What’s an Intermediate Care Facility? Pros, Cons + Costs


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

People who need help don’t fit easily into categories of care. As people live longer and have complex medical and other needs, insurance companies and communities try to provide the care they require.

The term “intermediate care facility” has two meanings. The first is used to describe facilities that assist people with intellectual disabilities. Although these facilities exist throughout the US, there is a focus now on encouraging and supporting people with disabilities to live in their own homes, or independently in the community.

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The other definition of an intermediate care facility is the one that we will talk about in more detail. An intermediate care facility attempts to fill the gaps in care for people who have needs that aren’t met in other long-term care settings. Although most intermediate care facilities serve older adults, younger disabled adults can also live in intermediate care facilities. 

Definition of an Intermediate Care Facility

An intermediate care facility is primarily for people who can’t take care of themselves without some degree of nursing and custodial care. Here are some of the features and characteristics of intermediate care facilities (ICF):

  • An ICF is typically smaller than other care facilities and is for people with intellectual disabilities, mental health disorders, and older adults.
  • ICFs provide care that relies on activities of daily living such as assistance with dressing, bathing, hygiene, going to the toilet, medication reminders, housekeeping, laundry, and transportation. 
  • ICFs may have some nursing available, but they differ from nursing homes in that they don’t have round-the-clock nursing. If someone has complex medical needs, then an ICF is not appropriate for them.
  • Some ICFs have occupational and physical therapists and social workers who work with residents who can benefit from those services.
  • Residents of an ICF can transition back home or live in the ICF long term.
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Who Typically Uses an Intermediate Care Facility?

Sometimes people need care, but not specialized care like that provided by skilled nursing or a hospital. Some examples of people who can benefit from an intermediate care facility:

Older adults

An intermediate care facility is valuable for older adults who have chronic medical or neurological conditions. An example would be someone with Parkinson’s disease who needs assistance with bathing, dressing, and mobility but doesn’t have ongoing nursing needs. Other older adults may not be able to live independently but also not qualify or require 24-hour nursing care.

Intellectual and developmental disabilities

Adults with intellectual disabilities may need an intermediate care facility because they require someone to assist them with activities of daily living. Each state has policies and regulations that govern ICFs for this group.

Mental health 

People with mental health problems can also suffer from chronic health conditions and need assistance every day to remain safe and functional. An ICF is an option for these individuals who can’t live independently and need monitoring and medication management.   

How Do You Pay for an Intermediate Care Facility?

Paying for an intermediate care facility depends on what type it is. For people with intellectual disabilities who qualify for Medicaid, an ICF might be covered under that program. Others may have to pay privately for an ICF since the services are not reimbursed under Medicare. 

Medicare and other insurance plans don’t usually cover assistance with activities of daily life. Medicare covers medically necessary programs, and an ICF is focused more on custodial care. However, an ICF will be less expensive than a nursing home and more affordable for many people. 

Pros and Cons of an Intermediate Care Facility

An intermediate care facility has pros and cons, just as there are for any care community. Whether an ICF is right for you or a loved one depends on factors such as cost of care, family involvement, and quality of life.

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Pros of an intermediate care facility

  • An ICF can be a less expensive alternative to a nursing home or even in-home care for long-term care needs.
  • An ICF promotes independence by providing only what the resident needs to function.
  • An ICF can take the pressure off of families who have been trying to provide care for a loved one.
  • An ICF has the goal of returning the resident to their home or a less restrictive environment. That doesn’t always happen. People can live in an ICF for years.
  • An ICF affords the resident more independence and autonomy.

Cons of an intermediate care facility

  • An ICF is still institutional living, and some people would prefer to be at home with home care or help from their family.
  • An ICF isn’t able to provide for increasing nursing needs.
  • An ICF may be difficult to find in your area.
  • An ICF is not for acutely ill residents or those that need a lot of help.
  • Even if you find an ICF, they may not have a room available for your loved one. 

How to Find an Intermediate Care Facility Near You

Finding an ICF near you could be a challenge due to their lack of availability compared to other types of senior living. You may very well do a lot of searching only to find out there are no options available near you. If that is the case, consider some of our other suggestions for care.

Skilled nursing homes

Your loved one may have a stay in a skilled nursing home rehab setting and need additional care that can’t be provided at home. Ask the discharge planner about the possibility of an ICF in the area. 

Home health and home care companies

Home health and home care companies may know of an ICF since sometimes their patients need continued care beyond what they can provide. You can ask for the case manager of either company to get recommendations. 

Geriatric physician

If your loved one has a geriatric physician, ask their office about an ICF. Some geriatric clinics have a nurse case manager who makes these referrals and might be able to help. If your loved one’s doctor does not specialize in geriatrics, it’s still worth asking them for a referral.

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Online search

You might have success with an online search, but be aware that numerous other senior living communities might appear under the name ICF. Make sure that you get an accurate description of what they provide so you know it is an ICF and not another type of senior care. 

Senior care placement specialist

A senior care placement specialist is a local professional who helps families find senior placement. Their services are typically free to the consumer since the facilities reimburse them after someone moves in. A good senior care placement specialist will have broad expertise in all types of senior housing, including ICFs.

Popular Alternatives to Intermediate Care Facilities

There are alternatives to intermediate care facilities, but they might be more expensive. The cost of round-the-clock care for someone who needs consistent help with activities of daily living can be high. But if it is something you can afford, it is doable, especially when there are few nursing needs. 

Assisted living

Assisted living is an alternative to an intermediate care facility because they have staff to assist residents with activities of daily living. Nursing care is minimal, but it is in an ICF, as well. Whether assisted living is an option for you depends on the level of care they can provide. Some assisted living communities can offer round-the-clock care to help with transfers, bathing, and dressing. But that extra care comes at an additional cost.

In-home care

In-home care is a logical replacement for an ICF, but the cost can soar if you need someone all day, most days. Home care companies do not typically offer nursing-only help with activities of daily living, companionship, transportation, cooking, shopping, dressing, and bathing. The other advantage to in-home care is its flexibility. You can change the schedule depending on your loved one’s needs or family availability for caregiving. 

Boarding home or residential care home

A boarding home is a residential care home with a few rooms for older or intellectually disabled adults. Most of these communities fall under state-assisted living regulations but don’t have the amenities of typical assisted living. In some cases, they have staff to assist residents with activities of daily living, transportation, medication management, and limited nursing. 

Boarding homes are also usually less expensive than any of the other alternatives and offer a home-like feel that many people prefer. Every boarding home will have a menu of services and amenities, so make sure they have what you require before committing. If your loved one requires help overnight, ask about staffing availability for their needs. 

Intermediate Care Facility: Pros, Cons, and Costs

An intermediate care facility might be a good choice for you or your loved one. The challenge might be finding one that meets your specific needs. As you do your long-term care planning,  investigate the availability of these facilities in your area in case you or your loved one needs this type of care.


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