7 Viable Alternatives to Nursing Homes for Older Adults


Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

As an exhausted caregiver, you may be thinking that a nursing home is the only way to provide for your loved one and get you some caregiver relief. It might be, but exploring alternatives may lead to some unexpected possibilities. 

Where you are in the process can determine what direction you should head in. If your loved one is fragile and living in assisted living, they may have no choice but to move to a nursing home. However, if there is a chance of bringing together several resources, you can avoid nursing home care for the short term and possibly forever.

1. Staying at Home

Most older adults say they want to age in place. As an alternative to a nursing home, it isn’t easy, but it is possible in some cases. Staying at home depends on several factors and whether the care that someone needs can be safely and affordably provided. These are some of the services and resources to consider.

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Home modifications

Home modifications can help with safety not only for older adults but for their caregivers as well. For example, start with shower chairs and grab bars. If the bathroom has a tub shower, convert to a walk-in. If stair access is needed in parts of the home, consider glide chairs. Move the washer and dryer from the basement to the main level.

Make sure to keep the home clutter-free and widen doorways if necessary to accommodate a wheelchair. Staying as safe as possible to avoid any further accidents or injuries is integral. If the home is too expensive to modify, consider moving your loved one to single-level living.

Home health care

Home health care is covered by insurance but in most cases is time limited. But home health can be a valuable bridge to help an aging adult recover from an illness, accident, or chronic disease.

Nursing, physical therapy, occupational therapy, and aides are all services that can be provided weekly.

Home care

Home care, also known as personal care or private duty, is a privately paid service that offers caregivers for varying lengths of time. State requirements dictate what these caregivers can do and not do, which means that at a minimum, caregivers can help with bathing, dressing, hygiene, cooking, shopping, and transportation.

Most agencies offer 24-hour or live-in caregiving, but the costs can get very high. For someone with dementia, caregivers can prevent wandering, cook meals, and offer diversions such as games, outings, and conversation.

Family caregiving

Families provide the majority of caregiving in the United States. When an older adult has nursing needs, those tasks can strain family caregivers due to their complexity and frequency. It is important to recognize that nursing duties should be performed by registered nurses.

Family caregivers can help in other ways by coordinating care, managing professional caregivers, and being healthcare advocates. If you need help, ask siblings or other family members to help.

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2. Assisted Living

Assisted living is different from a nursing home, but a viable possibility under certain circumstances. Assisted living communities are slowly changing to accommodate more medically frail individuals, but they cannot provide intensive nursing. So, what are your options?

Talk with the assisted living admissions nurse about what specific tasks their staff can’t provide. Then see if you can put together a care plan to satisfy those needs. For example, if your loved one requires catheter care or IV medications, those can be provided by a home health company. For ongoing needs beyond what home health provides, look into private nursing. If the care is intermittent, it may very well be more affordable than the cost of a nursing home.

Hire private caregivers for activities of daily living (ADLs) such as bathing, dressing, and transfers. You may also want to ask family members to pitch in and help fill the gaps in care in assisted living. 

Another option to consider is motorized mobility. Some assisted living communities permit motorized scooters as long as the residents can operate them safely. This also helps to alleviate assisted living staff from having to accompany a resident to meals and activities personally.

However, if your loved one has dementia, their behaviors and personal care needs may stress the staff. Think about moving your loved one to memory care, where they will get more individualized attention. 

3. PACE 

PACE, also known as Programs for All-Inclusive Care for the Elderly, is funded by Medicare and Medicaid and limited to select regions in the U.S. For example, in a search for PACE programs in the state of New York, 18 are available. In the entire state of Iowa, there are only four. We strongly recommend seeing if there is a PACE program in your community. 

The central goal of the program is to keep people at home and out of a nursing home. To accomplish this, a whole range of services is provided in a person’s home. These include but are not limited to nursing, therapies, medications, transportation, social services, respite, laboratory and x-ray services, and home care. 

