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Senior Living Communities: Options, Pricing, and Differences
Aug 31, 2023
Fact Checked
Key Takeaways
- As the United States population matures, more older adults and their caregivers will need to make a plan for where they will live as they age.
- In general, senior living communities aim for a balance between honoring an older adult’s independence and providing the level of care needed.
- The five most common senior living options are independent living communities, assisted living, memory care, nursing homes, and in-home care. As older adults’ needs increase, they may require a move from one type of community to another.
As we are all aging, most of us would prefer to stay in our homes, also known as “aging in place.” Yet it’s helpful to know the other senior living options available. Senior living communities, such as independent living or assisted living, offer varying levels of independence and a host of services. Knowing what each type of community offers is an important first step in deciding which option is best for you or someone you care for.
The NCOA Adviser Local Care Reviews Team created a clear, comprehensive guide to senior living communities. We want you to feel more informed about your options and more confident about the next steps in determining how and where you will live as you age.
Why you can trust us
Our 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 ⓘA geropyschologist is a professional psychologist who specializes in the needs and well-being of older adults, and a geriatric nurse practitioner
- Surveying thousands of older adults and their caregivers about their search for senior living facilities
- Conducting focus groups with caregivers helping older adults find assisted living
- Mystery shopping dozens of brands and facilities associated with long-term care for older adults
- 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
What are senior living communities?
The United States Census Bureau reported one in six people in the United States were 65 and older as of 2020, representing nearly 17% of the entire population. [1]United States Census Bureau. 2020 Census: 1 in 6 People in the United States Were 65 and Over. May 25, 2023. Found on the internet at https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html According to the Census, the growth of the older adult population won’t slow until about 2030, when all baby boomers are age 65 and older. As the population ages, more and more families are having conversations about where the older adults they care about will live as they age.
Many older adults will elect to stay in their homes. Aging in place has multiple benefits, including maintaining your independence and remaining in your community. But some older adults may need more support—or more social interaction—than they get at home. For those older adults, there are several types of residential senior living communities to consider.
The term senior living usually refers to a spectrum of residential options for older adults, ranging in the degree of services and amenities provided. Most senior living options provide meals and social opportunities for residents, but only some of these communities offer personal care or medical services.
Medicare does not cover any form of senior living. For older adults meeting the income eligibility requirements, Medicaid and Medicaid waivers may help to pay for assisted living, memory care, nursing home care, and in-home care, but not independent living.
Table 1 Overview of main senior living options
Type of senior living community | Who is it for? | What care is provided? |
|---|---|---|
| Independent living | Older adults in relatively good health wanting a maintenance-free lifestyle and access to social activities and on-site amenities, like fitness centers and movie theaters | Usually a meal plan and light housekeeping. Personal care and medical services not provided, unless arranged by resident with third-party contractors |
| Assisted living | Older adults no longer able to live independently, and may need assistance with medication management and assistance 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., like bathing and dressing | Meals and snacks, housekeeping, laundry, and ADLs as needed |
| Nursing home | Older adults needing ongoing skilled nursing care, which can no longer be provided at home or in assisted living | Required to have a registered nurse (RN) on staff 24/7 to provide skilled nursing services |
| Memory care | Older adults living with Alzheimer’s or another form of dementia | Some, but not all, will offer skilled nursing care and have secured entrances and exits |
| In-home care | Older adults needing additional services to help them age in place | A range of care—from companionship services to skilled nursing—provided by professional caregivers, including certified nursing assistants (CNAS) or RNs |
When is it time to consider senior living options?
If you’re an older adult aging in place, it’s important to monitor your physical, emotional, and social health as you age. This is especially true for older adults living alone. Here are some signs it might be time to consider senior living options:
- You feel lonely, isolated, or depressed.
- You’re finding it harder to prepare meals and to clean and maintain your home without help.
- Activities of daily living, such as bathing or dressing, feel more challenging than they used to.
- You often forget to take medications or have a hard time keeping medications organized.
- You have experienced a fall, or are having mobility issues requiring extra care to reduce your risk of falling.
If any of these statements are true for you or someone you care for, it might be time to start thinking about senior living options.
Planning for senior living and retirement
Whether you want to age in place or join a community of peers in a residential care setting, it’s important to plan ahead. It’s almost never too early for adults to start thinking about readying for retirement, including how and where they want to receive care.
Without a specific plan in place, many older adults are forced to make quick decisions after experiencing a fall or receiving a new medical diagnosis. No one wants to make a major life decision in the middle of a crisis.
