What Is Assisted Living?

Aug 17, 2023
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As an older adult—or the caregiver of an older adult—the search for assisted living isn’t just about a place to live. It’s about access to a healthy lifestyle with built-in support.

In our Local Care Reviews Team’s March 2023 survey, 40% of respondents said their search for senior living was prompted by a medical diagnosis or a fall.1 The last thing you need at such a challenging time is another headache, yet 26% of survey respondents said they spent 10–20 hours searching for assisted living and other senior living options, and 24% spent 20–30 hours on their search. If you feel frustrated by a lack of transparent information about senior living, you’re not alone.

Our goal is to provide older adults and their caregivers with an honest, comprehensive guide to assisted living. We want you to feel more informed about your options and more confident about the next steps in your search process.

Why trust our expert review?

Our Local Care Reviews Team works hard to provide clear, transparent information to older adults and their caregivers seeking senior living and home care. To provide you with the best possible information, we have spent more than 250 hours:

How is assisted living different from other senior living options?

Assisted living is a type of residence for older adults who need daily care, but not as much care as a skilled nursing home provides. In an assisted living community, you or your loved one may receive prepared meals, housekeeping, medication management, and personalized help with activities of daily living (ADLs), such as bathing, dressing, or using the bathroom. Because assisted living is regulated at the state level, services available to residents will vary depending on your location.

Here’s an overview of services typically provided in assisted living in comparison to services provided in independent living or a nursing home or memory care facility.

Table 1 Comparison of services provided in senior living facilities

Independent livingAssisted livingSkilled rehab centerNursing homeMemory careContinuing care retirement community*
Daily meals
Transportation and planned outings
Social activities
Medication management
Help with ADLs
24/7 emergency care
24/7 skilled nursing care
Permanent Residence

*In a continuing care retirement community, residents can receive all the care services listed in this table, though they may have to move to a different floor or building to receive a higher level of care.

What kind of senior living is right for me?

Names used for senior living facilities may vary from state to state, as might the services offered in each kind of facility. This can make it challenging to determine which type of senior living is a good fit for you or your loved one.

Here’s an overview of the types of senior living as well as names commonly associated with each type of facility. We’ve listed them in the order most people need them.

Independent living

What is it?

Independent living refers to communities of adults 55 and older who live in their own apartments. Benefits may include communal meals, transportation to grocery stores and doctor’s appointments, and daily activities like yoga, movies, gardening, and book clubs.

Who needs it?

Independent living communities are for older adults who do not need daily personal care but no longer want to drive, cook all of their meals, or be entirely responsible for home cleaning and maintenance.

Other common names for independent living include retirement community, retirement home, or active adult community.

Assisted living

What is it?

In assisted living, older adults receive personal care based on their needs. Benefits may include communal meals, a social activities calendar, and as-needed 24/7 care, including medication management and help with ADLs such as bathing and dressing.

Who needs it? 

Assisted living communities are for older adults who need help with ADLs but want to live somewhat independently in a home-like setting with their own belongings. People might transition to assisted living after living at home or in an independent living community.

Other common names for assisted living include residential care, long-term care, supportive living, or an extra-care community.

Skilled rehabilitation center

What is it?

A skilled rehabilitation center is a temporary residence with 24/7 skilled medical care paid through Medicare or Medicare Advantage insurance. The benefits of skilled rehab include dedicated therapies and medical care for acute health conditions following at least three nights of hospitalization.

Who needs it?

Skilled rehab is for people who need care for an acute condition. For example, someone who experienced a fall, broke their hip, and underwent surgery might temporarily move to a skilled rehab facility to receive physical and occupational therapy. According to research by the Kaiser Family Foundation (KFF), the average skilled rehab stay is 26.3 days.2 People often transition from skilled rehab to assisted living or a nursing home. If the person receiving care is aging in place, they can transition back to their home after home care support has been arranged.

Other common names for a skilled rehabilitation center include skilled nursing home or transitional nursing care facility.

Nursing home

What is it?

A nursing home is a permanent residence with 24/7 personal and medical care. Benefits of nursing homes include nutrition support, social activities, and skilled medical care.

Who needs it?

Nursing homes are for older adults with chronic diseases that require ongoing, skilled care, such as Alzheimer’s disease, congestive heart failure, or other conditions that have worsened near the end of life. People might move to a nursing home from an assisted living community or from a home setting where they were being cared for by family.

Other common names for a nursing home include long-term care and skilled nursing care.

