Assisted living vs. skilled nursing

Varying levels of assistance and help with daily tasks and activities

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    If you or a loved one is starting to struggle with daily tasks or health care requirements, it may be time to move somewhere that caters to th aging population. Senior living communities can provide medical care and help with daily activities, but not all residents need the same level of assistance. 

    Two of the most popular senior living options are assisted living and skilled nursing communities. Both types of facilities provide care, but they have several key differences and appeal to different people. Read on to compare these communities and see which one is right for you or your loved one.

    What is skilled nursing care?

    “Skilled nursing” refers to medical care that can only be performed by licensed medical professionals. It's particularly common after complications from a chronic medical condition or a recent injury or illness.

    Some examples of medical care that fall under skilled nursing include:

    • Injections
    • Catheter care
    • Physical, occupational and speech therapy
    • Wound care
    • Intravenous therapy
    • Monitoring of specialized equipment or vital signs

    Licensed medical professionals, such as speech therapists, physical therapists, occupational therapists, doctors, physician assistants, nurse practitioners and registered nurses, can administer skilled nursing care.

    Generally speaking, skilled nursing care can be administered anywhere, including in a hospital, a long-term care facility (nursing home) or at home.

    Sometimes, skilled nursing care is needed for a short period of time, such as after a hospital stay or an injury. At other times, skilled nursing care may be needed indefinitely, such as when a chronic medical condition gets worse. If your loved one’s condition improves, they may no longer need skilled nursing care. This means they could return home or transfer to a less intensive living arrangement, such as assisted living.

    What is an assisted living facility?

    Assisted living is a type of senior living that offers on-site amenities and assistance with daily tasks and activities. Some assisted living facilities are set up like private apartments. Others may be structured as shared housing where residents have their own bedrooms but share common areas.

    Services at an assisted living facility are usually customized to meet the needs of each resident. Assistance and support are provided only when and where needed. This allows residents to remain as independent as possible.

    Each facility decides the types of care, services, assistance and support it provides, so these vary from facility to facility. However, most assisted living facilities focus on providing assistance with activities of daily living (ADLs).

    Examples of activities for daily living include:

    • Mobility assistance
    • Dressing
    • Bathing
    • Toileting
    • Eating
    • Medication management

    Other services may include social and recreational activities, housekeeping, laundry, meal prep and cooking.

    Assisted living communities should have a more residential atmosphere than nursing homes, which may feel like medical facilities. Assisted living residents are often encouraged to do things that make them feel at home, such as bringing personal belongings or decorating.

    Nursing services and health care may or may not be offered by an assisted living community. Some assisted living facilities have a nurse on-site during business hours to provide basic care, but others may choose not to offer nursing care at all. While on-site nursing options vary from facility to facility, almost all assisted living facilities have an on-call doctor or nurse available to help in an emergency.

    Compare assisted living vs. skilled nursing

    Choosing where you or your loved one will live is an extremely personal choice. Everything from the cost to the available amenities and services will inform whether assisted living or skilled nursing is the right choice. We’ve compared assisted living and skilled nursing across various factors below to help you decide.

    Assisted living
    • Residential community setting
    • Designed for active seniors
    • Personal care services available
    • On-site and off-site activities

    Skilled nursing

    • Medical setting
    • Long-term or temporary needs
    • 24/7 personal and nursing care available
    • Some other medical treatments provided on-site
    Assisted living
    • Private/shared rooms or apartments
    • Private baths
    • Shared common areas
    • Small kitchenettes and outdoor space available in some communities

    Skilled nursing

    • Private/shared rooms
    • Shared common areas
    • Shared bathrooms common
    • Limited or restricted outdoor space
    Length of stay
    Assisted living
    • Average stay of two to three years

    Skilled nursing

    • Average stay of 485 days, according to the National Center for Health Statistics
    Assisted living
    • Average cost of approximately $4,300 a month, according to Genworth’s 2020 Cost of Care Survey
    • Higher costs common for memory care

    Skilled nursing

    • Average cost of approximately $8,800 a month, according to Genworth’s 2020 Cost of Care Survey
    Assisted living

    Skilled nursing

    • Short-term stays covered if certain criteria are met:
      • Having Medicare Part A
      • Having days left for skilled nursing in your benefit period
      • Having a qualifying hospital stay
      • Needing skilled care daily
      • Facility certified by Medicare
    Assisted living
    • Availability varies by state
    • Not accepted by all facilities
    • Room and board generally not covered
    • Certain criteria may need to be met

    Skilled nursing

    • Covered in all 50 states and Washington, D.C.
    • Details still vary by state
    Insurance coverage
    Assisted living
    • Certain services may be covered
    • Room and board generally not covered by health insurance
    • Long-term care insurance benefits may help with out-of-pocket expenses

    Skilled nursing

    • Varies by policy
    • Short-term stays may be covered after hospital visits
    • Facility may need to be in insurer’s network
    Payment options
    Assisted living
    • Vary by facility
    • Check, bank transfer, money order or credit card payments common
    • Additional financial assistance, such as VA Aid and Attendance, can help with costs

    Skilled nursing

    • Vary by facility
    • Check, bank transfer, online, money order and credit card payments common
    24/7 care offerings
    Assisted living
    • Personal care services and help with ADLs
    • Nursing care is usually not available around the clock

    Skilled nursing

    • Nursing and personal care
    Assisted living
    • Three meals a day and snacks usually provided
    • Some facilities offer restaurant-style dining while others serve more family dinner-style meals
    • Kitchenettes allow some residents to cook or prep their own meals

    Skilled nursing

    • All meals and snacks provided
    • Staff preps and cooks all meals
    • Residents may be able to keep snacks in their rooms
    Housekeeping service
    Assisted living
    • Varies by facility
    • May be included in the basic cost or available for an additional fee
    • Living space cleaning, vacuuming, bathroom cleaning and laundry service common

    Skilled nursing

    • Provided by the facility
    • Usually includes room cleaning and laundry service
    Medication management
    Assisted living
    • Medication reminders usually available
    • Specifics vary by facility
      • Some may help sort and administer medication
      • Others require residents to self-administer their own medications

    Skilled nursing

    • Staff handles all aspects of medication, including ordering, sorting and administering
    • Staff can administer IV and injectable medications
    Assisted living
    • Variety of recreational activities often available
    • On- or off-site activities
    • Limited supervision by staff

    Skilled nursing

    • Limited recreational activities
    • Activities supervised by staff
    Assisted living
    • May be offered by the facility
    • Third-party transportation, such as dial-a-ride services, may be available for an additional charge

    Skilled nursing

    • Facilities typically help arrange transportation to outside medical appointments

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      Bottom line: Assisted living or skilled nursing?

      Determining which facility is right for your or your loved one is no easy task. There are thousands of assisted living and skilled nursing facilities across the country, and each one offers different services and amenities. However, defining the level of care you’re looking for will help you determine if assisted living or skilled nursing is the right choice.

      • Assisted living may be appropriate if you or your loved one needs help with activities of daily living.
      • Skilled nursing may be appropriate if a higher level of medical care is needed.

      Once you’ve picked the type of facility, you can think about other factors to narrow down your options. Looking at monthly costs, available services, amenities, locations and housing options can help you choose the right community.

      Article sources
      ConsumerAffairs writers primarily rely on government data, industry experts and original research from other reputable publications to inform their work. Specific sources for this article include:
      1. Genworth Financial Inc., "Cost of Care Survey." Accessed April 28, 2021.
      2. National Center for Health Statistics. “Long-term Care Providers and Services Users in the United States, 2015–2016.” Accessed May 17, 2021.
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