Here are a few resources to help you to start thinking ahead about your senior living options:
- Work with a financial professional specializing in assisting older adults as they plan for retirement.
- Discover which programs and services you qualify for as you age with BenefitsCheckUp.
The five main senior living options
Every older adult is unique, and so are their shifting needs and preferences. A senior living community that works well for one person might not be a great fit for another. To help you decide the best option for you or someone you care for, start by reviewing the five most common types of senior living options.
1. Independent Living
Independent living communities are a great option for older adults in generally good health who don’t want the burden of home ownership. Independent living communities usually consist of a single building—or a few buildings on a single campus—made up of studios, condos, or apartments with 1–3 bedrooms. Some independent living communities are incorporated into a continuing care retirement community (CCRC) that includes the levels of care residents may need in the future. Typically, a resident of independent living will receive a meal plan as part of their monthly fee, or as an optional add-on fee, as well as other services, like light housekeeping.
Like independent living facilities, retirement communities and 55+ senior apartments are also intended for active older adults, offering amenities like pickleball courts, fitness rooms, and clubhouses for communal gatherings. But retirement communities and senior apartments typically don’t offer any services beyond the building’s amenities.
Cost of independent living
Typically, independent living facilities charge a monthly, all-inclusive fee for room, board, and additional services, which may include housekeeping, complimentary transportation, and regularly scheduled activities. The cost of independent living can vary widely depending on where you live and the type of apartment you choose. Brookdale, the largest senior living operator in the United States, reported a range of $870–$7,545 per month for independent living rents. [2]Brookdale Senior Living. Independent Living Costs. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html
Low-income senior housing
Subsidized senior apartments offered through the United States Department of Housing and Urban Development (HUD) typically do not offer services like housekeeping and personal care services, but some do offer services such as care coordination and wellness programs.
HUD housing for seniors often has a long waiting list. Use HUD’s affordable rents tool to find subsidized senior housing near you. And learn more about the Section 8 Housing Choice Voucher Program and Section 202 Supportive Housing for Older Adults.
Independent living amenities
In independent living communities, older adults can enjoy amenities intended to improve their quality of life, such as restaurant-style dining, fitness rooms, libraries, and guest rooms for overnight visitors. Some luxury independent living facilities also have on-site movie theaters, swimming pools, pickleball courts, and mini-golf courses or putting greens. Amenities provided will vary depending on your budget and location.
It’s important to note fancy amenities don’t necessarily mean a more positive experience. For many older adults, the most important feature of an independent living community is an engaged community of peers.
Independent living services
The all-inclusive rent at independent living facilities usually includes light housekeeping, three meals per day, and a full activities calendar. Some communities will also offer laundry services and complimentary transportation to shopping, medical appointments, and social events.
Independent living communities do not provide personal care or medical services of any kind. Residents needing additional help, such as assistance with activities of daily living (ADLs), can contract with third-party service providers to provide the care they need to continue living independently. These third-party services may include a home health agency, companion services, or physical and occupational therapy.
2. Assisted living
Assisted living offers more support than independent living, but provides less support than a nursing home or memory care facility. Typically, assisted living residents receive help with medication management and some activities of daily living.
Some assisted living facilities include separate, secured memory care units for residents living with Alzheimer’s or another form of dementia. Residents of these units have access to the same services as other assisted living residents, but with an added focus on dementia-specific care.
Cost of assisted living
The median monthly cost of assisted living in the United States is $4,500, though this fee will vary depending on your specific region. [3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care It’s important to know the initial cost cited by most assisted living facilities is for room and board only, and does not include fees for additional services, like medication management or help with bathing. These additional fees could increase the monthly assisted living facility bill by hundreds or thousands of dollars.
Assisted living services and amenities
In most assisted living facilities, the following services are included in the all-inclusive monthly fee:
- 24/7 emergency care
- A shared or private room or apartment
- Three meals per day and snacks between meals
- Daily planned activities, including some group outings
- Pain management care, which may include a combination of medications, physical therapy, and or supplying a mattress for back pain.
In assisted living, older adults also receive a host of personal care services, some of which are customized to the individual resident. Residents are regularly assessed to determine which personal care services the resident needs and how often they need those services. These are the personal care services available to residents of assisted living:
- Administration and management of medications
- Personal hygiene assistance, such as showering, dressing, toileting, and caring for hair and nails
- Ambulatory assistance, such as bed transfer, escorts to and from communal spaces, and physical and occupational therapy
According to the NCAL, the most common activity of daily living assisted living residents need help with is bathing. [4]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 Assisted living facilities are not required to have registered nurses (RNs) on staff, so they do not provide skilled nursing care. Assisted living communities are regulated at the state level. These regulations, such as required services and staffing levels, vary by state.
