Assisted living is playing a growing role in dementia and memory care. According to a recent report from AARP, more people 85 and older now reside in assisted living than in nursing homes. Of assisted living residents, 44 percent live with Alzheimer’s disease or another dementia, and many communities are responding by adding or expanding memory care units.
For families navigating this landscape, the expansion of memory care is both an opportunity and a challenge. On one hand, assisted living can feel less institutional than a nursing home and may support quality of life for older adults who are still physically capable. On the other hand, assisted living and memory care are regulated mostly at the state level, and the name on the brochure doesn’t always tell you what level of care a facility can truly provide.
What Is Assisted Living?
Today, 1 million Americans live in assisted living communities. Assisted living is often described as a middle ground between independent living and a nursing home. It typically combines:
- Housing (a private or semi-private apartment or room)
- Meals and housekeeping
- Supervision and help with activities of daily living (ADLs), like bathing, dressing, and eating
- Some health-related services, which may include help with medication administration
Assisted living is not the same as a nursing home, which provides a higher level of medical oversight and skilled nursing care. Also, note that services offered by assisted living facility may vary by facility.
If your loved one needs round-the-clock medical care, you may need to look beyond assisted living.
How Do Assisted Living Facilities Serve Residents With Dementia?
Assisted living facilities primarily serve people with dementia by offering help with ADLs, which can become increasingly challenging as people age and dementia progresses. Some assisted living facilities provide dementia training to staff, but it is more common in specialized memory care facilities.
Not all assisted living is memory care, but many facilities offer it as a distinct, more specialized option within the same community.
Memory care facilities specifically serve people with dementia. Many states have developed a special licensure for assisted living facilities marketed as “memory care.” In those states, memory care facilities generally, but not always, have greater oversight of resident safety and staff receive dementia training.
What Role Do Family Caregivers Play?
While assisted living offers some support for people with dementia, family caregivers typically continue to provide support. Assisted living facilities typically offer limited hours a day of personal care services. When a resident’s needs exceed this, family caregivers or outside aides often step in.
This caregiving can involve out-of-pocket costs. Family caregivers of assisted living residents with dementia report spending just shy of $9,000 annually on caregiving related costs, including things like personal supplies, transportation, and gaps in facility coverage.
What Questions Should Families Ask a Facility Before a Loved One Moves In?
Before a loved one with dementia moves into an assisted living facility, families should consider what services the facility provides and whether it can meet the needs of their loved one. As dementia progresses, the resident’s needs may increase over time, and a good facility should be able to adapt to changes in those needs.
Cost is also a major consideration. In 2024, the median annual cost of assisted living was $70,800, while the median income for adults 75 and older was $47,790. Facilities may charge additional fees for certain services, which can add up.
Keep in mind that Medicare does not pay for long-term custodial care, so most assisted living residents pay out of pocket. If funds run low, families often look to Medicaid. In New York, Medicaid is available to help with the costs of facilities that participate in the Assisted Living Program (ALP), and in other facilities may be available to pay for the cost of an outside aide, while the resident or their family pays for the room and board.
The following questions can help families consider whether an assisted living facility is a good fit for a loved one with dementia.
- How many hours a day of help with daily tasks are provided?
- Who provides hands-on care and who administers medication?
- Are staff members trained in dementia care? How many residents does each staff member typically care for?
- Is there a nurse on site? If so, when?
- Is this a memory care facility?
- Is the memory care area secured? What happens if a resident is wandering and tries to leave?
- What supports are provided for residents with dementia?
- As dementia progresses, how does care adapt to meet a resident’s needs? How often is the care plan reassessed?
- What are the monthly and yearly fees? Are services such as help with medication billed à la carte?
- How do you respond to agitation, refusal of care, or sundowning?
What Should Families Understand in a Contract Before Signing?
A contract is more than a financial document. It governs key rights and expectations.
Because assisted living is largely regulated at the state level and residents’ rights can depend on state rules and contract terms, have a licensed attorney review the facility’s contract before you sign it.
Elder law attorneys can help families understand:
- the costs of services listed in the contract,
- when fees can increase and how increases are communicated,
- what happens if the resident needs to move out of the facility, and
- how disputes are handled.
An elder law attorney can also help advise on the opportunity to have Medicaid cover a portion of the costs involved in assisted living. Elder law attorneys can provide critical support by helping seniors navigate Medicaid’s often complex financial and functional requirements. They can help seniors protect their assets and ensure that they receive the care they need while maintaining their financial well-being. Contact the experienced elder law attorneys at Kurre Schneps to learn more about planning for assisted living and Medicaid.
