Understanding nursing homes and assisted living | Wisconsin Jewish Chronicle

Understanding nursing homes and assisted living


Times are changing, medicine is advancing and people are living much longer today than they have ever before. The landscape of long-term care facilities is also advancing as seniors are provided with more choices in supportive senior care, other than a nursing home setting.

Twenty years ago, if your elderly loved one needed care outside the home, you might find yourself visiting grandma or grandpa in a nursing home.

In Wisconsin, and elsewhere around the country, there have been significant shifts in how to approach aging-in-place as we step away from institutional skilled nursing settings, and toward community-based, higher acuity, residential, long term care communities or “assisted living.”

Lauren O’Desky

Assisted living can provide very much of the same caregiving support to seniors such as help with bathing, dressing, transferring and medication management. It’s also an environment that promotes independence in a setting where people receive individualized care in a residential-like, social setting. In contrast to an institutional setting, assisted living has less regulations which means people typically find they have more choices.

Nursing homes are highly regulated long-term care facilities that provide seniors with access to 24-hour nursing on-site. Assisted living, on the other hand, are for people still needing some level of care services and who do not need 24-hour access to on-site nursing services.

In both nursing home and assisted living communities, the care that individuals receive is typically provided by caregivers or certified nursing assistants and they are monitored and managed by nurses. The main difference is that in assisted living, nurses are not physically on-site at all times, but they are available on-call most or all of the time.

In fact, some assisted living communities are beginning to have 24-hour nursing onsite as well.

Just like nursing homes, assisted living communities offer a range of services from very little care all the way to higher acuity “skilled” care needs that previously were only available to nursing home residents.

Wisconsin has been on the forefront of this change and currently has three types of assisted living communities that are licensed by the Wisconsin Department of Health Services – adult family homes, community based residential facilities and residential care apartment complexes. Each provide a different level of care to the residents dependent on their individual needs, ranging from assistance with meals and housekeeping, full dementia care, social and recreational activities, diabetes monitoring and complex management for chronic conditions, just to name a few.

In addition, assisted living communities either provide or arrange for therapeutic services provided by Medicare, including physical, occupational and speech therapy. Most also work with hospice companies, provide some skilled nursing services either in house or by working with a skilled home health agency and disease specific programs for those with Alzheimer’s or other dementias.

Assisted living is growing by leaps and bounds as lawmakers, communities, medical practitioners and Medicare continue to hone in on aging well in place. The growth is monumental but unfortunately regulators are struggling to not only keep up, but to monitor compliance.

Unlike nursing homes, assisted living communities do not have to be held to the same federal and state requirements. While regulators are indeed struggling to keep up with the growing number of assisted living communities, states like Wisconsin have put in place programs and regulations to try to keep up with the growing demand.

The ability to provide a lot of high level care in assisted living, including a small amount of nursing care, has been very important for people not just in being able to have choice in how they live and receive care, but choice in how they spend their assets.

Assisted living is less expensive than its nursing home cousin. According to Genworth Financial, the average monthly cost of nursing home care in the Milwaukee area in 2017 was $11,041. The same survey states the average monthly cost of assisted living in the Milwaukee area in 2017 was $4,025.

When choosing care, it will really help to understand the differences between assisted living and nursing homes. Good luck!

Lauren O’Desky is president and owner of Oasis Senior Advisors, with services offered at SeniorAdvisorsMilwaukee.com. She is a regular contributor to the Chronicle on senior living issues.