For many older adults and their families, assisted living can feel like the next logical step when daily tasks become more challenging. But the high expense of assisted living places it out of reach for many people.

Consider this: The national average cost for a month of assisted living in 2025 was $6,200, but this price tag varies greatly depending on where you live. Massachusetts reported an average monthly cost of $9,600, compared with $7,000 in California and $5,666 in Texas.¹ It’s no wonder that only about 1.4% of older Americans live in assisted living facilities today.²

“Medicare doesn’t cover most of the costs associated with assisted living, so those expenses must be paid out of pocket or by other means,” said Daniel Davis, NCOA Associate Director for Integrated Care.

Fortunately, assisted living is far from the only care option for older adults who need a bit more support day to day. “Most people prefer to stay in their homes and communities for as long as possible, and with the right support, that may be more realistic than you think,” Davis explained.

What are some alternatives to assisted living?

Alternatives to assisted living include in-home care, respite care, adult day programs, PACE, Medicaid home and community-based services, adult foster care, structured family caregiving, and home safety modifications.

Whether you’re an older adult exploring your choices, or a caregiver helping a parent navigate care decisions, you should know there are long-term care alternatives that can provide sufficient support—often at a much lower cost than assisted living.

Eight alternative care options worth exploring:

1. In-home care

In-home care allows older adults to receive regular, hands-on assistance without having to move to a residential facility. Depending on your needs, this type of care can range from a few hours of help each week to around-the-clock assistance.

Home care providers may help with both basic and instrumental activities of daily living (ADLs) such as:

• Bathing and dressing
• Hygiene and personal grooming
• Eating and feeding
• Toileting
• Moving and transferring
• Shopping and preparing meals
• Chronic disease management (e.g., diabetes)
• Light housekeeping
• Money management
• Transportation to appointments

In-home care offers the comfort of familiar surroundings while still providing needed support. It can also be more flexible than assisted living, since services can be scaled up or down as needed over time.

Most private health plans don’t cover the costs of non-medical home care. Medicare only covers certain home health services, such as skilled nursing and therapy, for eligible beneficiaries when specific requirements are met.

Some home care services are paid privately (by the hour), while others may be covered through Medicaid programs, veterans benefits, or long-term care insurance. Beyond these traditional funding sources, some states are exploring public long-term care insurance programs. Washington is the first state to roll out its own version of this, WA Cares, which offers coverage for in-home care and care provided in other residential settings. Workers living in-state can begin drawing on this benefit as of July 1, 2026. Other states, such as Massachusetts and New York, are looking at similar solutions.

✅ Tip: When hiring an independent caregiver, be sure to ask about their education, credentials, and any certifications they hold (e.g., Home Health Aide (HHA) or Personal Care Aide (PPA)). It's also a good idea to check at least two references and perform a background check.

If hiring through a home care agency, ask about their licensure, insurance coverage, and hiring processes (e.g., Do they perform routine background checks on employees? Are their caregivers credentialed?). Check online consumer reviews to get a sense of others' experiences. It’s also wise to look into whether any complaints or violations have been filed against the agency with state or local entities that oversee home care services—such as your state's Department of Public Health or equivalent regulatory board.

2. Respite care

Caregiving can be a rewarding endeavor, but it can also be emotionally and physically exhausting. Respite care provides family caregivers a temporary break while ensuring their relative continues to receive safe, compassionate care. This allows them to travel, manage personal matters, or just look after their own mental well-being.

Respite care can be planned in advance or arranged in emergency situations, depending on your needs. It may last anywhere from a few hours to several days or more. Care may be provided at home, through adult day programs, or in residential settings.

There are several forms of respite care. In-home respite care provides temporary help in the older adult’s home, while adult day programs offer supervision and activities during the day. Some assisted living facilities and nursing homes also provide short-term overnight or weekend respite stays.

While respite care is widely recognized as being critical for caregivers, it’s worth noting that ongoing direct-care workforce shortages have impacted the availability and access to professional respite care services.

✅ Tip: If you’re a caregiver, look into respite care before you reach the point of total burnout. Start by scheduling short, regular breaks—even just an hour or two—so both you and your family member can get used to the new caregiver and routine.

3. Safety monitoring devices and home modifications

Technology has made it easier for older adults to live independently while helping families feel more connected and reassured.

Today’s high-tech safety monitoring devices include:

• Medical alert systems
• Health monitoring devices (e.g., blood pressure, blood glucose)
• Fall detection sensors
• Interactive remote caregiving systems (including instant audio/video check-ins, two-way communication, and medication reminders)
• GPS tracking for people with dementia or other cognitive impairments
• Video doorbells and home monitoring systems

Of course, these tools are not a replacement for hands-on care. And while home monitoring devices can provide peace of mind, they should be selected in consultation with the older adult whenever possible. For many people, the best solution is one that improves safety while respecting their privacy, independence, and personal preferences.

Making accessibility improvements to a home can also offer significant benefits for older adults who want to age in place. Home safety modifications (e.g., grab bars, better lighting, walk-in showers, and wheelchair ramps) help prevent falls and make daily tasks easier. This is evidenced in the CAPABLE program (Community Aging in Place—Advancing Better Living for Elders), a home-based intervention that includes home modifications and other measures to help older adults stay safe and independent in their own homes. Research shows CAPABLE can save more than $30,000 in medical expenses by reducing the need for hospital stays and other outpatient care.

Together, safety monitoring devices and home modifications create an environment that allows older adults and people with mobility limitations to be more self-sufficient for longer.

