Assisted Living Care vs. Nursing Home Care


The objective of this work is to examine the pros and cons of nursing home care vs. assisted living care for the elderly. This work will examine the positive and negative aspects of each in terms of care, health, quality of life, and costs associated with each type of care for the elderly. At some point in the life of each individual, if that individual lives into the years commonly known as the 'elderly' years that individual will have to make choices regarding their own care and most individuals will face the same questions regarding elderly care for their parents. This is one of life's toughest decisions and as well, there are so many factors that may influence this decision depending upon the personal situation of the individual of advanced or elderly age. It is however, critically important that the decision-maker and the individual who will be placed in either nursing home care or assisted living care be satisfied that they have made the best decision possible.

I. Health and Safety

One of the first of the many important considerations at this juncture in the life of an individual of advanced age is the health and safety of that individual. While it is optimal to have a living arrangement that allows the most freedom, independence and autonomy possible, the individual's health both physically and mentally must be the first and foremost consideration. In the case that the individual has Alzheimer's disease or Parkinson's disease, assisted living may allow too much autonomy and therefore not be in the best interest of the elderly person. However, in the case of only mild forgetfulness assisted living offers an arrangement that includes the best of both worlds. Assisted Living is just as it sounds as the elderly individual is assisted with different aspects of daily living such as their meals, laundry, remembering to take medications and other various personal care areas in which an individual of advanced age might need assistance. For someone who has suffered a stroke it might be as simple as needing assistance with tying their shoes.

I. Review of Literature

In the work of Joseph Shapiro it is stated, "For the nation's growing number of elderly, assisted living facilities have become popular alternatives to nursing homes." (2002) Shapiro relates that the residents of assisted living have "their own private apartment, with a full bathroom and kitchen. Some apartments are luxurious, looking more like a hotel suite than a health care facility." (2002) the assisted living facility includes the provision of meals and light housekeeping assistance with the added security of "support staff, and usually some nursing care if need..." As well. (Shapiro, 2002) There are three basic types of care for the elderly, which are: (1) independent living: (2) assisted living; and (3) nursing home care. (Ibid) Independent living is for seniors who are healthy and self-sufficient however assisted living is inclusive of various kinds of housing with accompanying services for elderly who do not have medical problems that are of a severe nature but that still need assistance with bathing, dressing, grooming, or toileting. Considerations when determining the best care include the following considerations: (1) Temporary vs. long-term care: The elderly individual may enter the nursing home following a surgery or stroke for rehab and then return home; (2) Independence: Can the individual live alone and do they want to live alone? In some cases an environment that is more service-oriented may provide more of the nurturing needed; (3) Privacy: Privacy generally will decrease, as more assistance is needed; (4) Need for personal care: What type and how much personal care is needed or wanted by the elderly individual; (5) Needs for medical care: Is a chronic illness present that requires specialized medical care? Does the individual need ongoing medical professional services? If so, assisted living may not provide enough care and may not be suitable; (6) Costs: The financial aspects will probably have an influence on the choice made between assisted living care and nursing home care; (7) a walkthrough evaluation of several care facilities is a suitable approach; and (8) Seeking guidance from professionals who are experts in issues of senior housing is suitable: These individuals can assist will identification of goals and values, needs assessment, affordability determination and are able to intelligently and knowledgeably suggest suitable living facilities. (Choosing Senior Housing and Residential Care, 2007; paraphrased) the work of Reinardy and Kane (2003) entitled: "Anatomy of a Choice: Deciding on Assisted Living or Nursing Home Care in Oregon" published in the Southern Gerontological Society Journal states that in a study which was based on interviews with 1,215 assisted living and nursing home residents and family members which compared assisted living residents and families with counterparts in nursing home care in relation to preferences for long-term care and circumstances relating to their move when analyzed showed "some differences between reported preferences of assisted living and nursing home groups." (Reinardy and Kane, 2003) These authors state that while many similarities exist, "...high value" was appointed by both groups "to help with care from staff, decisions on how much care, and private rooms indicate policy planners and providers should take into account such preferences and develop a hybrid of positively values features in both assisted living and nursing homes." (Reinardy and Kane, 2003) the work of Linda L. Barrett, Ph.D. entitled "The Costs of Long-Term Care: Public Perceptions vs. Reality in 2006" states: "Most (59%) think Medicare will pay for extended nursing home stay, but it doesn't. Fifty-two percent incorrectly believe Medicare covers assisted living costs. Another 18% 'don't know'." (2003)

The various provisions of care are stated as follows:

1. Personal Care (Assisted Living Facilities) - Provisions of Care

Cooking and cleaning;




Using the Toilet;

Getting around in the house (mobility);

Transportation around the community;

Medication reminders;

Finding companionship; and Participation in social and recreational activities. (Russell, Rose, and Segal, 2007)

2. Community services and activities provided by senior living facilities include:

Communal meals;



Local transportation

Exercise facilities

Arranging for personal or medical care


Beauty Shops

Gardens (Russell, Rose, and Segal, 2007)

3. Community Services and Activities (may or may not be included)

Recreational, educational, and social events

Activity rooms or clubhouses

Golf courses

Tennis and Shuffleboard courts

Health and exercise programs or classes; and Chapels and religious services (Russell, Rose, and Segal, 2007) nursing home is likely a requirement in cases of extreme forgetfulness, and naturally in cases of dementia and as well in cases of frailty, or an existing condition of the chronic nature. (Russell, Rose, and Segal, 2007; paraphrased) a nursing home has the medical professionals needed in addressing ongoing medical needs. A nursing home might also provide the following:

Interim medical care

Rehabilitations services

Pharmacy, laboratory and radiology services

Therapeutic recreational and educational activities

Transportation on a limited basis

Laundry service (often for an extra cost)

End of life care (hospice); and Respite care (relief for caregivers) (Russell, Rose, and Segal, 2007)

Knowledge of costs in the work of include the facts that: (1) less than one in ten (8%) of individuals correctly estimate the monthly cost of a nursing home with +/-20% of the national average costs; (2) less than a quarter (23%) say they don't know the cost of an in-home visit from a skilled nurse. There is no real cost consensus among those who offer an estimate; (3) One in five (20%) say they don't know the cost of an in-home visit from an aide; (4) almost three in ten respondents age 45-plus (29%) say they purchased long-term care insurance." (Barrett, 2006) the work of Marc Cohen and Jessica Miller entitled: "The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders" states: "The costs associated with receiving long-term care in institutional settings are significant and pose a financial hardship to many individuals." (2000) the following chart shows the average monthly claims payments by residents for individuals living in Nursing Homes and individual living in Assisted Living.

Average Monthly Claims Payments by Residence

Source: (Cohen & Miller, 2000)

The following table illustrates the average monthly charges for assisted living residents in four different studies conducted between the years 1998 through 2000.

Average Monthly Charges for Assisted Living Residents

Source: Cohen & Miller (2000

Finally, it is stated additional that "...despite the fact that long-term care insurance is the primary payer source for 70% of nursing home claimants, only slightly more than half of residents indicate that their policy benefits are meeting their care needs in the facility." (Cohen & Miller, 2000) in comparison, a larger portion of those living in "assisted living" facilities state that their needs are met there is still 28% who state their needs are not met in assisted living facilities as only 96% of assessed insurance charges are paid in benefits. The average out-of-pocket expenses for individuals in the nursing homeā€¦