Assisted Living (ALFs) vs. Nursing Homes (LTC) Explained

Most people have an idea of what assisted living facilities and nursing homes are. You may have visited a family member at one of these facilities. You may have even worked as a nurse or nursing assistant at one or both of these facility types.

But do you know the difference between nursing homes and assisted living facilities? What if someone asked you, “Does my mom need assisted living or a nursing home?” Would you know how to respond?

By the end of this article, you’ll be able to explain the difference like a pro.

Assisted Living vs. Nursing Home Care

First, let’s understand the types of care residents receive in assisted living and nursing homes.

What Services Do Assisted Living Facilities Offer?

As its name suggests, an assisted living facility (ALF) helps older people with their daily lives. ALF residents are not necessarily sick. However, they can no longer live independently. The following are typical services in assisted living residences:

Supervision and assistance around the clock
Meals and dining services
Help with activities of daily living (ADLs)
Exercise, health, and wellness programs
Housekeeping and maintenance
Medication management or assistance
Transportation arrangements

Assisted living facilities do not directly provide healthcare services. However, they arrange for residents to receive the care they need such as the following services:

Skilled nursing care
Rehabilitation services, including physical, occupational, and speech therapy
Pharmacy
Dental
Podiatry
Mental health screenings or counseling
Hospice

Even healthy seniors are at a higher risk of falls and other accidents. The services offered at assisted living facilities give residents and their families peace of mind.

What Services Do Nursing Homes Offer?

Unlike assisted living facilities, nursing homes offer 24-hour skilled nursing care and other on-site healthcare services. Many nursing homes are also skilled nursing facilities (SNFs).

Nurses care for and monitor patients. They give patients medications and care for their wounds.
Physical therapists help patients recover their strength and balance. They teach patients how to get up and sit or lie down safely. They may also retrain patients to climb stairs and teach them to use walkers, canes, or crutches.
Occupational therapists help patients learn and practice techniques that make routine tasks necessary for everyday life easier.
Speech-language therapists assess and treat problems with swallowing, speaking, and understanding.

ALF vs. Nursing Home: Most Common Conditions

As a healthcare professional, you will want to know what conditions you will see in both of these settings.

What Are the Common Health Conditions of ALF Residents?

Here are the most common health conditions among ALF residents and the percentage of individuals with each condition:

High blood pressure: 48%
Alzheimer’s disease or other dementias: 42%
Heart disease: 31%
Depression: 29%
Diabetes: 17%

Many assisted living facilities offer memory care. About 18 percent of ALFs have dementia care units. Additionally, 11 percent of ALFs care exclusively for residents with dementia.

What Are Common Health Conditions of Nursing Home Residents?

Nursing homes care for patients/residents with a wide range of conditions.

Post-acute patients after extended hospital stays
People who have had strokes or other brain injuries
Post-surgical patients recovering from joint replacement surgeries
Post-surgical patients requiring frequent wound care
Patients with uncontrolled medical problems, such as diabetes, lung problems, and heart problems

There are similarities between the most common conditions in assisted living facilities and nursing homes.

Both settings care for patients with heart conditions and diabetes.

ALF residents mostly have these conditions under control. However, these same conditions are probably not well controlled among nursing home residents. Therefore, nursing home residents need a higher level of care.

Criteria for Assisted Living vs. Nursing Home

Assisted living facilities cater to older adults who need more assistance than adults who live at home or in independent living residences.

Nursing homes cater to individuals who need 24/7 medical and personal care. Most nursing home residents are older adults, but not all.

Residents of nursing homes and ALFs need help with activities of daily living. However, nursing home residents also have healthcare needs that require 24-hour access to medical care. About a third of nursing home residents also need rehabilitative services.

Assisted living facilities are long-term residences for older adults. These senior living options are typically not covered by long-term care insurance. Therefore, residents often have to pay out-of-pocket for assisted living costs.

