Assisted Living vs. Nursing Homes For People With Dementia


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

Having a loved one with dementia can be a heartbreaking experience. The person you have known your entire life seems to be slipping away, and you may not recognize them as the same person. Dementia does not affect everyone in the same way, and the symptoms—although similar—can come on with speed or more slowly and discretely.

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Generally speaking, dementia symptoms fall into two categories. People may have significant cognitive problems, like memory loss and poor judgment, but be physically stable. Or they may experience cognitive issues along with co-occurring medical conditions and loss of physical function. 

As you decide on the safest care for your loved one, you might be at the point of choosing between assisted living, memory care, and a nursing home. 

Overview: Assisted Living vs. Nursing Homes for Those With Dementia

Memory care units are usually part of an assisted living community, but not always. Some are free-standing communities specifically for people with cognitive impairment or behavioral problems. Memory care units in assisted living facilities are typically on different floors or in different sections of the assisted living building. The dividing line between whether someone needs assisted living or memory care is often blurred.

Nursing home care is for people with complex medical needs who may also have dementia. Almost 50% of nursing home residents have some form of dementia. How and when to place your loved one in any of these care communities is not an easy decision.  But we have some guidelines to follow.

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Assisted Living vs. Nursing Home For Those With Dementia: Who Are They For?

Most people prefer to live independently and with as much autonomy as possible. Even though you as a family member may think it’s time for your loved one to move to assisted living or memory care, they may disagree. What often happens is a gradual process of first living at home with in-home care, then in assisted living, then memory care, and then, in some cases, to a nursing home. At other times, a catastrophic illness or injury leads to a clear decision, and dementia is a co-occurring condition.

Assisted living and memory care

Assisted living and memory care communities differ somewhat in terms of their admissions criteria and resident milieu. In almost every assisted living, you will find residents with cognitive impairment, but they’re often in the mild or beginning stages.

Assisted living is for:

  • People who are no longer able to manage safely at home without significant in-home support
  • People who need assistance with activities of daily living such as bathing, dressing, transferring, and medication management
  • People who want and need the variety of social engagement opportunities offered by these communities

Memory care is for:

  • People with significant cognitive impairment who can’t manage safely without close supervision
  • People who need assistance with almost all activities of daily living, including eating
  • People who wander and are in danger of leaving the facility if not inside a secure unit
  • People who may have aggressive behaviors or outbursts

Nursing homes

A diagnosis of dementia alone is unlikely to qualify someone for nursing home care. Nursing homes are not considered places for people without additional medical needs to live. Nursing homes are for:

  • People who are unable to be cared for at home or in assisted living/ memory care
  • People who have complex medical needs such as catheter care, IVs, wound care, etc.
  • People who have significant cognitive impairment that impedes their ability to take care of themselves safely

Assisted Living vs. Nursing Home For Those With Dementia: Type of Care Received

Assisted living and memory care communities increasingly provide as much care as they can for people with dementia to keep them from going to nursing homes. But at some point, nursing home care may become inevitable due to the higher level of medical services they offer.

Assisted living and memory care

The care offered by assisted living and memory care communities includes: 

  • All meals and snacks. In memory care, staff is available to supervise eating.
  • Aides to assist with bathing, grooming, hygiene, and transfers
  • Transportation to medical appointments
  • Recreational and cultural activities. In memory care, activities are specifically designed for residents who have memory problems and short attention spans. One-on-one activities are usually available to residents, as well.
  • Nursing care. Nurses in both assisted living and memory care manage medications, supervise, and communicate any medical issues to family and outside health providers. 
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Nursing homes

The care offered by nursing includes:

  • Round-the-clock access to nursing and aide service
  • All meals and activities
  • Medication management
  • Physical, speech, and occupational therapy if appropriate
  • Complex medical care like tube feeding, ventilators, catheter care, wound care, IVs, x-rays, and more.

Assisted Living vs. Nursing Home For Those With Dementia: Costs and Paying for Care

Assisted living, memory care, and nursing home care are all expensive, and each of them requires out-of-pocket payment until long-term care insurance (if you have it) or Medicaid kicks in. Medicare does not pay for nursing home care, only skilled nursing.  The monthly median cost of care, according to Genworth, was $4300. A shared room in a nursing home was $7756. 

