One of the best gifts you can offer your aging loved one is a plan that both honors their independence and anticipates the support they may need. Senior care options aren’t one-size-fits-all, and you don’t want to be caught flat-footed in the event of an unexpected health crisis. The time to start researching eldercare facilities, experts recommend, is before you need one.
Read on to learn the types of senior care available and the cost differences among them.
[READ: 7 Signs It’s Time to Move to a Senior Living Facility]
Understanding the Different Types of Eldercare: Custodial vs. Skilled Nursing Care
There are many options for care for your aging loved one.
Before understanding the types of long-term care facilities, however, it’s important to establish how coverage options like Medicare and Medicaid categorize the types of senior care:
— Custodial care. Custodial care, or long-term care, is any type of care that can be performed by nonmedical or unlicensed assistive personnel. This kind of care may involve assisting older adults with activities of daily living, such as bathing, dressing or eating, for instance. Or, it could be helping an older person with grocery shopping and bills. Custodial care is a primary offering at assisted living and nursing homes and is generally not covered by Medicare. Some seniors may qualify for custodial care through Medicaid, depending on their state’s availability and eligibility requirements.
— Skilled nursing care. Skilled nursing care requires trained or licensed personnel to perform a task, such as IV therapy, wound care or medication administration. Medicare Part A, which covers inpatient care, offers some coverage of skilled nursing after a qualifying hospital stay. Medicaid may provide some coverage for those who meet specific eligibility requirements.
[READ: Does Medicare Pay for Assisted Living?]
Home-Based Senior Care
Many older adults prefer to age in place at home as long as possible. In fact, “99% of the people I meet say they want to stay at home,” says Howard S. Krooks, an elder law attorney with Cozen O’Connor who practices in Florida, New York and Pennsylvania. Krooks is also a past president of the National Academy of Elder Law Attorneys.
In some cases, a senior may receive home-based care through informal caregiving from a friend or relative. However, not all seniors have adult children or other friends and relatives to help full-time with shopping, cleaning, driving and other activities of daily living. When they don’t, they need to enlist services provided by a home care agency or hire an eldercare aide.
Home health eldercare
Home health care may refer to an umbrella of services, including:
— Personal care, such as assistance with a morning routine or cooking meals
— Skilled nursing care, such as catheter changes
— Therapy, such as speech, physical or occupational therapy
Home care is only covered under Medicare Part A for skilled services, not for custodial care.
Krooks also says there are issues in the home care industry that make it challenging for seniors to receive care at home.
— Workforce shortages. Seniors may have trouble securing a professional home health aide. The U.S. is currently experiencing a severe shortage of home care aides. “Despite increasing demand, home care positions remain difficult to fill due to low wages, physically demanding work and limited career advancement. This shortage is especially acute in rural areas and underserved urban neighborhoods,” he explains.
— High cost of private-pay home care. As a result of the labor shortage and rising wages, the cost of hiring a private home care aide has increased significantly.
— Limited insurance coverage. Home care is often not fully covered due to state policies and budget constraints. “Some states have a waiting list, and in many cases, the number of hours approved by Medicaid are insufficient for the proper care of a loved one,” Krooks says. Medicare typically doesn’t cover home care at all. Opting for a long-term care insurance policy can be expensive and come with benefit limits and strict eligibility criteria, which often means paying out of pocket.
“Home care is a desirable option,” Krooks adds, “but only if the person can afford to pay out of pocket or qualifies for adequate Medicaid benefits — which is becoming increasingly difficult.”
[READ: What Happens When Medicaid Stops Paying for Nursing Home Care?]
Facility-Based Senior Care Options
For a long-term eldercare option, a senior care facility is often the most economical choice. All senior living facilities provide custodial care, but many also provide additional care, such as skilled nursing and therapy.
These care options include:
— Continuing care retirement communities
— Assisted living facilities
— Board and care homes
— Skilled nursing facilities or nursing homes
— Memory care
Continuing care retirement communities
Continuing care retirement communities (CCRCs), sometimes called life care communities, are “full-service” communities that include multiple levels of care on a single campus.
Thus, seniors in CCRCs can “age in place” as their needs change. The resident can, for example, first move into an independent housing unit — a house or apartment — and then transition into assisted living housing when some daily activities become difficult. Later, when health deteriorates, there is skilled nursing care right next door.
Grace Ferri, chief marketing officer for United Hebrew, a campus of comprehensive senior services in Westchester County, New York, believes that “It’s really important to go to a facility where your loved one can age in place. Change is hard.”
Aging in place also prevents transfer trauma, or the stress of continually having to keep moving.
“Having to do that all over again is challenging,” Ferri adds.
Assisted living
Assisted living, as the name implies, is an option for eldercare that provides assistance to residents with their activities of daily living.
