When Dan and his wife, Erin* realized they needed to consider supervised care for his father, Gene who was showing signs of memory loss and reduced mobility, they weren’t sure where to begin. Searching online, they found plenty of options for older adult living within a 2-hour drive of their home. But they were overwhelmed by the information. In particular, they didn’t objectively understand the difference between nursing home care and assisted living care.

Though not a widely researched topic, surveys have shown that Dan and Erin are not alone in their confusion: Whether as a matter of marketing or geographic preference, different names are often used to describe types of residential care for older adults. For example, nursing homes may also referred to as long term care facilities, skilled nursing facility, or homes for the aged. 

In reality, there are two broad categories of care settings for older adults: 

• nursing homes 
• assisted living communities

Understanding the differences between a nursing home and an assisted living community can make the process of choosing elder care less stressful and more reassuring for your family.

What type of care is provided at a Nursing Home?

Nursing homes are legally permitted to provide extensive, 24-7 nursing and medical care under the supervision of a practicing physician and medical specialists. This care is somewhat similar to (but more extensive than) hospital care and can include:

• near-constant monitoring of individuals who have significant physical and/or cognitive impairment and serious medical conditions
• round-the-clock nursing care
• assistance with personal hygiene, toileting, dressing, cleanliness of room 
• various types of physical rehabilitation / therapy (speech, hearing, cognitive)
• social-emotional therapeutic services
• meals are provided according to the medical needs of each patient, similar to a hospital stay
• visitation hours are not open-ended but are similar to hospital visiting hours
• recreational and social programs are limited and may not be provided at all depending on a person’s health condition(s)

Importantly, families need to understand that nursing home care is a custodial arrangement in which the medical staff are the custodians of care for the older adult. In a custodial arrangement, the room to which your loved one is assigned is not their private, personal space. Medical staff and other personnel may enter the room at any time of the day or night.

The length of an individual’s stay at a nursing home can be a short-term (several weeks) or long-term (months or years). Some individuals may transfer into and out of nursing home care based on reoccurrence of medical symptoms/complications that cannot be sustained in hospital care.

What type of care is provided at an Assisted Living Community?

An assisted living community describes older adult care found on a continuum and often referred to as Continuing Care Retirement Communities (CCRC). These communities are licensed to offer different levels of healthcare and wellness care to support the quality of living for older adults as their needs change over time, including physical, medical, social and emotional, and spiritual needs. 

Older adults who reside within an assisted living community are considered independent to the extent that they are capable of participating in and, at the least, partially managing their basic daily living needs within their private living quarters. The extent of assistance needed is a determining factor in cost to reside at an assisted living community. 

Assisted Living Communities provide a wide array of services based on iwhat is needed by a resident. Services can include:

• Meals provided and/or restaurants on site
• Recreational areas indoors and out
• Entertainment and enrichment programs
• Concierge services
• Shared common areas for activities
• 24-hour medical staff accessible to all residents regardless of level of independence
• Personal hygiene assistance (dressing, bathing)
• Medication reminders
• Housekeeping
• Laundry 
• Transportation 
• Security 

Assisted living communities focus on preserving an older adult’s well-being and uphold a resident’s right to personal privacy, autonomy, and dignity while promoting community and family involvement.

Assisted living centers do not employ a custodial arrangement. Rather, the older adult’s living space (usually an apartment style set-up) is considered a private residence. As such, an older adult enters the community as an active and independent resident who needs minimal assistance, but should their health decline in a way that prevents truly independent living, the community provides a transition to stepped-up care. This can include receiving help with daily living activities, physical rehabilitation and adaptations in their same living space – or transitioning to more medically intensive long-term care services such as Memory Care or skilled nursing (with appropriate permits as required by law).

In the broadest sense, nursing homes focus strictly on medical care – from short-term rehab to long-term ongoing medical care. Assisted living is focused on supporting the evolving health and wellness needs of older adult residents for the duration of their “golden years”.

How do I know if my aging parent needs placement in assisted living or a nursing home?

Foremost, the type of care an aging parent needs will be determined by their medical needs, as indicated by their healthcare provider. Additionally, the extent to which they require help managing their health and personal business, is a significant factor in deciding type of care for an aging family member: 

• What is the extent of their physical or cognitive impairment? Is it short or long-term?
• Can they manage their medication regiment on their own? 
• What is their medical prognosis?
• If their condition is likely to worsen over time, which means the care they need now will change in months or years, can you step in to help? 
• Will the facility they start out at be able to provide care for changing needs or will you need to relocate them to a different type of facility?

