ALFs, LTCFs & SNFs — Decrypting the Alphabet Soup

There are many different types of facilities for people who are unable to remain in their own homes or apartments – assisted living facilities, homes for the elderly, foster care homes, nursing homes, and personal-care homes, to name a few. For persons who are not in the elder and disabled care business, the variety can be confusing. Three of the most important general types of facilities are assisted living facilities, long-term care facilities, and skilled nursing facilities.

The information at is helpful in comparing “nursing homes” and “assisted living facilities” (ALFs). The chart is easy to understand and presents a coherent picture of both types of care. is one of a set of websites cataloging different organizations that provide care to persons with disabilities. The other websites are,, and The nursing home versus assisted-living facility chart was compiled by the publishers of and

The “SNF” website provides comprehensive and generally accurate information about nursing homes, but it attempts to erase the distinction between nursing homes and skilled nursing facilities. A decision was made in creating the websites and chart to refer to nursing homes as skilled nursing facilities. A possible reason is that the term “skilled nursing facility” has a more positive connotation than “nursing home.” This is a re-branding decision that sows confusion where greater clarity is needed. People often use the term “skilled care facility” (SNF) to mean “nursing home” or “long-term care facility” (LTCF) and vice versa. This article and the accompanying table will sort out the differences between LTCFs and SNFs.

Re-labeling LTCFs as SNFs is like re-labeling pickup trucks as sport-utility vehicles because SUVs are considered to be more classy than pickups. However, confusing the LTCF/SNF distinction is more pernicious because some SNFs are also LTCFs and the difference is not apparent to the general public. Nursing care, also called basic care, is not the same as skilled care. The distinction is apparent in that persons in LTCFs are usually called “residents,” while persons in SNFs are “patients.”

Nursing care, or basic care, is provided by aides or Certified Nursing Assistants (CNAs) to residents who need medical and non-medical care due to chronic illness or disability. To qualify for care in an LTCF, the resident must need help with two or more activities of daily living (ADLs): dressing, bathing, transferring (moving from bed to wheelchair or chair), eating, and toileting; or must require 24/7 supervision due to mental incapacity.

Skilled care is health care provided when the patient needs skilled nursing or rehabilitation staff to manage, observe, and evaluate care. Skilled care might involve intravenous injections and drips, nutrition or fluids through tubes, wound care, ventilator management, or various types of therapy. Skilled care requires the involvement of skilled nursing or rehabilitative staff in order to be given safely and effectively.

The following table contrasts SNFs and LTCFs:


John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2012 John B. Payne, Attorney

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