Assisted Living vs. Nursing Home vs. Memory Care: How They Differ
The three differ mainly in how much care they provide, and Medicare pays for none of them as long-term care.
By naveen · Updated · How we research our guides
What to know
- Assisted living is for people who need help with daily care but less than a nursing home provides; memory care means special units for people with dementia; nursing homes add nursing care and 24-hour supervision.
- Medicare doesn't pay for long-term care in any of them; it covers only a short skilled nursing stay after a qualifying hospital stay.
- Medicaid can pay for nursing home care for people who qualify, and in some states for parts of assisted living.
- Help at home is an option worth comparing first.
- Retirement Checklist puts care decisions in order with the money and legal steps they depend on.
Assisted living vs. a nursing home comes down to how much care each provides. The National Institute on Aging (NIA) says assisted living "is for people who need help with daily care, but not as much help as a nursing home provides." Memory care is dementia care, and Medicare pays for none of them as long-term care.
We don't recommend specific facilities, chains or placement services, and we don't take referral fees from any of them.
| Assisted living | Memory care | Nursing home | |
|---|---|---|---|
| Level of care | Help with daily tasks and medications, 24-hour supervision | Special units with staff trained in dementia care | Nursing care, 24-hour supervision, therapy |
| Suited to | Needs help with daily care, not round-the-clock nursing | Living with Alzheimer's or another dementia | Can't care for themselves and may need ongoing medical care |
| Medicare pays long-term? | No | No | No: only a short skilled stay |
What is assisted living?
Assisted living is housing with help for people who need some daily care. NIA says residents "usually live in their own apartments or rooms and share common areas," with services that include "up to three meals a day; assistance with personal care; help with medications, housekeeping, and laundry; 24-hour supervision, security, and on-site staff; and social and recreational activities." It is less medical than a nursing home: NIA says nursing home services "focus more on medical care than most assisted living facilities." Exact arrangements "vary by facility and by state," in NIA's words.
What is memory care?
Memory care is care for people living with Alzheimer's or another dementia, provided in special units. NIA says "Some assisted living facilities have special Alzheimer's units with staff who check on and care for people with dementia," and "Some nursing homes have special Alzheimer's care units." Those units "are often in separate sections of the building where staff members have special training to care for people with dementia." When you visit, NIA suggests asking whether there is "a safe place for the person to go outside" and whether the unit's costs differ from the rest of the facility.
What is a nursing home?
A nursing home provides the most care of the three; NIA notes they are "also called skilled nursing facilities." NIA lists "nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities," plus physical, occupational and speech therapy. NIA describes nursing homes as being "for people who can't care for themselves anymore and may need ongoing medical care." Some stays are short: Medicare.gov says "Many nursing homes also offer skilled nursing facility care," which Medicare covers only on a short-term basis.
Who pays for assisted living and nursing homes?
Your parent pays, unless Medicaid or a long-term care policy applies. Medicare covers a skilled nursing stay only after "a qualifying inpatient hospital stay" of at least 3 days in a row, and "Part A limits SNF coverage to 100 days in each benefit period" (Medicare.gov). It doesn't pay for long-term care, "including care in a nursing home or in the community" (Medicare.gov), and NIA states that "Medicare does not pay for assisted living."
That leaves savings and income, long-term care insurance if a policy exists, and Medicaid for people who qualify. Unlike Medicare, Medicaid "does pay for custodial care in nursing homes and at home," according to the Administration for Community Living (ACL). For assisted living, NIA says Medicaid "may provide coverage for some aspects of assisted living, depending on the state and whether the person is eligible."
Can your parent stay at home instead?
Sometimes, with help. NIA calls this "aging in place" and lists the kinds of home-based support available: personal care, household chores, meals, transportation, and help with money and health care. Home changes count too: NIA suggests correcting dangers "such as loose stair railings and poor lighting" and installing grab bars near toilets and in the tub or shower. Adult day programs and short-term respite care can cover hours when a family caregiver isn't available.
The people matter as much as the house. NIA notes that "Family, friends, and neighbors are the biggest source of help for many older people," so it can help to ask early who is close enough to help, and for how long. NIA also says home-based services "can be expensive, but they may cost less than moving into a residential facility."
What questions are worth asking?
- What does your parent need help with day to day, and how is that changing?
- What does your parent want? Have they been asked directly?
- For any facility: what level of care can it provide, and what happens if needs increase beyond it?
- What would it cost per month where your parent lives, and how would that be paid for one year, and for five?
- Is there a power of attorney in place, so someone can sign the admission paperwork if needed?
Frequently asked questions
What is the difference between assisted living and a nursing home?
The amount of care. Assisted living offers a room or apartment, meals, help with personal care and medications, and 24-hour supervision for people who need help with daily care. A nursing home adds nursing care and therapy for people who can't care for themselves and may need ongoing medical care, according to NIA.
What is memory care?
Care for people living with dementia, provided in special units. NIA says some assisted living facilities and some nursing homes have special Alzheimer's units, where staff have special training to care for people with dementia. Ask what the unit provides and whether it costs more.
Does Medicare pay for assisted living?
No. Medicare doesn't pay for long-term care, and NIA says it does not pay for assisted living. Medicare Part A can cover a short stay in a skilled nursing facility, up to 100 days per benefit period after a qualifying inpatient hospital stay of at least three days in a row, but not ongoing custodial care.
How do I know when my parent can no longer live alone?
There's no single test. NIA lists signs that someone needs more support, including significant weight loss or gain, poor hygiene, confusion, falls, trouble walking, missed medications, and trouble cooking safely. NIA says the best way to know what someone needs is to ask them directly, and suggests a visit to a health care provider if you're concerned.
Is aging in place an option?
It can be, with support. NIA describes home-based care that covers personal care, chores, meals, transportation and help with health care, along with home safety changes such as grab bars and better lighting. Whether it works depends on how much care your parent needs, the home itself, and who is nearby to help.
What are the disadvantages of assisted living?
Cost and limits. NIA says "Most people pay the full costs of assisted living themselves," and Medicare does not pay for it. Its services focus less on medical care than a nursing home's, so a move may follow if needs grow. Arrangements vary by facility and by state, and NIA advises reading the contract carefully before signing.
Does my parent need assisted living or a nursing home?
It depends on care needs. NIA says housing choices may depend on the person's health, ability to perform activities of daily living, financial resources and personal preferences. If you're unsure which services would help, NIA suggests asking a health care provider. Your parent should be part of the decision.
Getting started
Every family's order is different. The plan this site builds asks four questions, including which state your parents live in, and puts the handful of steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- National Institute on Aging, Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care: What each setting provides and who pays.
- National Institute on Aging, Alzheimer's Caregiving: Finding Long-Term Care: Special Alzheimer's care units in assisted living and nursing homes.
- Medicare.gov, Long-term care coverage: Medicare's statement that it doesn't pay for long-term care.
- Medicare.gov, Skilled nursing facility care: The 100-day limit and the 3-day qualifying hospital stay.
- Administration for Community Living, Medicaid and long-term care: Medicaid's coverage of custodial care in nursing homes and at home.
- National Institute on Aging, Aging in Place: Growing Older at Home: Home-based care and paying for care at home.
- National Institute on Aging, Home Safety Tips for Older Adults: Lighting and grab bars.
- National Institute on Aging, How To Choose a Nursing Home or Other Long-Term Care Facility: Questions to ask and reading the contract.
- National Institute on Aging, Does an Older Adult in Your Life Need Help?: Signs that someone needs more support.
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