Assisted Living

Sometimes, an older adult needs more help with personal care than they can get at home from family, other caregivers, or home-based formal support programs.  Assisted living are for these older adults, who needs care that cannot be met in their home, but they do not yet require skilled nursing services available all the time.  This option can provide help to an older adult while protecting their privacy and independence.

Services, Quality Standards, and Licensing

States license assisted living by requiring them to offer certain services and having quality controls in place. These services and quality standards vary by state.

States generally require assisted living to offer the following services:

  • 24-Hour staffing to meet the needs of residents (Note: This does not mean that skilled nursing services must be available 24 hours a day.)
  • Social services
  • Housekeeping and laundry
  • Recreation and meals
  • Help with daily activities, like bathing and dressing.
  • Health-related services (for example, help with managing medications)
  • Transportation

Generally, the State Department of Social Services, not the Department of Public Health regulates assisted living. This is because these facilities are not offering skilled nursing services.


Cost of an assisted living varies widely based on amenities, and care a person may need. Generally, assisted living costs less than care in a nursing home. Part of the difference in costs is because assisted living doesn’t provide skilled nursing.

Most older adults must pay for assisted living themselves, with no help from the government. However, some states use Medicaid to pay for assisted living for some people with few financial resources.

Types of Assisted Living

Group Homes

Group homes are houses or apartments where two or more unrelated people who live together receive some basic help. People share a living room, dining room, and kitchen but usually have their own bedrooms. Social opportunities, privacy, and independence are among the benefits of this type of home.

Group homes have different types of residents. For example, many homes specialize in helping people with chronic mental illness or dementia.

Most group homes are run as for-profit businesses. Some states require these homes to have licenses to operate.

Adult Foster Care

Foster care homes generally give people room, board, and some help with daily tasks. The family that manages the home or other paid caregivers usually live in the home.

An advantage of adult foster care is that older adults are in a more home-like environment. Regulations for foster care vary by state, and some states require licenses to operate

Some states will cover costs of adult foster care through their Medicaid programs. 

Sheltered Housing

Sheltered housing is often in a home that offers personal-care support, housekeeping, and meals. Staff may also provide social services and manage activities for people who live in this type of housing. 

Continuing-Care Retirement Communities

Some older adults may choose to live in a continuing-care retirement community (CCRC). These communities usually have choices ranging from apartments or condominiums, to assisted living and skilled nursing homes.

Often, older adults enter the CCRC in the more independent living areas. If they get disabilities,they may move into assisted living or skilled nursing facilities.

CCRCs often provide healthcare using three financial models:

  1. The all-inclusive model. This provides total health care coverage, including long-term care.
  2. The fee-for-service model, where payments match the level of care.
  3. The modified coverage model, which covers long-term care to a maximum amount.

Most CCRCs require:

  • A large entry fee, which may or may not be refundable
  • A variable monthly fee to pay for rent and supportive services. Monthly fees vary, depending on the level of care the older adult is getting and can be quite expensive.

Older adults generally pay to live in these communities. However, some of them have beds for skilled nursing care that Medicare or Medicaid will cover.

Memory Care Assisted Living

These are specialized assisted living facilities or homes that specialize in the care of older adults with dementia, like Alzheimer’s disease. They operate like nursing homes. However, they focus on treating people with specials needs related to dementia or cognitive impairment (problems with thinking and remembering). Often some assisted living facilities have a memory care unit instead of a free standing memory care assisted living facility.


Last Updated June 2023

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