Understanding the Difference Between Assisted Living and Skilled Nursing

Many older adults find themselves in need of some level of assistance or medical care as time goes by. As you search for what options are available to you, you may have run across two that seem to meet your needs — assisted living and skilled nursing care. The natural next step is determining which of these two care options is right for you. To determine this, you’ll need to understand the difference between both assisted living and skilled nursing. Continue reading to find answers to all your questions about the differences that exist between assisted living and skilled nursing care.

Assisted Living vs. Skilled Nursing Care

When you compare assisted living to skilled nursing care, the biggest difference between the two is the level of medical care that’s provided, and who provides the required care.

Both options deliver a variety of services — medical, social and personal — to individuals who require some level of assistance to accomplish everyday living activities.

Residents are encouraged to live as independently as possible in an assisted living community, although someone is always close at hand to aid when needed. In a skilled nursing community, residents are monitored closely by professionally licensed staff who are trained to deal with medically complex or chronic medical issues, permanent disabilities, severe pain or patients recovering from hospitalization, illness, surgery, injury or health altering event. The care provided in a skilled nursing community is more institutional in nature than that in an assisted living community.

In an assisted living community, residents receive assistance with IADLs (independent activities of daily living), while continuing to remain as independent as possible. IADLs refer to more complex care activities such as preparing meals, shopping, housekeeping and laundry, medication management, transportation, handling finances, etc.

With all these IADL services considered, the next step in the continuum of care structure is skilled nursing. Residents in a skilled nursing community receive around-the-clock skilled nursing care as well as assistance with most, if not all, ADLs and IADLs.

Assisted Living Communities

For older adults who don’t require the medical care that is provided in a skilled nursing community, but need extra assistance with day-to-day activities, an assisted living community might be the best option to meet their needs. At an assisted living community, the staff is available to assist the resident (when needed) with basic care tasks; while at the same time being encouraged to live as independently as possible.

Living in an assisted living community is similar to living in your own apartment but having the luxury of assistance when needed — assistance that is never more than a call button away. The apartment-style residence may be private or semi-private, depending on what has been contracted. Each living space layout typically consists of a bedroom with a private bath. Residents are generally encouraged to bring their own furniture and personal items to create their own personal living space that truly feels like home.

Although residents may choose to entertain guests in their own personal living space, communal dining areas are available so residents may take pleasure in the company of others as they enjoy a healthy, chef-prepared meal. No more eating alone, unless you want to.

One of the goals of all assisted living communities is to provide a healthy social environment. To this end, one or more common living areas are generally available, providing for a feeling of community and countless opportunities to socialize with other residents. Additionally, an activity calendar filled with daily planned activities is published so residents can fill their days with enjoyable activities and socialize with friends, new and old. Residents are free to set their own schedules, picking and choosing which activities in which to take part.

Transportation is generally made available in most assisted living communities, making it possible for residents to remain active in their local community, shop, take part in offsite events, attend religious services, go to beauty appointments, along with various other activities and outings.

Although assisted living communities don’t provide the medical care that is offered at skilled nursing communities, they do provide licensed nursing services at regularly scheduled times. Although not always present and onsite, licensed practical nurses (LPNs) and registered nurses (RNs) are generally accessible in assisted living when at a continuing care retirement community (CCRC). In an assisted living community, medication  oversight and assistance is available.

Skilled Nursing Care

Skilled nursing communities provide all the care services of an assisted living community offers, plus 24/7 skilled nursing care and daily rehabilitation services in a skilled-care setting. When skilled nursing care is required, it must be supervised by a licensed physician. Unlike assisted living, the cost of skilled nursing care is covered by most long-term care insurance policies and Medicare and Medicaid when all stipulations are met.

Short-term or temporary stays are available in a skilled nursing community. In fact, approximately 25% of a skilled nursing community’s care population will remain in their care for less than three months. Short-term stays are generally arranged for post-acute care — typically following a hospitalization, injury, surgery or a significant health event such as a stroke or heart attack where skilled nursing services are required. Most short-term stays allow the skilled nursing community to provide care that is generally focused on rehabilitation with the goal being to help the residents return home to their previous independent lifestyle.

For the remaining 75% of the skilled nursing community’s care population, the community becomes the resident’s long-term or permanent home. Long-term residents receive assistance with ADLs and IADLs, generally at a greater level than what is required by assisted living residents, as well as 24/7 complex medical care and supervision. The staff are highly trained and professionally licensed to provide the medically intensive care that is required. Skilled nursing community residents often have high care needs for medically complex or chronic medical conditions that require routine skilled nursing care.

Skilled nursing care includes:

  • Physical, speech and/or occupational therapy
  • Wound care
  • Advanced stage pressure ulcer care (bed sores)
  • Feeding tubes
  • Intravenous (IV) medications
  • Respiratory therapy or ventilator care
  • End of life or hospice care
  • Laboratory, radiology and pharmaceutical services
  • Supplies, equipment and other services necessary to the health of the patient

At a certified skilled nursing community, licensed practical nurses (LPNs) are on duty around-the-clock. A registered nurse (RN) is on duty at least eight hours of every day. On average, a skilled nursing community will have forty nursing assistants, thirteen LPNs and seven RNs on staff to provide for the needs of their residents.

Living in a skilled nursing community could be compared to that of a long-term hospital stay. Residents may have a private or semi-private room, although most rooms are generally semi-private. Residents receive their meals in a communal dining area unless they are too incapacitated or ill to do so. Just as in an assisted living community, the skilled nursing community has a published calendar of daily activities for residents to enjoy. Pastimes and activities are brought to the rooms of those who are too incapacitated to attend group activities.

What Option is Right for Me?

When it becomes difficult or unsafe for a person to live alone and independently, it becomes obvious that changes need to be made, because some level of care is required. That’s when many people find themselves comparing assisted living communities and skilled nursing communities.

Once you determine the needs of the person who requires care and understand the options available to them, it can become pretty apparent which care arrangement will best serve their needs — assisted living or skilled nursing care. If the person requires 24/7 skilled nursing care for a medically complex or chronic medical condition and/or daily rehabilitation services in a skilled-care setting, then a skilled nursing community will be required to provide those services.

When you are looking at communities, it’s also good to think ahead, realizing that care needs may change from one day to the next, sometimes drastically.  That’s when a continuing care retirement community (CCRC) really shines. When you choose to live in a CCRC, you know that your care needs will be met, no matter what the needs are or how often they change.

CCRCs, such as Havenwood Heritage Heights, provide for all levels of care because they offer various senior living options — independent living, assisted living, memory care, skilled nursing and rehabilitation services. Havenwood Heritage Heights is only one of three New Hampshire CCRCs accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).

Want to learn more about life here at our continuing care retirement community? For more information, please contact our friendly team today!

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