Assisted Living vs. Skilled Nursing: What’s the Difference?

So, how do you know what senior living option is the right fit when aging at home isn’t an option? Learning about the different features and benefits of both can help you find the right care solution for you or your loved one.

The leading difference between skilled nursing and assisted living is the amount and types of care offered. Skilled nursing and assisted living facilities provide similar services, such as assistance with everyday tasks and medication management, but there are some key differences between skilled nursing and assisted living.

Assisted living communities offer a long-term housing option for seniors that want to enjoy their independence but need some extra help with activities of daily living (ADLs). Skilled nursing provides more intensive medical care to patients that require around-the-clock support for an injury or illness.

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Determining the level of care your loved one’s needs should be the first step when you’re deciding which type of facility is the right option.

Skilled nursing care

In a skilled nursing facility, a patient may focus more on recovery, therapy services, and treatments. Patients typically stay until they’re able to live independently again, whether that’s at their home or at another supportive living environment.

Skilled nursing facilities provide access to around-the-clock nursing support and caregiving services. Expect to have licensed practical nurses (LPNs) on duty at all times, as well as a registered nurse (RN) at least eight hours per day.

Because rehabilitation is typically the endgame, skilled nursing facilities benefit patients who:

• Have a chronic condition that requires constant care
• Need rehabilitation therapies
• Have mobility issues

Access to care in assisted living communities

The care needs of residents in assisted living are often significantly less complex than those of people in a skilled nursing facility. Residents might need some help with everyday tasks but don’t require as much extensive medical care as someone in skilled nursing.

Assisted living communities aim to provide an individual with a balance of independence and assistance with ADLs and instrumental activities of daily living (IADLs), which can include cleaning and running errands.

Caregivers are also available around the clock, but constant access to on-site medical personnel isn’t available most of the time like at a skilled nursing facility. Assisted living communities may have an on-call nurse, but they aren’t usually staffed to provide around-the-clock access to nursing care.

Many assisted living communities have services and amenities that create the feeling of an all-inclusive retreat. A skilled nursing facility offers its own set of amenities and services, but the specialized environment makes it feel more like staying in a hospital rather than a hotel.

Assisted living amenities

Assisted living communities tend to offer services and amenities that promote residents’ well-being and social interactions. Residents are generally in charge of their own schedules and can fill their days with the activities they enjoy the most.

There’s an abundance of amenities and services provided by assisted living communities. They can include:

• Barber and beauty services
• Transportation to appointments and other errands
• Fitness studios and wellness programs
• Engaging community activities and outings
• On-site devotional services
• Dining options — meals are usually served in the community dining room, but residents may prefer cooking in their own kitchens or kitchenettes as well

Skilled nursing services

Skilled nursing patients can enjoy similar amenities to those provided in assisted living, such as daily meals, activity programs, and housekeeping. However, the services tend to be more centered on medical care, such as:

• IV therapies and medications
• Wound treatment
• Pharmacy services
• Regular vital sign monitoring
• Artificial respiration, such as ventilator care or respiratory therapy
• End-of-life or hospice care

Additionally, a person living in a skilled nursing facility may have a more limited schedule than someone in assisted living, depending on the amount of medical care needed, and scheduled activities are usually less active or strenuous. Some activities can be provided in a group setting, or one-on-one if a patient can’t leave their room, and may include:

• Reading or storytelling
• Pet therapy
• Art projects or simple crafts

Residents can expect to live in a homelike atmosphere in assisted living. With skilled nursing, care is provided in more of a medical setting.

What assisted living looks like

Assisted living communities offer care from a more residential-type setting than a skilled nursing facility might. These communities typically have a main dining room for residents to enjoy restaurant-style meals, as well as shared indoor and outdoor common areas for scheduled community activities.

Residents usually live in private and semi-private apartment-like residences that come equipped with:

• Full-sized kitchens or kitchenettes
• Private bathrooms
• Safety features, such as emergency call systems or grab bars

This apartment lifestyle can accommodate the differing needs of elderly couples, such as if one spouse needs help with ADLs while the other is independent. Residents are typically encouraged to decorate their space with their own personal items, which helps give it a homelike feel and makes the transition process a bit easier.

