Key Takeaways

• Assisted living and independent living can both be good options for older adults who want to maintain independence while also receiving help with daily tasks, such as housekeeping and meal preparation.
• Assisted living facilities offer personal care services, including help with activities of daily living (ADLs) ⓘActivities of daily living, also called ADLs, are activities related to necessary personal care. These include bathing, dressing, toileting, eating, walking, and transferring in and out of a bed or chair.. Independent living facilities do not offer personal care services, but residents can still arrange such services through third-party providers.
• Assisted living is usually more expensive than independent living. Medicare or Medicaid covers neither, although Medicaid may cover some personal care services that eligible residents receive in assisted living facilities.

Long Term Care Insurance Providers

The conversation around living options for older adults, including independent and assisted living, often centers around health and personal care needs. But many older adults seek supportive living situations out of a desire to live more fully, not simply to manage diseases or disabilities.

The Local Care Reviews Team wants to help you or someone you care for live as independently and joyfully as possible. It’s important to know what types of residential facilities will provide the support you need while also offering the lifestyle you want.

Our guide to assisted living vs. independent living can help you make an informed decision about where to live as you age.

Why you can trust us

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

• Consulting with our advisory board, which consists of a certified life care manager, a board-certified geropyschologist, and a geriatric nurse practitioner
• Analyzing and synthesizing nationwide data from the Centers for Medicare & Medicaid Services (CMS), the National Investment Center for Seniors Housing & Care (NIC), and the National Center for Assisted Living (NCAL)
• Analyzing and synthesizing state-specific data from government health regulatory agencies
• Surveying thousands of older adults and their caregivers about their search for senior living facilities
• Conducting focus groups with caregivers who are helping older adults find local care
• Mystery shopping dozens of brands and facilities associated with long-term care for older adults

What is assisted living?

Assisted living facilities are not regulated by the federal government but rather by one or more state agencies. As they are state-regulated, the exact definition of assisted living and the scope of care provided in assisted living facilities will vary depending on your state. Because of these state-to-state differences, a national definition of assisted living is broad but still valuable for understanding the general scope of care provided.

The National Center for Assisted Living (NCAL) defines assisted living as “a long-term care option preferred by many individuals who typically need help with everyday activities and some health care services but typically do not require 24-hour skilled nursing care services for extended periods of time.” ^[1]National Center for Assisted Living. Assisted Living State Regulatory Review, 2022 Edition. Found on the internet at https://www.ahcancal.org/Assisted-Living/Policy/Documents/2022_reg_review.pdf The NCAL also emphasizes that these communities offer companionship, independence, and security while prioritizing the choice, dignity, and privacy of residents. Based on this broad definition, you can expect most assisted living residencies nationwide will provide similar services.

Most assisted living residences offer the following:

• A private or shared room or apartment within a larger residence
• Regular housekeeping, which may or may not include laundry services
• Three meals per day, including snacks and support for some special diets
• Social activities for residents
• Some help with activities of daily living (ADLs), such as bathing, grooming, toileting, transferring in and out of bed or a chair, eating, and continence, though the degree of help provided will vary by facility
• Some nursing care, although assisted living residences are not required to have a registered nurse (RN) on staff

Assisted living facilities sometimes go by other names, such as residential care, adult care homes, or, less commonly, board and care homes. Some people use the terms assisted living and nursing home interchangeably, although these facilities do not offer the same level of care. Skilled nursing facilities, or nursing homes, offer regular, skilled nursing care services unavailable in assisted living facilities unless provided by an independent, contracted home care agency.

What is independent living?

Independent living usually refers to a residential or housing community exclusively for older adults, 55 and older or 62 and older, depending on the community. We spoke with Jennifer Avila, executive director of Chicago-based Custom Home Care, who has more than 20 years of experience in senior housing and health care, to clarify distinctions between assisted and independent living. Avila defined independent living as senior living geared toward older adults who are in relatively good health but don’t want the burden of home ownership.

