Assisted Living vs Skilled NursingAssisted Living vs Skilled Nursing

The decision to move from the home you’re used to into a home where you can receive more care is already an incredibly difficult one for most seniors and their loved ones to make. No one likes the idea of trading their own home and independence for a more crowded, regimented and institutional setting, but not all seniors can manage to stay in their own homes until the end of their lives.

If making the decision to move itself is difficult, knowing whether to go with an assisted living or nursing home is no easier. It often seems simple, because nursing home abuses of the last century managed to give the whole industry a bad reputation. But not all nursing homes deserve that reputation and many seniors who choose assisted living homes find themselves having to move soon because they actually need the level of care offered at a nursing home.

The Main Differences Between Assisted Living and Nursing Homes

Assisted living homes provide services like meals, housekeeping, transportation and help with basic activities of daily living like getting dressed and bathing. What they don’t provide is 24-hour care or medical supervision. While assisted living homes typically have registered nurses and/or doctors come in for visits to check on residents, they’re not required to have staff members with medical licenses. And they’re not regulated by the federal government.

What they do offer is a higher level of independence for seniors who don’t require the level of medical care provided at a nursing home, but do still need help with things like getting dressed or taking care of daily meals.

Nursing homes, in contrast, make medical care a central component of what they offer. They are required to have medical staff available at all times and are subject to laws and regulations from the government on the quality of care provided. Private rooms are less common in nursing homes and they do sometimes have a more institutional feel, which accounts for a lot of the resistance to choosing a nursing home over assisted living, even when it may be the more appropriate choice for a senior’s needs.

How to Choose Between The Two

Nothing about assisted living homes or nursing homes makes one the inherently better option. Which one is best for you or your loved one depends entirely on your particular health issues and needs, and what’s available in your area.

Fortunately, we can offer a few tips to help you make a better decision.

1. Think long term.

We can’t see the future so there’s no way to completely know where you or your loved one will be in 1-3 years, but do talk to your doctor about what kind of symptoms and issues they expect will be coming in the near future. If you only need a little bit of help now, but you’ll very likely need 24-hour medical care within a couple of years, then going through the difficult process of moving and making friends in an assisted living facility probably doesn’t make sense. If you move straight to a nursing home now, you can establish the community you’ll be a part of for the years to come and be able to settle in knowing this is really home.

2. Know the real cost.

Don’t assume the listed cost is what you’ll be paying. If a home that seems to cost a lot takes your insurance or Medicare/Medicaid, you could ultimately end up saving a lot of money going with them. You may also find the listed price doesn’t cover everything you need. If you choose an assisted living home where certain types of care are treated as an add-on cost, you could end up paying much more than expected.

Ideally, cost won’t be the main consideration for the home you choose to go with, but be careful not to make a rash decision based on price without making sure you understand the full implications. Be prepared to ask lots of questions and do lots of research to make sure you really know what you’ll be paying.

3. Pay attention to the details of individual locations.

Some assisted living homes provide more medical care than others, or work on a tiered continuing care model that makes it easy for a senior to move from the assisted living section of the community into the skilled nursing home part when the time comes. You may find that there’s a comfortable, suitable assisted living home nearby that meets all your needs (and your expected needs for the next few years). Or you may find a nursing home in your area that has the comfortable feel of home you’re looking for.

Don’t assume you know exactly what to expect from a place because of the labels. Research all of your nearby options, visit the ones that look the best to you, and ask lots of questions. Find out if the assisted living home you’re considering is familiar with the types of care you need, and how long residents usually stay before moving into a nursing home. And talk to residents of the nursing home you check out about whether they’re lonely or feel they don’t get enough privacy.

Finding the right senior living home is all about knowing what you need and want, then doing the research to find the option that comes closest to meeting your requirements and preferences.

Kristen Hicks is an Austin-based copywriter and lifelong student with an ongoing curiousity to learn and explore new things. She turns that interest to researching and exploring subjects helpful to seniors and their families for


  1. Judah Gutwein July 14, 2015 Reply

    Great read!

