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There comes a time when some seniors can no longer care for themselves nor receive home health services due to complex medical needs. In such circumstances, a senior has to weigh skilled nursing vs assisted living care. While both types of facilities offer assistance to the elderly, there are subtle differences between the services provided. 

What is an Assisted Living Facility?

Assisted living facilities are suitable for seniors looking for a long-term and comfortable residence. They provide a safe environment and the opportunity to maintain an independent lifestyle while receiving help with their day-to-day needs. Residents in assisted living communities are typically mobile without any serious medical concerns, allowing them to live alone in private studios or apartments. 

The primary function of an Assisted Living Facility (ALF) is to assist seniors with Activities of Daily Living (ADLs), which are routine and essential tasks that healthy individuals can perform independently. The inability to perform ADLs can lead to poor quality of life and unsafe living conditions. Therefore, assisted living facilities primarily provide ADL assistance to seniors in a safe and controlled environment. 

ADLs are categorized into two types: 

  1. Basic ADLs – These include: 
A senior couple visiting a facility to assess skilled nursing vs. assisted living care before deciding which facility is more appropriate for them to move to.
A senior must weigh skilled nursing vs. assisted living care to assess which facility is more appropriate.
  • Ambulating or transferring, or, moving independently from one position (e.g., lying down) to another (e.g., sitting) and walking independently
  • Feeding oneself (getting food into the mouth independently)
  • Dressing, or, selecting appropriate clothing and putting on and taking off the clothes
  • Personal hygiene, or, the ability to bathe and groom oneself, including dental hygiene, nail care, and hair care
  • Continence, or, having complete control of bladder and bowel movements
  • Toileting, or, getting to and from the toilet while using it appropriately and cleaning oneself
  1. IADLs (Instrumental Activities of Daily Living) – These are self-care tasks usually learned during one’s teenage years, as they require more complex thinking and organizational skills. Although IADLs are not necessary for functional living, performing them can significantly improve a person’s quality of life. The primary IADLs services offered in assisted living facilities include:
  • Assisting with finances  – Paying bills and managing financial assets
  • Organizing transportation – Arranging suitable transport for seniors to attend appointments
  • Shopping and meal preparation – Helping residents shop for personal items and preparing all meals, including food shopping, cooking, and washing the dishes.
  • Housecleaning and maintenance – Cleaning the kitchen after eating, tidying one’s living space, and maintaining the general upkeep of the home
  • Managing communication – Corresponding with people via telephone, mail, or email
  • Managing medication – Collecting and distributing medication as directed by the physician

When a senior is admitted into an assisted living facility, they will need to be evaluated in terms of their ability to perform ADLs and IADLs. The admissions staff will then create a personalized care plan using the assisted living software program that details the level of care needed. 

What is a Skilled Nursing Facility?

A Skilled Nursing Facility (SNF) is a healthcare institution that meets the federal requirements for Medicaid and Medicare reimbursements and typically includes an onsite physician and full-time nursing staff supervising the residents’ care.  

Like assisted living facilities, skilled nursing staff must also ensure that all resident care is coordinated and regularly updated using the nursing home EMR software. This allows authorized staff to access relevant resident information, address changes in conditions, dispense correct medication, and implement an effective care plan based on the resident’s personalized needs. 

Depending on a resident’s needs, skilled nursing facilities are available for long-term and short-term stays. However, short-term (temporary) visits are typically more common, because skilled nursing facilities generally provide care for residents following a significant health decline or hospitalization. Therefore, they primarily emphasize rehabilitation and preparing residents to return to their independent lifestyles. 

While the level of care in assisted living facilities is more general, skilled nursing facilities offer more specialized medical procedures, such as  IV medication, ventilators (artificial respiration), and respiratory therapy. Therefore, when seniors or their families are researching the difference between skilled nursing vs assisted living facilities, they must understand each facility’s different levels of care to determine which services are needed.  

The Difference Between Skilled Nursing Facility and Assisted Living

Sometimes, a person may not fully understand the difference between skilled nursing facility and assisted living facility settings. So let us now take look at skilled nursing vs assisted living facilities and their differences:

  1. Type of Setting

First and foremost, an assisted living facility is considered a residential setting where seniors can enjoy their golden years in a social community with organized social events, daily assistance, and private accommodation. 

A group of seniors participating in an exercise class to assess the difference between skilled nursing facility and assisted living facility settings.
Seniors must understand the difference between skilled nursing facility and assisted living facility settings before making their decision.

They emphasize comfort and hospitality while offering a range of amenities that may not be available in skilled nursing facilities. Some of the services offered include: 

  • Fitness centers and personal trainers to cater to residents’ well-being
  • A high level of personalization (e.g., controlled room heating and air conditioning)
  • On-site beauty salons, barber shops, and entertainment rooms to ensure the residents enjoy a high quality of life

A skilled nursing facility is considered a medical or rehabilitation center. Traditionally, skilled nursing facilities were viewed as being “institutional” and hospital-like, deterring potential residents from staying there. However, modern nursing homes have made strides in being more resident-centric and homelike, thus improving residents’ comfort.    

  1. Medical Staff Availability

In accordance with the standards in place for the medical treatments offered in skilled nursing facilities, there must be an onsite Registered Nurse (RN) for at least eight hours per day, seven days a week. In assisted living facilities, though, it is not required by law to have an onsite medical professional. Still, ALFs are required to have an accessible or on-call Licensed Practical Nurse (LPN) or a registered nurse in case of an emergency. 