Most independent living communities offer the following services:

• Regular, light housekeeping
• Three meals per day
• Social activities, including planned outings to museums, restaurants, parks, and movie theaters
• On-site amenities, such as beauty salons, laundry facilities, libraries, and fitness centers
• Transportation to and from doctor’s appointments and nearby stores

Life in an independent living community is much like living at home, but within a community of other older adults. Independent living offers a single monthly fee that includes rent, options for meals, and access to on-site amenities and social activities.

Unlike assisted living, personal care and medical services are not offered by independent living communities, although residents of these facilities may contract with third-party agencies to receive services, such as home health aides or physical therapy.

Independent living facilities sometimes go by other names, such as retirement communities, 55-plus communities, active adult communities, or senior living apartments.

Continuing Care Retirement Communities (CCRCs), also called Life Plan Communities, differ from independent living. CCRCs are a type of senior living that combines several care levels—independent living, assisted living, nursing care, and memory care—on one campus. In these communities, people move from one level of care to the next as their needs change. These communities can be an excellent option for older adults at any level of care, but the costs can be prohibitive. CCRC entrance fees alone can range from $50,000–$450,000, according to the Internal Revenue Service. ^[2]Internal Revenue Service. Elderly Housing Report, 2004. Found on the internet at https://www.irs.gov/pub/irs-tege/eotopicg04.pdf

Assisted living vs. independent living: four main differences

Assisted living and independent living have many similarities. In both types of residences, the monthly fee may include:

• A private or shared apartment
• Housekeeping services
• Three meals per day
• Planned social activities

Significant differences also exist between the two types of senior living, including levels of care provided, monthly costs, types of social engagement, and community design.

Table 1 Assisted living vs. independent living: four main differences at a glance

	Assisted living	Independent living
Levels of care	Help with activities of daily living (ADLs) Medication assistance Some medical care	No care provided (unless arranged by residents through contracted services)
Cost	Monthly median base fee of $4,500, not including fees for additional care services*	Monthly rents ranging from $870–$7,545**
Social activities	Accommodates people with physical or cognitive limitations (walking groups, chair yoga, board games)	Geared towards active adults (pickleball, yoga, weekly community outings)
Community design	Smaller and more self-contained May have locked units for dementia care	Larger with more outdoor spaces Designed for active older adults

*Source: Genworth Cost of Care Survey ^[3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html
**Source: Brookdale, largest operator of senior living in the United States ^[4]Brookdale Senior Living. Independent Living Costs. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html

1. Levels of care and support

The primary difference between assisted living and independent living is the types of personal care services available to residents. Here’s a breakdown of how personal care services work for each kind of community:

Assisted living personal care services

In an assisted living facility, each resident must be assessed by a certified staff member either shortly before or after their move-in date. This assessment determines the level of care each resident needs.

The level of care assessment may determine that some residents need help with just medication reminders and one or two ADLs, such as bathing or dressing. Other residents may need assistance with several ADLs, including toileting or bed transferring. In some cases, when a person’s needs are too great for the staff to manage, assisted living residents may be referred to a skilled nursing facility, where they can receive a higher level of support in addition to medical services.

Keep in mind that assisted living facilities are regulated on the state level, so the scope of care each facility must provide will vary depending on where you live. Each facility must follow licensure guidelines from their state health department.

Independent living personal care services

In independent living, Avila shared, “Residents needing additional support services usually have to set them up on their own. The community may have options on-site, but the resident or family coordinates the care services through a home services or home health agency, just like when you’re in your own home.”

Examples of services you may want to set up for yourself or someone you care for in independent living include physical and occupational therapy or a home health aide for daily visits to administer medications and help with bathing and dressing.

Regulation of independent living facilities is less clear-cut than that of assisted living. While there is no official state oversight of most independent living facilities, each community must have a business license and adhere to local health, safety, and building regulations. Although Avila noted, “If an independent living facility offers health care services, they must be licensed by the state and are subject to regular inspections and regulatory requirements.”

2. Cost and financial considerations

For both independent and assisted living, costs vary widely from state to state, and even from facility to facility. In most cases, the cost of independent living is less than the cost of assisted living. Yet in certain instances, Medicaid may help cover the cost of care services in assisted living for eligible older adults.

