A senior woman sits on a couch and poses for a photo with her wood walking cane

The Difference Between Assisted Living and a Nursing Home

Assisted living or nursing home?

Some similarities and differences.

As time goes by, individuals and families pass milestones on the continuum of care needed to preserve independence, personal safety and dignity in our later years. Fortunately, there are many options and levels of care to consider and from which to choose. The question becomes, which is the right level for me or my loved one? Assisted living? Nursing home care? What are the differences between assisted living and a nursing home? How do I make the right choice at this particular time?

There’s a lot to think about, including the various options for residential care and the benefits and realities of living in a supportive care environment. Here’s a brief overview of what you’ll find in assisted living vs. nursing homes, and the questions to ask before selecting one or the other.

A look at the basics.

Assisted living typically represents the first level of supportive care by providing personal assistance to otherwise independent older adults. This often means help with the activities of daily living (ADLs), such as bathing, dressing, toileting, and household tasks such as cooking and cleaning. Residents may have difficulty driving and need occasional help with transportation. Residents in an assisted living community usually have their own apartment. The goal of assisted living, essentially, is to preserve independence for as long as possible.

By contrast, a nursing home is for those who need daily, ongoing observation or continual care for more pronounced medical needs, or because they’ve become too fragile to manage daily life on their own. Nursing home residents usually reside in a private or semiprivate room or suite, with a nurse’s station situated not far away.

adult woman handing an elderly man a cup of coffee while sitting in a chair
How much help is needed?

This is often the determining factor in choosing between a nursing home or a residence in an assisted living community. If help with some of the basic activities of daily living is the extent of what’s needed bathing, dressing and meals, for instance assisted living may be the answer. But if an individual requires daily therapy, IV medication, or the use of a ventilator, a nursing home is better equipped to meet those needs. One area that spans both assisted living and skilled nursing care is medication management. If you need help taking your medication accurately each day, both nursing homes and assisted living will provide it, though you may be charged extra for this service in assisted living.

Here are five frequently expressed needs by people who choose assisted living:
  • Daily living (bathing, dressing, food prep)
  • Mental health (depression or isolation)
  • Medication management
  • Social support
  • Managing personal finances
Answers to these key questions can help determine if a nursing home is the right choice:
  • Are the needs primarily custodial or medical?
  • Has a professional medical assessment been completed recently?
  • Do the needs exceed what a family caregiver can reasonably deliver?
  • Is the need for nursing care temporary or permanent?

A nursing home is normally the highest level of care for older adults outside a hospital.

Skilled nursing communities are designed for individuals who require full-time care, or assistance with most, if not all, activities of daily living. These communities are licensed and offer care by trained medical staff, such as a registered nurse or therapist, 24 hours a day.

healthcare worker assisting a senior woman by helping her with her clothing
Consider the setting.

A nursing home is generally thought to be more of a medical setting, whereas assisted living is considered residential. Skilled nursing residences can feel more “institutional” than assisted living communities, but that’s changed in recent years. Skilled nursing residences in a continuing care retirement community have become less like hospital rooms and more like home. You should explore the options today by touring more than one community that provides long-term nursing care. Talk with residents. Ask questions. Observe carefully. You may be pleasantly surprised.

Do the same for a number of communities offering assisted living residences. Tour the apartments. Learn about the activities and programs offered. Eat in the assisted living dining venue if possible. Ask for references and testimonials of those whose family members live there. 

What level of medical staff is available?

Nursing homes are typically required to have a registered nurse on-site eight hours each day. For assisted living residences, licensed practical nurses or registered nurses must be accessible and on call, but they’re not required to be on-site. Depending on the need for regular access to medical personnel, choosing skilled nursing may be your only option.

The bottom line.

Assisted living provides privacy and the chance to extend one’s personal independence. It also offers customized care according to the needs of each resident. But assisted living is not a nursing home. Residents have their own apartment with a partial kitchen, full living room, one or two bedrooms, and a private bathroom designed with the physical needs of seniors in mind. Residents may keep their own furniture and belongings. Assisted living offers the safety and security of 24-hour support and access to care. Day or night, help is just a phone call away. You’re completely free to continue to do what you can for yourself and to participate socially in meals, events and activities.

A nursing home is the better choice for someone whose needs require full-time medical care or access to services and equipment that are more often found in a hospital than at home. Because nursing homes offer extensive care, they provide more stability and continuity of care to seniors who might otherwise spend extended periods of time in the hospital.

Which is right? Assisted living is more for someone who still has the desire and ability to be somewhat independent but may need assistance with the activities of daily living. Nursing homes are ideal for those who may need more care than an assisted living community can provide those living with a health complication or who have limited mobility. A professional medical assessment is always advisable. 

Choose your level of care at Mary’s Woods.

Kellogg Assisted Living on the campus of Mary’s Woods in Lake Oswego offers personalized care and upscale lifestyle choices to seniors in a forest and garden setting. Residential care at Villa Maria within our Marie Rose Health Center provides round-the-clock licensed nursing care and individualized, restorative care. For more information, or details on direct admittance with no entrance fee, please contact us through our website or call 503-400-6448.