A Brief Overview and Comparison of Elder Care Facilities

Assisted Living

Assisted living facilities provide the help their residents need for extra care while still allowing them to maintain an independent lifestyle. These facilities house residents who do not need a higher level of care from a nursing home, but also cannot live without additional help. The services offered vary based on the needed level of care for the individual (National Institute on Aging, 2017). A resident who suffers from dementia requires different needs than a resident who deals with deteriorating motor skills. Services can include managing medication, cooking meals, doing laundry, cleaning rooms, and arranging bus trips to the store. Additionally, designated medical staff respond to emergencies and can monitor the health of the residents daily to endure their well-being. Doctors also visit onsite to provide services including physical therapy, routine checkups, and mental health assistance.


Residents live in their own apartments, but share common spaces such as a cafeteria and an activity room. (Note: Residents with dementia usually have their own wing separate from those who require a lower level of care). Apartments consist of accessible features that aid those with mobility issues. They also come equipped with an emergency button that allow residents to contact medical staff. The common spaces let residents socialize with each other and also become a venue for activities that residents can participate in. Group activities, such as bingo, movie night, etc., provide entertainment outside of the apartment. Assisted living facilities intend to provide a safer environment for residents without the dependent constraints of higher-level care facilities.


Nursing Homes

Nursing homes house residents who need a high level of care. Many of them have severe disabilities that affect their day to day mental and/or physical functioning. This means that residents require around the clock (medical) attention and resources. In addition, Health in Aging (2020) reports that at least 80 percent of residents need help with “three or more [activities of daily living] (such as dressing and bathing). About 90% of residents who are able to walk need assistance or supervision. More than half of residents have incontinence (the inability to control bowels or the bladder), and more than a third have difficulty with hearing or seeing”(Health in Aging, 2020). In addition to the physical problems, around half to 70 percent of nursing home residents suffer from dementia, two-thirds from memory problems in general, and three-fourths from trouble with making daily decisions (Health in Aging, 2020).


Nursing homes are commonly set up in the same way as assisted living facilities. Although, nursing home residents usually reside in single rooms instead of apartments and are more likely to share that room with someone else, unless the resident is willing to pay extra. Additionally, nursing homes tend to have more advanced medical equipment and skilled medical staff on hand to assist with caring for the residents.


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

Nursing homes and assisted living facilities mostly house those aged 65 and older (Colello, 2020 and El, 2021). A report completed by the Congressional Research Service states that “[assisted living facilities] are considered community-based settings, as opposed to institutional-based settings such as nursing homes” (Colello, 2020). The general differences between the two are the level of care (and consequently, the cost) and the level of government regulation.

Level of Care

Nursing homes provide a higher level of care to their residents than assisted living facilities. Nursing homes have access to a wider array of medical services including feeding tubes and ventilators (Castaneda and Levine, 2022). Generally, those in assisted living need more help with daily tasks such as cooking and doing laundry. Nursing home residents have more demanding medical needs that inhibit their ability to care for themselves to a severe degree. For instance, someone who had a major stroke and has to live with the severe neurological effects of it (Castaneda and Levine, 2022). Some assisted living facilities do offer more care than the standard level which residents need to pay extra for.

Cost

On average, the cost of a nursing home facility in the United States is higher than that of assisted living. However, this is due to the higher level of care needed for residents in a nursing home. The cost of both nursing homes and assisted living facilities varies by location. Nursing home care in the Washington, D.C. metro area is particularly expensive, typically exceeding $10,000 per month. While assisted living facilities appear cheaper than nursing homes, those in nursing homes have access to more programs, such as Medicaid, to help with the payments. Payment options for nursing homes and assisted living facilities differ due to their separate requirements for programs, funding and oversight.


Oversight, Regulations, and Medicaid

Assisted living facilities do not receive any federal funding or oversight. They are private businesses that follow regulations set by and monitored by the state. Nursing homes receive federal funding and need to comply with federal regulations set forth in 42 CFR §483. Assisted living facilities collect money by charging residents for room, board, and any further medical expenses. Additionally, nursing homes accept Medicaid which can cover the entire cost for eligible applicants, including room and board, while assisted living facilities only accept Medicaid in limited circumstances (depending on the state and the availability of the specific programs). Even if accepted, Medicaid will not cover room and board for residents in assisted living facilities (Colello, 2020). The federal Medicaid statute “essentially…delineates that housing is separate from health and social services provided to an individual in a private home or residential setting” (Colello, 2020). Assisted living facilities fall under the “private home or residential setting” aspect, therefore, residents do not qualify for room and board coverage under Medicaid. Consult an experienced elder law attorney if you are thinking about using Medicaid to pay for long-term care because programs and eligibility vary from state to state.


In-Home Care

In-home services give individuals another option to consider when thinking about long term care. Individuals can choose to pursue in home care if they do not want to live at a facility. Medicaid is accepted for in-home care for needed medical assistance such as necessary equipment and home modifications for accessibility. Many states (no federal mandate exists) include non-medical personal care assistance in their Medicaid plans (American Council on Aging, 2022). Medicaid eligibility and “exact functional need varies by the state and the program” (American Council on Aging, 2022). In other words, a certain degree of care is required to determine whether an individual qualifies under Medicaid. In some states, family members can get paid to take care of their loved one, although some restrictions exist depending on the program.


Works Cited

American Council on Aging (2022). Medicaid and home health care & non-medical, in-home care. https://www.medicaidplanningassistance.org/in-home-care/

Castaneda, R., & Levine, D. (2022). Nursing homes vs. assisted living. U.S. News. https://health.usnews.com/best-nursing-homes/articles/nursing-home-vs-assisted-living

Colello, K. J. (2020). Overview of assisted living facilities. Congressional Research Service. https://crsreports.congress.gov/product/pdf/IF

/IF11544

El, S. (2021). U.S. nursing home population statistics and facts. Simply Insurance. https://www.simplyinsurance.com/nursing-home-statistics/#tve-jump-1764e16e24f

Health in Aging (2020). Nursing homes. AGS Health in Aging Foundation. https://www.healthinaging.org/age-friendly-healthcare-you/care-settings/nursing-homes

National Institute of Health: National Institute on Aging (2017). Residential facilities, assisted living, and nursing homes. https://www.nia.nih.gov

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