What’s the Difference between Assisted Living and a Nursing Home?

Basically, there are two different types of care-homes for seniors who are not able to live on their own anymore: “Skilled Nursing Facility” and “Residential Care Facility for the Elderly.”

It’s a little confusing though, because, in addition to these “official” names, there are many “common” names for each option. On top of that, people  tend to use the names interchangeably – confusing matters even more.

Skilled Nursing Facilities are for people who require 24-hour nursing or medical care and supervision. These days, they are primarily for rehabilitation: For example after a stroke or a broken hip.

Some of the more common names for Skilled Nursing Facilities are:

  • nursing homes
  • convalescent homes
  • rest homes

Although some people with dementia require 24-hour supervision, that need is not considered “medical,” so dementia alone does not qualify someone for nursing-home care.

Nursing homes aren’t usually equipped to handle dementia-specific issues like wandering.

A Residential Care Facility for the Elderly (RCFE) is the more common option for long-term care for someone with dementia. RCFEs are also called:

  • assisted living (usually the big, apartment-like setting)
  • board and care (a smaller setting or private home)
  • memory care (dementia-specific)

Although some RCFE communities have a nurse on staff, they are not a medical setting. They provide care and supervision. Their services include meals, socialization, and assistance with the “activities of daily living” (ADL): Dressing, personal hygiene and medication management.

Some assisted living communities specialize in dementia care. Some have a designated area for residents with dementia. Some are not set up for dementia at all.

As far as the cost goes, Medicare and other health insurance plans pay for some skilled nursing (all sorts of rules and restrictions, of course) but not for assisted living.

There are organizations that can help you sort through all the options and find the right placement for your loved-one. Their help is free; my understanding is that they get paid with a finder’s fee from the care-facilities. Senior Care Solutions is one I’ve worked with (and was very happy with) in the Sacramento area: www.seniorcs.com.

* Disclaimer: I live in California. The terminology may be different elsewhere. If so, please share; I’d love know how things work where you live.

My dad with his mom when she was in a nursing home after she'd had a stroke (sometime in the 1990s).

My dad with his mom when she was in a nursing home after she’d had a stroke (sometime in the 1990s).