Cost of assisted living

According to the Genworth Cost of Care Survey, the median monthly cost of assisted living in the United States is about $4,500. But the survey also shows this cost varies depending on where you live. For example, California’s median monthly cost of assisted living is about $5,250 compared to $3,612 in South Carolina. This cost will also vary from city to city. San Francisco assisted living averages about $6,319 per month, but in Bakersfield, California, the monthly average is $3,750. ^[3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html

Assisted living also comes with a variety of additional fees that can increase the monthly rate by hundreds or even thousands of dollars. Typically, the monthly fee cited by the facility is a base fee that covers room, board, housekeeping services, on-site social activities, and transportation to doctor’s appointments. This fee does not cover any personal care services, such as help with ADLs or medication management. Instead, a resident will be assessed by staff and then placed in a level of care corresponding to a specific additional monthly price. The facilities we researched had three or four levels of care each, with additional fees ranging from $400–$1,700 per month.

Medicare will not cover the cost of any long-term care, including assisted living. In some cases, if a person is eligible, Medicaid will cover the cost of personal care services a resident receives in assisted living, even if it won’t cover room and board. Some Medicaid waiver programs will pay the entire cost of assisted living for Medicaid-eligible older adults. To learn more about Medicaid coverage for assisted living in your state, get in touch with your local area agency on aging and ask about Home & Community-Based Services, also called 1915(c) waivers or HCBS Waivers. ^[5]Medicaid.gov. Home & Community-Based Services (1915c). 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

Medicare and Medicaid often cover durable medical equipment (DME), such as commodes, grab bars, hospital beds, and limited renovations to make an apartment safer. This type of portable equipment is usually allowed inside an assisted living setting. Still, you may need to work with the facility to certify that the resident can manage the equipment independently. Assisted living will also require a building sign-off for any installation that involves building alteration, such as installing a ramp or a grab bar.

Cost of independent living

Similar to assisted living, the cost of independent living usually includes a range of amenities, including a private or shared apartment, three restaurant-style meals per day, and light housekeeping. Unlike assisted living, independent living facilities do not offer medical or personal care, so there are no additional fees for those services.

The cost of independent living will vary widely based on the facility’s location and amenities. Many independent living communities are managed by large companies with locations in several states. Our research found that all-inclusive rents in independent living facilities started in the range of $1,709–$4,595 per month, although Brookdale, the largest operator of senior living in the United States, reported an even wider range of cost for independent living, with rents averaging $870–$7,545 per month. ^[4]Brookdale Senior Living. Independent Living Costs. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html

Insurance, including Medicare and Medicaid, will not pay for independent senior living, though it may cover the cost of medical or therapeutic services a resident receives while residing in an independent living community. As with an assisted living setting, Medicare and Medicaid will often cover the cost of DME used in an independent living setting. The building’s administration will need to sign off on any renovations that alter the facility’s structure, such as a ramp or grab bar, but you won’t need to go through a certification process for portable equipment such as a commode.

3. Social engagement

A 2020 report showed social isolation puts older adults at risk for dementia, stroke, depression and anxiety, and even premature death. ^[6]National Academies Press. Social Isolation and Loneliness in Older Adults. Found on the internet at https://nap.nationalacademies.org/read/25663/chapter/1 That’s why a full social calendar is an important feature of both independent and assisted living communities, although the types of activities vary between the two types of facilities.

Social activities in assisted living

We viewed activities calendars for assisted living facilities across the country. We found various events, clubs, and classes, including walking groups, movie nights, floral arrangement classes, book clubs, and sing-alongs. Games were also popular, with several facilities offering weekly bunco, bingo, and Scrabble games. Most facilities offered at least five activities each day in addition to three communal meals, which are also social events for residents.

In assisted living, social activities usually remain on-site. Avila explained that some activities in this setting—such as chair yoga and pet therapy groups—are designed to be engaging for people with physical or cognitive limitations. Staff will often remind assisted living residents about upcoming events and, if needed, escort them to activities.

Social activities in independent living

Avila shared that social programs are targeted toward active adults in independent living. “It’s common to find classes and learning opportunities, pickleball, yoga, trips, and opportunities to volunteer and give back to the greater community,” she said.

