The Difference Between Assisted Living vs. Skilled Nursing Settings

Written by Megan Williams, MBA Freelance Writer, IntelyCare
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Reviewed by Marie Hasty, BSN, RN Content Writer, IntelyCare
Young woman in light blue scrubs holding the arm of a senior woman in a gray cardigan.

As you get into your healthcare career, you’ll realize how many workplaces are out there and hiring nursing professionals just like you. It’s understandable if there’s some confusion between assisted living vs. skilled nursing environments. Let’s take a closer look at the differences.

What Is an Assisted Living Facility?

Assisted living facilities (ALFs) 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. ALFs can offer multiple levels of support, with residents having the option to pay for higher levels. For example, some facilities are assisted living with skilled nursing services available.

ALF residents typically live in their own rooms or apartments, sharing a common area. 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 a Skilled Nursing Facility?

Skilled nursing facilities (SNFs) are often short-term and help a patient rehabilitate after a hospital stay for severe illness, surgery, or an accident. Unlike at ALFs, a patient does not live permanently at a SNF.

Nursing professionals who work here 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. When comparing a nursing home vs. assisted living vs. skilled nursing facility, providing optimal care for patients and/or residents is at the core of all three settings.

What Is Skilled Nursing Care?

SNFs offer skilled nursing care, which requires staff to have 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. Many certified nursing assistants (CNAs) are also critical members of SNF care teams.

Skilled nursing care includes tasks like:

  • Wound care
  • Medication administration
  • Physical assessments
  • Catheter care
  • Mobility assistance
  • Tube feed management
  • Diabetes management
  • Patient and family education

Assisted Living vs. Skilled Nursing: Key Areas of Difference

While these post-acute facilities serve similar demographics of patients, there are some key differences between skilled nursing vs. assisted living environments.

Feature Skilled Nursing Facility Assisted Living Facility
Medical services offered Extensive Moderate
Patients or residents Patients are typically there short-term Residents live there full time
Environment More clinical than apartment-like More apartment-like than clinical
Federal regulations Extensive Less strictly monitored
Recreational activities Limited Extensive
Support for activities of daily living Extensive Moderate

1. Medical Services Are More Extensive at SNFs

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

2. Support for Daily Activities Is Stronger at SNFs

SNFs offer more extensive support for daily needs than at ALFs. Staff — including RNs, LPNs, and CNAs — 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.

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

3. Recreation Is a Hallmark of ALFs

There are different levels of recreation options at assisted living vs. skilled nursing facilities. ALFs provide 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 have opportunities for residents 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.

4. Regulations Are Tighter for SNFs

Another key distinction of assisted living vs. skilled nursing settings lies in how they’re regulated.

SNFs are governed by federal regulations set out by the Centers for Medicare and 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 undergo periods of change. For example, the Skilled Nursing Facility Prospective Payment System (PPS) rule for fiscal year 2023 requested input on direct care staffing requirements and their impact, along with feedback to establish minimum staffing requirements for long-term care facilities.

5. 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 on staff-to-resident ratios.

But ALFs and nursing homes also go through times of change. In 2022, a proposed overhaul of the staffing levels in nursing homes represented the most substantial increases in this type of regulation since 1987. The proposal came as a response to the fact that CMS 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 infirm Americans continues to develop, it’s important that you stay on top of the shifting differences between skilled nursing vs. assisted living facilities — especially what they mean for your goals and responsibilities as a healthcare professional.

Assisted Living vs. Skilled Nursing Work Opportunities

While there are plenty of differences between the facilities, they both have one thing in common: They’re looking for talented nursing professionals like yourself. Find out how IntelyCare can help you stay informed on the latest jobs for nursing professionals.