Care Settings: Assisted Living, Nursing Homes & Memory Care
Many buildings look the same from the outside — but “assisted living,” “memory care,” “skilled nursing,” and “independent living” all follow different rules, have different expectations, and are paid for in different ways. This page uses publicly available information to explain the basics in plain language.
This is educational only. It is not legal, financial, or medical advice, and does not recommend any specific facility or product.
Independent living (senior apartments, 55+ communities)
Independent living is usually housing for older adults who can live mostly on their own, with optional services layered on top.
- Looks like apartments or cottages.
- Often age-restricted (55+ or 62+).
- Focus is on housing, not hands-on care.
- Meals, housekeeping, and transportation may be offered as extras.
Payment: Usually private pay (rent + optional services). Medicare and Medicaid generally do not pay for rent here.
Assisted living
Assisted living is designed for people who need help with daily activities but do not require full nursing home care.
- Help with dressing, bathing, medications, meals, and housekeeping.
- Staff on site, but not the same level as a hospital or nursing home.
- Private or semi-private apartments/rooms with shared dining and activities.
- Some memory care units are located inside assisted living communities.
Payment: Mostly private pay. Some states have Medicaid waiver programs that help with services, but families usually still pay room and board.
Memory care
Memory care is structured for people with Alzheimer’s disease or other dementias who need a secure environment and more cueing or supervision.
- Secure units or buildings to reduce wandering risk.
- Staff trained in dementia communication and behavior support.
- Routines and activities tailored for memory support.
- Often located inside assisted living or as stand-alone communities.
Payment: Largely private pay. Medicaid coverage, where available, often helps with services but not room and board. Rules vary by state.
Skilled nursing facilities (nursing homes)
Nursing homes provide the highest level of ongoing medical and personal care outside a hospital. They may have both short-stay rehab and long-term care units.
- 24-hour nursing supervision.
- Help with all activities of daily living.
- Medication management and medical monitoring.
- On-site or visiting therapies (physical, occupational, speech).
Payment:
- Medicare: often covers short-term rehab after a qualifying hospital stay.
- Medicaid: the main payer for long-term nursing home care for people who qualify financially and medically.
- Private pay: families may pay out of pocket until Medicaid eligibility is met.
Short-term rehab vs. long-term placement
The same building may serve two very different roles:
- Short-term rehab: focused on recovery after hospitalization or surgery, usually for days to weeks.
- Long-term care: ongoing residence for those who cannot return home safely.
Families often don’t realize when a stay is shifting from “temporary rehab” to “long-term,” which has very different financial and emotional implications.
Questions to ask any facility
Regardless of level of care, families can use publicly available information and direct questions to get a clearer picture:
- How is this setting licensed in this state?
- What care is included in the base rate, and what costs extra?
- Do you accept Medicaid now? If so, under what circumstances?
- How many residents here are on Medicaid or assistance programs?
- What happens if a resident’s money runs out?
- How are staffing levels monitored and reported?
- Can I review recent inspection or survey reports?
Public reports (such as state inspections and federal datasets) can provide additional context, but they rarely tell the full story on their own.
Matching setting to needs and preferences
No single care setting fits everyone. Choosing between staying home, moving to assisted living, or transitioning to nursing home care often depends on:
- how much daily help is needed
- medical complexity and safety risks
- budget and benefit options (Medicare, Medicaid, VA, private pay)
- location and proximity to family
- personal preferences about privacy, community, and routine
Understanding how each setting works makes it easier to weigh options instead of deciding in fear or confusion.