Choosing Assisted Living vs. Memory Care? 4 Differences to Know

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

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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: 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. 

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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: 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 2019 was $4,051. 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/inforesources/community-care-licensing.
  2. “State Regulations.” National Center for Assisted Living, www.ahcancal.org/ncal/advocacy/regs/Pages/AssistedLivingRegulations.aspx.
  3. Mullaney, Tim. “ Hard Hit Memory Care Sector Faces Long Road to Recovery.” Senior Housing News, 29 July 2019, seniorhousingnews.com/2019/07/29/hard-hit-memory-care-sector-faces-slow-road-to-recovery.
  4. “ How Medicaid Can Help Seniors Cover the Cost of Assisted Living.” American Council on Aging, www.medicaidplanningassistance.org/assisted-living.
  5. “Cost of Care Survey.” Genworth Financial, www.genworth.com/aging-and-you/finances/cost-of-care.html

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