Assisted Living vs. Memory Care? 4 Differences to Know

Updated

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

Not every person who has memory problems will be in need of memory care. Plenty of people with cognitive impairments can live full, rich lives in assisted living. For others, memory care comes under greater focus as an option because of symptoms like confusion, disorientation, and wandering. 

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One of the reasons some families wait so long to move someone from home or assisted living to memory care is based on the stereotypes of memory care units as well as the perceived ambiance. If you have had the chance to visit a memory care unit, it can be a stressful place. Some residents have advanced dementia and your loved one may not.

There is no “right time” to make the decision, but visiting a community and talking with staff can help you and your loved one address any unease.

Assisted Living vs. Memory Care: Overview

Deciding between assisted living and memory care is not easy. There are situations where your loved one may be in assisted living, and the facility requests that you move them to memory care. In other cases, you may be faced with having to choose between the two. 

Memory Care

One way to fairly evaluate whether your loved one needs memory care is to assess their overall cognitive condition. If they have a progressive disease like dementia, you know that they will worsen over time. There may be value in moving them to assisted living first and then memory care later, but sometimes moving twice can be traumatic.

If some of your loved one’s behaviors or actions are unsafe, such as leaving the stove on, wandering, or aggressiveness, then memory care is better equipped to handle these issues. 

On the other hand, if their situation is likely to remain stable, assisted living might be worth trying. Having the opportunity to live as independently as possible might positively affect your loved one’s overall mental and physical health. You can even consider hiring private caregivers to assist with daily tasks in assisted living to delay a move to memory care for as long as possible. 

It is important to consider safety. Both assisted living and memory care have systems in place to provide as safe an environment as possible, but memory care offers more. Most memory care units are locked to prevent wandering, with residents unable to leave. The higher staff to resident ratio ensures more individualized attention and the ability to keep residents safe. 

Activities are designed to appeal to people with limited attention spans and memory problems. One-on-one activities help residents who might otherwise not do well in group settings—memory care staff focus on keeping people engaged to prevent isolation.

Assisted living

Assisted living will have wide-ranging activities to appeal to almost any interest, and people are free to come and go as they like. The door to the community might be locked after certain hours, but resident’s movements are unrestricted. Assisted living is much more independent than memory care, and although residents may receive a lot of personal care help, they can plan their days with flexibility.

We will cover every aspect of assisted living and memory care so you can make the best decision, with the understanding that once you move your loved one to memory care, that is probably where they will stay.

 

                             Assisted Living                          Memory Care

Cost

Varies depending on where you live, and the amount of care your loved one will need.

Depending on where you live and the amount of care your loved one will need. Costs could be higher than assisted living.

Who is it for?

Anyone who can pay for it. Although most residents need help with activities of daily living, anyone can move to assisted living. 

For people with dementia or other medical problems that cause memory loss, behavior problems, and wandering.  

Admissions Process

A nurse conducts an assessment to ensure that the needs of the resident don’t exceed what they can provide. 

A nurse conducts an assessment to ensure that the resident doesn’t have medical or behavioral problems that exceed what they can provide.

Type of Care

All meals, housekeeping, transportation, activities, aide, nursing, and in some facilities on site physician services.

All meals, housekeeping, transportation, activities, aide, and nursing. Most memory care communities are locked and secure. Activities are tailored to people with cognitive impairment. 

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Pros and Cons of Assisted Living vs. Memory Care

There are pros and cons of assisted living versus memory care, and if the situation is not clear cut, it can be stressful to choose. Consulting with family and other professionals can help you clarify the issues and reach an informed decision.

Pros and cons of assisted living

Pros

  • Independence: In assisted living, you can come and go as you please. There are no restrictions on your activity, although you might have certain meal times to adhere to.
  • Diversity of residents: You will likely have a wide age range and diversity of personalities, and functioning levels in assisted living.
  • Choices of communities: There are probably far more assisted living communities to choose from than memory care since the demand is higher. For some people, the more options, the better.

Cons

  • Too much togetherness: For some people, all of the activities and group dining are too much togetherness. Introverts can struggle with the pressure to attend events and interact with other residents.
  • Limited medical care: If your loved one requires special ongoing medical care, an assisted living probably won’t provide it. Most communities have a nurse available for minor issues and medication management, but that is about it.
  • Expense: Costs can add up in assisted living, especially if you live in a state where the average price is high, and then on top of that you need lots of care. 

