Independent Living, Assisted Living, and Nursing Homes: Understanding the Differences

The names sound much the same. The care is not the same at all.

Independent living is housing with ease and company. Assisted living adds help with daily tasks. A nursing home adds round the clock nursing care.

The right choice turns on one thing. How much help does the person need each day? Start there, and the rest gets clear.

This guide is part of our Aging at Home hub. If you are still torn on the first step, our guide to staying at home versus moving can help you work through the choice.

Key takeaways

• Independent living is for people who can care for themselves. It gives housing, meals in some places, and social life. It does not give personal care.
• Assisted living is for people who need help with daily tasks, like a bath or dressing. It does not give full time nursing care.
• A nursing home gives the most care. It gives nursing care, help with daily tasks, and watch care day and night.
• Nursing homes that take Medicare or Medicaid are licensed and checked by the state. You can look up their ratings on Care Compare at Medicare.gov.
• Medicare does not pay for long term care that is just help with daily tasks. It can pay for a short skilled stay after a hospital stay, if strict rules are met.
• Medicaid can pay for nursing home care for people who qualify. In some states, it can also help with care at home or in assisted living.
• Most people pay for independent living and assisted living on their own.

Start with daily needs

Long term care is help with basic tasks of daily life. The National Institute on Aging and Medicare.gov call these tasks activities of daily living. They include a bath, dressing, eating, and use of the bathroom.

Some help is medical. Some help is not. That split shapes both the place and the pay.

Ask three plain questions. Can the person bathe, dress, and eat on their own? Can they take their drugs in the right way and on time? Do they need a nurse each day, or just a helping hand? Your answers point to the right level of care.

What independent living is

Independent living is housing for older adults who can live on their own. You get your own flat or small house. You keep your own keys and your own routine.

The gain is ease. There is no yard to mow and no roof to fix. Many places serve one or more meals a day in a shared dining room. Many plan trips, games, and social events. Some give rides and house cleaning.

What you do not get is care. Staff do not help you bathe or dress. Staff do not give your drugs. If you need that help, you must hire it on your own or move to a place that gives it.

Some large sites hold more than one level of care on one campus. The Administration for Community Living notes that continuing care sites can hold independent living units, assisted living, and nursing homes in one place. That can make a later move less hard. It does not change what independent living itself gives. On its own, it is housing, not care.

Independent living is not a medical setting. Rules for it vary by state, and it is not checked the way a nursing home is checked. Tour with care. Ask what the monthly fee covers, what costs extra, and what takes place if your needs grow.

If a move is on your mind, our guide to downsizing without making every decision at once breaks the work into small steps.

What assisted living is

Assisted living sits in the middle. It is for people who need help with daily care, but not as much help as a nursing home gives. That is how the National Institute on Aging puts it.

You live in your own room or flat and share common areas. You can get up to three meals a day. Staff can help with personal care. Staff can help with drugs, house cleaning, and laundry. Staff are on site day and night, with watch care and security. There are social events and group pastimes.

Assisted living gives more help if you pay more. The National Institute on Aging notes that most places offer a few levels of care. You pay more if you need more help or special care. Ask for the full list of fees in print before you sign.

What assisted living does not give is full time medical care. It does not take the place of a nursing home for a person who needs skilled nursing each day. The Administration for Community Living puts it in plain terms too. Assisted living and board and care homes give housing and help with personal care and meals. In most cases, they do not give medical care.

Assisted living is licensed by the state, not by the federal program. Rules, names, and what staff must do vary by state. Two places with the same name in two states may not give the same care. Ask your state who licenses the place and where you can read its last check.

What a nursing home is

A nursing home gives the most care of the three. Nursing homes are also called skilled nursing facilities. The National Institute on Aging says their care leans more on medical care than assisted living does.

Care in a nursing home can include nursing care and watch care day and night. It can include three meals a day and help with daily tasks. It can also include rehab care, such as care to help you move, do daily tasks, or speak and swallow after an illness.

Medicare.gov says nursing homes are places for people who in most cases need care day and night. A nursing home can give short term care after surgery or illness. It can also give long term care for people who need help with daily tasks for a long time.

Some people stay for a short time to heal. Most people who live in a nursing home live there for good. They have health needs that call for steady care and watch care. That is why the check and rating rules for nursing homes are the strictest of the three.

How nursing homes are checked

A nursing home that takes Medicare or Medicaid must be licensed and certified. Medicaid.gov states this rule in plain terms. These homes must be licensed and certified by the state, based on federal rules. They are checked on a set cycle to keep that status.

State survey teams do the checks. They look at care, safety, staffing, food, and how residents are treated. If they find a flaw, they cite it and the home must state how it will fix it.

You can read the results for yourself. Medicare runs Care Compare, a free tool at Medicare.gov. The National Institute on Aging points readers to that tool to find and compare nursing homes in their state. Use it to look at ratings, staffing, and check results side by side before you choose.