Memory care

What is it?

Memory care is long-term care specifically for people with memory loss caused by Alzheimer’s disease or another form of dementia. Memory care may be embedded in an assisted living or nursing facility, but it is a separate kind of care. Benefits of memory care include help with ADLs and a safe, regulated environment that minimizes confusion.

Who needs it?

Memory care facilities are for people with memory loss that interferes with their ability to live independently. Because of the focus on routine, memory care can reduce anxiety, a common symptom for people with memory loss and/or cognitive impairment. Memory care facilities are also designed to safeguard against wandering, a common risk for anyone living with Alzheimer’s disease or other dementia.3

Other common names for memory care include dementia care or a special-care unit.

Continuing care retirement community (CCRC)

What is it?

CCRCs offer all levels of care at one location with each level of care typically delivered in a different building or on different floors within a building. Residents can move from one level of care to another as their needs change.

Who needs it?

CCRCs accommodate older adults needing any level of care, but CCRC entrance fees and monthly costs can be prohibitive. According to the Internal Revenue Service, CCRC entrance fees can range from $50,000 to $450,000.4

Other common names for CCRCs include retirement communities and life plan communities.

What are the pros and cons of assisted living?

Types of assisted living available to you or your loved one will vary depending on the state where you or they live. In most cases, assisted living refers to a residential setting where managed care is provided alongside a healthy social environment.

Benefits of assisted living

The structured setting of assisted living allows older adults to maintain some independence while also receiving personalized care. The around-the-clock presence of caregivers and certified nursing assistants helps provide older adults and their caregivers with peace of mind.

Here are some of the other benefits of assisted living:

In most assisted living facilities, a medical alert system is located in each resident’s apartment, allowing for 24/7 emergency care.

Six benefits of assisted living facilities for older adults and their caregivers

Assisted living facilities have several benefits for older adults and their caregivers.

Drawbacks of assisted living

While the peace of mind provided by an assisted living facility can benefit families, this type of care isn’t ideal for everyone.

Here are some of the drawbacks of assisted living:

To ensure you or your loved one will receive timely and consistent care, ask about both the staff turnover rate and the caregiver-to-resident ratio at the assisted living facilities you tour. If you live in one of the 12 states with minimum staffing ratios for assisted living facilities, ask the communities you tour if they are meeting that standard.8

If your state does not have minimum staffing ratios, Payne recommends talking to as many caregivers and residents as possible when you tour facilities. “Look for positive interactions between residents and caregivers, as well as a sense of community within the facility,” she said. “These are good indicators that caregivers are regularly engaged with residents and that they’ve been on staff long enough to form positive relationships with residents.”

Who lives in assisted living facilities?

According to the American Health Care Association’s National Center for Assisted Living (AHCA/NCAL), about 55% of residents in assisted living communities are 85 or older, and 26% are between the ages of 75 and 84.9

Still, age alone is not a determining factor when it comes to assisted living. More important than age is the degree to which someone needs assistance with ADLs or care for chronic disease.

According to a 2021 report by the National Center for Health Statistics, 61% of assisted living residents need help with three or more ADLs. According to the same report, 34% were living with Alzheimer’s disease or another form of dementia.10

What are the qualifications for assisted living?

Assisted living facilities have guidelines to ensure they will be able to meet the needs of future residents. In most assisted living facilities, residents:

What are the requirements for moving into assisted living?

Before you move into assisted living, you’ll need to provide the facility with a few important documents. These documents will vary by facility, but the list below covers the items most assisted living facilities require upon move-in.

How do I know it’s time for assisted living?

“Every single person will at some point in their life care for someone or need to receive care from another,” said Certified Life Care Manager Carla Payne, founder of Aging Care Matters. She recommends starting conversations early with your loved ones and discussing your wishes and priorities so you’re prepared when the time comes for assistance.

Honest conversations with loved ones can help determine the next level of care for older adults. In March 2023, our Local Care Reviews Team organized a focus group of six caregivers of older adults to understand their experiences with searching for senior living options. More than one participant shared that the older adult they cared for sometimes found it difficult to have honest conversations with their children or other family members about their needs.11 It might be helpful to ask a doctor or certified care manager to be present for this discussion.

Here are some questions for older adults to help them and their families decide when it’s time for assisted living:

Here are some questions for caregivers to help them decide when it’s time to talk to their loved one about assisted living:

If you or your loved one answer yes to one or more of these questions, it might be time to start talking about assisted living options.12

How much does assisted living cost?

