Consider the differences between costs, services, privacy and levels of care when deciding on assisted living or nursing home care

    Levels of Care:

What is Assisted Living?

Assisted Living is a type of senior housing that allows residents to lead active, independent lives with less privacy and fewer responsibilities than they had at home.

Assisted living facilities  have wide hallways, open meeting areas, group dining rooms and protected outdoor gathering spots. The decor is cheerful and well lit. The environment is set up for line of sight supervision by staff, fall prevention and socialization. 

The apartment areas have individual doors with personalized door decor and name plates.Being in assisted living means living “behind closed doors”. That allows a level of privacy and personal responsibility that’s less than they had at home, but more than is possible in a nursing facility. 

Responsibility for independent living tasks like housekeeping and meals is on the staff in an assisted living facility, or ALF. Often the ideal candidate for an ALF is someone who has financial resources, is sociable and alert but no longer able to live in a private home. While ALFs encourage active engagement, residents are free to choose their level of involvement and remain in their rooms if privacy or rest is preferred.

Services in ALF’s are provided for housekeeping, medication administration, transportation and meals. Those activities have  typically become difficult for residents with cognitive and medical issues. and are performed by staff at an ALF.

Driving, cooking, financial management medication management are areas that are not only difficult, but possibly dangerous, as dementia arises. Many people move to assisted living because of errors or accidents that occured at home in one or more of those high risk areas. A car accident, a kitchen fire, hospitalization due to medication error are stories shared with others in the group dining room.   

Assisted living facilities generally have private apartments for accommodations. The apartments have a living area, sleeping area, table, kitchenette and a private bathroom. The bathroom is usually large enough to accommodate a wheelchair.

An ALF is designed for Aging in Place with accessible bathrooms and a call light system and 24 hour staffing. Many of the residents have low vision or are hard of hearing. 




Medication accuracy is addressed differently in nursing homes and assisted livings, according to the level of care

Additional service packages are available in assisted living facilities, and tailored to the  needs of the resident. The details of the service package,  are agreed upon in advance and may include help with bathing and dressing. ALFs have nurses and nursing aides on staff. It’s the nursing aides that provide personal care for the resident when the resident needs help. 

Activity aides conduct diversional activities. Often there is a scheduled program of music, arts and crafts, field trips and religious events for residents.

There’s a social worker to act as liaison between the facility and the resident, ensuring that the residents needs and their families expectations are met. Periodic care planning meetings are held by ALF staff.

As a rule, assisted living is paid for by private funds or long term care insurance, but not traditional health insurance or Medicare. 



    Levels of Care: 

What is A Nursing Home?

A nursing home, also called a Skilled Nursing Facility or SNF (“sniff”) provides a higher level of resident care, and a lower level of privacy and responsibility for the resident.

The outward appearance of the facility may be less home like, more institutional, than an ALF. There’s a higher level of skilled or professional staff employed there, as mandated at the state level.

Group activities are common. Medications and treatments are done by nursing staff. The door to a resident room is open, except during private routines and fire drills. A draw curtain provides privacy between beds.

Everyone know that hospital services are directed by doctors. While doctors are also involved in nursing home care, the highest level of care provided around the clock often comes from a nurse or a nurse practitioner. The nurse practitioner represents the doctor, and consults with the doctor though the doctor is not always physically present.

Social workers and activity aides working in a SNF. The SNF food service can provide specialized diets or treatments to residents who require them.

Residents of a SNF often came from a hospital for an operation, a fall, fracture, a car accident, or  cancer treatment. In those cases, the resident transferred from a hospital to a SNF for rehabilitation care also known as Short Term Rehab (STR) or Skilled Care. The definition of skilled care is that the patient requires the skills of healthcare professionals, such as nurses and therapists.

If a rehab client in the SNF improves enough they return to community living, such as a private home or ALF. Some, however, do not return to the community and transition to a different level of care, Long Term Care (LTC), possibly in the same building. Some residents are admitted to LTC directly from home due to family’s difficulty caring for the person.

When someone lives in a nursing home they are receiving Long Term Care. Long term care is paid for by long term care insurance or private funds. If the resident has limited financial resources, then care may be paid for by state funded Medicaid insurance.

Often families are surprised to learn that long term care is not covered under traditional health insurance programs, such as Medicare. The business office of a SNF has in depth knowledge of insurance coverage conditions that apply to their potential customers. 

Nursing homes provide complex medical care for residents

    Levels of Care:

What is Rehabilitation?

Residents in a SNF receive specialized care not only from nurses but also from Occupational, Physical, Respiratory and Speech therapists and other skilled providers. They may require wound care, IV medication, dialysis, specialized feeding or oxygen.

Nursing homes often have a Short Term Rehabilitation section of the facility. A Rehabilitation unit is different from a Long Term Care unit because it accepts residents who no longer require specialized hospital services but are unable to go home due to medical complexity. In such cases Rehabilitation services are paid for by health insurance, as long as the resident has potential to improve and requires skilled care. 

This person's right arm was paralyzed by a stroke
Skilled Occupational, Physical and Speech therapies are important aspects of Short Term Rehabilitation care
Exercise is an important component of skilled care after hospitalization