4. Medicaid Waiver Programs

Medicaid Waiver programs can be complicated, but if your loved one qualifies, they may be able to stay out of a nursing home. The Medicaid Waiver programs allow states to target high-risk individuals (not just aging adults) who qualify for nursing home care. The “waiver” part of the program enables the states to provide Medicaid services that would otherwise only be available by qualifying for Medicaid in a nursing home.

On a practical level, this program allows individuals to stay in their homes with home health (without time limits), nursing, home modifications, respite care, medical supplies, and more. In some cases and some states, the waiver program can support and pay for assisted living. Medicaid Waiver programs may have limited availability, so best to apply early. There will be income and asset criteria to meet as well.

5. Adult Foster Homes

Adult foster homes go by several different names across the country, including boarding homes and board and care. These are residential homes that have a few residents with 24-hour supervision. Each state has different oversight of foster homes. However, there are both positives and negatives to this arrangement.

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Pros of adult foster homes

Adult foster homes provide a more home-like environment, so residents live among a smaller group and feel less like a large sterile facility. It is also easier for staff to manage and monitor a few residents.

It is also less expensive than institutional care, especially when Medicaid can help to pay a portion of the cost of care. Residents are still responsible for paying for room and board, however.

Cons of adult foster homes

Some states have lax oversight of adult foster homes, which could lead to substandard care and difficult to enact change.

Not all adult foster homes will have nursing and aide services, as some staff prefer more independent residents. In addition, if your loved one eventually needs more care than the foster home can provide, they may need to move to a nursing home.

6. Skilled Nursing 

A skilled nursing facility provides recuperative therapy via a short rehabilitation stay following an accident or illness. A three-night stay in the hospital is required for Medicare to authorize payment. You may be thinking, what does rehabilitation have to do as an alternative to a nursing home? Despite being eligible for skilled nursing, not everyone takes advantage of this intensive service.

Skilled nursing can be the difference between recovery and continued decline. Here are some of the benefits you can expect in skilled nursing:

  • Intensive physical, occupational, speech, and respiratory therapy at least five days a week
  • 24-hour nursing
  • Physician services
  • 24-hour aide help for dressing, ambulating, toileting, and bathing
  • Lab draws and imaging services.

Skilled nursing is time-limited, but having this level of supportive medical care can help guide someone to a more full recovery at home. Once home, your loved one can begin home health to continue therapies and nursing care to monitor medical conditions.

7. Staying Healthy

It may seem obvious, but the best alternative to nursing home care is to avoid the diseases and conditions that require that type of care. The single most effective intervention is to prevent falls, resulting in the hospitalization of over 800,000 people a year. Many of these people do not recover their previous functioning level, leading to a downward, deteriorating decline.

Regardless of your loved one’s conditions or diagnoses, talk with their doctor about strategies for improvement. Take a proactive and positive approach to recovery. It can’t hurt to find out what can be done in the short term.

Ask about reducing medications and making lifestyle changes that can bring positive benefits. Encourage your loved one to increase their activity level with the help of an aide or physical therapist. Address social isolation by hiring caregivers for companionship and stimulation. If depression and anxiety are an issue, seek treatment for these common mental health problems, which can exacerbate medical problems and interfere with recovery.

Alternatives to a Nursing Home

Most people want to avoid nursing home care. It is not always possible, but by trying out some of the alternatives above, you might find something that works. Talk with your loved one and your family to create a plan of care where safety and wellness are the priorities. Being open to other options can help you and your loved one create a plan that leaves you feeling both prepared.

If you're looking for more on long-term care, read our guides on how to become a caregiver and assisted living vs. memory care.


  1. “PACE.” Medicare.gov. www.medicare.gov/your-medicare-costs/get-help-paying-costs/pace#:~:text=Programs%20of%20All%2DInclusive%20Care,home%20or%20other%20care%20facility.
  2. “State Waivers List.” Medicaid.gov. www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html
  3. “Are Adult Foster Homes a Good Long-Term Care Option?” Next Avenue. www.nextavenue.org/adult-foster-homes-long-term-care-option/
  4. “Falls are Serious and Costly.” Centers for Disease Control and Prevention. www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html 

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