3. Nursing homes
Nursing homes, also called skilled nursing facilities, are for adults needing ongoing, skilled care that can no longer be provided at home or in an assisted living facility. Nursing home residents can receive personal care, such as help with activities of daily living, as well as regular nursing care provided by registered nurses. Nursing homes offer both short-term and long-term care.
Some nursing homes have separate memory care units for older adults living with Alzheimer’s or another form of dementia, which the Alzheimer’s Association reported to be 58% of all long-term nursing home residents. [5]Alzheimer’s Association. 2023 Alzheimer’s Disease Fact and Figures. Found on the internet at https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf
Nursing home costs
In the United States, the monthly median cost for a nursing home facility is $7,908 for a shared room and $9,034 for a private room. [3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care For many Americans, this is not a manageable out-of-pocket expense. Fortunately, more government funding options are available for covering nursing home costs than for other types of senior living.
Nursing home services and amenities
Nursing homes offer both short-term and long-term care, often in the same building or on the same campus. It is possible for residents to transfer from short-term care to long-term care, although some short-term residents will return home after receiving therapeutic services.
Short-term nursing home care is often called rehabilitation, or rehab. This type of nursing home care is generally covered by Medicare. After a qualifying inpatient hospitalization, older adults may require a short stay in a nursing home to receive physical, occupational, or speech therapy. These therapies help care recipients recover from illness, injury, or stroke; and help to restore mobility, strength, and endurance. Short-term nursing home residents will also receive personal care, including prepared meals, medication management, and as-needed help with ADLs.
Long-term nursing home care offers comprehensive treatment for those with chronic diseases or conditions requiring ongoing care, such as Parkinson’s disease. Long-term nursing home care might include the following services:
- Medication management and administration
- Care for overall health and well-being, including nutritious meals and social activities
- Assistance with ADLs, such as bathing, toileting, incontinence, and transferring to and from bed or a wheelchair
- Skilled nursing care, including wound care, diabetes management, catheter care, blood pressure monitoring, and injections
4. Memory Care
Memory care is specialized residential care for older adults living with Alzheimer’s or another form of dementia. Most memory care facilities have staff-secured entrances and exits to prevent residents from wandering.
Most memory care units are located within assisted living or nursing home facilities, although some are standalone communities entirely dedicated to older adults living with some form of dementia.
Memory care cost
According to Dementia Care Central, the average monthly cost of memory care in an assisted living facility in the United States is $6,160, or about $73,920 each year. Nursing home care may be required as dementia progresses. The national average for a shared room in a nursing home is about $286 per day or about $8,580 per month. [6]Dementia Care Central. Alzheimer’s/Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Updated February 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/
Memory care services and amenities
Residential memory care facilities typically provide the same services and amenities as assisted living facilities, including a private or shared apartment, three meals per day, housekeeping, laundry, and personal care services, such as help with ADLs. Memory care facilities located within a nursing home also offer skilled nursing care provided by registered nurses.
Most memory care facilities also offer specialized care for people living with dementia. The National Center for Health Statistics (NCHS) reported 91% of dementia special care units within residential facilities offered dementia-specific activities for residents, and 90% had doors with alarms to alert staff if someone left the unit. [7]Centers for Disease Control and Prevention/National Center for Health Statistics. Dementia Special Care Units in Residential Care Communities: United States, 2010. November 2013. Found on the internet at https://www.cdc.gov/nchs/data/databriefs/db134.pdf These common features of memory care facilities engage residents while also keeping them safe.
5. In-home care
In-home care, also called home care, refers to a range of services provided to older adults in their own homes. These services range from simple companionship to help with activities of daily living and skilled nursing care.
Table 2 Types of in-home care and services provided
Type | Details |
|---|---|
| Companion care | Companion services are provided by non-certified, non-licensed aids. Services include companionship, driving to appointments and errands, light housekeeping, laundry, and meal preparation. |
| Personal care assistance | Personal care assistance can be provided by non-licensed, non-certified aids, or by certified nursing assistants (CNAs). Services include medication reminders and administration, and assistance with activities of daily living, including bathing and toileting. |
| Home health | Home health care is provided by licensed medical professionals, such as registered nurses (RNs) or licensed professional nurses (LPNs). Services include skilled nursing services, such as catheter care, injections, and wound care. |
In-home care costs
The cost of in-home care will vary considerably based on the type of care needed by you or someone you care for, as well as how frequently you need care. In the United States, the median monthly cost for 40 hours per week of homemaker services, or companion care, is $4,506. The median monthly cost for 40 hours per week of home health aide services is $4,680. [3]Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care Medicare does offer coverage for some home health care services under Medicare Part A or Part B.