Choosing the Right Care for an Aging Parent

Ultimately, Dan and Erin had many conversations with Gene’s physicians to understand Gene’s functional limitations now and would things would likely be in the months and years ahead, with his failing memory a top concern. They also used an eldercare mediator to help explain to Gene the reasons why he could not remain at home alone. Together, they toured several assisted living communities with a preference for those with social programs and wellness activities that aligned with Gene’s friendly nature, but most importantly with progressive stages of memory care and on-site physical therapy for when his medical conditions further decline.

Even an older adult who is mostly independent in their self-care, today, will encounter times when their healthcare needs become too extensive for living on their own. You may want to choose an older adult community like Everbrook Senior Living, which provides transitional care to support your loved one as their health and wellbeing changes over time. 

Resources

Connecticut Assisted Living Association Resource Guide

How to Choose Assisted Living or Nursing Home

National Institutes of Health: Residential Facilities, Assisted Living, and Nursing Homes 

Helpful Guidance for Managing Older Adult Long-Term Care

Eldercare Locator
Ph: 800-677-1116
This email address is being protected from spambots. You need JavaScript enabled to view it. 

You can also call or search online for your local Area Agency on Aging or Department of Human Services.

*Names changed to protect identity

​Navigating important healthcare, financial, and end-of-life planning with an aging family member can be a difficult and heartbreaking process. Even as you’re trying to safeguard your loved one’s dignity, privacy, and independence, the emotional weight of the situation can sometimes lead to contentious interaction between an elderly parent and their adult children. Should you recognize the bond between family members becoming strained—and better still, to prevent even getting to that point—consider working with an eldercare mediator to guide your family through decision making with an aging family member.

What is an eldercare mediator?

An eldercare mediator is a trained professional who acts as a confidential resource and impartial facilitator for families as they navigate aging-related healthcare, lifestyle, and financial decisions. Unlike a judge or arbitrator, eldercare mediators do not make decisions for you or your loved one; instead, they family members navigate options and reach agreement on the best path forward for their loved one’s care. Eldercare mediators also focus on preserving the bond between family members. 

What roles does an eldercare mediator have when working with families?

• Mediators Act as Neutral Party: They do not take sides or advocate for one specific family member.
• Mediators Build a Communication Bridge: They help lower the emotional "temperature" so everyone can be heard.
• Mediators Focus on Problem Solving: They assist families in finding practical, mutually agreeable solutions.
• Mediators Empower Family Members: They often ensure the senior's own voice and wishes are central to the discussion. 

What are the benefits of using an eldercare mediator?

• Privacy:  Mediation sessions are confidential, unlike public court proceedings.
• Cost-Effective: Mediation is often much less expensive than hiring separate attorneys for a legal battle.
• Efficiency: Issues brought to mediation can often be resolved in a few weekly sessions rather than months in legal proceedings.
• Relationship Preservation: Mediators focus on collaboration, which helps keep the family intact. 

What types of decisions can an eldercare mediator assist with?

Families often turn to a mediator when they are at an impasse regarding: 

• Living Situations: Mediators identify the benefits and drawbacks pertaining to whether or not (and if it is feasible for) an aging family member should move to assisted living or stay at home.
• Caregiver Roles and Obligations: Mediators allocate daily care duties among adult siblings in consideration of all relevant factors.
• Financial Decisions: Mediators manage the elder's assets, resources for paying for care, and can address inheritance disputes.
• Safety Concerns: Mediators examine the variable impacting an elder’s ability to safely live independently including sensitive topics such as living alone, driving, and self-care.
• Legal & Medical Options: Mediators help determine the individuals who can best serve as a medical proxy or financial power of attorney. 

What type of training do eldercare mediators have?

Many eldercare mediators have backgrounds law (some may have been or are attorneys), social workers, or geriatric care managers who have taken specialized conflict resolution training. 

How do I find an eldercare mediator?

A good place to start is the Academy of Professional Family Mediators and the National Care Planning Council.

Everbrook Senior Living: Supporting Families with Aging-Related Care Options

At the heart of the work we do for the families we serve is compassionate understanding for the challenges inherent in choosing aging-related care for a loved one. The Everbrook communities are intentionally designed to address the needs of older adults from the active Golden Years through assisted living and memory care. Our exceptional staff can help facilitate honest conversations between family members faced with making decisions about care for aging parents. Our first and utmost concern is that all involved have a voice in finding the best fit for their loved one’s social-emotional, spiritual, medical, and financial needs.

Contact us to learn more about how we can assist with the conversation and decision making between aging parents and adult children. 

Additional Resources:

Eldercare Mediation

AARP’s Guide to Choosing an Eldercare Mediator

Legal Guidance for Eldercare Mediation Services and Resolving Family Conflicts