In addition to wisdom, aging brings changes that can make staying in a cherished home difficult, if not impossible. As an older adult’s care needs change over time, so will their senior housing options. Whether you’re creating your own long-term care plan or helping an aging loved one explore their possibilities and preferences, learning the differences between independent living, assisted living and nursing home care is the best place to start.

As a director for an agency whose mission is helping older adults stay in their homes for as long as possible, I know that sometimes, despite valiant efforts, a person must move to a setting that is better equipped to meet their growing needs. On many occasions it is not the senior, but rather a concerned family member, who recommends this move from the home where they have created so many memories over the years. This certainly isn’t an easy decision for caregivers—especially if they promised to never consider nursing home placement for their care recipients.

The move to senior living will always be an emotional one, but steps can be taken to make this transition a little less difficult.

Long-Term Care Planning

As with many things in life, this transition is usually much smoother when faced head on. Plan ahead—it can’t be said enough. Although we may joke about getting older, very few of us actually accept that it is happening and prepare accordingly.

Advancing age is similar to an approaching hurricane. I live in Florida, where we experience these devastating storms every year. Still, it is remarkable how many people fail to prepare for these events. The main distinction between hurricanes and aging, though, is that the latter affects everyone. Planning ahead ensures you’ll be better prepared to face some inevitable decisions and even surprises that may spring up along the way.


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Levels of Care for Seniors: Least Restrictive Environment

One of the greatest fears associated with getting older is placement in a nursing home. It’s common to hear aging parents say, “I don’t want to end up in a nursing home,” or, “Promise me you won’t put me in a nursing home.” The public tends to believe that nursing homes are the only option for seniors when they can no longer safely remain in their own residences, but this notion could not be further from the truth.

Senior care options grow every year as demand increases, preferences change and elder care evolves. The first step in planning for long-term care needs is learning about various possibilities available in the surrounding community. Common elder care terminology typically includes in-home care, assisted living facilities, family group homes, board and care homes, independent senior living communities, nursing homes, memory care units, intentional communities and continuing care retirement communities (CCRCs).

The second key component is understanding that senior living options are not “one size fits all.” Each person has different needs, and eligibility for certain long-term care settings is dependent upon those needs. Take an honest look at your loved one’s medical conditions and care requirements so that you will have a clearer idea of which levels of care would be appropriate for them. Undergoing a comprehensive care assessment is usually the best way to obtain personalized elder care recommendations.

The third part of planning is researching each type of facility. There are several things to bear in mind when conducting this research. Caregivers must understand the concept of selecting the “least restrictive setting.” In other words, this setting is where a senior can maintain as much of their independence as possible. A person’s own home is often the least restrictive environment possible, whereas a nursing home and memory care unit would be considered the most restrictive settings on the elder care continuum.

When thinking about the least restrictive environment, it is vitally important to consider future needs as well. If possible, ensure the living arrangement you choose is one that will be able to accommodate a loved one’s needs for as long as possible. It is tragic when a person is placed in an environment that is too restrictive too soon, causing them to lose years of independence unnecessarily. It is equally tragic when a person is placed in a setting that is very unrestrictive yet cannot meeting their increasing needs. Ultimately, both these scenarios result in multiple moves to different facilities, which can be very disruptive and disorienting for older adults—especially those living with dementia.

Types of Senior Living Facilities

While there are many different senior housing options available today, the three main types are independent senior living communities, assisted living facilities and nursing homes.

Independent Living Communities

Independent living facilities are exactly what they sound like. They are usually set up with a mix of residential settings and house large numbers of seniors. They may also be known as retirement communities or continuing care communities. These unrestrictive settings allow a person to maintain complete autonomy and are very good options for older adults who can still do most things for themselves but prefer to live amongst and engage with their peers. They usually have on-site staff members who provide minimal supervision for safety and security purposes. Many offer a wide variety of recreational activities, amenities and social events for their residents.

Key points about independent living facilities:

  1. Residents maintain their independence.
  2. Facilities may provide no care whatsoever or a tiered approach of increased levels of care as needs change. Continuing care retirement communities (CCRCs) fall into the latter category. CCRCs are unique in that they offer a full range of residential elder care options (independent living, assisted living and nursing home care) on one campus.
  3. Activities are often arranged for residents to remain social and stay engaged.
  4. Independent living is paid for privately, but federal housing authorities may provide financial assistance for low-income seniors at some complexes.

Assisted Living Facilities

Assisted living facilities (ALFs) are designed to help those who have difficulty caring for themselves to the extent that they can no longer safely live in their own homes without assistance. These facilities are staffed 24 hours a day with employees who are trained to assist residents with activities of daily living (ADLs) in their private apartments. An elder who lives in an ALF may need help bathing, toileting or getting dressed.

ALFs are more regulated, therefore this type of facility is more restrictive than independent living. While many seniors are resistant at first, they often wind up loving the environment after acclimating to the change. Touring these communities with your loved one is the easiest way to demonstrate that living in an ALF is the right choice.

An important point concerning ALFs is that facilities may offer different levels of care depending on where they are located. State regulations and licensing rules vary, but generally ALFs are not intended for residents who require regular skilled nursing care.

Key points about ALFs:

  1. Direct assistance is available to those who need support to perform activities of daily living.
  2. Trained staff members are available 24 hours a day.
  3. This setting is more restrictive than independent living but is still an environment that promotes independence.
  4. Dependent upon licensing, tiered levels of care may be available to address increasing needs on site.
  5. The cost of living in an ALF can be expensive. According to Genworth’s 2020 Cost of Care Survey, the national median cost for an ALF is $4,300 per month. Most care costs are paid for out of pocket, but some costs associated with eligible services may be covered by benefit programs.
  6. A specialized type of assisted living called memory care is available for seniors with Alzheimer’s disease or related dementias. These settings are typically secured to prevent wandering, staffed by individuals who are trained in dementia care, and designed to engage seniors with memory loss while minimizing agitation and confusion.

Nursing Homes

Nursing homes are designed to house and assist individuals who have chronic health conditions that require constant monitoring and 24/7 availability of trained medical personnel. Because of the high level of supervision and care that these facilities provide, they are typically considered the most restrictive senior living option.

Important points about nursing homes:

  1. Skilled nursing care is available 24/7 to provide medical monitoring and full assistance with activities of daily living for individuals with serious health conditions.
  2. This care is expensive to pay for privately. According to the Genworth survey, the median monthly rate for a semi-private nursing home room in the U.S. is $7,756, while the rate for a private room is $8,821.
  3. Medicare only covers medically necessary short-term care in a skilled nursing facility if certain conditions are met, but Medicaid covers long-term nursing home care for seniors with limited income and assets. Some veterans may qualify for nursing home benefits through the VA as well.

Choosing Senior Housing

Few of us want to find ourselves living somewhere unexpectedly or as a last resort. These senior living options are just the tip of the iceberg—the general categories to guide your search for the appropriate long-term care setting. As you look to make the best choice for your loved one, talk to people you trust about their experiences with long-term care in your community. Understanding the senior housing options, services, locations and amenities available near you will ensure your loved one’s care needs are met in a safe and comfortable setting.

Need additional guidance? A care advisor can help you determine which level of care is appropriate for a loved one’s needs, find and compare senior living facilities in your area, and even schedule tours. Contact an advisor today to jumpstart your search for senior housing.