Housing and Care Options: From Aging in Place to Memory Care
Where should your loved one live as their needs grow? A sourced walk through aging in place, assisted living, nursing homes, and memory care — including what each actually costs and who pays.
Few caregiving decisions are heavier than where a loved one should live. The best time to plan is before a lot of care is needed — options narrow quickly in a crisis.[1]
Aging in place
Staying in your own home as you get older is called "aging in place," and a wide network of services supports it: personal care with bathing and dressing, household chores and meals, help managing money, in-home health care, transportation, and safety updates.[1] Go room by room to identify hazards, fixing immediate dangers like loose stair railings and poor lighting first; the National Institute on Aging publishes a home-safety checklist.[1]
Home-based services can be expensive, but they may cost less than moving into a residential facility.[1] Adult day programs, volunteer visitor programs, respite services, medical alert systems, and geriatric care managers (especially useful when family live far apart) fill gaps.[1] Financial help for home repairs and safety updates may be available through state housing finance agencies and social services departments.[1]
Residential options, from least to most care
- Board and care homes — small group homes, usually 20 or fewer residents, with staff around the clock for personal care and meals, but usually no nursing or medical care on site.[2]
- Assisted living — for people who need help with daily care but not the level a nursing home provides; communities typically offer several levels of care, with higher fees for more services. It bridges the gap between living independently and living in a nursing home.[2][3]
- Nursing homes (skilled nursing facilities) — 24-hour supervision, nursing care, meals, help with everyday activities, and rehabilitation therapies. They are licensed by the state and regulated by the federal government.[2][3]
- Memory care / special care units — dementia-specific settings that exist within various types of residential communities, often as a dedicated floor or unit, which may or may not be secured.[3] Assisted living is not federally regulated and definitions vary by state, so ask specifically what dementia services a community provides.[3]
- Life plan communities (CCRCs) — independent housing, assisted living, and skilled nursing on one campus, usually with a substantial one-time entrance fee plus monthly fees.[2]
Signs it may be time to consider a move: the person is becoming unsafe at home, their health or the caregiver's health is at risk, or care needs exceed what the caregiver can physically provide. During middle-stage Alzheimer's, 24-hour supervision becomes necessary.[3]
What it costs
The 2024 national median costs, from the Genworth/CareScout Cost of Care Survey:[4]
| Care type | 2024 national median |
|---|---|
| Adult day care | $26,000 / year |
| Assisted living community | $70,800 / year |
| Homemaker services | $75,504 / year |
| Home health aide | $77,792 / year |
| Nursing home, semi-private room | $111,325 / year |
| Nursing home, private room | $127,750 / year |
These costs are rising faster than incomes: from 2019 to 2024, home care and assisted living costs rose nearly 50 percent while household income for those 65+ grew 22 percent.[5] Costs also vary widely by state — as much as twice as high in the most expensive states as in the least costly.[5]
Who pays
The single most misunderstood fact in long-term care: Medicare generally doesn't cover long-term care in a nursing home, and Medicare does not pay for assisted living.[2][6] Most people who enter nursing homes start by paying out of pocket.[6] Medicaid — the joint federal-state program for people with limited income and resources — may cover nursing home care, and most, but not all, nursing homes accept it; many residents "spend down" assets until they qualify, so check early whether a chosen home accepts Medicaid.[6] If the person may need Medicaid later, the Alzheimer's Association recommends asking a community directly what happens if they run out of money, and consulting an elder-law attorney before move-in.[3] Long-term care insurance varies widely; some policies cover only nursing homes while others also cover adult day care, assisted living, and in-home care.[6]
Choosing well
Visit more than once — including at least one unannounced visit, and at different times of day, such as meal times. Ask to see the latest state inspection report and check Medicare's Care Compare tool.[3][2] After a move, get to know the staff, advocate for the person's preferences, and be supportive and listen to concerns — but don't argue with the older adult about why they need to be there.[2] Every state also has a Long-Term Care Ombudsman program that advocates for residents of nursing homes, board and care homes, and assisted living.[3]
The Eldercare Locator (800-677-1116, eldercare.acl.gov) is the federal front door for finding all of these services locally.[7]
Sources
Every numbered claim in this article links to one of these sources.
- 1Aging in Place: Growing Older at Home — National Institute on Aging (NIH), 2023
- 2Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care — National Institute on Aging (NIH), 2023
- 3Long-Term Care (residential care options for dementia) — Alzheimer's Association
- 42024 Cost of Care Survey — Genworth / CareScout, 2024
- 5AARP Report Finds Long-Term Care Costs Outpacing Americans' Incomes — AARP, 2026
- 6How can I pay for nursing home care? — Medicare.gov (CMS)
- 7Eldercare Locator — Administration for Community Living
This article is general information, not medical advice. Talk with a healthcare professional about your specific situation.