The decision to move a loved one from an Assisted Living (AL) facility to a Skilled Nursing Facility (SNF), commonly called a nursing home, is a difficult but often necessary step in the continuum of elder care. Assisted living provides a residential setting with support for daily activities, known as custodial care. A nursing home, by contrast, is a medical setting licensed to provide complex, round-the-clock skilled medical care. The shift is driven by a fundamental change in a resident’s health needs, moving beyond what non-medical staff can safely manage.
Understanding the Difference in Care Levels
The core distinction between these two environments lies in their licensing, staffing, and the level of medical intervention they can legally provide. Assisted living facilities are primarily designed for supportive care, helping residents with Activities of Daily Living (ADLs) such as bathing, dressing, and medication reminders. Staffing in an AL community is typically non-medical, with licensed nurses often available on call or during scheduled hours, not necessarily 24 hours a day.
A Skilled Nursing Facility (SNF) is a medical institution regulated to deliver continuous, high-level medical care. SNFs must maintain licensed medical staff, including Registered Nurses (RNs) and Licensed Practical Nurses (LPNs), on duty 24 hours a day. This staffing structure allows them to perform complex medical procedures like intravenous (IV) therapy, tube feedings (G-tube), and complex wound care.
Primary Triggers Physical Decline and Skilled Needs
A resident’s decline in physical function and the resulting need for ongoing, complex medical intervention are the most definitive reasons for a move. A significant loss of mobility is a common trigger, especially when a person becomes bedridden or requires the assistance of two staff members for transfers. This level of dependence exceeds the general custodial capacity of most AL facilities.
The need for specialized medical equipment or procedures that demand continuous licensed nursing oversight also compels a move. This includes the administration of intravenous medications or fluids, frequent monitoring of unstable vital signs, or the management of percutaneous endoscopic gastrostomy (PEG) tubes for nutrition. Conditions like severe, uncontrolled diabetes or frequent hospitalizations signal that the resident’s medical needs have surpassed the capabilities of an assisted living setting. Furthermore, the development of advanced pressure ulcers (Stage III or IV) requires frequent, skilled dressing changes and monitoring that only a facility with 24/7 licensed nursing staff can reliably provide.
Indicators Related to Cognitive Impairment and Safety
When cognitive impairment progresses, the resulting safety and behavioral issues often necessitate the higher level of supervision found in a nursing home. Severe progression of dementia can lead to significant functional impairment, making a person unable to follow safety directions or cooperate with basic self-care. This decline can be measured using tools like the Mini-Mental State Examination (MMSE), where a score in the mild to severe range indicates a need for more intensive support.
A major safety concern that forces a transition is elopement, or severe wandering, where the resident is at high risk of leaving the secured premises. Assisted living facilities are typically not equipped with the specialized, locked memory care units or the staff ratios required to manage this constant supervision risk. Complex behavioral issues, such as persistent aggression or agitation that disrupt the environment or endanger others, often require specialized therapeutic interventions and higher staffing levels available in an SNF setting.
The Formal Assessment and Financial Considerations
The process for determining a resident’s need for a higher level of care begins with a formal assessment. This determination is usually made by a physician, the facility’s Director of Nursing, or a state-mandated assessment team. The assessment evaluates the resident’s current medical condition, ability to perform Activities of Daily Living (ADLs), and cognitive status to ensure the proposed move aligns with the resident’s best interests and the new facility’s licensing capacity.
If a transfer is necessary, the Assisted Living facility will initiate a care plan review and issue a formal notice of transfer, which includes a specified notice period for the family. The financial reality of this transition is significant, as the median monthly cost of a private room in a nursing home is substantially higher than that of an assisted living apartment. Assisted living is primarily funded through private pay, long-term care insurance, or state-specific Medicaid waivers. Nursing home care is often covered long-term by Medicaid for eligible individuals, as well as by long-term care insurance. Medicare coverage for nursing homes is generally limited to short-term skilled rehabilitation following a qualifying hospital stay, not for long-term custodial care.