Assisted Living vs. Skilled Nursing
While aging has its benefits, such as grandchildren and more time for hobbies, it also brings challenges. They include reduced mobility and the increased risk of needing medical care. The Administration for Community Living estimates 70% of adults aged 65 today will need some form of long-term care service in the future. The problem seniors and their families sometimes encounter is choosing the type of care needed. For example, assisted living and skilled nursing share some common features, but the former is primarily a nonmedical service and the latter medical. However, both care for seniors struggling to cope with activities of daily living (ADL), such as getting in and out of bed and bathing.
If you or your loved one is finding it increasingly difficult to perform ADLs, you may need support. However, you may be wondering if you should consider entering an assisted living facility or if you require skilled nursing services in a medical institution, such as a hospital or nursing home. Depending on your state, assisted living providers may be able to offer limited medical services, such as speech and physical therapies, and in most cases, your care plan will be developed by a registered nurse. However, if you’re in need of more care, such as treating wounds or administering medications intravenously, skilled nursing is probably what you need. Your physician will be able to advise you.
This guide considers what types of care assisted living and skilled nursing offer. It also touches on potential costs and which option is most suitable for seniors in need of varying levels of care.
Social and medical
Private and shared rooms, studios, and one- or two-bedroom apartments
Private or semi-private rooms, at home
Housekeeping and linen services typically included, laundry services sometimes cost extra
Housekeeping, linen and laundry services provided on-site or by staff visiting the senior's home
Typical Care Provided
Help with ADLs, medication management and medical appointment transportation
Help with daily living functions, managing medications, occupational/physical/speech therapies, wound care, etc.
Average Monthly Cost
$7,908 for a semi-private room, $9,034 for a private room*
Seniors struggling with ADLs
Seniors with medical issues and those rehabilitating after hospitalization or struggling with ADLs
*Source: Genworth’s 2021 Cost of Care Survey
Assisted living facilities are staffed 24/7 by licensed nurses trained to deliver nonmedical care to seniors who need help with ADLs. Some facilities have visiting registered nurses who conduct regular wellness checks, and there may also be visiting therapists to support residents with mobility and speech issues.
It’s common for residents to furnish their rooms with items from their own homes and many facilities also allow small pets. Meals are usually chef-prepared and served restaurant-style in dining rooms. There are often many indoor and outdoor amenities, such as fitness rooms, libraries, beauty salons/barbershops and walking paths surrounding facilities. Fees can vary wildly from city to city, but the average monthly cost in the United States is $4,500.
Skilled nursing isn’t simply nursing home care because it also covers short-term high-level medical care in a hospital and in the senior’s home. The common denominator with all three environments is the senior receives direct 24/7 care from medical professionals, such as registered nurses, licensed therapists and physicians.
In a hospital/nursing home, seniors reside in a private or semiprivate room, get three freshly-prepared meals daily and cleaning and laundry duties will be undertaken by others. At home, a housekeeper will visit to do light cleaning and make meals. There isn’t a figure for hospital and home costs, but the average monthly cost for a semi-private room in a nursing home is $7,908. A private room is $9,034.
Frequently Asked Questions
What are the most common ways to pay for assisted living?
Private pay, where the senior uses their own funds, is the most common way to pay for assisted living. This can be their savings, Social Security benefits and pension payments. It’s also not unusual for seniors to take out reverse mortgages or annuities to cover their monthly care costs.
Will Medicare pay for assisted living?
In short — no. This is because Medicare’s purpose is to cover some medical costs for eligible seniors who don’t have medical insurance (or inadequate insurance). Assisted living facilities typically provide nonmedical care, although, if a specific facility offers some types of medical care, such as occupational therapy, Medicare may be able to cover the costs in the short term.
What is the Program of All-Inclusive Care for the Elderly (PACE) and does it pay for assisted living?
PACE is a program only available in certain states and specific zip codes within those states. It combines the benefits of Medicare and Medicaid for adults aged 55+ who qualify, enabling the PACE provider to manage all aspects of their medical and nonmedical care. Although it can cover care services in an assisted living facility, it can’t pay room and board costs.
Can you stay in a skilled nursing facility paid by Medicaid if you only need help with ADLs?
No. Medicaid’s purpose is to pay for medical care services for people on low incomes. Although it can also pay for the senior’s ADL care services, the person’s primary reason for being in the facility is because they have a qualifying medical condition.
Will Medicare or Medicaid pay for skilled nursing services?
Medicare Part A can cover up to 100 days of skilled nursing services in any benefit period where the senior has a three-day qualifying hospital stay. Benefit periods are defined as the times spent receiving skilled nursing care separated by 60-day intervals where no care is delivered. Medicare won’t pay for long-term skilled nursing services, but Medicaid can pay up to 100% for qualifying seniors.