✅ Tip: Search for devices that are easy to use and set up, prioritizing:

• Simple controls, with large buttons and large-type displays
• Interoperability with hearing aids and other assistive devices
• Clear sound, with features like voice activation or automatic alerts

Before you pay out of pocket for home safety modifications, look into grants from federal agencies and nonprofit organizations that can help cover some or all of these costs (this website is a good place to start). And additional help may be on the horizon. Congress recently passed the 21st Century ROAD to Housing Act, which includes the Whole-Home Repairs pilot program. If enacted, this program could expand grants and other resources for home repairs and accessibility improvements to help older adults maintain their independence.

4. Adult foster care

Adult foster care (also called adult family care) is a long-term care option in which an older adult or person with disabilities lives in a smaller, home-like setting and receives 24/7 support from trained caregivers. Care may include supervision as well as help with meals, bathing, medication management, and other personal needs.

Adult foster homes usually serve only a very small number of residents, which allows for more personalized attention and a deeper bond with caregivers. This option may appeal to older adults who would benefit from daily support but may feel overwhelmed by larger residential communities.

Adult foster care is typically less expensive than assisted living and nursing home care, but cost depends on location and the resident's individual care needs. Costs may be paid privately, through long-term care insurance, or through Medicaid programs in certain states.

5. Adult day health programs

Adult day health programs provide supervised care, social activities, meals, and health-related services for older adults during daytime hours. In the evening, care recipients return home. These programs can also give family caregivers time to work, recharge, or manage other responsibilities. They’re especially valuable for caregivers who work during the day or need regular support.

Services at adult day health programs often include:

• Social activities
• Exercise programs
• Therapeutic services
• Meals and snacks
• Medication assistance
• Memory care activities
• Nursing supervision
• Transportation

Beyond practical support, adult day care can help reduce isolation. Many participants enjoy the chance to socialize with friends, pursue hobbies, and stay active and engaged outside their home.

6. PACE programs

PACE stands for Program of All-Inclusive Care for the Elderly. These programs help older adults receive medical care and long-term support services while continuing to live in the community. Many PACE programs are built around a day center where participants can access health care, social services, nourishing meals, exercise, and social activities all in one place. Transportation and home-based services are coordinated as needed.

You don’t have to be enrolled in Medicare or Medicaid to take part in PACE. But what you’ll pay for these services depends on whether you are.

Depending on your needs, PACE services may include:

• Primary care
• Specialty care
• Emergency services
• Hospital care
• Prescription drugs
• Laboratory work
• X-rays
• Physical therapy
• Occupational therapy
• Recreational therapy
• Nutrition counseling
• Dental care

PACE helps older adults get the care and support they require while continuing to live at home and stay connected to their community.

✅ Tip: Right now, PACE is only available as a Medicaid benefit in 33 states and the District of Columbia, but you have the option to self-pay. Use Medicare’s search tool to find a PACE program near you.   

7. Medicaid HCBS programs

Medicaid Home and Community-Based Services (HCBS) programs help eligible older adults and people with disabilities receive care outside of nursing homes or institutions. These programs typically provide two main types of support: health services and human services. Depending on the program, participants may receive a mix of these services, though not every HCBS program offers every type of support.

HCBS programs may cover services like:

• Personal care assistance
• Home health aides
• Meal delivery
• Transportation
• Adult day health care
• Home modifications
• Caregiver support

Like with PACE, the goal of HCBS programs is to help older adults remain safely in their homes and communities for as long as possible. Eligibility rules differ by state, and since some programs have enrollment caps and limited funding, waiting lists are common.

✅ Tip: If you or your care recipient need support right away but are still waiting for the full Medicaid assessment and care planning process to be completed, one option to explore is an HCBS provisional service plan (if offered in your state). This temporary plan may allow certain services to start before a complete care plan is finalized. Check with your state’s Medicaid agency to learn more about this option and the assistance pathways available to you.

8. Structured family caregiving

Many older adults already rely on their spouses, children, and other family members for everyday help. Structured family caregiving is a Medicaid program that helps support relatives who provide unpaid care to someone receiving Medicaid HCBS through a waiver program. In almost all structured family caregiving programs, the care recipient must live with the caregiver.

This care model may offer:

• Financial stipends for caregivers (typically around $40-$70 per day)
• Caregiver training
• Ongoing support and supervision
• Access to care coordinators

This option can be especially helpful for families where an adult child or relative has become the primary caregiver. Instead of managing everything alone, caregivers receive valuable guidance and resources that can make caregiving less stressful and more sustainable. Learn more about finding financial assistance as a caregiver.

✅ Tip: Structured family caregiving is not offered in every state. To see what’s available where you live, contact your state Medicaid office.

Finding the right fit for your long-term care needs

There’s no one-size-fits-all solution when it comes to long-term care. Some older adults thrive with just a little extra help at home, while others may eventually need more comprehensive, structured support. What matters most is finding a care solution that meets your needs while preserving as much comfort and independence as possible.

Exploring long-term care alternatives early on can give you or your family member more choices in how care is received. And you don’t have to figure it out all on your own.

If you’re unsure where to start, consider reaching out to:

• Your local Area Agency on Aging (find yours here)
• A Center for Independent Living, if you're living with a disability (find CILs in your state)
• A geriatric care manager (find one near you)
• A Medicaid counselor or benefits specialist (find your local SHIP)

Sources

1. CareScout. Cost of long-term care calculator. Found on the internet at https://www.carescout.com/cost-of-care

2. Consumer Affairs. Assisted living statistics. Updated January 25, 2024. Found on the internet at https://www.consumeraffairs.com/assisted-living/statistics.html