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Investigate long-term care options


Facility-based long-term care may be needed when an older adult can no longer safely or comfortably look after themselves or when in-home caregivers can no longer safely or effectively look after them. This article lists the main types of long-term care facilities and when it might be appropriate for the older adult to move into one. It then lists some key factors in choosing a facility, typical costs of each kind, and ways to pay.

When to consider long-term care 

Facility-based long-term care may be the best option when an older adult can no longer safely or comfortably look after themselves or when in-home caregivers (including family caregivers) can no longer safely or effectively look after them.

Three major options for facility-based long-term care are: 

  1. Assisted living facilities / communities 
  2. Memory care facilities 
  3. Skilled nursing facilities (also called nursing homes)

When to consider an assisted living facility

Assisted living facilities (also known as assisted living communities) are residences for older adults who are still active but need help with some activities of daily living (ADLs), such as bathing, dressing, or toileting. They are appropriate only for people whose medical needs are fairly low, as they do not offer extensive medical care or continual monitoring.

Signs that an older adult may be better off in an assisted living facility than at home include:

  • The person can’t carry out some ADLs and family members are unavailable, unwilling, unable, or lacking in the confidence to provide caregiving
  • In-home care is becoming more complicated or expensive than having the person live in a facility 
  • The person is showing signs of loneliness or isolation
  • The person’s care needs have become too high for family caregivers to manage safely
  • Family caregivers have reached the point of chronic stress or burnout

When to consider a memory care facility

Memory care facilities are residences that are specially designed to serve older adults with dementia and other cognitive conditions. They provide 24-hour supervision, specially trained staff, and security features such as alarmed doors and tracking devices to keep residents from wandering.

Some memory care facilities are special units within assisted living facilities or nursing homes; others are standalone facilities. A memory care unit or facility might be appropriate if:

  • The older adult has mid- to late-stage dementia
  • The older adult is becoming aggressive or starting to wander
  • The home cannot be sufficiently adapted to keep the person safe
  • The caregivers are burned out, worried about the person’s safety and well-being, or worried about their own safety

When to consider a skilled nursing facility (nursing home)

Skilled nursing facilities, commonly referred to as nursing homes, are hospital-like facilities for people with medical needs that require extensive care and monitoring. Unlike with assisted living facilities or memory care facilities, the older adult needs to qualify to be admitted into a nursing home. They do this by meeting their state’s criteria for “Nursing Home Level of Care.” The main criterion is usually that the person is unable to take care of themselves in at least two of the following four ways: medical, cognitive, behavioral, or functional.

It may be time to consider a skilled nursing facility if the older adult meets the previously mentioned criteria and also:

  • Has a medical condition besides dementia
  • Is non-ambulatory (unable to walk)
  • Is falling or injuring themselves, or is clearly at risk of doing so
  • Has been discharged from the hospital and needs rehabilitation
  • Has medical needs beyond what family caregivers can reasonably or safely provide

Choosing a long-term care facility

There are several main steps in choosing the right long-term care option:

  1. Decide on the level and type of care—assisted living, memory care, or a skilled nursing facility—that is appropriate for the older adult’s condition. 
  2. Make a list of local options. Good resources for this are the Medicare Compare tool and the AARP and Alzheimer’s Association’s Community Resource Finder.
  3. Look at brochures or websites for each. 
  4. Visit each facility on the list, ask questions about services and training, and narrow down the options to a short list.
  5. Revisit the short-list options multiple times, including after business hours, when fewer staff may be present. If possible, have a meal there.
  6. Consider the results in light of factors such as
  • Location
  • Cost
  • The “feel” and attractiveness of the facility
  • How happy the residents seem and how well staff members interact with them
  • Level of staff training
  • Security and safety measures

The non-profit group Argentum (formerly ALFA) offers an extensive checklist for assessing and selecting a long-term care facility. It is a very useful guide to the process.

Costs and funding for long-term care

Costs vary for the three main types of long-term care, with assisted living being the least expensive, nursing homes the most expensive, and memory care usually falling in the middle.

As of 2021:

  • Assisted living facilities cost an average of $2,500 to $4,000 a month.1 
  • Memory care units cost an average of $7,000 a month2
  • Semi-private rooms in skilled nursing facilities cost an average of $275 a day, or about $8,300 a month.3 

Assisted living funding

Most assisted living costs are paid for privately. People fund this using personal savings, sale of the home or a life-insurance policy, etc. Assisted living facilities are generally not covered by Medicare, but they may be covered by Medicaid if the person receiving care has a low enough income or has used up all of their own money.4 However, only people in facilities that belong to the state-funded Medicare program will be able to apply for these benefits. Long-term care insurance policies usually will start paying for care if the person receiving care is unable to do at least two activities of daily living and has paid out of pocket for 30-90 days.5

Skilled nursing facility funding

Medicare often pays for a short amount of time (usually the first 100 days) in a nursing home, but not for long-term care. In Medicaid-certified facilities, residents with a low enough income can qualify for Medicaid coverage; by law, residents in these facilities cannot be discharged if their personal funds run out. Those in non-certified nursing homes, however, can be discharged. 

Memory care funding

As with other conditions, benefit programs don’t offer funding specifically for dementia or other memory conditions. Therefore, memory care can be paid for either privately or partly through Medicare/Medicaid, depending on whether the person receiving care is in an assisted-living or skilled-nursing level of facility. 

Related information

Assisted living facilities

Balance care responsibilities

Dementia: support for caregivers

Nursing homes and memory care

Skilled nursing facilities (nursing homes)

Paying for long-term care

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