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Assisted living vs. nursing home vs. home care

How to choose the right living situation for your aging loved one

Profile picture of Jami Barnett, Ph.D.
by Jami Barnett, Ph.D. ConsumerAffairs Research Team
granddaughter sitting with her arm around her grandmother

Choosing a senior living arrangement can be a difficult, complicated decision. From comparing facilities to figuring out how to cover the high costs, the process can easily feel overwhelming. Keep your budget, your needs and your preferences in mind and you should be able to find a comfortable, affordable solution.

Compare assisted living vs. nursing home vs. home care

Before making a decision about where your loved one should live, you need to know the costs, assistance options and features available. Having an open conversation about your loved one’s preferences also gives them some control over their life. Three of the most popular senior living options are assisted living, skilled nursing and in-home care.

Assisted livingNursing homeIn-home care
FeaturesActive lifestyle options, social entertainmentSocial options, skilled nursing care, more securityAt-home treatment, full-time and part-time options
Average cost*$4,300 per month$8,821 per month$4,576 a month
Medicare/Medicaid assistance available?Medicare: Yes
Medicaid: No
Yes, but some don’t accept MedicaidYes
*Average costs are based on Genworth’s 2020 Cost of Care Survey

What are the benefits of assisted living?

Assisted living facilities offer older adults a multitude of activities and entertainment options as part of a relatively independent living experience. Assisted living residents usually have the freedom to move about these facilities at their discretion. Think of these facilities like active apartment complexes with added benefits, like housekeeping and occasional help with tasks.

Most assisted living facilities have bigger rooms than other options because federal mandates require them to be at least 220 square feet (compared to the 90-square-foot requirement for nursing home rooms). These rooms may also include additional features like a small kitchen or sitting area.

In addition to their generally more comfortable living arrangements, assisted living facilities offer extracurricular activities and areas like:

  • Gyms
  • Workout classes
  • Walking trails
  • Day trips
  • Gardens
  • Game rooms

Most assisted living facilities pride themselves on providing healthy dining options, but some also offer on-site restaurants and bars. Most of the time, families can dine with residents as well.

If it seems like these facilities are more lax on rules and regulations, it’s because they usually are. That being said, reputable assisted living facilities are still staffed by full-time licensed care professionals.

Benefits of nursing homes

The main benefit of nursing homes is that they provide 24/7 medical care. This makes them a good option when your loved one needs regular medical care that you can’t provide at home. Whether a resident needs daily medication management, help going to the bathroom or routine visits from physical therapists, nursing home staff can manage their care plans. This is part of the cost at most facilities, which is why they’re so much more expensive than other senior living options.

The main benefit of nursing homes is that they provide 24/7 medical care.

Most nursing homes also offer entertainment options like bingo, movie nights and arts and crafts classes. Some nursing homes may offer outings, but their options are somewhat limited. In general, nursing homes don’t have as many amenities as assisted living facilities because residents require more care and are more prone to injuries or other medical concerns that make traveling difficult.

Most nursing homes also have smaller rooms because of safety concerns. If there’s too much space or too many pieces of furniture in a room, accidents are more likely. Nursing home rooms for two people are required to be at least 90 square feet, but many facilities offer larger rooms. Most rooms include their own bathrooms, which are extra large for added safety. These rooms are also frequently outfitted with panic buttons and call systems in order to provide immediate help when needed.

Generally speaking, nursing homes are designed with safety in mind, not social interaction. They may feel more stuffy than assisted living facilities, and they often don’t provide as many amenities. Nursing homes focus on security because they may have residents with memory problems or other conditions that can make them more likely to wander off or hurt themselves.

Benefits of in-home care

Unlike relocating your loved one to a nursing home or assisted living facility, in-home care is just that — in your home. In-home care is usually reserved for older people who can mostly get by during their day-to-day lives without help but may require assistance with things like bathing. In-home care can be scheduled in a few ways, ranging from 24/7 support to part-time help.

Most in-home caregivers offer general support like help with cooking, cleaning, therapy, dressing and bathing. For some people, in-home care also provides a simple form of social interaction. Even if a spouse or other caretaker is available, a private nurse can provide more skilled medical care, like inserting an IV.

Usually, older adults who receive in-home care have a long-term chronic illness, injury or disability that means they need assistance but doesn’t require them to stay in a nursing home. However, many people choose in-home care on a short-term basis, like after surgery when it’s hard to get to and from the hospital. This type of in-home care may be covered by insurance.

What is the difference between assisted living and nursing homes?

In general, the biggest difference between an assisted living facility and a nursing home is the level of medical services available and included in the cost:

  • Assisted living facilities are a better option for older people who don’t need medical attention on a regular basis but are looking for social interaction, general care and entertainment.
  • Nursing homes are designed to be a more clinical solution, with around-the-clock medical care and specialized care like physical therapy.

This difference dictates a lot of the other features at these facilities. For example, nursing homes include architectural features to prevent wandering and maximize resident safety, like locked doors and alarms. This also means most nursing home residents are unable to move around the facility on their own. At assisted living facilities, residents have more freedom to walk around because wandering is less of a concern.

Expect to spend about twice as much for a nursing home stay versus assisted living. This is because the nursing home rates often include 24-hour medical care. With assisted living, most medical care is an additional cost.

If your loved one needs more medical care, it’s safer and potentially cheaper to choose a nursing home. However, if your loved one is relatively healthy and maintains an active lifestyle, consider assisted living. You can always change your mind if you realize it’s not right for your loved one’s situation.

Assisted Living Benefits

  • Custodial care
  • Limited medical care
  • More freedom
  • Apartment-like atmosphere
  • Cheaper

Nursing home benefits

  • Medical care
  • Specialized care
  • More security
  • Hospital-like atmosphere
  • More expensive

Bottom line

If you’re already comparing your options, you’re on the right path. Just remember to take your loved one’s opinions into account and bring them with you to visit facilities so they feel as included as possible. Then, compare prices and payment options from a few of your picks to make sure you’re getting a good deal. Finally, be patient with the process and know you’re doing the right thing by researching and taking your time.

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Profile picture of Jami Barnett, Ph.D.
by Jami Barnett, Ph.D. ConsumerAffairs Research Team

Jami Barnett, Ph.D., is an experienced researcher, and she believes consumers have a right to clear and honest information about products. In her role at ConsumerAffairs, she thoroughly researches products and companies by interviewing experts, reviewing research studies, reading governmental regulations and investigating customer service responses. Her work gives consumers the information they need to make smart purchasing decisions.