Types of Assisted Living Options

Understanding living options for seniors and identifying each setting's strengths and weaknesses can be challenging. Assisted living, independent living, memory care, nursing homes — what do all these terms mean, and how do I know which one is right for my loved one or myself?

This guide takes a close look at assisted living options for seniors. A report from the American Health Care Association and the National Center for Assisted Living reveals that the U.S. has roughly 30,600 assisted living facilities (ALFs), with roughly 1.2 million licensed beds. Although it is just one type of senior living arrangement, there may be subtypes depending on your location. 

Caring.com has researched key factors to help you understand your options and choose a living situation that fits your unique needs.

Rest homes, convalescent homes, old folks' homes, and retirement homes are names people use when talking about ALFs. These facilities are one long-term housing option for older adults who need help with activities of daily living (ADLs). 

ADLs are all our personal care tasks, like dressing, bathing, using the toilet, and shaving. Unlike nursing homes — another long-term housing option — ALFs do not generally offer skilled medical care. These settings do, however, have 24/7 staff available for emergencies. In some cases, ALFs may have memory care units or provide hospice services.

Each assisted living facility is unique and likely to vary in the details. Some, for example, offer luxury services like an on-campus golf course. Others have fewer amenities but also cost less. 

As noted above, ALFs differ from nursing homes in that they may not have skilled nursing care available 24/7. They also are not the same as independent living facilities, which are housing complexes for older adults who do not need outside assistance.

In addition to staff who can help with ADLs, common services provided by ALFS may include:

• Help with managing medications
• Hot and cold meals prepared daily
• Housekeeping and laundry services
• Transportation to doctor's offices, shopping, and other locations
• Building and grounds maintenance
• On-site or off-site physical and occupational therapy services

Other optional amenities may include a salon or barber shop, fitness center, worship space, group dining room, and outdoor walking areas or gardens.

Assisted living may be a good fit for seniors who need daily assistance but not regular medical intervention. They may have mobility challenges (for example, they may need to use a wheelchair), but they are not bed-bound or in need of skilled daily nursing. 

If you or your loved one fits that bill and seeks a community with opportunities for social engagement and private living spaces, it may be worth looking at ALFs in your region. 

One common type of assisted living is an ALF with an affiliated memory care unit or wing. ALFs with memory care facilities are ideal for the approximately 6.9 million seniors living with Alzheimer's disease or another form of dementia in the U.S. 

These facilities help keep seniors safe and offer the appropriate care to allow them to live fulfilling lives. ALFs with memory care units are not the same as continuing care retirement communities (CCRCs), which we cover below.

An assisted living facility with memory care will likely feature the same amenities as a basic ALF. In addition, however, you may also find the following features:

• Locking doors and windows with keypad entry
• Personalized activities, exercises, and games that stimulate cognitive function
• Staff members trained in dementia care
• A higher staff-to-resident ratio
• Intuitive layouts that allow for easy navigation
• Alarms on all external doors
• Use of personal safety devices such as medical alert systems
• Security cameras monitoring entry and exit points
• Enclosed or fenced outdoor areas
• Music or art therapy classes

An ALF with memory care may be a good choice for someone who is experiencing Alzheimer's or another type of dementia who does not need daily skilled nursing services. These environments may also benefit couples where only one of the partners is living with dementia. Couples can often live together or near each other in the same facility, each receiving their required level of care.

CCRCs also fall under the umbrella of assisted living facilities. These residential communities for seniors can provide multiple types of settings and services on one campus, including assisted living facilities, independent living residences, and skilled nursing care. 

These residences provide a continuum of care for seniors, who may graduate, for example, from living independently to a unit with a higher level of care as their health requires it. These options allow them to stay at the same facility and maintain friendships with other residents. 

A CCRC may include apartment-like dwellings, a space for people with memory care needs, an assisted living facility, and a building or wing to house those with extensive medical needs.

Residents can enter several types of continuing care contracts with different features. In general, they may have the following benefits:

• Three meals a day
• Weekly housekeeping and laundry
• Banking and postal services
• Social, recreational, and educational activities, which may include classes
• Transportation as needed
• Group events and outings 
• A pool, fitness center, movie theater, or other amenities
• Access to an on-site doctor by appointment, with the possibility of house calls during an illness

Possibly, the biggest benefit to a CCRC is its "one-and-done" nature. After admission, your care needs are ensured for the rest of your life, and you will not need to search out a new residential setting if your requirements change. As such, a CCRC can be a good choice for anyone who values stability and security while looking for a residential setting that allows for group activities and socialization.

