Memory Digest

Choosing Memory Care or a Nursing Home

How to tell when a move to residential care may be needed, the differences between assisted living, memory care units and nursing homes, what to ask on a visit, and how families usually pay.

Last reviewed: October 2026

Many families promise each other, "We'll never put Mom in a home." Then dementia changes the picture. Deciding on residential care is one of the hardest choices a caregiver faces. It is not a failure. As the Alzheimer's Association puts it, wherever care takes place, the decision is about making sure the person gets the care they need.

This guide walks through the main options, the signs that it may be time, and how to compare places.

When home may no longer be enough

The Alzheimer's Association notes that in the middle stage of Alzheimer's, a person usually needs 24-hour supervision to stay safe, and in the late stage care needs become even more intensive. See Middle-Stage Dementia and Late-Stage Dementia.

The Association suggests asking yourself honestly:

• Is the person becoming unsafe in their current home?
• Is the person's health, or my health as a caregiver, at risk?
• Are their care needs beyond my physical abilities?
• Am I becoming a stressed, irritable or impatient caregiver?
• Am I neglecting my work, my family or myself?
• Would the structure and social life of a care community help the person?

If several answers are "yes," it may be time to start looking, even if you aren't ready to move yet. Caregiver exhaustion is real and serious; see Caregiver Stress and Burnout. Short breaks through Respite Care can also help while you decide.

The main types of residential care

According to the Alzheimer's Association, the options include:

• Retirement housing. May suit someone in the early stage who can still care for themselves. Offers limited supervision, plus social activities and transportation.
• Assisted living (also called board and care or supported care). Bridges the gap between living independently and a nursing home, usually combining housing, meals, support services and some health care. Assisted living is not regulated by the federal government, and definitions vary by state. Not every assisted living community offers dementia-specific services, so ask.
• Memory care units (also called Alzheimer's special care units). Designed for people with dementia and found inside assisted living communities or nursing homes. They may or may not be locked or secured. Because state laws differ, ask exactly what "memory care" means at each place: staff training, activities and how staff handle behavior changes.
• Nursing homes (skilled nursing or long-term care facilities). Provide around-the-clock care and medical treatment. They are licensed by the state and regulated by the federal government.
• Life plan communities (formerly continuing care retirement communities). Offer independent living, assisted living and nursing care on one campus, so a resident can move between levels as needs change. They often charge an entry fee plus monthly fees.

How to compare places

The Alzheimer's Association recommends that you:

• Visit several communities. Make an appointment for the first visit, then make one or two unannounced visits.
• Go at different times of day, including mealtimes.
• Talk with staff, residents and their families.
• Ask for the latest inspection (survey) report, and in some states the Special Care Unit disclosure form.
• Get on a waiting list early, even if you're not ready to decide.

For nursing homes, Medicare's Care Compare tool lets you look up ratings and inspection results for Medicare- and Medicaid-certified facilities.

Questions worth asking

The Alzheimer's Association offers a long checklist. Some of the most important questions:

Staff and care - Are staff trained in dementia care? How long is the training, and is it required by the state? - What is the ratio of residents to staff? How long have workers been there, on average? - Is a registered nurse on site at all times? How often do doctors or nurse practitioners visit? - How do staff handle challenging behaviors? See Agitation and Aggression.

Daily life - Are there activities on evenings and weekends, matched to residents' abilities? (Ask for the schedule, and see whether the listed activity is actually happening.) - Is personal care such as bathing and toileting done with respect and dignity? - Can residents bring familiar items such as photos, bedding or a favorite chair? - Is the food appetizing? Do staff help with eating when needed and watch for good nutrition?

Safety and setting - Are indoor and outdoor areas safe, secure and easy to navigate? What is the rate of falls? - Is the place clean and free of unpleasant odors?

Policies - How are families included in care planning and told about changes? - What could lead to a discharge—for example, behavior changes or running out of money? - Can residents "age in place" as the disease progresses? Is hospice available? See Hospice and End-of-Life Care.

Paying for care

Costs vary widely. The Alzheimer's Association, citing Genworth's Cost of Care Survey, gives national median costs of about $74,400 a year for basic assisted living, $114,975 for a semi-private nursing home room and $129,575 for a private room. Prices in your area may be higher or lower.

Key facts about coverage:

• Most families pay out of pocket, according to the Alzheimer's Association. Long-term care insurance, veterans' benefits and Medicaid may help.
• Medicare generally does not cover long-term "custodial" care—help with bathing, dressing or eating. Medicare Part A may cover short-term skilled nursing or rehab (up to 100 days) in a Medicare-certified nursing home after a hospital stay, when skilled care is medically necessary (Medicare.gov).
• Medicaid rules vary by state, and not every community accepts it. If you're paying privately, ask what happens if the money runs out. The Alzheimer's Association suggests meeting with an elder law attorney before a move if Medicaid may be needed.

Learn more in Medicare, Medicaid and Dementia Care and Financial Planning and Paying for Care.

Coping with the move

Even a well-planned move can be stressful, and guilt is common. The Alzheimer's Association says these feelings are common, and that families who have been through it often say it helps to gather information and move forward. A move can also free you to spend more of your time simply being a spouse, son or daughter. Keep visiting, bring familiar things and stay involved in care planning.

Where to get help

• Alzheimer's Association 24/7 Helpline: 800-272-3900. Care consultants can help with long-term care decisions.
• Long-term care ombudsman: every state has an ombudsman program that advocates for residents of nursing homes and assisted living. Find yours through the National Long-Term Care Ombudsman Resource Center.
• Eldercare Locator: 800-677-1116 for local aging services.

Talk with the person's doctor, too. They can help you judge the level of care needed and fill out any medical forms a facility requires.

Sources

1. Alzheimer's Association: Long-Term Care (residential care options, questions to ask and costs)
2. Medicare.gov: Nursing home care coverage
3. Medicare.gov: Care Compare (nursing home ratings and inspection results)
4. National Long-Term Care Ombudsman Resource Center

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Caregiving Guide: Where to Start
• Caregiver Stress and Burnout
• Middle-Stage Dementia
• Late-Stage Dementia
• Medicare, Medicaid and Dementia Care