If the person with Alzheimer’s or other dementia prefers a communal living environment or needs more care than can be provided at home, a residential setting may be the best option. Different types of communities provide different levels of care, depending on the person’s needs.

Types of Residential Care

Learn about the different types of long-term care to determine which one best fits the needs of the person living with dementia.

Retirement Housing

Retirement housing may be appropriate for individuals in the early stage of Alzheimer’s (sometimes referred to as the mild stage in a medical context) who are still able to care for themselves independently. This type of senior housing generally provides limited supervision and may offer opportunities for social activities, transportation and other amenities.

Assisted Living (Also Called Board and Care, Adult Living or Supported Care)

Assisted living bridges the gap between living independently and living in a nursing home. It typically offers a combination of housing, meals, supportive services and health care. Assisted living is not regulated by the federal government and its definitions vary from state to state. Not all assisted living providers offer services specifically designed for people with dementia, so it is important to ask.

Nursing Homes (Also Called Skilled Nursing Facility, Long-Term Care Facility or Custodial Care)

Nursing homes provide around-the-clock care and long-term medical treatment. Most nursing homes have services and staff to address issues such as nutrition, care planning, recreation, spirituality and medical care.

Nursing homes have different staff-to-resident ratios, and their staff members have various levels of experience and training. Nursing homes are licensed by the state and regulated by the federal government.

Alzheimer’s Special Care Units (SCUs) (Also Called Memory Care Units)

SCUs are designed to meet the specific needs of individuals with Alzheimer’s and other dementias. SCUs can take many forms and exist within various types of residential care communities, including assisted living, and they may or may not be locked or secured units. Such units most often are cluster settings in which persons living with dementia are grouped on a floor or a unit within a larger residential care building.

Some states have legislation requiring nursing homes and assisted living residences to disclose their fees and list the specialized services their SCU provides, including a trained staff, specialized activities and ability of staff to care for residents with behavioral needs. Because laws vary, it is important to ask specific questions about what type of care is provided in an SCU to ensure that the level of care is appropriate for the person.

Life Plan Communities (Formerly Known as Continuing Care Retirement Communities or CCRCs)

Life plan communities provide different levels of care (independent, assisted living and nursing home) based on individual needs. A resident is able to move throughout the different levels of care within the community if his or her needs change. Payment for these types of services can include an initial entry fee with subsequent monthly fees or payment may be based solely on monthly fees.

When Living at Home Is No Longer an Option

There may come a time when the person living with Alzheimer’s disease or dementia will need more care than can be provided at home. During the middle stages of Alzheimer’s, it becomes necessary to provide 24-hour supervision to keep the person with dementia safe. As the disease progresses into the late-stages, around-the-clock care requirements become more intensive.

Making the decision to move into residential care may be very difficult, but it is not always possible to continue providing the level of care needed at home.

The questions below may be helpful when determining if a move to residential care is a good option:

• Is the person with dementia becoming unsafe in their current home?
• Is the health of the person with dementia or my health as a caregiver at risk?
• Are the person’s care needs beyond my physical abilities?
• Am I becoming a stressed, irritable and impatient caregiver?
• Am I neglecting work responsibilities, my family and myself?
• Would the structure and social interaction in this setting benefit the person with dementia?

Even if you planned ahead with the person for a move, making this transition can be a stressful experience. You may feel guilty and wonder if you are doing the right thing. These feelings are common. Families that have been through the process tell us that it is best to gather information and move forward. Keep in mind, that regardless of where the care takes place, the decision is about making sure the person receives the care they need.

Costs

The cost for care varies widely depending on the type of provider. The national average cost for basic services in an assisted living setting is $57,289 per year.^* The average cost for a private room in a nursing home is $115,007 per year^* and the average cost for a semi-private room in a nursing home is $100,679 per year.^*

Most families pay for long-term care costs out of their own pockets. Types of benefits that may cover nursing care include long-term care insurance (check the policy as certain requirements may need to be met before receiving benefits), Veterans benefits and Medicaid.

Medicare does not cover the cost of care in a residential care community. Medicare only covers short-term skilled care after a hospital stay.

^*Genworth. (n.d.). Cost of long-term care by state: Cost of care report. Genworth. https://www.genworth.com/aging-and-you/finances/cost-of-care.html