What is an assisted living facility — and how does it differ from a nursing home?

Boston Globe

17-07-2025

What is an assisted living facility and how is it different from a nursing home?
Assisted living residences are nonmedical facilities that provide older adults with housing, meals, and support for daily activities like dressing, bathing, and medication. They promote independence while offering a safety net of care.
'[Assisted living] is often the next logical step in the continuum of care for adults who don't need complex medical treatment but would benefit from daily support in a setting that values independence, freedom of choice, and quality of life,' said Brian Doherty, president and CEO of Massachusetts Assisted Living. 'Assisted living also provides structure and support for individuals with cognitive impairment, memory loss, or Alzheimer's disease through specialized memory care units.'
Unlike nursing homes, which provide round-the-clock care for individuals with significant medical needs, assisted living residences offer a more homelike environment. Residents typically live in private or semiprivate apartments and receive help with activities of daily living — such as bathing, dressing, grooming, and mobility.
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Nursing homes are licensed and inspected by the state Department of Public Health. Assisted living residences are certified by the Executive Office of Aging & Independence (AGE), which does not require the same level of clinical staffing or oversight.
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'[Assisted living residences are] very loosely regulated,' said Malka Young, an aging consultant and director of Allies in Aging JFS Elder Care Solutions.
Young says each facility varies by the level of care that's needed. The care involves one wellness nurse, which can only provide first aid.
'The one nurse is responsible for the well being of each person in the community. They can't give injections, they can't take blood pressure, so there's not really any medical services,' she explained.
What are the different types of aging services?
Managed long-term care programs include:
Program of All-inclusive Care for the Elderly (
Senior Care Options (
Aside from aging at home, options for long-term care include:
Senior housing (includes public, privately-owned subsidized, and congregate and supportive housing)
Continuing Care Retirement Communities are sometimes known as a life plan community, where
independent living, assisted living, and skilled nursing care are offered.
Assisted living residences provide meals, housekeeping, and help with personal care, but charge separately for additional services like medication management or assistance with bathing and memory care.
Rest Homes / Residential Care Facilities are considered a healthcare facility, though they offer basic care, not skilled nursing, and are often included in MassHealth coverage.
Nursing/skilled-nursing and rehabilitation facilities operate under a medical model, offering care typically covered by Medicaid or long-term care insurance and could include memory care units.
How much does it cost — and who pays?
The average monthly cost for assisted living in Massachusetts is nearly $10,000, or $300 a day, depending on location, room type and level of care, according to
'Each person is given an individual care plan, and sometimes you have up to one hour of care and if you need help with your medications, then that's an additional fee,' Young said.
Nursing homes are more expensive, often exceeding $13,000 per month, but may be partially covered by Medicaid if the resident qualifies financially.
Health insurance only covers assisted living facilities if someone has long term care insurance.
'I'll have couples come to me and they'll have a million dollars, and they think they have a lot of money, but that's really not a lot of money if someone's in their late 70s or even early 80s,' Young said.
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Gabriel House served a high number of low-income seniors.
More than 75 percent of its residents are enrolled in Medicaid, state officials have said, and it charges significantly less than a typical assisted living facility does for private-paying patients. Built in 1964, Gabriel House had been the subject of several complaints from family members about living conditions, the Globe
Subsidies also depend on potential tax credits, the median income of the community and what they offer
.
'Gabriel House in Fall River was mainly for people who were on veterans benefits or MassHealth,' Young explained. 'But there's a subgroup of regular assisted livings that depended on how the building itself was financed, they're called tax credit units.'
Robin Lipson, secretary of AGE, raised the possibility that facilities that heavily dependent on government housing or Medicaid payments, 'should be regulated or supported in a different way' from those that rely on private payers.
Michelle Woodbrey, co-owner of 2Sisters Senior Living Advisors, serving families across New England, said assisted living facilities that support lower income seniors are rare to find and 'often don't provide high levels of care.'
'If you're on MassHealth and can't pay privately, a nursing home is typically your only option, and there are very few exceptions,' she said.
Each year, Woodbrey said, more people are falling into a growing gap: they don't meet the high medical threshold for nursing home care, but can't afford assisted living or home care services.
' . . . someone can't just move into a nursing home because they're out of money. There's this group of people who fall between the cracks. Gabriel House served many of those people.'
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How do you know that the one you've selected is high quality?
Young suggests people consider how long staff has been there in a high-turnover job market, if there's an on-site chef , and what types of activities and length of stays are offered.
'Ask about the staff's education,' she advises. Also,some programs, will highlight they have a resident committee and they vote on what they want. Well, that means they don't have any staff or professional input.'
Sarah Rahal can be reached at