1/12/2020 What's the difference between a nursing home and assisted living?

— Quartz

GETTY IMAGES/ RIVER NORTH PHOTOGRAPHY

But what kind?

GLOSSARY

The differences between nursing homes, assisted

living, and “life plan communities”
✦ Member exclusive by Lila MacLellan for The birth of geriatric cool

The senior housing market can be bewildering to newcomers, partly because not
everyone within it speaks exactly the same language. The terminology for the wide
range of arrangements can vary slightly between businesses, states, and countries.

To help you sort it out, here is a glossary of the categories common across the US
industry:

Skilled nursing facilities

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A skilled nursing home is typically used for short-term stays, both by seniors who need
help with daily activities and have medical needs and by short-term rehabilitation
patients who are coming out of the hospital. The services here for seniors are typically
covered by Medicare, but for limited periods. In addition to their titular professionals,
these institutions employ other medical specialists, like speech pathologists, social
workers, and physical therapists.

Nursing homes
Nursing homes are where seniors in need of constant care or supervision can go to live
inde nitely. They will have fewer specialists on staff. Medicaid will cover nursing home
care if you qualify for it. If not, average fees in the US reach an average $7,513 per
month for a semi-private room.

Assisted living facilities

These hotel- or resort-like senior residences are essentially “private pay,” meaning the
consumer foots the bill without any government assistance. (In a few states, Medicaid
will reimburse providers for part of the cost of assisted living, but usually in small
amounts.) Seniors in assisted living often need help managing their medications, or
getting dressed, or bathing safely, but only require medical attention occasionally.

Assisted-living homes are far less regulated than nursing homes and are governed only
by state (or, in Canada, provincial) and not federal authorities. The looser regulations
can also allow for a higher risk of recklessness. On the upside, they also mean that an
older person can live in a room with carpets, ambient lighting, and their personal
effects, like an Amazon Alexa-enable device or digital keyboard, which may not be
allowed in a nursing home. (To be fair, some progressive nursing homes are overhauling
the quality of day-to-day experiences and the culture, but they remain a minority.)

The cost of living in assisted living varies by geography, but averages $4,051 per month
in the US, according to GenWorth’s 2019 price survey. That fee usually includes rent,
three meals a day, snacks, daily care, and “life enhancement” programs and
entertainment. The highest of high-end assisted-living homes now arriving in cities
like New York and Chicago may charge more than $20,000 per month.

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Memory care
Most assisted living homes include at least one memory-care oor or wing for people
with dementia. To prevent residents from wandering out into the world—often in a bid
to go home—and getting lost, this space will be secured by a keycode or fob-controlled
elevator or door. But memory care is more expensive, at a mean rate of about $6,300 per
person, per month, according to gures from the nonpro t National Investment Center
for Seniors Housing & Care (NIC). In recent years, more developers have been building
Memory Care standalone properties, some with progressive Alzheimer’s-speci c
programs and design.

Independent living
Seniors who have few health concerns, but no longer want to live alone or in a house
that’s progressively more dif cult to maintain with age, might choose independent
living, at the average cost of $2,552 per unit. These suites or apartments typically come
equipped with kitchenettes and may include a private balcony or garden. Residents can
come and go as they please and might choose to pay for meal service or medication
management, as needed.

“Active adult” or “independent living light”

Senior Housing News editor in chief Tim Mullaney calls this “a growing part of the
market, where it’s really more of a lifestyle play.” And the lifestyles can get niche: For
example, in Florida, singer Jimmy Buffett’s Margaritaville company has partnered with
Minto Communities to launch Latitude Margaritaville, for seniors “age 55 and better”
(according to the marketing copy) who perhaps feel called to live on sponge cake and
watch the sun bake while “wastin away,” like the protagonist of the 1977 Buffett hit for
which the project is named.

Continuing care residential communities (CCRCs)

In CCRCs, which are also known as life plan communities, clients have access to
independent, assisted, and memory-care levels of care. Someone might move into an
independent living “neighborhood,” as a wing of senior housing is often called, but
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eventually relocate as their care needs change. Unlike standard assisted-living homes
which follow a fee-for-service price structure, CCRCs charge hefty entry fees that can
range from $100,000 to $500,000, but guarantee the customer care for life and a refund
of any money that remains unused when someone moves out or passes away, in which
case the returned capital goes to the estate. Even after paying the entry fee however, a
customer will pay monthly dues for meals and services, for instance.

Some properties allow a customer to lay down less money at the beginning, with the
caveat that care services will be limited to a certain threshold, after which the customer
agrees to pay extra.

Home care
Hiring a caregiver to come into your home may make the most sense when an older
person needs a few hours per day of assistance and has a support network that prevents
them from spending too much time alone otherwise. Medicaid covers various
community or in-home health services for those who qualify. For those who don’t,
paying out of pocket can quickly add up: the average cost of care is currently $4,385 a
month, for 44 hours of care per week.

More resources
Argentum 
(A trade association for senior housing and assisted living companies.)

Eldercare locator

Leading Age
(An advocacy group representing not-for-pro t organizations in senior services.)

National Association of Area Agencies on Aging

Nursing Home Compare

MyLifeSite.net (Helps consumers compare continuing care retirement homes)

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ProPublica’s “Seven questions to ask when searching for assisted living”

SAGE, an advocacy organization for LGBTQ seniors

rade press and podcasts for industry news and trends

Senior Housing News

McKnight’s Senior Living

Bridge The Gap

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