On the other hand, many nursing home residents only need short-term post-acute care and rehabilitation. Many do not need long-term care. On average, post-acute patients are in nursing homes for 28 days. Post-acute stays are typically covered by insurance.

Assisted Living Facility vs. Nursing Home: Age of Patients

Most residents in both types of facilities are older adults. However, nursing homes have more varied populations.

What Age Are Residents in Assisted Living Facilities?

Around 818,800 people live in assisted living facilities in the United States. The vast majority of these people are adults 75 and older. Here’s the breakdown:

Age 85 and older: 50%
Age 75 to 84: 31%
Age 65 to 74: 13%
Age 65 and under: 6%

What Age Are Patients in Nursing Homes?

Approximately 1.3 million people were in nursing homes in 2020 (National Center for Health Statistics). However, only about 57 percent of these people were long-term residents. The other 43 percent were there for short-term post-acute skilled nursing care and rehabilitation.

Most nursing home residents are also over 65. Nevertheless, nursing homes have more young residents than assisted living facilities. Here are the stats:

Short-term nursing home residents under 65: 18.6%
Long-term nursing home residents under 65: 14.9%

Assisted Living vs. SNF: Comparing Healthcare Staff

Knowing who works at a facility helps clarify the type of care each setting provides.

Which Health Professionals Work in ALFs?

Approximately 1.46 million nursing professionals and 35,000 social workers are employed full-time in long-term care settings. Nearly 300,000 of these full-time employees work in assisted living facilities.

Assisted living facilities mainly help residents with activities of daily living. Therefore, nursing assistants make up the largest percentage of employees:

Certified nursing assistants (CNAs): 66%
Licensed practical or vocational nurses (LPNs/LVNs): 19%
Registered nurses (RNs): 15%
Social workers: 0.8%

There are only about 4,500 occupational, physical, recreational, and speech-language therapists combined in assisted living facilities nationwide.

Assisted living facilities are also increasingly relying on contract workers, such as PRN nurses and nursing assistants, to provide the necessary care.

Are you wondering whether you should pick up PRN jobs in assisted living facilities near you?

Which Healthcare Professionals Work in SNFs?

Skilled nursing facilities provide 24-hour nursing care and on-site rehabilitation. Therefore, these facilities employ a much broader range of healthcare professionals. The following are national estimates for healthcare professionals employed in skilled nursing facilities:

Nursing Assistants (458,590)

Skilled nursing facilities need more certified nursing assistants than any other type of healthcare professional.

Residents in SNFs need assistance with several activities of daily living. Furthermore, they need this assistance numerous times throughout the day. Therefore, these facilities need CNAs on staff at all times.

Nurses (295,630)

Nurses make up the next most prevalent group of healthcare professionals in skilled nursing facilities. There are 171,290 licensed practical and vocational nurses and 124,340 registered nurses employed in SNFs.

Nurses are in high demand in nursing homes because they offer 24-hour nursing care.

Physical Therapy Professionals (21,710)

Physical therapists (12,520) and physical therapist assistants (9,190) are the next most important group. Together, they constitute over 20,000 employees in this setting. The prevalence of physical therapists and their assistants indicates the high need for physical rehabilitation among SNF residents.

However, there are fewer physical therapy professionals than nurses because residents receive a maximum of one or two hours of physical therapy per day. On the other hand, nursing care must be available around the clock.

Occupational Therapy Professionals (16,850)

Occupational therapy is the next largest group of healthcare professionals in SNFs. There are 9,950 occupational therapists and 6,900 occupational therapy assistants in skilled nursing facilities.

Their prevalence in skilled nursing and rehab facilities indicates that many patients need to recover abilities for daily life. They may need to learn how to prepare meals or push a shopping cart.

Speech-Language Pathologists (5,770)

The number of speech and language pathologists is significantly lower than that of physical and occupational therapists. The lower number indicates less need for these services among SNF populations.

