate to bring it up. Communication is important when trying to find the right setting for your loved one.”

Duration of Stay

The need for skilled nursing is a short-term temporary stay unless an individual will require long-term medical care. After a hospitalization or sudden health event, skilled nursing is most often needed.

Assisted living is long-term and allows residents to enjoy as much independence as possible with added assistance to help with everyday tasks that may require assistance.

Goal of the stay

Rehab and returning to independent living are the primary goals for skilled nursing facilities. A rehabilitation program may also aim to prepare an individual for a more permanent living environment. However, if skilled nursing is long-term, round the clock medical care is the goal.  

Assisted living is more permanent and not temporary living arrangement. The goal is to offer independence to an individual while also providing extra assistance with tasks such as preparing meals, medication management, bathing, and dressing that maybe needed.

Assisted living and skilled nursing facilities offer opportunities for social interaction tailored to the interests and abilities of their residents. A supportive living environment can provide a variety of activities. The overall living environment creates a homelike atmosphere that allows residents to do more living, which is the way life is meant to be. 

Degree of independence

Skilled nursing is available to people who have been hospitalized or have suddenly declined in health and require frequent monitoring and constant medical care. As a result, residents have limited independence depending on the medical services they need.

While assisted living residents enjoy more independence, deciding what assistance is needed based on their abilities. To help residents avoid driving, assisted living communities offer transportation services. 

A person living in an assisted living facility does not necessarily require constant medical attention, but staff is available just in case.

“Staffing at each facility in assisted living is based on the individual needs of the residents. Assisted living employees RNs, LPNs, Resident Aides, HHAs, PCAs. Care is provided on site 24/7 should needs arise,” said Bernard.

Financial commitment and insurance coverage

Due to the round-the-clock medical care that is required by skilled nursing facilities, skilled nursing care costs are higher than assisted living. There are, however, options for those in need of skilled nursing to help take care of these costs, such as long-term care insurance or Medicaid.

Most skilled nursing facilities offer Medicare and/or Medicaid options. Health insurance and Medicare do not usually cover assisted living, except in limited circumstances. Although there are some long-term care insurances that may cover it, the resident usually pays for it. If you are unsure about your options, contact connecting with a skilled nursing or assisted living professional can help. Aging seniors can find ways to budget for senior care to help prepare for the future.

For specific questions regarding assisted living and skilled nursing options near you, click here.

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