When a loved one needs more care than can be provided at home many families find themselves navigating an unfamiliar landscape of care options. Nursing homes, assisted living facilities, memory care units, and continuing care retirement communities all serve different needs at different levels of care and cost. Understanding the differences can help families make more informed decisions during a stressful time.
Skilled nursing facilities
A skilled nursing facility — commonly called a nursing home — provides the highest level of care outside of a hospital. It is designed for people who require around the clock medical supervision and assistance with most or all daily activities.
Skilled nursing facilities provide:
- 24 hour nursing care
- Assistance with bathing, dressing, eating, and mobility
- Physical, occupational, and speech therapy
- Medical monitoring and wound care
- Social services and activities
- Meals and nutrition management
Skilled nursing facilities are licensed and regulated by state and federal governments. They are the only type of long term care facility covered by Medicaid for extended stays and by Medicare for short term skilled care following a qualifying hospital stay.
Assisted living facilities
Assisted living facilities provide housing, personal care, and support services for seniors who need some help with daily activities but do not require the intensive medical care of a skilled nursing facility. Residents typically live in their own private or semi-private apartments and receive assistance as needed.
Assisted living facilities typically provide:
- Help with bathing, dressing, grooming, and medication management
- Meals served in a common dining area
- Housekeeping and laundry services
- Social activities and transportation
- Some health monitoring services
Assisted living is not covered by Medicare. Medicaid covers assisted living in some states through home and community based waiver programs but coverage varies widely. Most assisted living residents pay privately.
Memory care facilities
Memory care facilities are specialized units or standalone facilities designed specifically for people with Alzheimer’s disease, dementia, or other forms of cognitive impairment. They provide a secure environment with staff trained in dementia care.
Memory care facilities typically offer:
- Secured or locked environments to prevent wandering
- Staff specially trained in dementia care
- Structured daily routines designed for cognitive impairment
- Therapeutic activities focused on cognitive engagement
- Higher staff to resident ratios than standard assisted living
Memory care may be a standalone facility or a dedicated wing within an assisted living facility or skilled nursing facility. Costs are generally higher than standard assisted living due to the specialized care provided.
Independent living communities
Independent living communities — also called retirement communities or senior apartments — are designed for active seniors who do not need assistance with daily activities but want to live among peers in a maintenance free environment.
Independent living typically offers:
- Private apartments or cottages
- Dining options ranging from optional meal plans to full service dining
- Social activities, fitness facilities, and amenities
- Housekeeping and maintenance services
- Transportation services
Independent living does not provide personal care or medical services. Residents must be able to care for themselves independently. These communities are not licensed as healthcare facilities and are not covered by Medicare or Medicaid.
Continuing care retirement communities
A continuing care retirement community — also called a life plan community — offers multiple levels of care on a single campus. Residents can move from independent living to assisted living to skilled nursing care as their needs change without having to relocate to a different facility.
Continuing care retirement communities typically offer:
- Independent living apartments or cottages
- Assisted living services
- Memory care
- Skilled nursing care
These communities usually require a significant entrance fee ranging from tens of thousands to hundreds of thousands of dollars depending on the location and contract type, plus monthly fees. In exchange residents are guaranteed access to higher levels of care as needed.
Adult day care centers
Adult day care centers provide daytime care and supervision for seniors in a community setting, allowing family caregivers to work or take a break from caregiving responsibilities. Participants return home in the evening.
Adult day care typically provides:
- Supervision and personal care assistance
- Social activities and therapeutic programming
- Meals and snacks
- Some health monitoring services
- Transportation in many programs
Adult day care is significantly less expensive than residential care options and may be covered by Medicaid in some states. It can be an effective way to delay or supplement residential care.
Home care and home health care
For seniors who wish to remain at home two types of in-home services are commonly available:
- Home care — provides non-medical assistance with daily activities such as bathing, dressing, meal preparation, housekeeping, and companionship. Home care workers are sometimes called home health aides or personal care aides.
- Home health care — provides skilled medical services in the home such as wound care, physical therapy, medication management, and monitoring of medical conditions. Home health care is ordered by a physician and may be covered by Medicare under certain conditions.
How to choose the right type of care
Choosing the right care setting depends on several factors including:
- The level of medical care required
- The presence of cognitive impairment
- The person’s preference for independence and privacy
- The availability of family caregivers
- Financial resources and insurance coverage
- Geographic location and availability of facilities
A geriatric care manager — a professional who specializes in assessing the needs of older adults and coordinating care — can be a valuable resource for families navigating these decisions.
Key terms to know
- Skilled nursing facility — a licensed facility providing 24 hour medical care and supervision
- Assisted living — a residential setting providing personal care assistance without intensive medical services
- Memory care — specialized care for people with dementia or Alzheimer’s disease
- Independent living — housing for active seniors who do not need personal care assistance
- Continuing care retirement community — a campus offering multiple levels of care from independent living through skilled nursing
- Adult day care — daytime supervision and care in a community setting
- Home health care — skilled medical services provided in the home
- Geriatric care manager — a professional who assesses needs and coordinates care for older adults
Sources
- Medicare.gov — Nursing Home Compare
- Medicaid.gov
- National Institute on Aging
- USA.gov — Eldercare
This article is for general informational purposes only and does not constitute legal, financial, or medical advice. Laws and program details vary by state and are subject to change. Consult a licensed professional for guidance specific to your situation.