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End-of-life housing: assisted living vs. a nursing home

Many people choose to make their end-of-life plans early to make things easier for grieving family members. However, one decision that often gets overlooked is where someone will live when it’s no longer possible for them to live alone. When someone who lives independently starts to require more help and supervision, it might be time to consider end-of-life housing options. However, deciding when to move into an assisted living facility or a nursing home can be a difficult decision. This article will help explain the difference between assisting living vs. nursing homes, and when you may need one or the either. 

How is assisted living different from a nursing home?

The major difference between an assisted living facility vs. a nursing home is that assisted living is for people who don’t have any significant medical issues and can live somewhat independently. Nursing homes, on the other hand, are for people who have serious medical problems and need more care and attention. 

Assisted living facilities

Assisted living facilities are similar to residential apartments, with most units having kitchenettes and private bathrooms. The facility may have extensive common spaces for dining and socializing and outdoor areas for walks and activities. Services vary depending on a person’s needs but may include help with personal care, medication management, laundry, housekeeping, and general supervision. Residents may cook for themselves in their rooms or take advantage of any meal services the facilities offer. Essentially, residents may need some assistance but can primarily handle daily tasks and personal care on their own. 

One benefit of assisted living facilities is they offer a range of optional recreational activities to help residents stay active and socially connected with others — two things that are important for maintaining good health. 

Nursing homes

Nursing homes provide 24-hour medical care in a clinical setting. Rooms may be private or shared, and there are some common areas for social gatherings. Recreational activities are limited due to the resident’s extensive range of medical needs, however, some nursing homes offer art or cooking classes, animal therapy, games, and performances to keep residents mentally stimulated and raise their spirits. 

Residents of nursing homes need daily care and may have cognitive or mobility issues. The staff helps residents take their medications, bathe, dress, and use the restroom. Laundry services, housekeeping, and meals are provided by the staff. 

What are the criteria for assisted living vs. a nursing home?

Assisted living facilities provide services that support health and wellness, a secure setting where seniors can be safe, and minimal assistance to help people live independently. 

The criteria to qualify for an assisted living facility will vary, but overall the person must be mobile enough to function independently and only need minor medical supervision. For instance, residents may be required to move from the bed to a wheelchair without assistance as well as feed themselves. If a resident needs more personal or health assistance than the facility can provide or has behavior issues that could put other residents in danger, they will not qualify for assisted living and may need to move into a nursing home with round-the-clock care instead. 

Are assisted living facilities more expensive than nursing homes?

Assisted living facilities are not as expensive as nursing homes, mainly because nursing homes provide intensive medical care services. Assisted living facilities only provide medical assistance as needed, keeping costs down. 

Assisted living vs. nursing home costs

Costs for assisted living facilities and nursing homes vary depending on location, services offered, and age and quality of the facility itself — for example, a newer building with modern amenities or high-end services may cost more than residing in an older facility. 

According to a 2020 study by Genworth, the national median cost for an assisted living facility is $51,600 per year. A private room in a nursing home averages $105,850 annually, while semi-private rooms are $93,075. 

Assisted living facilities are usually paid for out-of-pocket, while Medicare will cover some costs of a nursing home for a short-term stay. Once you’ve “spent down” your assets paying for the nursing home and can demonstrate financial need, Medicaid may offer some assistance depending on eligibility rules in your state. 

One option to help with future care costs is to purchase long-term care insurance. While policies differ, long-term care insurance may cover anything from adult day care to nursing home costs. This is something to look into while you are healthy because you won’t qualify once you have a severe medical condition. Long-term care costs can quickly deplete your savings, so these insurance policies help protect your assets. Insurance also provides more choices for care, as more facilities may accept private insurance vs. Medicare.  

What is the next level of care after assisted living?

Usually, the next level of care after assisted living is a nursing home. You’ll make the decision to move from assisted living to a nursing home when you’re no longer able to live independently and need a greater level of assistance and medical supervision. 

Alternatively, some families choose in-home care so their loved one can spend their final days resting comfortably at home. In these cases, you can hire a private healthcare provider to help with bathing, eating, dressing, administering medicines while also keeping a watch on vital statistics and overall medical condition. The national median cost of home health aide services in 2020 was $54,912

Planning for the future

Researching and making a list of your preferred end-of-life housing options is a helpful part of end-of-life planning. You may also want to start thinking about making a will, appointing a power of attorney, and deciding where you’d like your final resting place to be. Download our end-of-life checklist to guide you through your end-of-life planning needs. 

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