Written by attorney Jonathan Alan Rosenfeld

What is right for you? Nursing Home vs. Assisted Living Facility

Don't assume 'nursing home' and 'assisted living facility' are interchangeable terms. Learn the differences and similarities between these facilities to determine which is best for your loved one.

What really is a nursing home?

Nursing homes differ from assisted living facilities in terms of the level of medical care and services they provide. Nursing homes provide 24-hour medical care to people with chronic medical conditions who do not require the acute care a hospital may provide.

What really is an assisted-living facility?

Assisted living facilities provide a combination of housing, support services and some level of heath care. Individuals in assisted living facilities are given more flexibility as to the type of assistance they desire. Nonetheless, in order for a facility to call itself an 'assisted living facility' it must: provide at least two daily meals for its residents, have a daily resident check-in system, provide weekly housekeeping services and assistance with daily living activities. Assisted living facilities also must offer certain health related services with administration of of medication.

Questions for the nursing home administrator

  • Is the nursing home Medicare or Medicaid certified?
  • Does the nursing home have the level of care needed and is a bed available? (Check with DH and/or ask the facility directly.)
  • Is there a full-time registered nurse in the nursing home at all times?
  • What is the nursing home's staff retention rate?
  • Does the same team of nurses and certified nursing assistants work with the same residents most days per week?
  • Is there a choice of food items at each meal, and are residents able to get their favorite food items?
  • Are staff members available to help residents eat and drink during mealtimes?
  • Are there daily activities for the residents?
  • Does the facility allow pets?
  • Is there an active volunteer program?
  • What is the nursing home's safety and care plan in the event of an emergency?

Little regulation of assisted living facilities means more work for you

Because assisted living facilities have less governmental regulation than nursing homes, it is essential to be an advocate for your loved one and and get satisfactory responses to all questions. It is also advised that you ask to review a copy of the residence agreement outlining services, prices, extra charges, admission and discharge criteria, staffing and residence rules.

Questions for the director of an assisted living facility

  • Are additional services available if a resident's needs change?
  • What are the costs of the services?
  • Are residents required to purchase renters' insurance for personal property in their units?
  • Does the residence have a clearly stated procedure for responding to a resident's medical emergency?
  • What are the medical services available and how are they provided?
  • Is staff available to meet scheduled and unscheduled needs?
  • Are pharmacy, barbers and physical therapy offered on-site?
  • Is transportation available for residents to go to doctor appointments, etc.?
  • Are there organized activities for residents?
  • Can residents have pets?
  • Do volunteers come into the residence to help with or conduct programs?
  • Do food menus vary from day to day and meal to meal, and are they nutritionally balanced?
  • Are staff welcoming and professional?
  • Do the residents socialize with one another?

Never take anyone's word. Visit each facility.

Nothing can take the place of a visit to a facility. Making an unannounced visit to a nursing home or assisted living facility can be a helpful way to scope out its day-to-day function. Is there a substantial difference between 'planned' and 'unplanned' visits. Take a note of the following:

  • Is the facility well-kept?
  • Are the residents clean, appropriately dressed, and well-groomed?
  • Are the staff polite and respectful?
  • Do the staff recognize the residents by name?
  • Do the staffing levels appear appropriate for the number of residents?

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