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Alternative Housing > Assisted Living > Alt 2

Nursing Home vs. Assisted Living

Is it time for you or a loved one to move into alternative housing, but you are not sure what the differences are?  Read below the differences between two alternative housing options.  Nursing Home vs. Assisted Living.

Assisted living residences

otherwise known as Assisted Living Facilities are for older people who no longer feel comfortable or safe living alone, but do not need 24-hour nursing and medical care. While assisted living residences monitor the well-being of their residents and help coordinate health services by licensed outside agencies or providers, they do not provide these services directly and are not designed for people with serious medical needs. State law prohibits assisted living residences from admitting or retaining individuals who need skilled nursing care for more than 90 days in a 12-month period.

Assisted living residences combine apartment-like living with a variety of support services, including:

• meals.

• assistance with activities of daily living such as bathing and dressing.

• on-site staff to respond to emergencies and help with medications.

• housekeeping and laundry services.

• social and recreational programs.

• 24-hour security.

Assisted living residences have one or two-bedroom units with private bathrooms and entry doors that lock. Some units may also have a living or sitting room. In addition to a group dining area, assisted living residences typically provide either a private kitchenette or access to a communal cooking area. Units are usually furnished with a resident’s personal belonging and furniture.


• National Center for Assisted Living (NCAL) – Comprehensive consumer information on assisted living is available either online at or by calling 202-842-4444.

• Alzheimer’s Association – The Alzheimer’s Association’s “Assisted Living Consumer Guide” is used in evaluating an assisted living residence for someone with memory impairment. The guide is available online at or by contacting the Massachusetts Chapter of the Alzheimer’s Association at 617-868-6718.

Nursing Homes

Skilled Nursing Facilities, or Nursing Homes, may be independent or part of a senior continuing care community. 24-hour medical care is available, in addition to custodial care. Residents may be there temporarily for a period of rehabilitation, or may be there for long-term care. State regulations define the services that Skilled Nursing Facilities can provide.

A Nursing Home, also known as a Skilled Nursing Facility or SNF, has Registered Nurses who help provide 24-hour care to people who can no longer care for themselves due to physical, emotional, or mental conditions. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Most nursing homes have two basic types of services: skilled medical care and custodial care.

Skilled medical care includes services of trained professionals that are needed for a limited period of time following an injury or illness:

• An R.N. doing wound care and changing dressings after a major surgery, or administering and monitoring I.V. antibiotics for a severe infection.

• A physical therapist helping to correct strength and balance problems that have made it difficult for a patient to walk or get on and off the bed, toilet or furniture.

• A speech therapist helping a person regain the ability to communicate after a stroke.

• An occupational therapist helping a person relearn independent self-care in areas such as dressing, grooming and eating.

Skilled care may also be needed on a long term basis if a resident requires injections, ventilation or other treatment of that nature.

Custodial or personal care includes assistance with what are known as the activities of daily living, such as:

• bathing

• dressing

• eating

• grooming

• getting in and out of bed, or walking around

• toileting (incontinence care)

People who are able to recover from a disabling injury or illness, may temporarily need the custodial care as they are getting back the strength and balance to be independent again. For people who are losing their ability to function independently due to chronic disease and increasing frailty, custodial care may be a long-term need. In the most severe cases where a person is bed-bound, ongoing supervision by an RN is necessary along with the custodial care, to ensure proper hydration and nutrition and to prevent skin breakdown. If a custodial care resident becomes ill or injured, they may spend a period of time in skilled care, and then return to custodial care. Whether a resident is under skilled or custodial care is important in terms of who provides the care and who pays for the services provided.

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