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Michigan Elder Law Today

Thursday, November 3, 2011

What’s the difference between a nursing home and assisted living facility?

As an elder law attorney practicing in Oakland County, I am often asked “what’s the difference between a nursing home and assisted living facility?”  The difference in the appearance between the two types of facilities can be dramatic, because nursing homes tend to be more hospital like. 

A nursing home provides residents with a room, personal care, nursing care, medical services, and meals.  As to the room, it is often semi-private, meaning the resident has a roommate.  Residents of nursing homes tend to have chronic conditions requiring long-term care and need assistance with multiple activities of daily living, such as bathing, dressing, eating, toileting, transferring in and out of beds or chairs, and help with continence issues.  Moreover, residents of nursing homes often have cognitive and memory problems due to various forms of dementia, such as Alzheimer’s disease.  Medicare does not pay for this long-term custodial care in a nursing home, but Medicaid will pay for nursing home care provided that the asset, income, and medical criteria are met.

Nursing homes also provide care for patients needing shorter-term recovery after a hospitalization.  Medicare may pay for up to 100 days of this type of skilled nursing care per spell of illness, which tends to be physical therapy and rehabilitation services after a stroke or broken bone.

The average cost of a nursing home in Michigan in 2011 is $220 per day, $6,692 per month, or $80,300 per year.

Assisted living residences provide services for people who are not able to live independently, but who do not require the level of care provided in a nursing home.  For instance, assisted living facilities provide housing for those who need help with day-to-day living, but who do not need the 24-hour level of care found in nursing homes.  Residents of assisted living may need help with personal care, assistance with meal preparation, some assistance with some of the activities of daily living, and housekeeping services.  Residents of assisted living facilities tend to have their own private living space, which can range from just a bedroom with a private bathroom, to a small apartment with a living room, bedroom, bathroom, and small kitchen area.  Assisted living facilities tend to have many activities for their residents.  Sometimes they seem like a nice resort with good staff and lots of activities.

Many assisted living facilities have special “memory units” for older people with Alzheimer’s and other forms of dementia who need a great deal of supervision. 

The average cost for assisted living in Michigan is $3,425 per month or $41,100 per year.  However, costs can easily exceed $5,000 a month for assisted living residents living in memory units.  Assisted living facilities in Michigan do not accept Medicare or Medicaid as a payment source for the cost of room and board.

In conclusion, nursing homes tend to be more institutional and hospital like.  They accept Medicaid as a payment source.  Some of the residents tend to be very frail, many others have dementia, and some residents of nursing homes are there because they have inadequate financial resources to live in assisted living or elsewhere.  Assisted living facilities are more home-like, though they can provide a similar level of care as a nursing home.  Assisted living facilities are strictly private pay, meaning the resident or family has to pay the bill out of their own funds or with long-term care insurance or the veteran’s Aid and Attendance benefit.


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