Typically, older adults in independent living will manage their own schedules and attend social activities that interest them. Residents may also initiate their own group activities.

4. Community design

Both assisted living and independent living communities should be designed to prioritize their residents’ safety, health, and well-being. Additionally, both types of facilities must adhere to state and local ordinances regarding accessibility for people with disabilities and physical limitations. However, the design of each community is different based on the needs of residents.

Community design in assisted living

Assisted living communities are often smaller than independent living communities and are typically enclosed within a single building. If the assisted living facility offers memory care, it may have smaller, self-contained areas designed for residents with Alzheimer’s disease or other forms of dementia. “Assisted living facilities offer smaller apartments, which can be easier for residents to manage,” Avila said. Sometimes, apartments will have a small kitchenette or no kitchen area at all because the facility provides all meals in a separate dining room.

Typically, assisted living residents can access on-site conveniences, such as beauty salons, physical rehabilitation centers, communal dining rooms, and recreational areas. Ideally, assisted living facilities will also offer media rooms, outdoor patios, and gardening areas.

In most cases, luxury private-pay assisted living facilities will have more amenities than facilities primarily accommodating lower-income residents. While you should consider an assisted living community’s look and feel, it’s important to note that outward appearances don’t always match the quality of the care provided. Leadership, staffing levels, type of staff and their experience, and staff engagement play a significant role in the culture and quality of care encountered in an assisted living facility.

Community design in independent living

Independent living communities usually offer more spacious apartment options. While small studios may be available, so are apartments with one to three bedrooms, multiple bathrooms, and full kitchens.

Independent living communities tend to attract active adults, so they may have larger campuses with more outdoor spaces. Amenities may include club rooms, pickleball courts, walking paths, putting greens, and even pools or spas.

How do I choose between independent and assisted living?

Deciding where to live as you age requires careful consideration. Maybe you’re interested in independent or assisted living but aren’t sure which kind of community is right for you. Through our interview with Avila, independent research, and the input of expert advisers, we’ve put together a few recommendations to help you feel more confident in your choice.

Assess needs and preferences

One of the most important factors in deciding where to live as you age is the amount of care you will need. “Be realistic about care needs with the expectation that the older adult will eventually need additional care and services,” Avila said. She also urged older adults to pick the level of care that meets their current and future needs, not an idealized version. It’s easy to “get dazzled by the amenities” and then choose a community that’s actually not a great fit. One family Avila worked with insisted that their mother move to a community with a swimming pool, but she hadn’t been swimming in many years and ultimately did not use the swimming pool after she moved into the retirement community.

Consulting with a trusted health care professional is a good way to make an informed decision about the kind of care you’ll need, and what kind of community can best provide your care. If available, consider exploring facilities that offer independent and assisted living in anticipation of future needs. Moving within a continuing care facility may be easier than moving to a new facility as needs change.

Know your budget

The high cost of long-term care can be prohibitive for many low- and middle-income Americans. Before you decide about where to live, consider taking these steps:

• Find out if you qualify for Medicaid or a Medicaid waiver program in your state. ^[7]Medicaid.gov. State Overviews. Found on the internet at https://www.medicaid.gov/state-overviews/index.html
• If you have a long-term care insurance policy, find out the details of your policy. Specifically, know your deductibles and the specifics of your monthly benefits.
• Evaluate your assets, including your home, stocks, and savings accounts. Which, if any, can be used towards the cost of long-term care?

Assisted living is generally more expensive than independent living, but depending on where you live, Medicaid waivers may help cover the cost, but only if you’re eligible and are receiving Medicaid. Similarly, aging in place with the assistance of home health aides could be more affordable than joining an independent living community, depending on your monthly rent or mortgage payment.

Tour communities and ask questions

One of the best ways to understand the difference between assisted living and independent living is to visit the communities themselves. Make a list of facilities in your area and pick a few to tour.

