Assisted Living vs. Long-Term Care in BC: What's the Difference?

If you are helping a parent or loved one find care in British Columbia, you have probably encountered the terms "assisted living" and "long-term care" (sometimes called "residential care" or "nursing home"). Many families use these terms interchangeably, but in BC they refer to very different levels of care with different costs, regulations, and admission processes.

Understanding the distinction matters because it affects what your loved one pays, what care they receive, and how you access it. This guide breaks down the key differences so you can make an informed decision.

Assisted living in BC is designed for seniors who need some daily support but can still live relatively independently. Here is what defines it:

• Living arrangement: Private suites (studio or one-bedroom) with a kitchenette, bathroom, and living space. Residents have their own front door.
• Care provided: Help with daily activities like bathing, dressing, grooming, and medication management. Meals, housekeeping, and laundry are included.
• Staffing: Personal care aides available during the day and evening. Overnight monitoring but not 24-hour nursing care.
• Independence: Residents can come and go freely (unless in a secured dementia unit). They maintain their own routine and lifestyle.
• Regulation: Governed by the Community Care and Assisted Living Act. Registered with the Assisted Living Registrar.

Assisted living works well for seniors who need a safety net — someone checking in daily, help with meals and medications — but do not need constant nursing oversight.

Long-term care (residential care) is for seniors with complex health needs who require round-the-clock professional nursing care. Here is what defines it:

• Living arrangement: Single or shared rooms within a care facility. Less private than assisted living — residents typically have a room with a bed and personal space, but share common areas.
• Care provided: 24-hour nursing care including wound care, IV therapy, complex medication management, mobility assistance, and end-of-life care. All meals, housekeeping, and personal care included.
• Staffing: Licensed practical nurses (LPNs) and registered nurses (RNs) on site at all times, supported by care aides. Higher staff-to-resident ratios than assisted living.
• Independence: More structured daily routine. Residents may have limited mobility and require assistance with most activities of daily living.
• Regulation: Licensed under the Community Care and Assisted Living Act. Subject to health authority inspections and Seniors Advocate oversight.

Long-term care is appropriate when someone's health has declined to the point where they cannot safely manage, even with daily support. This includes advanced dementia, significant physical frailty, or complex chronic conditions.

The right level of care depends on your loved one's specific situation. Here are some questions to help guide the decision:

Assisted living may be right if your loved one:

• Can walk independently or with minimal assistance
• Needs help with some daily tasks (cooking, cleaning, bathing) but not constant supervision
• Can manage their own medications with reminders or simple assistance
• Is cognitively aware enough to use an emergency call system
• Would benefit from social activities and community living
• Does not require regular nursing procedures (wound care, injections, catheter care)

Long-term care may be right if your loved one:

• Requires assistance with most or all activities of daily living
• Has advanced dementia and needs a secured environment
• Needs regular nursing care (wound management, complex medications, monitoring)
• Has had multiple falls or is at high risk of falling
• Cannot be safely left alone for extended periods
• Has been assessed by a health authority case manager as needing residential care

If you are unsure, request a Home & Community Care assessment. The case manager's evaluation will clarify which level of care is clinically appropriate.

How you access assisted living versus long-term care differs depending on whether you are going through the public system or choosing private-pay.

Subsidized (public) pathway:

1. Contact your health authority's Home & Community Care office
2. A case manager conducts a clinical needs assessment
3. Based on the assessment, you are approved for assisted living or long-term care
4. You choose up to three preferred facilities
5. You are placed on a waitlist
6. When a spot opens, you receive an offer (typically 24-48 hours to accept)

Private-pay pathway:

1. Research and visit facilities directly
2. The facility may conduct its own assessment to determine if they can meet your loved one's needs
3. If accepted, sign the residency agreement and arrange move-in
4. No health authority waitlist — availability depends on the facility

Many families use a combination approach: getting on the subsidized waitlist while exploring private-pay options that may have immediate availability.

Yes, and this is actually one of the most common transitions in senior care. Many people start in assisted living and move to long-term care as their needs increase. Here is what to know about the transition:

• Reassessment: If your loved one's needs change, request a reassessment from their case manager. The new assessment may recommend a higher level of care.
• Facility transitions: Some facilities offer both assisted living and long-term care on the same campus. This allows a smoother transition without a complete change of environment.
• Timing: The transition does not always happen immediately. There may be a waitlist for long-term care placement even if your loved one is already in the system.
• Family advocacy: If you feel your loved one is not receiving adequate care at their current level, speak up. Talk to the care team and request a reassessment if needed.

Planning for this potential transition is wise. When choosing an assisted living facility, ask about their process for residents whose needs increase and whether they have long-term care beds on the same site or a relationship with nearby long-term care homes.

Retirement homes (also called independent living communities) are a third option that sometimes adds to the confusion. Here is how they fit in:

• No regulated care: Retirement homes do not provide personal care or nursing services. They offer housing with amenities like meals, housekeeping, social activities, and sometimes transportation.
• Fully private-pay: There is no subsidized retirement home option in BC. Costs typically range from $2,500 to $6,000+ per month.
• No health authority involvement: You do not need an assessment or referral. You apply directly to the community.
• Best for: Active seniors who want a social community with convenient services but do not need help with personal care.

If your loved one is still quite independent but you are worried about isolation, nutrition, or home maintenance, a retirement home might be the right first step before assisted living or long-term care becomes necessary.

Finding the right care option in BC can feel overwhelming, but you do not have to figure it out alone. Here is where to start:

• Request an assessment: Contact your regional health authority's Home & Community Care office for a professional evaluation of your loved one's needs.
• Research facilities: Use CareCompare to search and compare assisted living and long-term care facilities across BC, complete with quality data and reviews.
• Talk to other families: Caregiver support groups (like those offered through the BC Caregiver Support Line at 1-877-520-3267) can provide invaluable firsthand insight.
• Visit in person: No amount of online research replaces walking through a facility and meeting the staff.

The most important thing is to start the process before a crisis forces a rushed decision. Planning ahead gives you more options and better outcomes.