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What’s the Difference Between Assisted Living and a Nursing Home?

Often, people use the terms “assisted living” and “nursing home” interchangeably. These terms, however, represent two very different concepts in senior living. By understanding the differences between the two concepts, people may discover that they have more options for themselves or for their family members than they realized.

In short, these are the differences between the two supportive living environments:

  • Assisted living facility or community — a homelike setting that encourages independence and personal development
  • Nursing home — an institutional living environment that provides round-the-clock healthcare and monitoring

The living experiences in assisted living communities and nursing homes are significantly different from each other, and each has its own regulations under Texas and federal laws as well. Here, we’ll discuss those differences, both from a lifestyle perspective and from a legal perspective.

About Assisted Living Communities

Improved health and wellness has created a new trend in senior living arrangements. To meet the needs of active people who seek a close-knit, engaged community – and who may or may not require some level of daily assistance – assisted living communities have emerged as an attractive option.

Assisted living and memory care communities offer residents advantages that include:

  • Amenities and programs to live an active, social lifestyle
  • A comfortable, private residence
  • Events that further personal development
  • Wellness programs that promote positive, holistic health
  • Restaurant-style dining
  • Personal privacy and autonomy

In addition, home and yard maintenance is often taken care of in an assisted living community. At The Villages of Windcrest, we offer landscaping services, appliance maintenance, home repair and weekly housekeeping services. By having fewer chores and responsibilities, residents have more time to enjoy a care-free lifestyle and take advantage of the resort-like amenities at the communities.

Assisted living communities also have staff members who assist residents with activities of daily living as needed. These may include dressing, grooming, toileting and eating. Medical care is not provided on-site, but transportation can be scheduled to doctor’s appointments. Residents may require some degree of assistance, but can live otherwise largely independent lives.

Types of Assisted Living in Texas

To operate in Texas, assisted living communities and memory care communities are licensed by Health and Human Services (HHS). The HHS evaluates the physical and mental condition of a facility’s residents and categorizes them into two types:

  • Type A — Residents can sleep unattended through the night. In an emergency, they can follow instructions and evacuate.
  • Type B — Residents must be attended to at night. In an emergency, they cannot follow directions or evacuate without help. Type B facilities care for people who have Alzheimer’s disease, dementia and similar memory conditions.

To learn more about types of Texas facilities, see the new regulations for assisted living in Texas.

About Nursing Home Care

A nursing home or nursing facility provides housing and care for people who need around-the-clock medical care from licensed health professionals. Compared to the more homelike environment of assisted living communities, these nursing homes more closely resemble a hospital, and they offer:

  • An emphasis on medical care and 24/7 monitoring
  • Limited opportunities for personal development and social interaction
  • Minimal personal privacy and autonomy
  • A higher cost than assisted living communities

Regulations for Assisted Living Services

Texas regulations define the criteria for assisted living facilities:

Criteria for Assisted Living in Texas

As mentioned, there are not only differences in the lifestyles of assisted living communities and nursing homes, but also differences in the legalities they face. Specific sections of the HSC and TAC describe an assisted living community as different from a Texas nursing home due to factors that include:

Person-Focused Philosophy: HSC 247.0011 (c) requires that an assisted living facility “emphasizes personal dignity, autonomy, independence and privacy.”

Cost Control: HSC 247.026 (2) requires facilities to “ensure quality care and protection of the residents’ health and safety without excessive cost.” Assisted living facilities are usually less expensive than nursing home care.

Sufficient Staff: Requirements for employees in , “Standards for Type A and Type B Assisted Living Facilities,” include a manager and attendants. A trained attendant must be present whenever residents are in the facility. Registered nurses aren’t required, but attendants must be certified to provide medication and assist with medical care.

Admission Policies: The TAC also requires that no person be admitted with a condition the facility can’t support. Assisted living communities often bring in medical professionals on an as-needed basis. People with medical or psychological needs that the facility can’t manage usually must go to a nursing home.

Criteria for Nursing Homes in Texas

Nursing home care is heavily regulated by both Texas laws (such as HSC 242, “Convalescent and Nursing Facilities and Related Institutions” and TAC Title 40, Part 1, Ch 19, “Nursing Facility Requirements for Licensure and Medicaid Certification”) and federal laws (such as Social Security Act s1819, “Requirements for, and Assuring Quality of Care in, Skilled Nursing Facilities,” and s1919, “Requirements for Nursing Facilities” and 42 CFR Subpart B, “Requirements for Long Term Care Facilities”).

These laws draw distinctions between nursing homes and assisted living communities, with features of the latter including:

Higher Aged Population: when describing Texas nursing homes, HSC 242.002 defines “elderly person” as people who are 65 or older. A person younger than 65 might be admitted, however, depending on individual facility rules. But a large percentage of nursing home residents are at least 85. Very few are under 65.

Institutional Setting: HSC 242.002 emphasizes that Texas nursing homes and facilities aren’t a homelike setting. HSC also defines “institution” only as a provider of medical care and the basic needs of food, clothing and shelter.

Hospital Style Living: whether the nursing facility is in an actual hospital, TAC 40 defines “bedrooms” like hospital beds. Each room may sleep up to four. Privacy measures consist only of “full visual privacy for each resident,” which can be achieved by “cubicle curtains, screens or procedures.”

Focus on Medical Treatment: federal guidelines in the Social Security Act define nursing homes as institutions that deliver a level of care that can be provided only in an institutional facility. To meet that standard, 42 CFR Subpart B requires that a licensed nurse be on-site each day. Additional nursing staff is required as needed. Staff requirements and a hospital setting usually make nursing home services more expensive than assisted living.

Choose the Right Living Option for You

For people who live mostly independent lives and who value privacy and social engagement, assisted living communities have become popular options. To learn more, download our assisted living resource guide to learn about options and to answer your questions about these communities.

The  is an assisted living community in Fredericksburg, TX, that offers resort-style amenities and an program calendar full of interesting and fun events. To learn more, complete an online information request or call us at  830-856-2450. We look forward to telling you all about life at The Villages of Windcrest!


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