  2. Joan Bowie July 16, 2015 Reply

    I am 68. Over the years I have been exposed to nursing home stays of friends and family in various nursing homes in Virginia, Florida, and myself personally in Mobile, Alabama. Scary is all I can say. I first went to a nursing home for rehab after surgery. Thecstay was for 30 days. During that period Ivsaw a doctor 3 times and nurses only for pills…no other interaction at those times. Vital statistics were not taken daily as required and most times not at all. I was unable to walk and was in a wheelchair most of the time. The CNAs, except for a selective few were lax and lazy. I was told to transfer myself to a chair many times by CNAs who thought I should be walking and were too lazy to help me. I was left at night for 1-3 hours before bathroom assistance. I watched the same treatment of other patients and one lady nearly died because they didn’t abswer ger call button and her oxygen was off. Cannot even list the violations.

    The second nursing home I tried after knee replacements was about 25% better. I stayed there for one 7 day stay and a 10 day stay. I was more mobile so didnt require much assistance. But still had long waits for things I did need. The night nurse and his supervisor from this stay refused to give. me pain medications ordered by my doctor because I was too independent and bubbly so I couldnt be in such pain. After knee replacements and nerve damage in one leg I was in real pain. I was treated like a drug addict abd gad to endufe lits if pain. I saw similar priblems in visitations to others in all 3 states.

    I was mostly very independent so I hated to see those who needed assistance receiving such awful carrier. Ivwillvdue before I go to another nursing home. By that I mean I will go to a state that provides assisted suicide.

    I really believe my observations are the rule and not the exception in nursing homes. Unless one has family to monitor things it us an unbearable place to have to live out your life.

    • Amelia Willson July 20, 2015 Reply

      Hi Joan,
      It saddens me to hear about the negative experiences you’ve had or seen others have in nursing homes. Have you considered writing reviews of these facilities on our site? It sounds like you have some important feedback to share that it would benefit other families to hear about.

  3. Ellen July 26, 2015 Reply

    It saddens me to hear that people dont take the time and research which nursing home is best or their loved one, so I thank you for writing this.
    Nursing home care is hard to find and good nursing care is even harder. I have found a nursing home facility that has quality nursing care for your loved one in Danville, Illinios. Gardenview Manor has a campus that speaks for itself. The staff are certified LPNs, RNs and CNAs and are wonderful caring individuals.

    • Amelia Willson July 27, 2015 Reply

      Hi Ellen,

      Thanks for reading! I’m glad to hear you’ve had such a positive experience finding skilled nursing care for your loved one at Gardenview Manor. I encourage you to leave a review and help spread the word to other families looking for care. Here’s the link to the review page for Gardenview Manor.

  4. Denise Stewart August 24, 2018 Reply

    I am a certified caregiver and I can relate totally to this article. I have worked in numerous nursing homes and am now working at an assisted living facility. It’s very sad how residents are treated and how their hard earned money is being taken. I really wish that there was something I could do to expose the last nursing home I worked at. I’m no longer employed there, but all the negligent deaths and neglect are heartbreaking. I reported things to the corporate office and nothing was done. I was terminated for bogus reasons, but was relieved when God removed from that terrible place. I’m now employed at an assisted living facility, my first time. I work on the memory care unit and management and staff are awesome. People are treated with dignity and respect.

  5. Silas Knight June 29, 2019 Reply

    It’s good to know more about senior care. I love how you said that we need to look at the real cost of assisted living. I’m sure we can find a place for my mom that has a fair price.

  6. Larry Weaver August 13, 2019 Reply

    Thanks for mentioning how assisted living centers allow for greater independence for the seniors who live at these facilities. My dad currently lives on his own, and it is getting difficult for him to move around with how frail his arms and legs are getting. He can still do a lot of things on his own, but he does need help, so I think assisted living would be right for my dad.

  7. Ellie Davis September 16, 2019 Reply

    It’s interesting to know that assisted living homes provide services like meals, housekeeping, transportation and help with basic activities of daily living. My husband and his brother are looking for advice to help their grandmother with her daily living. I will let him know about the benefits of assisted living to help their grandmother.

Leave a reply

Your email address will not be published. Required fields are marked *


Our expert Senior Living Advisors are here to help.

Learn about your care options, local communities, pricing and more, with our free services. Complete the form below to receive a call.

First & Last Name

Email Address

Phone Number

By clicking Submit, you agree to our Terms of Use. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Privacy Policy for information about our privacy practices.