Residential care homes are another senior living option with tangible benefits. These smaller (usually housing 4-25 individuals) home-like facilities offer a balance between independence and 24-hour care. 

Although there may not be staff with medical training, caregivers offer medication reminders and help with emergency medical needs. The cost of residential care is roughly the same as assisted living but may offer fewer amenities and extras due to the smaller size.

Residential care homes are marked by their smaller size. They may even operate as private homes with enough bedrooms for residents to have their own living spaces in private or shared rooms. 

In smaller residential care homes, a single caregiver may live on the premises. Larger homes typically have multiple caregivers who can help with ADLs and provide other services.

Residential care homes may provide:

 

• Three meals a day and snacks in a group setting
• Supervision by caregivers and/or a house manager
• Emergency assistance when needed
• Medication reminders
• Laundry/housekeeping services
• Outside areas, a backyard, or gardens
• Close-knit community setting
• Help with ADLs
• Open visitation policy
• Limited health services, such as mobility equipment or ADA-compliant bathrooms

A person who thrives in a smaller, more personalized environment may be the best candidate for residential care living. These facilities focus on comfort and daily care rather than intensive medical assistance or rehabilitation. 

Residential care facilities are likely to be wheelchair-accessible, and although there may be medical care available, there is unlikely to be 24/7 medical staff on site. 

Independent living provides an environment for seniors who value their independence and can manage themselves without much additional help. 

Also called 55+ communities, these housing complexes resemble apartments or condos, where seniors have their own private living spaces, possibly including a kitchen, so they can choose to eat meals at home rather than in a communal dining room. In independent living, residents come and go as they wish and may even be able to keep their pets with them. 

Independent living facilities vary in available amenities, though many offer:

• Communal meals in a central dining area, as well as individual units with kitchens for private meals
• Maintenance of exterior areas and common interior areas
• Social and entertainment opportunities, such as group outings, classes, or movies
• Common areas such as an exercise room, computer room, library, or even restaurants and coffee shops
• Outdoor activities and amenities, such as an on-campus golf course or tennis courts, gardens, or a pool
• Housekeeping assistance and/or help with laundry
• Staff trained in basic first aid 

Ideal candidates for independent living can care for themselves but still require some assistance. Seniors who value their independence, seek privacy, and seek companionship from similarly aged peers may enjoy this type of residential setting. Although many independent living facilities feature easy access for people who use wheelchairs, walkers, or canes, they are not intended for individuals who need regular intensive medical care.

Older adults can seek care beyond services provided in independent living, residential care homes, and other housing for seniors. These options vary by location since ALFs are regulated at the state level rather than federally. 

For example, in Texas, ALFs operate as Type A, B, and C facilities. Type A residences offer the most independence, while Type B settings best suit those who need nighttime supervision and assistance in the event of an evacuation. Type C is entirely different — it's an assisted living facility with a license for only four beds or fewer. Other states have different designations and may have more subtypes than Texas.

To recap, here are some of the most common types of senior living facilities:

• Independent Living: This residential option features apartment-like units for seniors who wish to retain their independence and do not have serious medical needs. Although there may be group meals, events, and activities, residents maintain private living spaces.
• Assisted Living: Assisted living facilities provide housekeeping help and assistance with ADLs for seniors who need some help but do not require 24-hour medical care. ALFs may provide transportation, medication management, prepared meals, and planned group activities.
• Skilled Nursing: Skilled nursing facilities provide short-term and medium-term treatment and care for seniors recently released from the hospital. Generally, individuals expect to return to their homes eventually.
• Memory Care: Memory care units and residences provide focused care for people living with Alzheimer's or other forms of dementia. They may operate as free-standing structures or wings in an assisted living facility, nursing home, or CCRC.

Assisted living is an ideal option for older adults seeking a community living situation where they can receive some help with ADLs but don't need extensive medical care. ALFs vary from state to state, so finding the right provider for your needs requires you to ask questions, visit likely candidates, and discuss options with your loved ones and medical team. For some seniors, independent living, residential care homes, memory care, or CCRCs may offer a better choice than assisted living.

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