  1. Residency Goals

Skilled nursing facilities are temporary residences that prioritize residents’ rehabilitation. Therefore, the goal is to support the residents until they can return to independent living without endangering themselves or others. Meanwhile, assisted living facilities are long-term residences that prioritize the independence of their residents while providing ADL assistance. 

Both facilities offer services that vary depending on the resident’s needs. Therefore, the level of care to each resident is determined once the facility has assessed their health conditions. When a senior or their family researches facilities that fall under both categories, it is crucial to understand the realistic conditions of the senior before deciding which facility setting is more appropriate. 

  1. Price Differences

Assisted living residents do not need around-the-clock care, so costs are substantially lower than skilled nursing facilities. According to a 2021 Genworth survey, the national median cost for assisted living is approximately $4,500 per month, around $148 per day. 

In contrast, a skilled nursing facility offers a high level of security, around-the-clock care, medically-trained staff, emergency response systems,  and room and board, all of which make the costs considerably higher. Price will, of course, vary significantly depending on the level of comfort and assistance needed. For example, a semi-private room costs approximately $7,908 per month, and a private room will cost $9,034 per month. 

  1. Insurance Coverage

Most assisted living costs are covered by the resident, with no Medicare coverage for assisted living. Medicare contributes to the medical costs incurred in an assisted living facility but will not pay toward custodial care (personal care) costs, such as the room or board.

By contrast, Medicare will pay for rehabilitative services in skilled nursing facilities for a specific time providing the resident meets the following requirements:

  • The senior has days left in their benefit period, which begins the day the senior is admitted as an inpatient in an SNF and ends after they have not received skilled inpatient care in a SNF for 60 consecutive days.
  • The senior qualifies for a three-day hospital stay, followed by a SNF stay within 30 days, and needs skilled care. 
  • The chosen SNF is Medicare-certified.
  • The senior’s physician confirms that the senior needs daily skilled care provided by the skilled nursing staff.
  • The senior’s need for skilled services is related to either:
    • a medical condition treated during their qualifying three-day inpatient hospital stay
    • a condition that appeared while they were receiving care in the SNF (e.g., the resident developed an infection like sepsis that requires skilled care like IV antibiotics). 

If seniors have a long term care insurance policy, this can assist with skilled nursing and assisted living costs. However, every insurance policy is different with different requirements. Therefore, seniors or their families must check what coverage is offered, the elimination period, and how much is reimbursed. 

While it is essential to conduct sufficient research into skilled nursing vs assisted living facilities, it is equally necessary to determine a senior’s goals and the tools they need to live a fulfilling life in their golden years. 

Contact us here if you would like to learn about our user-friendly long term care software and how it can assist skilled nursing facilities. 

Finding Facilities That Provide Assisted Living with Skilled Nursing Services

As mentioned above, it is essential to determine what level of care is needed before admitting a senior into a facility. Even though a senior may appear active with only minor health problems, inevitably, they will age, their health condition will worsen, and they will be forced to change their lifestyle. Therefore, seniors and their families should try to foresee future ailments and determine which facilities offer the most appropriate assisted living with skilled nursing services. 

The best senior living communities offer a broad continuum of care, meaning that provisions, services, and amenities that cater to different care levels are already in place. When assessing skilled nursing vs assisted living services, it is helpful to remember that facilities with a continuum of care for residents will not need to move them to another facility if their condition changes or worsens. 

A senior resident foresaw his future ailments before deciding which facility had the more appropriate assisted living with skilled nursing services.
Foreseeing future ailments helps to determine which facilities offer the most appropriate assisted living with skilled nursing services.

So when seniors or their families are looking to understand the difference between skilled nursing and assisted living, they should also research communities with a robust continuum of care programs and the following levels of care and services:

  • Independent living
  • Assisted living
  • Skilled nursing 
  • Rehabilitation

When residents enter a community with a continuum of care, they can rest easy knowing that they will receive whatever services they need. They can relax and enjoy the comfort and security of entering as independent or assisted living residents while taking full advantage of the lifestyle, surroundings, and community of residents. Further, by knowing the difference between skilled nursing facility and assisted living, they can make a decision that does not require them to move any time soon.

Furthermore, by choosing a community with a continuum of care program, residents can expect a higher level of care because communication between caregivers is stronger. For instance, if an assisted living resident develops a chronic condition and later requires specialized services from a skilled living facility, the facility staff will be alerted of their situation because it is documented via the nursing home management software, which is consistent among the different departments of the facility. 

In this way, caregivers can quickly adjust the resident’s care plan according to their current needs while tailoring and adapting care according to their health conditions. 

Choosing Between Skilled Nursing vs. Assisted Living Facilities

On the surface when looking at skilled nursing vs assisted living facilities, it may seem that they are similar. However, these communities are designed for the different levels of care their residents need. The distinct differences in levels of care each type of facility provides, the community environment, payment options, and funding are all critical factors that must be taken into consideration before admitting a loved one into a facility.

It is also worth noting that facilities with a continuum of care program offer stability and an overall better level of care for their residents. Therefore, when choosing between skilled nursing vs assisted living facilities, it is essential to determine the level of care needed—now and in the future—so that the senior can receive the appropriate level of care without being forced to move to a new setting before they are comfortable doing so. 

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Cindy Wong
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