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8 Signs It's Time to Move From Assisted Living to a Nursing Home

7 minute readLast updated October 7, 2022
Written by Miranda Stambler

A senior’s care needs will likely change as they age, just as they did when you and your loved one determined they could no longer age in their home. A day will likely come when you discover it’s time to move your loved one from an assisted living community to one that can provide more intensive support at all hours.

Assisted living may be the right environment for seniors in good health who need minor help with their activities of daily living (ADLs). However, your loved one may need to move from assisted living to a nursing home when their health begins to deteriorate to the point that they need round-the-clock care.

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When to move from assisted living to a nursing home

As you notice your loved one’s needs changing generally, you may wonder what specifically to look for in order to know when it’s time to move them from assisted living to a nursing home. From becoming bedridden to a sudden frequentness of hospital visits due to serious medical issues, there are signs that you should note when considering changing facilities.

1. Needing 24-hour care

While assisted living communities can provide round-the-clock care, it is typically for minor assistance. Nursing homes, also known as skilled nursing facilities, provide a high level of 24/7 care. This higher level of care is typically provided by staff including licensed practical nurses, registered nurses, and aides.

When hospitalization is not required, but 24/7 medical care is needed, an assisted living community may not offer enough support for your loved one. However, a skilled nursing facility may be the answer. Beyond assisting with ADLs, these facilities help with both everyday and emergency medical needs. To name just a few specific kinds of care, staff at a nursing home can perform the following:

  • IV therapy
  • Catheters placement and maintenance
  • Blood pressure monitoring
  • Respiratory therapy [01]

The majority of seniors in nursing homes need help with at least three ADLs, need assistance with walking, and struggle with incontinence.[01]

Seniors in need of nursing home care may also experience trouble eating on their own. They may require a feeding tube or a pureed or liquid diet. A specialized care facility like a nursing home has access to the equipment needed for these special dietary needs.

2. Developing complex medical conditions

When seniors start to develop complex medical conditions, it may be time to move into a nursing home.

Complex medical conditions that may require skilled nursing care include:

These are just a few of the many medical conditions that require attention from caregivers round-the-clock. However, the level of care required depends on your loved one’s needs and the progression of their condition. Consider whether your loved one needs specialized medical care, additional assistance, medication, or if there are complications with their condition.

Nursing homes can also care for seniors with Alzheimer’s disease and other types of dementia. However, facilities geared specifically for memory care might be a better option to consider for those experiencing cognitive decline.

3. Requiring hospice or palliative care

Seniors who are terminally ill with less than six months to live and who have chosen not to undergo or continue treatments to extend their life may consider hospice care. In hospice care, the main concern is the patient’s comfort.

Palliative care is for people with serious medical conditions like cancer, stroke, dementia, and heart failure. Differing from hospice care, palliative care aims to reduce suffering while addressing a patient’s underlying conditions.[02]

Nursing homes typically offer both hospice and palliative care services. While some assisted living communities may collaborate with a hospice team, not all of them have that option.

4. Becoming bedridden or needing a wheelchair

If your loved one has become bedridden or constantly needs assistance moving, they may need a nursing home. Nursing home caregivers are experienced in patient transfers and are adept at moving individuals, often wheelchair users, to or from a bed, chair, or toilet.

Additionally, seniors who must spend several hours a day in bed may get bedsores. Nursing home caregivers are typically trained to help prevent and tend to bedsores.

5. Frequent visits to the hospital

Sometimes, when recovering after a hospital visit due to an injury, illness, or other medical event, seniors may need follow-up care. If your loved one is recovering from a hospital procedure, they might consider a temporary stay at a skilled nursing facility.

To help seniors recover after a major medical event, nursing homes typically offer several therapy options, including:

Also, seniors who have been making repeated trips to the hospital, but who do not require ongoing hospitalization, could instead receive constant monitoring and any needed medical care at a nursing home. By transferring to a nursing home, your loved one could reduce the number of trips to the hospital and avoid risks like secondary infections, bedsores, falls, and more.[03]

6. Falling more often

As people age, their risk for falling increases with approximately one in four seniors 65+ experiencing a fall each year.[04] A fall can result in injury and could potentially be fatal. Caregivers in a nursing home are experienced in helping seniors with mobility issues. And, if a fall injury occurs and hospitalization is not required, then a skilled nursing home is able to provide needed medical care around the clock.

7. Needing medication administration

Seniors in nursing homes have access to licensed caregivers that can administer medications for complex conditions, such as giving injections for diabetes. Depending on the assisted living community, they may be qualified to distribute medications, though this is less common. Typically, assisted living caregivers manage medications.

8. Wanting help with the cost of living

While a skilled nursing facility may be more expensive than an assisted living community, many people qualify for government assistance.

Depending on the state and the services needed, Medicaid and other benefits may be applicable toward nursing home stays. Because Medicaid only covers medical assistance, assisted living costs are typically not covered.

For temporary stays after a hospitalization, seniors may qualify for Medicare benefits at a certified Medicare skilled nursing facility. However, if continuous care is needed after the approved benefits time period, seniors will need to look at other payment options like Medicaid. In addition to the nursing home being certified as a Medicaid Nursing Facility, seniors must be eligible for Medicaid in order to use the benefits.[05]

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How to move from assisted living to a nursing home

Prior to moving from an assisted living community, it is important to consider the requirements of a nursing home facility. One typical requirement is a doctor’s order that confirms a senior needs nursing home care. Other documents and tasks that may need to be completed prior to moving include medication and treatment orders, a physical examination, state-required forms, vaccines, a tuberculosis test, and the facility’s admission paperwork.

If you have noticed in your loved one any of the signs discussed above, consult with their doctor to see if moving to a nursing home is the best option. While you may have been through this process before, finding the right community can still be stressful. A Place for Mom’s Senior Living Advisors can help walk you through potential options, and their advice comes at no cost to you.

Table of Contents

When to move from assisted living to a nursing home

How to move from assisted living to a nursing home

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  1. Health In Aging Foundation. (2020, October). Nursing homes.

  2. National Institute on Aging. (2021, May 14). What are palliative care and hospice care?

  3. Fernandez, H. M., Callahan, K. E., Likourezos, A., et al. (2008, February 25). House Staff Member Awareness of Older Inpatients’ Risks for Hazards of Hospitalization. Archives of Internal Medicine.

  4. Centers for Disease Control and Prevention. (2020, July 9). Older Adult Falls Reported by State.

  5. Centers for Medicare & Medicaid Services. Nursing facilities.

Meet the Author
Miranda Stambler

Miranda Stambler is a former copywriter at A Place for Mom. Miranda volunteered at a nursing home and also personally witnessed her family's struggle with dementia and aging. She holds a bachelor’s degree in journalism with minors in English and animal science from North Dakota State University.

Edited by

Jordan Kimbrell

The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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