In this post, we describe the general differences between assisted living communities and nursing homes. We gathered the information below from Washington D.C. and Maryland sources. While the laws vary from state to state, generally, assisted living communities and nursing homes of each state operate similarly. Prior to your loved one moving into a nursing home or assisted living community, a nurse will assess him or her to make sure that he or she qualifies for the level of care that you are applying to. To save on costs, we recommend applying for the lowest level of care first. With that said, here is a guide to help you determine the appropriate setting of care for your loved one.

Assisted Living Communities

Assisted living communities may prepare meals, do house chores, organize activities, manage medications, and provide custodial care for their residents. Custodial care means helping with the six activities of daily living, which include: transferring, walking, toileting, bathing, dressing, and eating. Before becoming a resident, a nurse may assign a level of care to an applicant1.

Level 1 – Needs oversight of one or more of the ADLs
Level 2 – Needs occasional hands-on assistance with one or more ADLs
Level 3 – Needs frequent hands-on assistance with one or more ADLs

The community will charge the applicant based on the level of care the resident requires. If a person requires too much care, then the assisted living community may reject the application. A person cannot live in an assisted living community if he or she2:

  • Is dangerous to him/herself or to others
  • Needs more than intermittent skilled nursing care(generally needs more than 35 hours of home health or skilled care per week)
  • Need treatment of stage 3 or 4 ulcers
  • Needs ventilator services
  • Needs treatment for an active, infectious, and reportable disease or a disease or condition that requires more than contact isolation.

Nursing Homes

Nursing homes must provide three meals a day, housekeeping, laundry, and maintenance to the building. Just like assisted living communities, nursing homes also provide custodial care and medication management. They differ from assisted living communities because they can provide routine skilled care.

Most nursing homes employ nurses, physical therapists, occupational therapists, and doctors. With these professionals onboard, nursing homes can provide a higher level of care than assisted living communities. While some of the following services may be provided at an assisted living community, those who need the following on a routine basis should consider moving into a nursing home.

  • Immunizations
  • Feeding tubes
  • Catheters
  • Treatments requiring direct nurse supervision and observation

Those who require the following, even on an intermittent basis, should consider moving to a nursing home:

  • Ventilator services
  • Wound management, particularly stage 3 or 4 ulcers

Again, these are general rules, so if you are confused if your loved one requires too many skilled services or not, check with a nurse. If you don’t know one, then have one come assess your loved one from the assisted living community that you are considering. From our experience, nurses from assisted living communities are happy to qualify potential residents. If you’re not comfortable with that option, then some states have programs set up at local health departments to provide assessments. In Maryland, the program that does assessments is called Adult Evaluation and Review Services (AERS).

We also wanted to shed some light on the costs of assisted living communities and nursing homes. Here are the average monthly costs that we’ve researched in the DC, Maryland, and Virginia areas:

​Here are several payers for each type of care. Some payers require the applicant to qualify before the payer will sponsor the care. Not all counties have the same sources of payers as the ones we’ve listed below, but it’s worth checking with your county to see if the county has the program and if you qualify.

Once you’ve selected a care setting, if you still need help choosing the right community, we do an assessment using the following criteria: health, wealth, lifestyle, and preferred location. You can contact us here. You may choose to use our services for free or for a fee. We’re happy to help in the capacity that you choose.



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