What skilled nursing looks like

Skilled nursing usually takes place in a medical setting, such as a nursing home, hospital, or rehabilitation center. However, some health agencies may offer skilled nursing services in residents’ homes.

Similar to assisted living communities, a skilled nursing facility often has a communal dining room for residents to eat their meals, depending on their health, where meals are typically served cafeteria-style. Many skilled nursing facilities also have common areas, where they host activities such as:

• Gardening
• Low-impact exercises, such as chair yoga or stretching
• Board games, puzzles, and cards
• Special events for birthdays and holidays

Living accommodations in a skilled nursing facility have a more hospital-like feel than in assisted living communities. Since skilled nursing is usually a short-term living option, with 25% of patients staying for three months or less,^[01] the rooms aren’t usually decorated with personal items. Living spaces in a skilled nursing facility typically offer:

• Private or semi-private rooms
• An en suite bathroom
• A call button
• Window coverings
• Some furniture, which can include a bed, a night stand, and wardrobe or a dresser

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In 2021, the median monthly cost of a private room in a skilled nursing facility was about $9,000 and around $7,900 for a semi-private room.^[02] The median monthly cost of assisted living in 2021 was $4,500 per month.^[02]

Costs related to assisted living and skilled nursing facilities vary due to a number of factors, such as size, location, and services offered.

How much is assisted living?

Assisted living communities are generally less costly than skilled nursing facilities since they don’t provide full-time medical care. Many assisted living communities have base fees that include the costs of:

• Rent
• Basic utilities, which varies by community
• Care coordination
• Housekeeping services
• Activities and programs
• Daily meals, including snacks
• Transportation, though some communities may provide at an additional cost

Assisted living communities may also have extra fees such as:

• Internet service
• Pet fees and services, such as walking or grooming
• One-time fees — also called move-in or entrance fees — that can range from $2,000 to $5,000

Residents typically pay out of pocket for assisted living, but some communities may accept payment from Medicare, Medicaid, or long-term care insurance policies.

How much is skilled nursing?

Skilled nursing is generally the most expensive form of senior care due to the higher level of support needed. The monthly rate covers the costs of the following services:

• Dietitian-approved meals
• Rehabilitative therapies and treatments
• Room rate
• Full-time medical staff and round-the-clock nursing care
• Security and safety features, such as grab bars and alarm systems

Unlike many assisted living communities, skilled nursing care can be covered by most long-term care insurance policies and government assistance programs such as Medicare and Medicaid.

When it comes to deciding on skilled nursing versus assisted living, a majority of the decision will come down to how much care is needed. Skilled nursing may be a better fit for someone if they have more challenging medical needs than assisted living communities can provide care for. It may also be a better option for those who need:

• Round-the-clock nursing and medical care
• Speech, physical, and occupational rehabilitation services
• Palliative care
• Nutritional care or therapeutic diets
• Assistance walking and standing

In short, a skilled nursing facility is ideal for someone who just had a hospitalization or experienced medical issues, such as a heart attack or stroke.

Read related article:Skilled Nursing Facility vs. Rehab Center: How to Choose

Seniors will likely seek assisted living as a permanent living solution when they’re still generally active but it’s no longer safe for them to live at home. Assisted living may be a good fit for seniors who:

• Feel lonely
• Need help with two or more ADLs
• Struggle to maintain their home or complete household chores
• Need minimal nursing care or medical assistance
• Want to socialize and make new friends
• Have experienced a decline in mobility

Assisted living is optimal for seniors who want to preserve their independence as long as possible, while having help available when it’s needed.

When it comes to choosing between skilled nursing and assisted living, deciding which type of facility can best support your or a loved one’s care needs is the easiest part. Once that’s been established, you can get started researching, touring, and comparing those types of facilities to find the right match.

Whether you’re looking at assisted living communities or skilled nursing facilities, A Place for Mom’s Senior Living Advisors can help you every step of the way. They’ll take the time to learn about your family’s unique needs and point you to different senior care options in your area.