Assisted Living Vs. Skilled Nursing Care

Unfortunately we don’t get to stay young forever and at some point in time a large percentage of aging Americans will have to choose a place to call home that provides them assistance as they age. The difference between Assisted Living Facilities and Nursing Homes are quite simple. When touring a facility the person leading the tour will tell you all about what the facility can do for you or your loved one but what you need to ask is “What can’t they do?”

A common misconception is an assisted living facility is just a nursing home with fancy furniture. But the reality is an assisted living facility is not licensed to give nursing care. Typically, assisted living facilities are places where elders live in a supervised community, with some personal care services available. Meals, social activity, and help with the activities of daily living such as bathing and dressing are all usually offered. The focus in an assisted living facility is to provide a healthy social atmosphere and prevent social isolation in a safe environment.

If you or your loved one is in fragile health and seems to be steadily declining physically or mentally, be cautious about choosing an assisted living facility over a nursing home (also known as a skilled nursing facility). No one chooses a nursing home first. Nursing homes are similar to hospitals, as they must be to deliver skilled care to frail seniors. But if you or your loved one needs nursing care, and must be watched day and night, or likely to need such supervision in the near future, it is the only choice. Assisted living facilities are not licensed by Medicare or Medicaid to give skilled care. Some have a separate skilled nursing facility on-site or nearby, but it will have its own license to deliver skilled nursing care. That license does not apply to the assisted living component, even the two facilities are located on the same campus or are operated by the same parent company.

Many assisted living facilities do not have any licensed nurse on staff, and may have no nurse connected to them at all. Because they are considered nonmedical facilities, having a licensed nurse is not required by law. Even if a nurse is employed by the assisted living facility, the nurse cannot give hands-on care in the form of dressing a wound, administering around-the-clock insulin, administering oxygen, or other tasks that are defined by the federal and state governments as “skilled nursing care.”

Skilled nursing care may only be administered within a facility that is licensed to do so. Legally, this kind of facility is licensed as a skilled nursing facility, although it may have a different business name that it markets itself as, such as an “extended care” or “long-term care” facility. Medicare and Medicaid also designate these homes as skilled nursing facilities. Because skilled nursing facilities bill Medicare and/or Medicaid for skilled nursing care, they must comply with many complex legal regulations and requirements. Assisted living facilities are regulated by the state Department of Social Services, not the Department of Health, which regulates nursing homes. Assisted living facilities do not have the same safety or administrative requirements as a skilled nursing facility, and they are prohibited from giving care they are not licensed to give.

There are exceptions to some of the federal and state government’s licensing requirements. For example, a licensed assisted living facility may take care of residents with dementias, including Alzheimer’s disease, if it has a waiver to accept this kind of resident. The facility must also have certain protections in place to prevent injury to its demented residents. However, it is still prohibited from restraining a demented resident who has a tendency to wander. There are many other limitations to what an assisted living facility can do, even with waivers. Taking care of residents with dementia can be unpredictable, and skilled nursing can become necessary as the disease progresses.

When you or your loved one has to move out of the family home, or out of a long-term residence of any kind, the move can be difficult, even traumatic. If you are considering assisted living as an option, be sure your focus is on the long run. Carefully consider what will be needed a year down the road. Moving an elder twice within a short period can be extremely hard on them as well as yourself, so make your decisions based on the overall picture, not just on what the assisted living facility can do right now. If you are your loved needs medical assistance because of a declining condition, you must be fully aware of the limits of assisted living.