Exploring the Difference Between Skilled Nursing and Assisted Living Facilities

The difference between skilled nursing and assisted living

Nursing leaders need to understand the difference between skilled nursing and assisted living facilities more than ever—earlier this year, the Biden administration released a plan to improve safety and quality for older Americans and people with disabilities. 

This uptick in government attention means that leaders and staff in these facilities will need to keep up with coming changes, maintaining a keen eye on the treatments of skilled nursing facilities (SNFs) and assisted living facilities (ALFs). 

What is an ALF?

Assisted living facilities exist to help people who need support with daily care. Ranging in size from just 25 residents to over 120, they provide a lower level of care than nursing homes or skilled nursing facilities. They can offer multiple levels of support, with residents having the option to pay for higher levels. 

Residents in ALFs typically live in their own rooms or apartments, sharing the common areas. They are provided with a range of services, including assistance with personal care and medications, up to three meals a day, laundry, housekeeping, recreational activities, 24-hour supervision, and security. 

What is an SNF?

Skilled nursing facilities often fill the gap after a hospital stay for severe illness, surgery, or an accident. They take responsibility for helping patients reestablish their involvement in daily activities like personal hygiene, walking, bathing, dressing, and getting in and out of beds and chairs. SNFs are similar to nursing homes in that they provide around-the-clock care.

These facilities offer skilled nursing care, which generally requires advanced training and certification. This type of care must be provided by, or be administered under the direct supervision of licensed health professionals, including registered nurses (RNs) or licensed practical nurses (LPNs), but also speech/language pathologists and physical and occupational therapists. Certified nursing assistants (CNAs) are also critical members of SNF care teams. 

SNF vs. ALF: Key Areas of Difference

While both types of facilities provide care for similar demographics of patients, there are some key differences between skilled nursing and assisted living facilities. 

Medical services are more extensive at SNFs

In ALFs, residents have a range of medical attention available, accessing them based on individual needs. Some ALFs, for example, offer transportation to doctor appointments and help taking medications. Some also specialize in areas like memory care. Overall, people who are in ALFs are in generally good health.

SNFs, on the other hand, provide constant medical care, sometimes including rehabilitative services such as respiratory or speech therapy. Residents are in SNFs for shorter periods, but some do offer services for longer-term care. 

Support for daily activities is stronger at SNFs

ALFs ensure help with activities, including getting dressed and bathing. They also provide housekeeping, laundry and meal preparation for residents who need this type of support. 

SNFs offer more extensive support for daily needs. Staff, including RNs, LPNs, and CNAs will help patients bathe and dress themselves, also helping them use the restroom and take medications. Kitchen staff prepare meals and other staff handle laundry and cleaning. 

Recreation is a hallmark of ALFs

ALFs stand out for their recreational options, offering a range of activities to keep residents physically engaged and socially connected. These facilities typically offer activities for creative expression, physical exercise, and socializing. Some ALFs also offer opportunities to volunteer and attend religious services. 

In contrast, activities in SNFs are more limited. Exercise is often led by physical therapists who are working to support residents in improving mobility, gaining strength, and fall prevention. 

Regulations are Tighter for SNFs

One of the key differences between skilled nursing facilities and adult living facilities lies in how they’re regulated. 

SNFs are governed by federal regulations set out by The Centers for Medicare & Medicaid Services (CMS). They are subject to a range of requirements including: 

  • Transfer agreements with hospitals.
  • Maintain a compliance and ethics program that effectively detects and prevents administrative, criminal, and civil violations.
  • Establish and implement of a quality assurance and performance improvement program.
  • Report crimes to law enforcement facilities.
  • Specific requirements if they participate in Medicare or Medicaid.

These requirements are also undergoing a period of change. The recent Skilled Nursing Facility Prospective Payment System (PPS) rule for FY 2023 requested input on direct care staffing requirements and their impact, along with feedback to establish minimum staffing requirements for long-term care facilities. 

ALF regulations vary more

Like SNFs, ALFs employ a range of nurses, including RNs, LPNs, CNAs, and, in some cases, nurse practitioners (NPs). The difference is that staffing levels in ALFs are much less strictly monitored than they are in SNFs—at most, states offer guides to staff-to-resident ratios. 

But ALFs are also going through a time of change. This includes recent proposals that would represent the most substantial increases in this type of regulation since 1987. As things stand now for ALFs, the Centers for Medicare and Medicaid Services only requires “adequate” staffing levels which amounts only to a base level of round-the-clock nursing coverage headed by an RN who works at least eight hours in a day. 

As the conversation around support for older and disabled Americans continues to develop, make sure to stay on top of the shifting differences between skilled nursing and assisted living facilities—especially what they mean for your goals and responsibilities as a leader in the world of nursing. If you’re working to build a staffing strategy that’s flexible enough to keep up with the future of nursing, now is a great time to get started.


Megan is a business writer with over 15 years’ experience in healthcare enterprise technology. She holds an MBA and B.S. in Healthcare Administration. She now keeps an ongoing eye on the latest developments and successes in healthcare admin technology and the people who use it to build a better world for providers, patients, and their care communities.


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