Here are some questions to consider when touring assisted or independent living communities:

• How does the place make you feel? Can you imagine yourself living there?
• Chat with residents and determine if their interests and activity levels are similar to your own. Would they make good peers? What do the residents have to say about the quality of care and their experiences with the staff?
• Does the staff seem helpful, attentive, and friendly? Do their qualifications enable them to offer the care you need?
• Are the facility administrators transparent about pricing? Can you realistically afford to live there?
• What are the criteria for exit? Are there regulatory standards that will require you to move out of assisted living and into a skilled nursing facility if your needs change?

Additionally, New York-based geriatric nurse practitioner Christopher Norman advised that you interview a variety of staff members, not just the marketing team. These conversations will give you a clearer picture of the care that’s offered in each assisted living setting.

Prospective residents can also contact the local Long-Term Care (LTC) Ombudsman to discuss quality of care issues within the facilities that are being explored. LTC Ombudsman have jurisdiction over assisted living facilities and can provide information to individuals and families who are considering assisted living placement.

Involve family members in the decision-making process

Don’t try to make this decision on your own. When making a decision this important, consider the input of children, siblings, other family members, and friends who have worked through similar decisions.

Most importantly, Avila said, “Don’t wait to look at senior living. Once there is an emergency, your options are immediately more limited.”

Bottom line

Independent living is ideal for older adults who don’t need personal care services, such as help with ADLs, but no longer want the burden of home ownership and home maintenance.

Assisted living is ideal for older adults who would benefit from a social, communal setting and need assistance with ADLs and medication management.

In most cases, choosing between independent living and assisted living will come down to your budget and the level of care you need. Assisted living is typically more expensive than independent living, but Medicaid may cover some or all of the cost of assisted living, depending on where you live, and whether you are eligible. For some older adults, aging in place with home health services will be a more attractive option.

When choosing between assisted living and independent living, involve close friends and family in your decision-making process. Start your search today, before a health or financial crisis makes the search more stressful. Many assisted living communities have waiting lists for new residents. The more prepared you are, the more options you will have.

Frequently asked questions

What is the best age to move to assisted living?

The NCAL reported that 50% of assisted living residents are over the age of 85, and 31% are between the ages of 75 and 84. ^[8]American Health Care Association/National Center for Assisted Living. Facts & Figures. Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx But moving to assisted living is a personal decision, and only you can determine which age is best for this kind of transition.

What is the average cost of independent vs. assisted living?

The median monthly cost of assisted living in the United States is $4,500. ^[3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html Brookdale Senior Living, the country’s largest operator of senior living, reported that monthly rents for independent living range from $870–$7,545. ^[4]Brookdale Senior Living. Independent Living Costs. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html

How would you differentiate between residential care facilities and independent living facilities?

Residential care facilities, also known as long-term care facilities or assisted living, assist with activities of daily living (ADLs) and some medical care. Independent living facilities offer room, board, and other amenities for one monthly fee, but they do not provide personal care or medical services.

Does Medicare or Medicaid cover assisted living or independent living?

Medicare does not cover any form of long-term care. Medicaid may help to cover some services you receive in assisted living, and in some states, a Medicaid waiver can help bridge the gap between an older adult’s income and the cost of assisted living, but only if you are eligible. Because no care is provided in independent living, it cannot be paid for by any type of insurance, including Medicaid or Medicare.

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

Sources

1. Assisted Living State Regulatory Review. National Center for Assisted Living. 2022 Edition. Found on the internet at https://www.ahcancal.org/Assisted-Living/Policy/Documents/2022_reg_review.pdf.
2. Elderly Housing Report. Internal Revenue Service. 2004. Found on the internet at https://www.irs.gov/pub/irs-tege/eotopicg04.pdf.
3. Cost of Care Survey. Genworth. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care.html.
4. Independent Living Costs. Brookdale Senior Living. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html.
5. Home & Community-Based Services (1915c). Medicaid.gov. 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.
6. Social Isolation and Loneliness in Older Adults. National Academies Press. Found on the internet at https://nap.nationalacademies.org/read/25663/chapter/1.
7. State Overviews. Medicaid.gov. Found on the internet at https://www.medicaid.gov/state-overviews/index.html.
8. Facts & Figures. American Health Care Association/National Center for Assisted Living.  Found on the internet at https://www.ahcancal.org/Assisted-Living/Facts-and-Figures/Pages/default.aspx.