Top 8 Differences Between Skilled Nursing and Assisted Living


Choosing a supportive senior living environment for yourself or someone you love can be overwhelming. With so many residential types, fee structures, and potential benefits, finding the right place can quickly become a discouraging and confusing process. Rest assured: You are not alone. Keep doing your research and asking good questions and you will find the answers you need. Sometimes the best way to understand one option is to compare it to another one.

We’ve assembled a list that includes eight of the biggest differences between assisted living and skilled nursing here.

Skilled Nursing vs. Assisted Living

1. Level of Need

While both skilled nursing and assisted living exist to help individuals pursue exceptional lives, one clear differentiator is the type and level of care needed. In fact, the type and level of care needed will most often determine whether skilled nursing or assisted living is the most appropriate choice.

If someone needs daily therapy, IV medication, or artificial respiration (i.e, a ventilator), for instance, skilled nursing is better equipped to meet the need.
For the person who wants or needs help with simpler tasks, assisted living may be the answer. Five of the most frequently expressed needs by people who choose assisted living are as follows:

  • daily living (bathing, dressing, eating)
  • mental health (depression or isolation)
  • medication management
  • social support
  • financial management (remembering to pay bills)

Note that what you or your family member may need right now may not be what will be needed permanently. Choosing skilled nursing, for instance, may be the right temporary option when deeper care is needed that leads to a move toward assisted living. Assisted living may be the right solution now with the knowledge that skilled nursing at some point. Also, get opinions from your medical team or personal advisors who may be better equipped to provide an objective perspective.

2. Type of Setting

To be clear, skilled nursing is considered a medical setting, while assisted living is considered a residential setting. Skilled nursing often happens in the context of a traditional nursing home or rehabilitation center, while assisted living programs can be more residential in nature –anything from a stand-alone cottage to a high-rise apartment building.

Historically, skilled nursing residences have been accused of being more “institutional” than assisted living communities, but that has changed over the years. Skilled nursing has made huge strides by seeking to make its settings more resident-centric and less institutional. Skilled nursing residences are increasingly less like a hospital and more like a home. Do not be discouraged from considering the skilled nursing option based on a nursing home or rehabilitation center you may have visited in the past. Go see what options exist today. Request a visit. Tour the setting. Try out an activity. Talk to residents. Ask as many questions as you have. You may be pleasantly surprised by what you discover.

3. Availability of Staff

With few exceptions, skilled nursing residences are required to have a registered nurse on site for a minimum of 8 hours every day, 7 days a week. For assisted living residences, licensed practical nurses and/or registered nurses must be accessible and on-call, but they are not required by law to be on-site. If you or your loved one need regular access to medical personnel, choosing skilled nursing may be your best (or even only) option.

Be certain you make an honest assessment about what you or your family member needs before making the decision between skilled nursing or assisted living. The last thing you want to do is commit to assisted living, for instance, only to require a move in a few months when the needs become too great to handle. While this happens due to medical needs changing without notice, it can be an expensive and frustrating endeavor that can often be avoided by open discussion and careful consideration.

4. Length of Stay

Generally, skilled nursing is necessary for the short-term while assisting living is considered long-term. Skilled nursing is most often needed following a hospitalization or sudden decline in health, where assisted living exists to allow residents to enjoy life as normal while having available help nearby for tasks that are particularly challenging.

Important to note: “short-term” in this context simply means temporary. According to the American Health Care Association, 78% of individuals who move into a skilled nursing residence stay over 100 days. Meaning, longer-term assistance (calendar-wise) from a skilled nursing residence is common.

5. Goal of Residency

The goal for most skilled nursing facilities is rehabilitation, followed by return to independent living. Sometimes the goal is to rehabilitate an individual until he or she can move to another longer-term supportive living environment. In contrast to that, assisted living is not considered temporary. The goal is to provide an individual with as much independence as he or she desires, while assisting with tasks like bathing, dressing, and meal preparation (among others). One option isn’t better than the other; both serve a unique purpose based on current need.

One notable similarity between skilled nursing and assisted living is the opportunity to engage in social events. Depending on what a specific residence offers, both supportive living environments may provide a schedule of activities –including game nights, religious services, health centers, dining choices, etc.— leaving many residents to feel like they are on vacation with friends and not in an institution.

6. Level of independence

Because skilled nursing exists to help individuals following a hospitalization or sudden decline in health, it typically involves constant monitoring and round-the-clock medical care A resident’s schedule may be more limited based on medical services needed. On the other hand, residents of assisted living enjoy great freedom –entirely in control of their schedules – deciding how often and to what degree they need or want assistance. Many assisted living communities offer transportation services to allow residents the opportunity to come and go as they please without the burden of driving. Individuals choosing assisted living do not need round-the-clock medical attention or care.

Note: If presented with the choice, most individuals would initially prefer assisted living over skilled nursing for independence alone. Choosing skilled nursing (for someone else should be done with great care and compassion.

7. Cost

Skilled nursing care costs more than assisted living because of the round-the-clock medical care required for skilled nursing residences. Typically assisted living costs thousands of dollars less each month than skilled nursing. For the individual requiring skilled nursing, however, there are options to help cover these costs, such as Medicaid or long-term care insurance.

While cost is important, the issue of price shouldn’t be the only consideration when determining what care is needed.

8. Coverage of Insurance

With very few exceptions, skilled nursing residences participate in Medicare and/or Medicaid programs. Also with limited exceptions, assisted living is not typically paid for with health insurance or Medicare programs. While it can be covered with certain types of long-term care insurance policies, it is most often paid for by the resident. It should be noted that some states do cover some degree of assisted living services (specifically through Medicaid programs), but each state has a widely varying set of requirements and level of coverage. Talk to professionals in your area for specific information regarding options.

Enjoy Retirement in Pacific Grove, California

We know the decision of selecting a supporting living environment isn’t easy.  Regardless of whether you or a loved one needs a skilled nursing or assisted living residence, there are many factors–including environment, residents, and services–that set the options apart. Your goal when choosing between skilled nursing and assisted living must be based on need. Once the need is established, Then Your goal becomes finding the right place you or the person you love will be comfortable, happy and fully supported.

At Forest Hill in Pacific Grove, we offer a full-service retirement community that is unparalleled in its setting and offerings. Located in an elegantly restored historic hotel, the community combines the best of modern convenience with classic appeal while offering supportive retirement lifestyles. Enjoy the breathtaking views of the bay and the ocean in a vibrant community that knows how to care for its residents right.  Call us today to schedule an appointment. We would love to show you all that our community has to offer residents.

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