On average, assisted living costs about $4,000 per month for room and board, according to the AHCA/NCAL. This fee usually covers the cost of a shared or private apartment, Wi-Fi and cable, regular housekeeping and laundry services, and three meals per day.

In some cases, sharing an apartment with another resident can reduce the cost of room and board. One assisted living facility we researched in Fort Collins, Colorado, offered shared suites for $3,550 per resident, whereas the monthly cost for a private studio was $4,550.

What additional fees are associated with assisted living?

Additional fees could increase the monthly assisted living facility bill by hundreds or thousands of dollars each month. For example:

Most assisted living facilities will do a clinical services evaluation of the resident before or at the time of move-in to assess this. Based on this assessment, the resident will be placed in a certain level of care, each with a corresponding additional fee per month.

One facility we researched in Chapel Hill, North Carolina, had four levels of care, with Level One needing the least amount of hourly care and Level Four needing the most. For Level One care, residents paid an additional $400 per month; for Level Four care, an additional $1,250.

Another facility in Fort Collins, Colorado, had four levels of care ranging in cost from $700 to $1,700 per month. This facility also charged a $300 fee for medication management, regardless of the resident’s level of care.

In both of these facilities, Level One care included help once or twice per day with a few ADLs, such as showering and dressing. In Level Four care, residents needed help throughout the day with ADLs, medication management, escorts to and from the dining room, and transferring in and out of bed in the morning and at night.14

Long Term Care Insurance Providers

Mutual of Omaha
Share benefits with partner
Extra funds for care/expenses
Get some premiums back
Choose your coverage level
Discounts for couples
Detailed benefits customization

Does Medicare pay for assisted living?

Medicare pays for short-term rehabilitation, but it does not pay for any form of long-term care, including assisted living.

Medicare may pay for selected services older adults receive while they are assisted living residents, such as physical therapy or preventive health services.

To find out what you qualify for, get in touch with a Medicare advisor or use BenefitsCheckUp15

Does Medicaid pay for assisted living?

While Medicaid does cover the skilled nursing provided in a nursing home, it usually does not help pay for the room and board costs associated with an assisted living facility.

Medicaid may pay for selected services that Medicaid-eligible older adults receive while they are assisted living residents, such as physical therapy, personal care services, case management, transportation to doctor’s appointments, and personal medical alert systems.

Sometimes, a Medicaid waiver can help Medicaid-eligible seniors cover the cost of assisted living. Medicaid 1915(c) Home & Community-Based Services (HCBS) waivers have broad federal guidelines that states can tailor to meet the needs of residents in their state. Currently, there are 300 HCBS waiver programs across the United States.16

Though all Medicaid programs have federal oversight, each state runs its own Medicaid program. So, Medicaid rules and regulations will vary from state to state. For example, some states will provide additional medical and personal care services to residents of assisted living facilities. Others will only provide those services for in-home care.

To get answers about your Medicaid coverage, contact your state’s Medicaid office, find a Medicaid advisor through your local senior center, or consult BenefitsCheckUp.17

How can I pay for assisted living?

Table 2 How to pay for assisted living

How to payWhat to know
Personal savingsThis may include Social Security benefits, pension payments, stocks, and 401(k) or IRA accounts.
Reimbursement from long-term care insuranceKnow the details of your policy. Many have an initial 90-day out-of-pocket period. If the 90 days begin the day you start assisted living, you could be facing $20,000 or more of nonreimbursable expenses. If you are eligible for home care from an approved home care company, four hours in one day equals one day toward the 90-day elimination. Using an aide for 90 days would cost approximately $10,000. To save money, use the 90 out-of-pocket days before you begin assisted living.12
Home equityThis may include proceeds from the sale of your home or a reverse mortgage plan.
Veterans benefitsCheck with the Department of Veterans Affairs or use BenefitsCheckUp to discover your options.
Medicaid benefitsContact your state’s Medicaid agency to find out if you qualify for Medicaid or a Medicaid waiver.

How do I choose an assisted living facility?

You’re not alone in your search for assisted living. Currently, more than 800,000 people reside in senior care facilities in America, and that number will continue to grow as the population ages. 18

Our research shows many people begin the search for assisted living when their loved one is already in crisis. This can make the search feel even more overwhelming. Knowing where to look and what questions to ask can help you make an informed decision, even if you’re in a hurry. When researching your options, consider the following tips:

Alternatives to assisted living

In most cases, Medicaid will pay for nursing home care but not for assisted living. For low- and middle-income older adults, this means assisted living may not be financially feasible. This presents a new challenge: managing the gap between independent living and a nursing home.