Respiratory Therapists (4,760)

Respiratory therapists are more common in acute care settings. Most patients in skilled nursing facilities do not require respiratory therapy.

However, according to the American Association for Respiratory Care, skilled nursing facilities increasingly manage patients with respiratory therapy needs. Respiratory services include oxygen therapy, inhalation medication management, pulmonary rehabilitation, and ventilator care.

Recreational Therapists (2,040)

Of the nearly 900,000 healthcare practitioners, technical occupations, and support occupations in skilled nursing facilities, 2,040 are recreational therapists.

This relatively low number is likely due to the fact that the Centers for Medicare and Medicaid Services (CMS) does not cover the costs of recreational therapy.

Ironically, the CMS supports residents' meaningful and active engagement through programs designed to meet their physical, psychosocial, and wellbeing needs and improve their quality of life.

If the CMS’s long-term care insurance begins covering recreational services, the demand for recreational therapists will likely increase.

Assisted Living vs. SNF: Healthcare Professionals’ Salaries

According to the U.S. Bureau of Labor Statistics (BLS), the following are the average wages of healthcare professionals employed in assisted living facilities and skilled nursing facilities.

Healthcare Professionals	Assisted Living Facilities	Skilled Nursing Facilities
Speech-Language Pathologists	$105,540	$108,640
Physical Therapists	$103,690	$101,200
Occupational Therapists	$98,840	$101,740
Respiratory Therapists	$78,060	$76,690
Registered Nurses	$77,180	$82,930
Physical Therapist Assistants	$75,910	$76,110
Occupational Therapy Assistants	$74,670	$74,720
Licensed Practical and Licensed Vocational Nurses	$61,390	$63,730
Recreational Therapists	$46,840	$49,800
Nursing Assistants	$37,660	$38,730

It is important to put these average wages in context.

Analyzing the Salaries of Speech-Language Pathologists

Speech-language pathologists earn the highest wages among these professionals.

However, only 540 of these professionals are currently employed in assisted living facilities in the entire country. In other words, not all ALFs and nursing homes employ speech-language pathologists. Therefore, it may be difficult to find a job.

Putting Physical Therapists’ Salaries in Context

Physical therapists should also consider the supply and demand of positions. On average, these professionals earn more in assisted living facilities than in SNFs.

However, only 1,520 of these professionals work in ALFs nationwide. In contrast, 12,520 physical therapists work in skilled nursing facilities. In other words, these professionals have higher chances of getting jobs in SNFs.

Understanding Respiratory Therapists’ Pay in ALFs and SNFs

Respiratory therapists also make more in assisted living than in skilled nursing.

However, the BLS doesn’t have estimates on the number of respiratory therapists who work in assisted living. Considering that the number of these professionals working in skilled nursing is low, the number of respiratory therapists in assisted living is probably negligible.

Assessing Nursing Professionals’ Pay in ALFs and SNFs

Registered nurses in skilled nursing facilities make more than RNs in assisted living facilities. However, RNs in both settings make significantly less than the average for their profession ($94,480). Therefore, RNs who work in these settings are not primarily motivated by financial reasons.

On the contrary, licensed practical and vocational nurses working in ALFs and SNFs make more than the average for their profession ($60,790). Therefore, working in these settings is a smart financial decision for these nurses.

Like RNs, certified nursing assistants make less in ALFs and SNFs than the average for their professions ($39,610). However, the great demand for CNAs in these settings is a significant motivation.

Finally, remember that these averages reflect the salaries of in-house employees. Nurses and nursing assistants who pick up PRN long-term care jobs in nursing homes and assisted living facilities make significantly higher hourly wages.

Assisted Living vs. Nursing Home Explained

Now, can you explain the difference between assisted living and skilled nursing facilities? Which setting is more attractive to you?

If you’d like to experience working in these facilities firsthand, consider picking up PRN shifts at nursing homes or assisted living facilities near you.

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