These facilities are an option for older adults who can still take care of themselves most of the time but could use some help with tasks such as:
— Housecleaning
— Household chores
— Laundry
— Cooking
— Bathing or showering
— Medication management
— Transportation to medical appointments or stores
Assisted living communities are often like high-end apartment complexes or housing developments in that they include common areas such as dining rooms, a gym and community rooms. Most offer three meals a day, 24-hour security and recreational events within the facility or to places like museums, the movies or other locations. Residents can even keep pets at some facilities.
Assisted living has also evolved over the years.
“Today’s communities are designed to support people who are living longer and with more complex health conditions,” Ferri says. “You’ll often find on-site nursing, chronic disease support and support for Alzheimer’s disease.”
An assisted living community, however, does not offer and cannot provide more intensive medical or daily living care. For older adults who need a higher level of care, a skilled nursing facility is a better option. Some assisted living facilities might have a nursing home wing for higher levels of eldercare.
Board and care homes
Board and care homes are sometimes known as residential care facilities or group homes. The services provided are also similar to those offered at assisted living facilities. However, these eldercare locations are smaller, typically residences of 20 or fewer seniors who live in private or shared rooms. These facilities have staff available 24/7 to help with activities of daily living, and they usually include meals but not skilled nursing or medical care.
Nursing homes and skilled nursing
A skilled nursing facility, sometimes also known as a nursing home, provides state-licensed higher-level care, especially medical care that an assisted living facility cannot deliver.
A skilled nursing facility offers the same services for daily living that assisted living can provide, but it also has trained and registered nursing staff for:
— Nursing care
— Rehabilitation services, such as physical, occupational and speech therapy
— Custodial care, such as aid getting dressed or in and out of bed
— Frequent or daily medical management for chronic conditions
Some older adults need skilled nursing care for a short period, such as after an unexpected event like a heart attack or surgery, and are able to return home after they recover. A 2019 study in JAMA Internal Medicine reports that, among Medicare beneficiaries with an average age of 80 1/2, those who opt for skilled nursing after a qualifying hospital stay have lower rates of readmission compared with those who were discharged home. However, the majority of those who enter a skilled nursing facility have reached the stage where physical or mental health impairments require professional care and supervision for the rest of their lives.
Memory care
Memory care is a specialized type of long-term care for seniors living with Alzheimer’s disease or other types of dementia. Some senior care facilities have memory care as a primary offering, while others integrate memory care units or wings within the facility.
Memory care has a few key differentiating features from other senior care facilities, including:
— Enhanced security measures, such as additional security guards or locks, to protect seniors who wander
— Activities and care designed to support seniors with memory loss. This may include memory-focused therapy, structured routines or sensory stimulation aimed at protecting cognitive function and reducing sundowning and agitation.
— Staff who receive additional training to care for seniors who have dementia
For a loved one who has Alzheimer’s disease or dementia, memory care provides additional peace of mind that they are safe, secure and receiving special care to protect their cognitive ability.
How to Choose the Right Type of Senior Care
To choose the right type of senior care, start by asking questions such as:
— When can we visit the facility in person to take a tour?
— What level of eldercare and services do you provide?
— Do you offer any specialized medical equipment, such as Hoyer lifts?
— Do you offer any therapeutic recreation or rehabilitation programs, such as music therapy for dementia?
Ferri emphasizes starting the process as soon as possible, even before you or a loved one needs senior care.
“You might consider filling out some applications if facilities are in high demand,” she says. “Many have waitlists. Stay in touch with the admissions office to show your continued interest while you research your options.”
How Much Does Eldercare Cost?
If you’re like many families, you’re juggling how to ensure your loved one has adequate support and health care with how to handle their finances as they age.
To get you started:
— Consult an eldercare financial advisor. These professionals can help you navigate the eldercare landscape, including aging, benefits eligibility and estate planning.
— Check out available online resources. Area Agencies on Aging, Medicare SHIPs and the Veterans Affairs are reputable sources there to help.
Here is an at-a-glance eldercare cost comparison based on various senior living data:
Explore Top-Rated Senior Care Facilities With U.S. News
Start the process of finding the right senior care today.
“No one makes good decisions in crisis mode. Think broadly. We are all prone to resolving a problem at hand but not thinking about what could be coming in the future,” Ferri says.
Explore U.S. News and World Report’s top-rated senior living communities, CCRCs,assisted living communities, nursing homes and memory care communities near you.
More from U.S. News
Your Complete Guide to CCRC Contracts
Assisted Living vs. Nursing Homes: Which One Does My Mom Need?
Understanding the Different Eldercare Options originally appeared on usnews.com
Update 08/06/25: This story was previously published at an earlier date and has been updated with new information.
