Options for long-term care mean more choice for older adults

The Bottom Line

  • Long-term care refers to a range of services designed to help people who have lost function due to chronic illness or disability.
  • Home/community based care, assisted living and nursing home care all have related risks and benefits.
  • Decisions about long term care settings should consider the needs and unique circumstances of individuals and the people caring for them.

Long-term care refers to a range of services designed to help people who have lost function due to chronic illness, disability or advanced age. The type, frequency and intensity of services vary depending on the person’s needs but they usually involve housing, assistance with day-to-day activities and/or medical care. Most long-term care patients are 65 years or older (1).

Traditionally, long-term care has been associated with institutions such as nursing homes that provide 24-hour room and board, supervision and nursing/medical care. But long-term care is also provided in other settings: at home (either the individual’s home or that of a family member) or at one of several other types of residential/assisted living facilities.

The majority of older adults receive long-term care informally at home, from unpaid non-professionals – usually family members or friends (2). As needs change, the family may arrange for additional support, for example, a weekly or biweekly visit from a home care professional. Initially, the main advantage of home/community-based care was that it was much less expensive than going into a nursing home. Today, that’s still a factor for some, but it’s usually not the most important one. As more and more older adults strive to stay active, maintain their independence and enjoy a good quality of life, many prefer home/community-based long-term care (3).

It sounds great but it begs the question, is it a safe and effective long-term care option?

What the research tells us

To answer this question, the Agency for Healthcare Research and Quality (based in the US) compiled, reviewed and summarized the results of 32 studies conducted from 1995 to 2012 comparing home/community-based care and assisted living to nursing home care for older adults (4). What they found was that changes in physical and thinking abilities and emotional well-being did not differ greatly between nursing home and assisted living residents. There was also no significant difference in the mortality rate between residents in these two environments.

The comparisons between nursing home care and home/community-based care were not as clear, however the researchers found that different living environments pose different risks.  For example, nursing home residents were less likely to experience pain or use anti-anxiety medication but were more likely to get pneumonia or have a pressure sore than older adults who were receiving home/community-based care.   

What does that mean for older adults and their families weighing the pros and cons of long-term care options? While the evidence is considered “low-strength” and further research is recommended, these studies suggest that the risks and benefits may not be significantly different between home/community-based care, assisted living or nursing home care. Ultimately the best setting suits the needs and unique circumstances of each individual and the people caring for them. 

Get the latest content first. Sign up for free weekly email alerts.
Author Details


  1. Kaye HS, Harrington C. La Plante MP. Long-term care: who gets it, who provides it, who pays, and how much? Health Aff. 2010; 29:11-21. 
  2. Feinberg L, Reinhard S, Houser A et al. Valuing the Invaluable: The growing contributions and costs of family caregiving. Washington DC: AARP Public Policy Institute. 2011. 
  3. Keenan TA. Home and community preferences of the 45+ population. Washington DC: AARP Research & Strategic Analysis; 2010. 
  4. Wysocki A, Butler M, Kane RL et al. Long-term care for older adults: A review of home and community-based services versus institutional care. Agency for Healthcare and Quality (US). 2012;Report no 12 (3):EHC134-EF.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

Want the latest in aging research? Sign up for our email alerts.

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use