Deciding whether a nursing home is the right option for a loved one is one of the most important and emotional decisions a family can face. This guide explains what a nursing home is, how it differs from assisted living and skilled nursing care, and what families should expect when their relative moves into one of these facilities.
What is a nursing home?
A nursing home (also called a long-term care facility or skilled nursing facility) provides 24-hour supervision, personal care, and medical support for people who cannot safely live alone and need ongoing medical or personal assistance. Nursing homes are staffed by licensed nurses, certified nursing assistants (CNAs), and often have access to physicians, physical therapists, and other clinical personnel. They are designed to support residents with activities of daily living (ADLs) such as bathing, dressing, eating, toileting, and mobility, plus more advanced medical needs when appropriate.
Assisted living vs. skilled nursing: what’s the difference?
Although the terms are sometimes used interchangeably, assisted living and skilled nursing serve different needs:
- Assisted living: Best for seniors who are mostly independent but need help with some daily tasks—like medication reminders, bathing assistance, or meal support. Assisted living communities emphasize autonomy, social activities, and private or semi-private living spaces. They typically do not provide complex medical care 24/7.
- Skilled nursing (nursing homes): Provide a higher level of medical and personal care. Nursing homes are equipped to manage chronic conditions, wound care, complex medication regimens, and post-hospital rehabilitation. Residents often require continuous monitoring or frequent nursing interventions.
Services and support you can expect
Nursing homes usually offer a range of services that can include:
- 24-hour nursing supervision and medication management
- Personal care with bathing, dressing, and grooming
- Rehabilitation services: physical, occupational, and speech therapy
- Regular health assessments and care planning
- Medical care coordination with physicians and specialists
- Meals, housekeeping, and laundry
- Social and recreational activities tailored to resident ability
Who typically needs a nursing home?
Common reasons families consider nursing homes include:
- Significant mobility limitations or frequent falls
- Complex medical needs that require ongoing nursing care
- Dementia or cognitive impairment with behaviors that need supervision
- Care needs that exceed what family or in-home services can safely provide
- Need for intensive rehabilitation after hospitalization
Paying for care
Costs vary widely by location and the level of care. Private pay, long-term care insurance, Medicaid, and sometimes Medicare (for short-term skilled care after a qualifying hospital stay) can help cover expenses. Medicare typically does not pay for long-term custodial care, while Medicaid can cover long-term nursing home care for those who meet eligibility criteria. It’s important to consult a financial planner or elder law attorney for guidance tailored to your situation.
How to choose a nursing home
Choosing the right facility involves both practical research and personal visits. Key steps include:
- Ask about staff-to-resident ratios and staff qualifications.
- Review inspection reports and complaint histories from your state’s licensing agency.
- Tour multiple facilities at different times of day to observe staff interactions and resident activity.
- Ask about admission assessments, individualized care plans, and how families are involved in care decisions.
- Check policies on visiting hours, medications, handling emergencies, and end-of-life care.
Preparing for the transition
Moving into a nursing home is stressful for residents and families. To ease the transition:
- Bring familiar items—photos, favorite blanket, and personal clothing—to make the new space feel like home.
- Keep an ongoing list of medications, doctors, and key medical history to share with the care team.
- Stay involved: attend care planning meetings and communicate regularly with nursing staff.
- Encourage social engagement through activities that match the resident’s interests and abilities.
Questions to ask the facility
- What is your staffing model and training for nursing assistants?
- How do you handle behavioral changes and dementia-related care?
- What rehabilitation services do you provide and how are goals measured?
- How do you involve families in care planning and decisions?
- What are the costs, what is included, and how are additional services billed?
Final thoughts
Understanding the differences between assisted living, skilled nursing, and other care options helps families make informed decisions based on medical needs, safety, and quality of life. A thoughtful search, clear communication with providers, and ongoing family involvement can make a significant difference in how well a loved one adjusts and thrives in a nursing home setting.
If you’re starting this process, begin with a list of priorities—medical needs, desired location, budget, and level of family involvement—and use that list to guide tours and conversations with facilities.
Thank you for this clear explanation. It helped my family differentiate between assisted living and nursing home care when we were making plans for my father.
Good overview. I would add that families should verify whether the facility has experience with specific conditions like advanced Parkinson’s or post-stroke rehabilitation.
Helpful checklist of questions to ask facilities—especially the part about observing interactions during different times of day.