Types of residential care
A good long-term care facility should feel comfortable and homelike. Feeling at home offers privacy and provides opportunities to meet with other residents.
Learn about the different types of residential care to determine which one best fits the needs of the person with dementia.
Retirement housing may be appropriate for individuals with early-stage Alzheimer's who are still able to care for themselves independently. A person may be able to live alone safely, but has difficulty managing an entire house. Generally, this type of senior housing provides limited supervision and may offer opportunities for social activities, transportation and other amenities.
Assisted living (also called board and care, adult living, 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 facilities 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, custodial care)
Nursing homes provide round-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. Different nursing homes have different staff-to-resident ratios. Also, the staff at one nursing home may have more experience or training with dementia than the staff at another. Nursing homes are usually 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. Including assisted living facilities, and they may or may not be locked or secure units. Such units most often cluster settings in which persons with dementia are grouped on a floor or a unit within a larger residential care facility. Some states have legislation requiring nursing homes and assisted living residences to disclose their fees and list the specialized services their SCU provides, including 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 a SCU to ensure that the level of care is appropriate for the person.
Continuing care retirement communities (CCRC)
CCRCs 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 facilities 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
Join our ALZConnected online community and get advice and support from other caregivers facing similar situations.
There may come a time when the person 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, round-the-clock care requirements become more intensive.
Making the decision to move into a residential care facility may be very difficult, but it is not always possible to continue providing the level of care needed at home. The questions below may helpful when determining if a move to residential care 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 at a care facility 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 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 needed.
Choosing a care setting
Find the right fit
Use our Community Resource Finder to search for local residential care facilities.
- Plan on visiting several care facilities. Take a look around and talk with the staff, as well as residents and families.
- When you visit a care facility, ask to see the latest survey/inspection report and Special Care Unit Disclosure form. Facilities are required to provide these. The report and the disclosure form can give you a picture of the facility's services.
- Visit the facilities at different times of the day, including meal times.
- Ask the care facility about room availability, cost and participation in Medicare or Medicaid. Consider placing your name on a waiting list even if you are not ready to make a decision about a move.
- If you will be paying for the facility out of pocket, ask what happens if the person with dementia runs out of money. Some facilities will accept Medicaid; others may not. If you anticipate the need for Medicaid either now or in the future, plan to visit with a lawyer that specializes in elder care prior to moving into a facility to ensure a good financial plan is in place.
Care facility checklist
When choosing a care facility, there are a number of factors to consider, including the staff, the facility, the programs and the type of treatment residents receive. Use this checklist when considering a facility:
- Families are encouraged to participate in care planning
- Families are informed of changes in resident's condition and care needs
- Families are encouraged to communicate with staff
- Medical care is provided
- Personal care and assistance is provided
- Staff recognize persons with dementia as unique individuals, and care is personalized to meet specific needs, abilities and interests
- Staff is trained in dementia care
- Physicians and nurse practitioners on premises and registered nurse on site at all times
- Staff can handle challenging behaviors
- Ratio of residents to staff
Programs and Services
- Appropriate services and programming based on specific health and behavioral care needs are available
- Planned activities take place (ask to see activity schedule; note if the activity listed at the time of your visit is occurring)
- Activities are available on the weekends or during evenings
- Activities are designed to meet specific needs, interests and abilities
- Transportation is available for medical appointments and shopping for personal items
- Care planning sessions are held regularly
- Therapies available such as physical, occupational, speech and recreational
- Religious services and celebrations available to residents
- Personal care is done with respect and dignity; personal care times flexible, based on individual’s schedule
- Residents are comfortable, relaxed and involved in activities
- Residents are well-groomed, clean and dressed appropriately
- Rate of falls for residents
- Residents with psychiatric illness as their primary diagnosis on the same unit as residents with dementia
- Facility is free of unpleasant odors
- Indoor space allows for freedom of movement and promotes independence
- Indoor and outdoor areas are safe, secure and monitored
- The facility is easy to navigate
- There is a designated family visiting area
- Resident rooms are clean and spacious
- Residents are allowed to bring familiar items with them, such as photos, bedding a chair
- There are regular meal and snack times
- Food is appetizing (ask to see the weekly menu and come for a meal)
- The dining environment is pleasant
- Family and friends are able to join at mealtime
- Staff have a plan for monitoring adequate nutrition
- Staff are able to provide for any special dietary needs
- Staff provide appropriate assistance based on person's abilities (for example, encouragement during meals or assisted feeding in advanced stages)
- There are no environmental distractions during meal time (noisy TV etc.)
Policies and Procedures
- Family and friends able to participate in care
- Visiting hours work for the family
- Discharge policy has been discussed (learn about any situation or condition that would lead to a discharge from the facility, such as change in behavior or financial circumstances)
- As residents needs change, availability of continuing care
- Aging in place policy where residents can remain in the facility, even in the same room, throughout the course of the disease
- Escort to the emergency room if a visit is required
- Available end-of-life, hospice care
The cost for care varies widely depending on the type of facility. The national average cost for basic services in an assisted living facility is $45,000 per year*. In a nursing home, the average cost for a private room in a nursing home is $97,455 per year* and the average cost of a semi-private room in a nursing home is $85,775 per year.*
Most families pay for residential 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 long-term care in a care facility. Medicare only covers short-term skilled care after a hospital stay.
*Source: Genworth Financial, Inc. Genworth 2017 Cost of Care Survey. Home Care Providers, Adult Day Health Care Facilities, Assisted Living Facilities and Nursing Homes.
Help is available
Alzheimer's Association 24/7 Helpline care consultants can help you with residential care decision-making and provide you support. Call us at 800.272.3900 or visit our online Community Resource Finder tool.
Medicare's Nursing Home Compare provides detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country.
Argentum offers information about assisted living, a checklist of questions to ask when considering a facility, and a provider directory to identify facilities in a particular area.
The National Long-Term Care Ombudsman Resource Center provides information about federal ombudsman or advocates for residents of nursing homes, board and care homes and assisted living facilities. Ombudsmen provide information about how to find a facility and what to do to get quality care.
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) website allows you to search for accredited long-term care facilities. An accredited facility is a nursing home or assisted living that meets very high standards of care set by JCAHO.