If someone has dementia and is in assisted living or memory care, their costs could be considerably higher than $4300 due to significant care needs and where they live. 

Most residents of nursing homes eventually qualify for Medicaid, the insurance plan for low-income seniors and people with disabilities. Paying for assisted living, memory care, or a nursing home requires that families have significant savings or assets from the sale of a home or retirement income.

Assisted Living vs. Nursing Home For Those With Dementia: Admissions Process

The admissions process for assisted living, memory care, and nursing home care for those with dementia will be similar, but with some differences. Each care setting will want to ensure that they can safely manage any resident who is seeking to live there. 

Assisted living admissions process

For someone with dementia to reside in assisted living, they have to show evidence of managing some aspects of their own care. For example, if they are at risk of wandering off the property, they will not be admitted to assisted living. Or, if their memory is so impaired that they can’t safely manage day-to-day activities, they could be referred to memory care.

If a person with dementia has complex medical needs that can’t be managed by assisted living or memory care, they may be referred to a nursing home. The process of admissions in assisted living includes the following components:

  • Medical and physical history, including medications
  • An assessment by a nurse to determine medical needs
  • A functional assessment to document a person’s ability to perform activities of daily living
  • A resident agreement outlining how much care is needed and what the cost will be

Nursing home admissions process

The nursing home admissions process will vary by state, but in general, these are the requirements:

  1. Physician’s order for admission to a nursing home. A physician must certify that the person requires a nursing home level of care. 
  2. Physician’s order for medications and treatment. A physician must submit orders for care. 
  3. Medical history and physical examination. A physical exam along with a detailed medical history is required before admission. 
  4. State-required form. Every state has a required form for nursing home admission which states that the nursing home can meet the person’s medical needs. 
  5. Health care tests. Most nursing homes require flu shots, pneumonia vaccines, and tuberculosis (TB) tests within three days of admission. They also now require a negative COVID test.  
  6. Completed admissions paperwork which includes all demographic information and consent for treatment
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Assisted Living vs. Nursing Home For Those With Dementia: Finding Care

Finding assisted living and nursing home care for those with dementia is a process of careful examination of the options to find the best situation for your loved one.

Assisted living

When looking for assisted living for those with dementia, it is crucial to have a clear understanding of the severity of your loved one’s cognitive condition. If their illness has progressed, then looking for memory care might be your best option. However, if your loved one has mild cognitive impairment, then assisted living might work.

  • Use the services of a local senior care placement specialist. These professionals have first-hand knowledge of cost, location, and amenities.
  • Talk with your loved one’s doctor about recommendations.
  • Look online for ratings and reviews.

Nursing homes

Of course, finding good care is important, but if your loved one is hoping to qualify for Medicaid, then narrow your search to those facilities that accept Medicaid.

  • Call the state Ombudsman program, which is responsible for investigating complaints about long-term care facilities.
  • Ask friends and neighbors about any experience they have with nursing homes in the area.
  • Ask healthcare providers for recommendations. 

What Are the Alternatives to Assisted Living or Nursing Homes for People With Dementia?

There are alternatives to assisted living and nursing home care for people with dementia, but they will require careful monitoring.

In-home care

In-home care is probably the most common alternative to assisted living for people with dementia. But there is a cost as care needs increase. Someone with dementia can do well for years at home with professional caregivers as long as there aren’t significant medical issues.

Board and care

Residential care homes can be an alternative to people with dementia as long as the person is relatively independent and doesn't wander. Board and care homes have fewer residents—5-10 on average—and can keep a closer eye on residents. However, if your loved one has complex medical needs, they may require a nursing home since board and care homes have minimal medical services, if any.

Private nursing

If you have the means to pay for private nursing for a loved one with dementia,  you can use nurses to provide medical care, but you may also have to invest in medical equipment as well. 

Assisted Living vs. Nursing Homes for People with Dementia

Dementia is a challenging and stressful disease to manage. Anticipate changing care needs, plan in advance and thoroughly vet any potential care options to make the best choice for your loved one. 

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