Written by Jenny Smiechowski, staff writer for The Birches
What’s the difference between assisted living and a nursing home?
That’s a question a lot of people ask when they start sifting through senior living options for themselves or a loved one. Unfortunately, it’s not a simple question to answer, because the senior living landscape is constantly changing.
Before the 20th century, older adults didn’t have many residential options if they needed support and care. Older adults who couldn’t care for themselves and didn’t have family members to care for them lived in almshouses (also known as poorhouses), a form of charitable housing for people of all ages.
During the Great Depression, almshouses became overcrowded and unsanitary. So, in 1935, the Social Security Act provided income assistance to low-income older adults, which allowed them to find alternatives to charitable institutions like almshouses.
Private board and care homes for older adults already existed at this point. But the influx of cash into the hands of seniors caused the fledgling private senior care industry to grow. Many of these private board and care homes began offering nursing services to meet the health needs of the seniors moving in and earned the name “nursing home.”
In the 1960s, the enactment of Medicare and Medicaid fueled the expansion of the nursing home industry even more. Medicare offered matching federal dollars to state and local governments that funded long-term care for people with low incomes. Government funding brought more regulation, and gradually, nursing homes became more like hospitals in how they looked and operated.
In the 1980s, a new term emerged: assisted living. Not everyone loved the hospital-like direction nursing homes were heading. The assisted living movement developed to bring a different approach to senior living, one that delivered a higher quality of life for seniors beyond just medical care.
Assisted living was created to provide apartment-style living that included a variety of supportive services, while still allowing seniors to retain autonomy in their daily activities and health care decisions. The idea was popular with older adults and their children who wanted senior care that was more home-like and less institutional. By the mid-1990s, assisted living communities comprised half of all new construction in the senior living industry.
So, what exactly is a modern-day nursing home? What’s an assisted living community? And what’s the difference?
Well, just like senior living terminology continued evolving throughout the 20th century, it’s constantly changing in the 21st century too. Many senior care businesses are moving away from the term “nursing home” and calling themselves skilled nursing facilities, healthcare centers or rehabilitation centers instead.
Skilled nursing facilities are designed for people recovering from an illness or injury. That means they offer 24/7 nursing and therapy services. They also offer long-term and short-term care options.
Assisted living communities, on the other hand, don’t typically offer seven-day skilled nursing support and therapy services. Although, some assisted living communities do have nurses on the clock 24/7. Assisted living communities are also intended as long-term living options, like moving to a new apartment. However, there are assisted living communities that offer short-term stay options too.
Another major difference between assisted living and skilled nursing is privacy. Assisted living communities offer private rooms, while skilled nursing facilities often have shared rooms. Assisted living also has more robust enrichment programs. That means they offer activities and events, like fitness classes, art classes, concerts, restaurant outings and more.
Payment options differ between skilled nursing facilities and assisted living communities as well. Skilled nursing is covered, at least in part, by Medicare, but assisted living isn’t. Assisted living is private pay, which means you pay with your personal income, savings or investments. That said, low-income older adults in Illinois could be eligible for Illinois Supportive Living Program, which is essentially Medicaid-eligible assisted living.
Assisted living communities and nursing homes (a.k.a. skilled nursing facilities, healthcare centers, rehabilitation centers, etc.) both play an important role in the senior living space.
When you have severe health issues, skilled nursing facilities can be necessary for safety and recovery. But once the need for round-the-clock care has passed, many older adults find that assisted living communities strike the balance between support and independence they’re searching for.
Only you and your family can decide which option is right for you. But a candid conversation with your doctor and an initial meeting with staff at skilled nursing or assisted living communities in your area should help you determine where you’ll get the level of support you need.
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