Pros and cons of memory care

Pros

  • Safety: If you have a loved one who is unsafe at home or even in assisted living, memory care can bring peace of mind. Staff monitor residents for unsafe behaviors, and the secure nature of the community eliminates the dangers of wandering.
  • Individualized attention: For someone with dementia living at home, things can get lonely. Families can sometimes struggle to keep a loved one occupied and stimulated. In memory care, every effort is made to keep people engaged.
  • Companionship: Most staff in memory care communities are trained to support people with dementia. The caring and compassionate care they bring to residents can make a positive difference. 

Cons

  • The mix of residents can be distressing: Some memory care communities are large enough to separate their residents according to cognitive ability. But, most place everyone in the same unit regardless of their diagnosis. Some people may find the behaviors of others upsetting.
  • Confining space: Memory care environments can be small and claustrophobic. If your loved one likes to wander, these smaller spaces could cause agitation. If possible, look for memory care that has outdoor patio space and common rooms.
  • Expense: Due to the higher staff to resident ratio, costs for memory care can be high.

Assisted Living vs. Memory Care: What Type of Care Do You Receive?

Deciding between assisted living and memory care can be a challenge. You want to maximize your loved one’s independence, while still keeping them safe. Assessing the type of care someone receives in assisted living versus memory care might help you make that choice. 

Assisted living

Assisted living offers many of the same services as someone receives in memory care, but there are some differences. Both assisted living and memory care communities can offer all meals, transportation, medication management, housekeeping, activities, and part-time nursing.  

Aide service may also be available upon request, often at an additional fee. Aides can assist with bathing, dressing, one-person transfers, and accompany residents to meals and activities. 

Nursing assistance is limited to the supervision of medication technicians, CNAs, and intermittent care for residents. Each community will differ in terms of the role the nurse plays, but they do not provide the level of care that a nursing home or home health nurse is authorized to do. It might be a good idea to inquire about the nursing role and availability in any community under consideration.

Assisted living communities may have locked and secured access, but residents are free to come and go as they please. It is common for many residents to have their own cars.

Memory care

Most memory care communities have a higher staff to resident ratio than assisted living, as memory care residents require more one-on-one care and supervision. Recreation is tailored to people with memory or other cognitive problems and may include simple tactile, music, and current events activities in small groups. For some residents, one-on-one activities may be more appropriate than groups. 

A key difference between the two is that memory care units are locked and secure to prevent wandering. A code is usually required for family or friends to visit. Most communities will permit families to take their loved ones out for short outings or other activities.

Aides are also a part of memory care and are trained in helping people with memory and behavioral problems. Aides will check more frequently on a resident in memory care. Mealtimes are usually at the same time every day to provide structure and predictability.

Assisted Living vs. Memory Care: Who Are They For and What’s the Criteria for Admission?

In recent years, assisted living communities have started to accept more medically compromised residents. The main reason for this is that as the aging population has grown, so have their medical needs. Assisted living and memory care communities are responding in kind by accommodating people with more physical problems.

States have the authority and responsibility to regulate and license assisted living and memory care communities. The federal government does not. For example, California licenses and regulates senior living communities through The Department of Social Services: Community Care Licensing Division. The National Center for Assisted Living also has a state-by-state report of admission criteria and process. 

Most senior living communities typically can have assisted and memory care in the same building. Depending on the community’s size, memory care may be on one or more floors, with assisted living on different floors. Freestanding memory care communities also occupy a much smaller percentage of the overall assisted living/memory care market, but they do exist.

Assisted living admission criteria

As mentioned above, each state has the right to regulate and create specific admission criteria. A resident can be admitted from a rehabilitation center, the hospital, home, or another assisted living community. In general, assisted living communities will not accept residents who have the following:

  • Extensive medical needs.
  • Cognitive impairment that compromises safety (for example, wandering).
  • Require daily nursing.
  • Behavioral problems that threaten the safety of other residents.

Many people who choose assisted living do so because they are in need of more help than they can get at home. A loved one who is paying for in-home care may get to the point where the cost is too high. In other cases, family caregiving has reached a point where it is no longer sustainable. Some people who go to assisted living will need lots of help, and others may be very independent. 

Social isolation and loneliness are also increasing concerns among older adults. Assisted living communities can provide a built-in social structure with lots of opportunities to socialize and make friends.

Memory care admission criteria

Memory care admission criteria are very similar to assisted living with the main difference being that memory care is for people with dementia or behavioral problems. People with dementia typically need more structure in their living environment. 

Families consider memory care when their loved one is no longer safe to manage at home. Here are some reasons why families consider memory care for their loved one:

  • Increasing confusion or disorientation
  • A decline in physical health
  • Incontinence
  • Wandering
  • Agitation and/or violent outbursts
  • Inability to bathe, cook or eat without supervision and cueing

Memory care is also a good environment for people with head trauma, other neurological conditions, and mental health problems. 

