Do They Need Assisted Living or a Skilled Nursing Facility?

Assited Living Facility

Do They Need Assisted Living or a Skilled Nursing Facility?

So perhaps your loved one needs care and assistance. The goal when figuring out care options is to choose the least restrictive environment for your loved one that we possibly can. However, perhaps in your case care in the home (either by yourself or using an agency or other caregiver) is not an option. Where will your loved one live if in-home care isn’t a fit? Before making this decision or even taking a tour of the options, it makes sense first to understand the differences between two major categories that cover most (even if not all) non-home care placements in New Jersey. Those two settings are assisted living facilities and skilled nursing facilities (which we may also call “nursing homes”).


Assisted Living Facilities (ALF)

I have often heard assisted living buildings characterized as “land-locked cruise ships.” They provide comprehensive living arrangements for people with a variety of care needs. ALF residents generally maintain their independence overall and do not require constant medical care. The buildings have recreation and activities departments to keep the residents engaged and active. The buildings also provide personal care services for residents that need them; for example, residents may request assistance with grooming and dressing. If there is no need for those services the resident is encouraged to handle them independently. It is a New Jersey state regulation that ALFs must keep a registered nurse on staff or on call. Often, assisted living facilities have specialized areas devoted to people with severe cognitive issues, such as dementia. 

The majority of ALFs offer apartment-like units with their own bathrooms, kitchenette, and lockable entrance. The units can have 1-2 residents each. In New Jersey, buildings previously used as another type of facility, such as a boarding home, can also be converted into assisted living facilities. These often have shared occupancy units. AL services can also be offered outside of a traditional facility setting, such as within subsidized housing.

The cost of AL can vary based on living space and services. People are often surprised to learn that specialized intensive assisted living services can be just as expensive as nursing home rates. Assisted living facilities accept private pay and Medicaid, although Medicaid services in an assisted living present their own problems. We always suggest that a family looking to place someone in an assisted living facility contact an elder law attorney before signing any paperwork or leaving a deposit.


Assted Living

Elderly woman puts together a jigsaw puzzle at an Assisted Living Facility

Skilled Nursing Facilities (SNF)

SNFs are for patients who are not in need of acute care of the sort that is provided in hospitals, but still need ongoing medical care and supervision. These buildings typically have a wing devoted to short-term sub-acute rehabilitation, from which residents often are either discharged home or transferred to a long-term care bed elsewhere. Nursing homes are required to staff professional medical personnel including 24-hour skilled nurses and a variety of nursing aides. Some SNFs are prepared to help with specific care needs, such as ventilators, that others are not designed to handle. While SNFs typically also have activities and recreation, the limitations of their residents often limit what the buildings can provide.

SNFs typically offer rooms that look much like hospital rooms with hospital beds, and residents typically share a room with one or more other people. The buildings are typically either built specifically as nursing homes or they were hospitals at some point in the past. The cost of skilled nursing care in New Jersey typically exceeds $10,000 per month, and with ancillary charges it can reach as much as $12,000 per month. If qualified financially and medically, patients in New Jersey and Pennsylvania may pay for SNF with Medicaid or Medicare with restrictions. This process is no less complicated than applying for Medicaid in an assisted living setting, but it is more heavily regulated. Some people try to navigate this process with the help of the nursing home’s business office, but remember that any mistakes a resident’s family makes will be their fault and not that of the facility.


Caregiver assisting senior man in using Zimmer frame at Skilled Nursing Facility.

Overall, the differences between Assisted Living and Skilled Nursing Facilities come down to your loved one’s independence and medical needs which dictate the level of skilled care necessary. It is important to maintain a less restrictive environment if at all possible, so that your loved maximizes their quality of life and their social interactions with others.

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Leave a Reply 11 comments

John Carston - March 21, 2016 Reply

Your post has given me a lot of information that will be helpful to my family as I may be helping my parents with locating an assisted living facility in the near future. I didn’t know that there was an option between assisted living and nursing facilities or what the differences were, but your article has told me the difference. When the time comes I’ll be working with them to decide what type of facilities would best fit their needs and wants, like you said.

Jeff Curtis - April 15, 2016 Reply

Thanks for the helpful information on assisted living and nursing facilities. My father is getting to the point where we have to try to decide if we should put him in an assisted living facility or not. I think that it would be good for him to have his own apartment-like unit. I think it would be good for him to feel somewhat independent, but get the help he needs. Thanks!

Palmella Silverberg - May 21, 2016 Reply

It was really an informative Article on assisted living facilities, especially you describe the difference between assistance living facility and nursing option very well. I learned a lot from your blog post. Thanks

Audrey Kinley - June 24, 2016 Reply

I never knew that one in three senior adults fall every year. That seems like it’d be a tragic thing to watch. My grandma fell last year on vacation, and it was pretty bad. We’re hoping that we can put her in a nursing home this year so she’s not alone.

Louise Clark - November 18, 2016 Reply

My name is Louise Clark My mother is getting to a point where she can’t take care of herself. Thanks for the advice about how you can assess your relative’s medical situation by consulting a geriatric-care manager. Hopefully, we can find out what would be best for my mother. In the meantime, I’ll have to see about possible finding an adult daycare center.

Andrew - December 14, 2016 Reply

I am currently looking around for a home to take care of my uncle. I was unaware of the difference between the two types of facilities. I think an assisted living facility is going to be best for my uncle as time goes on.

Troy Blackburn - January 5, 2017 Reply

That’s really comforting that, like you mentioned. nursing facilities are required to staff professional medical personnel, including 24-hour skilled nurses and nursing aides. I’ve heard that senior citizens tend to feel much more taken care of and safe in nursing homes. Why do you think that is? My grandmother is at the age when we’re having to make this difficult decision, and these tips will help us decide if we should enroll her in a nursing home. Thank you!

Bernard Clyde - February 23, 2017 Reply

I agree that it is important to choose care for your loved one that is the least restrictive. It can be difficult to them to start losing some of their independence. Having a facility that can take care of their needs but let them move about fairly independently is important in the emotional and mental health of your loved one.

Chris Winters - March 27, 2017 Reply

I love the fact that assisted living facilities happen to have independent units. My wife has been considering finding a nursing home for her parents. I can only hope that we could find a nursing home that could enjoy help to accommodate her parent’s medical needs.

Kourtney - June 5, 2017 Reply

I like that you mentioned assisted living facilities have activity and recreation departments on site so that the residents are keeping active and engaged all while still living at a facility. My mother-in-law is getting older and may have to be transferred to assisted living but doesn’t want to feel babysat. This is definitely something that she could benefit from, being that she can still have her independence and will have a lot of people to interact with on a daily basis while doing activities.

John Billows - June 6, 2017 Reply

I hate to admit it but my mom does not remember things as easily as she used to. I think a skilled nursing facility is what she needs. Like you point out she does not need the care of a hospital, but she does need monitoring 24 hours a day. She may not like it, but in her older age a facility like that would be great for her.

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