Assisted living and independent living do not show up in that same federal tool. For those places, use your state licensing office and ask for the most new check report.

Side by side

Here is the split in short form.

• Your own care: Independent living — you care for yourself. Assisted living — you need some help each day. Nursing home — you need help and nursing care day and night.
• Help with a bath, dressing, and drugs: Independent living — no. Assisted living — yes. Nursing home — yes.
• Nursing care each day: Independent living — no. Assisted living — no, or only a small amount. Nursing home — yes.
• Meals and house cleaning: All three can give them. What is in the fee varies by place.
• Checks and ratings: Independent living — state housing rules, if any. Assisted living — state license. Nursing home — state license, federal certification, and public ratings on Care Compare.
• Who pays in most cases: Independent living — you pay. Assisted living — you pay. Nursing home — you pay, or Medicaid if you qualify, with Medicare only for short skilled stays that meet the rules.

Who covers what

A key point bears a repeat. A short rehab stay paid by Medicare is not the same as a long stay. When the skilled need ends, Medicare pay ends, even if the person still needs daily help. Plan for that gap well in advance.

If you hope to live near kin one day, our guide to planning a move closer to family can help you weigh place, cost, and care in one plan.

• Medicare: Medicare does not pay for long term care. Medicare.gov says most long term care is not medical, so Medicare and most health plans do not pay for it, in a nursing home or in the community. Medicare Part A can pay for short skilled care in a certified nursing home, but only if strict rules are met. You must first have a hospital stay as an inpatient for at least three days in a row. You must need daily skilled care. You must get that care in a Medicare certified place, in most cases within 30 days of leaving the hospital. Part A caps that care at 100 days in each benefit period. Medicare also does not pay for assisted living. The National Institute on Aging states that point in plain terms.
• Medicaid: Medicaid can pay for nursing home care. The Administration for Community Living states that Medicaid covers nursing home services for all eligible people age 21 and older. You must meet your state rules for income, assets, and level of care. Medicaid also covers home and community based services for people who would need a nursing home if they did not get help at home. In most states, Medicaid will also cover services that help you stay in your home, such as personal care and help with laundry and cleaning. Some states cover some assisted living services, and some do not. Medicaid does not pay for rent, a mortgage, utilities, or food. Check with your state Medicaid office for its exact rules.
• Private pay: Most people pay the full cost of assisted living on their own. The National Institute on Aging states that point too. Independent living is also paid on your own in most cases, much like rent. Long term care insurance may pay for some assisted living or nursing home care if the person has a policy. That turns on the policy terms. If no public program or policy pays, you pay for care that is not covered.

How to choose the right level

Match the place to the need, not to the name. Names vary by state and by firm. The care on offer is what counts.

Visit in person, and visit more than once. Go at a meal time and in the evening if you can. Watch how staff speak to residents. Ask how they handle a fall, a drug error, or a sudden illness at night. Ask what level of care would mean the person must move out.

Get the costs in print. Ask what the base fee covers, what each add on costs, and how fees have risen in past years. Ask if the place takes Medicaid, and if so, what takes place if a person runs out of funds.

Think one step ahead. Needs tend to grow with time. A place that fits today may not fit next year. Ask if the person can add care in place, or if a new move would be forced.

Sample Situation

Rosa is 81 and lives on her own in a small house. She drives, cooks, and pays her own bills. The yard work and the stairs have grown hard, and she feels alone in the evening. She does not need help with a bath or with her drugs. She moves to an independent living flat near her church. She keeps her car, eats lunch in the dining room when she likes, and joins a card group. Her health needs did not drive the move. Ease and company did.

Two years later, Rosa has a fall and a hip repair. After her hospital stay, she needs daily therapy and nursing care to heal. She spends a short time in a nursing home for rehab care, then goes back to her flat with some home help for a few weeks. The nursing home fit that short, skilled need. It was not a move for good, and her flat was still the right home base for the level of care she needs day to day.

Your next step

When you are ready to compare real places near you — what each type gives, and how they differ in your area — start with our guide to living options. Bring this page with you, and match each place you tour to the level of care you need.

Sources

• https://www.medicare.gov/coverage/long-term-care
• https://www.medicare.gov/coverage/skilled-nursing-facility-care
• https://www.medicare.gov/coverage/nursing-home-care
• https://www.medicare.gov/care-compare/
• https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes
• https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care
• https://acl.gov/ltc/costs-and-who-pays/who-pays-long-term-care
• https://acl.gov/ltc/medicare-medicaid-and-more/medicaid/medicaid-long-term-care-services
• https://acl.gov/ltc/housing/living-in-a-facility
• https://upload.wikimedia.org/wikipedia/commons/b/b9/Ferbane_Nursing_Home_2010_09_10.jpg