For older adults aging at home: Consider goods and services that make it possible to safely continue living at home or in an independent living community, for example:

For caregivers of older adults: Often, caregivers are juggling so much more than just caring for an aging loved one, including full-time jobs and raising young children. Consider programs that help you to care for your loved one at home, for example:

For older adults and their caregivers: Work together to learn your options and find the solution that works best for your family, for example:

Frequently asked questions about assisted living

The benefits of assisted living include a safe and secure environment, fun social activities, communal meals, and help with activities of daily living (ADLs).

Not all seniors need assisted living. Assisted living is ideal for older adults who need help with activities of daily living (ADLs) but want to live somewhat independently in a home-like setting.

The next level of care after assisted living is a nursing home. Nursing homes provide 24/7 skilled nursing care that cannot be provided in an assisted living facility.

Residents of assisted living do not have medical needs that require skilled nursing, such as advanced Alzheimer’s disease or dementia, tracheostomies, insulin pumps, or feeding tubes.

Assisted living costs will vary depending on the state where you live, but the average national room and board cost for assisted living is $4,000 monthly or $48,000 annually.

Have questions about this article? Email us at reviewsteam@ncoa.org.


  1. Local Care Reviews Team survey. 1,000 respondents. Conducted using Pollfish. Launched March 2023.
  2. Kaiser Family Foundation (KFF). Amid the COVID-19 Pandemic, Medicare Spending on Skilled Nursing Facilities Increased More than 4% Despite an Overall Decline in Utilization. June 2022. Found on the internet at https://www.kff.org/medicare/issue-brief/amid-the-covid-19-pandemic-medicare-spending-on-skilled-nursing-facilities-increased-more-than-4-despite-an-overall-decline-in-utilization/
  3. Alzheimer’s Association. Stages and Behaviors: Wandering. Found on the internet at https://www.alz.org/help-support/caregiving/stages-behaviors/wandering
  4. Internal Revenue Service (IRS). Elderly Housing Report. 2004. Found on the internet at https://www.irs.gov/pub/irs-tege/eotopicg04.pdf
  5. Thomas, Patricia. Trajectories of Social Engagement and Limitations in Late Life. Journal of Health and Social Behavior. American Sociological Association. Dec. 2011. Found on the internet at https://journals.sagepub.com/doi/10.1177/0022146511411922
  6. American Health Care Association / National Center for Assisted Living (AHCA/NCAL). Assisted Living Facts and Figures. Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx
  7. Federal Reserve Economic Data. All Employees, Nursing and Residential Care Facilities. Found on the internet at https://fred.stlouisfed.org/series/CEU6562300001
  8. Long Term Care Community Coalition. Assisted Living Fact Sheet: Staffing Ratios. Found on the internet at https://nursinghome411.org/wp-content/uploads/2019/01/LTCCC-Assisted-Living-Fact-Sheet-Safe-Staffing.pdf
  9. American Health Care Association’s National Center for Assisted Living (AHCA/NCAL). Assisted Living Facts and Figures. Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx
  10. Caffrey Christine, et al. Residential care community resident characteristics: United States, 2018. National Center for Health Statistics (U.S.). Division of Health Care Statistics. Long-Term Care Statistics Branch. Sept. 2021. Found on the internet at https://stacks.cdc.gov/view/cdc/103826
  11. Local Care Reviews Team Focus Group for Caregivers. 6 participants. Conducted Using Google Meet. March 2023.
  12. Interview with Carla Payne, Certified Life Care Manager. Conducted using Google Meet. March 2023.
  13. Local Care Reviews Team Focus Group for Caregivers. 6 participants. Conducted Using Google Meet. March 8, 2023.
  14. Mystery shopping at assisted living facilities in North Carolina, Colorado, Michigan, and Alabama. March 2023.
  15. Medicare.gov. Contact Medicare. Found on the internet at https://www.medicare.gov/talk-to-someone
  16. Medicaid.gov. Home & Community-Based Services 1915(c). Found on the internet at https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html
  17. Medicaid.gov. State Medicaid Links. Found on the internet at https://www.medicaid.gov/about-us/beneficiary-resources/index.html#when2contactstate
  18. American Health Care Association’s National Center for Assisted Living (AHCA/NCAL). Assisted Living Facts and Figures. Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx
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