In-home care services and amenities
In-home care can refer to basic homemaker services, such as running errands, providing transportation to appointments, and preparing meals. It can also refer to personal care assistance, such as assistance with bathing, dressing, and toileting. Home health, which refers to medical care provided in the home by a licensed medical professional, includes catheter and wound care, diabetes management, and injections.
Other Senior Living Options
Independent living, assisted living, nursing homes, memory care, and in-home care are the most common types of residential care provided to older adults. But there are other types of senior living options to suit the needs of any older adult seeking local care.
Table 2 Other senior living and senior care options
Alternative care option | Details |
|---|---|
| Continuing care retirement communities (CCRCs), or life care communities (LCCs) | Independent living, assisted living, nursing care, and memory care are in one location, with each level of care typically delivered in a different building or on different floors within a building. Residents move from one level of care to another as their needs change. |
| Congregational retirement communities | A complex of single-family units, condos, and apartment buildings, often organized around a communal gathering space, like a clubhouse. Many retirement communities have a homeowner’s association (HOA), coordinating social activities and services like lawn care and building maintenance. |
| Respite care | A temporary residence for older adults when their caregivers need to travel or just need a break from caregiving. Many assisted living facilities and nursing homes offer respite care. |
| Adult day services | A coordinated program of social and some health services for adults needing supervised care outside the home during the day, or as a respite care option. Adult day services usually operate during normal business hours five days per week, and some programs are also open in the evenings and on weekends. |
| Hospice care | Quality-of-life care for people experiencing advanced, terminal diseases. Hospice care may be provided in the home or in a residential hospice center. |
The bottom line: Choosing the right option
Knowing the differences between senior living communities is an essential step in deciding how and where you will live as you age. While many older adults will elect to age in place, remaining in the home is not always possible or preferred. In those cases, independent living, assisted living, memory care, and nursing home communities can offer a range of social, emotional, medical, and functional services to help older adults thrive.
Services provided in senior living communities include planned social activities; assistance with activities of daily living, such as bathing and dressing; medication management and administration; and medical services, like catheter care and diabetes management.
Talk to family, friends, and a trusted medical professional to help determine which senior living option is right for you or someone you care for. The earlier you begin this discussion, the better you’ll be able to navigate your options.
Frequently asked questions
The four main types of senior living facilities are independent living, assisted living, nursing homes, and memory care. These facilities offer a range of services to residents, from planned social activities to non-medical personal care and skilled nursing care.
Medicare will help to cover up to 100 days of rehabilitation in a skilled nursing facility following a qualifying hospital stay, but it will not cover any form of long-term care.
Many seniors pay for assisted living using a combination of personal savings, long-term care insurance, or home equity. In some cases, Medicaid will help Medicaid-eligible older adults cover the cost of assisted living.
Independent senior living facilities do not provide any medical or personal care services, so they are not regulated by any state or federal agency.
Have questions about this article? Email us at reviewsteam@ncoa.org.
Sources
- United States Census Bureau. 2020 Census: 1 in 6 People in the United States Were 65 and Over. May 25, 2023. Found on the internet at https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html
- Brookdale Senior Living. Independent Living Costs. Found on the internet at https://www.brookdale.com/en/our-services/independent-living/independent-living-costs.html
- Genworth. Cost of Care Survey. Found on the internet at https://www.genworth.com/aging-and-you/finances/cost-of-care
- 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
- Alzheimer’s Association. 2023 Alzheimer’s Disease Fact and Figures. Found on the internet at https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf
- Dementia Care Central. Alzheimer’s/Dementia Care Costs: Home Care, Adult Day Care, Assisted Living & Nursing Homes. Updated February 2023. Found on the internet at https://www.dementiacarecentral.com/assisted-living-home-care-costs/
- Centers for Disease Control and Prevention/National Center for Health Statistics. Dementia Special Care Units in Residential Care Communities: United States, 2010. November 2013. Found on the internet at https://www.cdc.gov/nchs/data/databriefs/db134.pdf