Assisted Living vs Memory Care: Cost of Care 

Costs of both assisted living and memory care can be prohibitive for many since insurance does not cover any of the costs. Unfortunately, there is no standardized pricing across the country, so you are at the mercy of the state and community you live in. For example, in Utah, the median monthly cost of assisted living is $3,400. In Maine, it is $5,942.

Assisted living costs

Most assisted living facilities will charge a deposit before move-in, which reserves the apartment. This fee is sometimes referred to as a community fee and can be a couple of thousand dollars depending on the community. This fee is usually non-refundable. 

Assisted living costs take into account the level of care that your loved one needs. For example, an assisted living facility will have a base rate (which covers rent, utilities, meals, activities, and housekeeping) and add on fees for the additional care that someone needs. 

This service fee could be anywhere from a couple of hundred extra dollars a month to over a thousand. Each tier—or level of care—adds additional activities of daily living to the resident’s care plan.

Some assisted living communities will have an all-inclusive fee covering any additional services the resident requires.

Memory care costs

Memory care costs are very similar to assisted living costs but might be more due to the higher staff to resident ratio. Some memory care communities have the same tier system that assisted living does, and others have all-inclusive pricing. 

You can expect that pricing for assisted living and memory care will go up each month. Most communities tell you the percentage increase to expect year to year. 

Assisted Living vs. Memory Care: What’s the Cost and How Do You Typically Pay for Care?

Both assisted living and memory care are paid for privately unless you have a long-term care insurance policy. Medicare does not pay for assisted living or memory care. Medicaid however, through state waiver programs may be available in your community. These programs are for people who deplete their assets and qualify for Medicaid. 

Both assisted living and memory care can be expensive. Most communities charge a base rate and then add on costs depending on how much care is required for a resident. According to Genworth, the monthly median cost for care in assisted living in 2020 was $4,300. Costs for memory care can be much higher due to higher staff to resident ratio.

People may typically pay for care by selling their home, and/or using income and retirement funds. Long term care planning may be the best way to assess how and for how long you can pay for assisted living or memory care.

Assisted Living vs. Memory Care: What’s the Admissions Process Like?

The state licensing entity will dictate the admission criteria for both assisted living and memory care. Overall, the admission process involves making certain that the community can safely take care of the resident. As a consumer, it is a good idea to visit several communities before making a final decision. 

Assisted living admissions process

An admissions process for an assisted living community may involve the following:

  • Contact is made with the assisted living community with a scheduled tour.
  • If you or your family member decides on a particular assisted living community, the admissions coordinator schedules a nursing assessment.
  • A nurse completes an assessment, which involves a review of medical history and medications. They will also assess your loved one’s ability to perform daily activities, any mental health or memory problems, mobility, and any transferring difficulties.
  • Denial of admission may be based on too many complex medical needs or memory problems. At this point, the nurse may recommend memory care if they feel that assisted living can’t adequately meet the person’s needs.
  • If you or your loved one is accepted for admission, you will sign a contract that specifies your monthly rate. This rate depends upon the nursing assessment results and the additional care you will need based on those results. You may want to ask what kind of yearly increase in costs you can expect.

Memory care admissions process

The memory care admissions process is the same as assisted living. There are, however, some differences in the assessment.

Possible reasons for exclusion from memory care are the following:

  • Aggressive or sexually inappropriate behavior that would be a threat to other residents.
  • Suicidal thoughts and actions.
  • Complex medical needs.

Even if any of these exclusionary reasons exist, some memory care communities may accept a prospective resident and try and work with them. Memory care staff are accustomed to challenging residents and have the skills to manage some of these problems. If your loved one moves to memory care, the adjustment can take some time.

Assisted Living vs. Memory Care

Assisted living and memory care communities are growing across the country. People have more choices than ever before. If you are a family member trying to make this decision, evaluate your options carefully. Understanding the differences between assisted living and memory care will guide you in making the best choice for your loved one. 

If you're looking for more resources on finding the best care, read our guides on finding senior care and alternatives to assisted living.


Sources:
  1. “Community Care Licensing Division.” California Department of Social Services, cdss.ca.gov.
  2. “State Regulations.” National Center for Assisted Living, ahcancal.org.
  3. Mullaney, Tim. “ Hard Hit Memory Care Sector Faces Long Road to Recovery.” Senior Housing News, 29 July 2019, seniorhousingnews.com
  4. “ How Medicaid Can Help Seniors Cover the Cost of Assisted Living.” American Council on Aging, medicaidplanningassistance.org
  5. “Cost of Care Survey.” Genworth Financial, genworth.com
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