People who turned 65 in 2020 have a 70% chance of needing long-term care in their remaining years, according to the Administration of Community Living. For many, that will mean home health care. For others, moving to an assisted living facility may be the best option.
If you or a loved one is considering moving to an assisted living community, you may be wondering what levels of care they offer and who each level is designed to support.
Here, we break down the common levels of care in assisted living communities to help you determine how best to take advantage of the benefits assisted living can offer older adults.
What Are Levels of Care in Assisted Living Communities?
Assisted living communities are dedicated to supporting and caring for older adults with varying needs. They typically help with activities of daily living, including:
— Medication management
— Bathing
— Dressing
— Toileting
— Emergency assistance
They also generally keep an eye on your loved one, making sure they’re eating well and engaging with other residents.
“When home care is no longer an option, assisted living can be a godsend,” says Dr. Elizabeth Landsverk, a geriatrician based in the San Francisco area. She offers an online telemedicine, education and support resource for eldercare professionals, caregivers and families.
Levels of Care in Assisted Living Communities
No two communities are exactly alike, but many offer up to five levels of care in assisted living.
Level 1: No assistance
Also sometimes called independent living, this lowest level is for seniors who don’t need daily assistance. At this level, older adults effectively live independently and manage their own affairs, but they have access to assistance and support if they need it. For example, this resident may benefit from reminders to take their medications as directed. Or, when a resident needs assistance with a complicated task — like programming a new smartphone or setting up a new television — staff can lend a hand.
This resident is active — they may still be working or volunteering and can drive off campus as they wish. Their decision to join the community is often driven by a desire for social contact and access to age-appropriate activities or to alleviate the demands of maintaining a home.
Access to communal meals and dining options also enables the resident to pursue other interests and reduces the burden of managing dietary needs, grocery shopping and meal preparation.
Level 2: Low or minimal assistance
Adults residing in this assisted living level of care are still largely mobile and don’t require ongoing supervision, but they typically need support with one of the activities of daily living, such as bathing or dressing. This resident may also benefit from more contact with staff and other residents.
For example, if they recently lost a spouse, more frequent check-ins may prevent a slide into depression, which often leads to more intensive care needs.
In addition, residents at this assisted living care level typically show some signs of difficulty with some of the more complex tasks of daily living. For example, this resident may have lost some of their dexterity due to arthritis and need help opening pill bottles or buttoning a shirt. Many also benefit from reminders about:
— Meal times
— When to take medications
— How best to manage personal hygiene
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Level 3: Moderate assistance
Residents who’ve progressed to this level of care typically retain some mobility and independence but likely need assistance or supervision with most or all activities of daily living. For example, a resident at this level might be able to dress on their own but need staff to help them with bathing.
Residents in the moderate assistance tier often struggle with meal preparation or remembering to take medications, and they can still benefit greatly from social interaction and activities with staff and other residents.
Level 4: Full assistance
What is the highest level of care in assisted living? In many facilities, it’s Level 4. At this level, residents need near-constant support and assistance with most if not all activities of daily living, including dressing, toileting and personal hygiene. They may not be mobile and often require intensive hands-on support to eat, bathe, dress and perform other daily tasks.
At this assisted living level, the care can look similar to that received in a nursing home, but they are not medical in nature. Rather, the services offered focus on helping the resident do what they still can for themselves, whether that’s eating with a fork, brushing their hair or participating in a group craft project according to their ability.
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Level 5: Memory care
Communities that offer memory care often list it as a separate level because of its specialized nature.
In assisted living communities that offer memory care, the Level 5 resident is a patient with dementia or another type of cognitive impairment who is unable to care for themselves.
At this level, residents receive ongoing support and supervision based on their needs. Care typically covers all the activities of daily living and is administered by staff who have been specially trained in techniques to assist people with dementia and other cognitive impairments.
“Dedicated memory care ‘neighborhoods’ are generally equipped to care for a senior through end-stage Alzheimer’s and dementia with the various behaviors associated with those diseases,” explains Haidy Andrawes, center administrator at Park Vista Assisted Living in Fullerton, California.
Communities that cater to memory care patients may further stratify the levels of care in assisted living on offer. Some may have specialized tiers designed to support people with:
— Other types of dementia
— Other conditions that lead to cognitive decline
Since these conditions are progressive, patients in earlier stages of these diseases typically need less hands-on support than people with advanced dementia. As those needs advance, staff will provide more direct, hands-on care to residents.
What Is Enhanced Assisted Living Care?
Some assisted living communities offer an additional tier of care that’s sometimes called enhanced assisted living care. This type of personalized care features medical support, such as nurses or a doctor checking in regularly. This level of care in assisted living is aimed at supporting residents with complex medical needs.
This care is similar to but still less intensive than what’s typically found in a nursing home. It may also share some similarities with memory care, as people with dementia, Alzheimer’s, Parkinson’s disease and other progressive, chronic conditions may benefit from more intensive medical intervention before needing to move to a skilled nursing facility.
A key difference between enhanced assisted living care and more conventional assisted living is the staff-to-patient ratio. Residents in an enhanced assisted living situation typically have more direct contact with staff, and those workers typically have additional training to better manage medically complex residents.
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How Do Assisted Living Communities Make Care Assessments?
Assisted living communities typically use a formal evaluation process to determine the appropriate level of care for a prospective resident. These assessments may consider a wide range of factors, such as:
— Whether the senior has any medical conditions or chronic diseases that require daily intervention
— Whether the senior is experiencing any loss of cognitive function
— How well the senior is able to communicate needs and preferences
— Whether the senior is able to perform any or all of the activities of daily living without assistance
— How involved family members plan to be while the senior is in assisted living
These assessments are made in several ways, including:
— Observation of how they engage with others and perform tasks
— Reports from any caregivers (family or a home health aide, for example) who have been involved in the senior’s care previously
— The senior’s doctors or other health care providers
— A physical exam that checks mobility and fine motor skills
— Questioning and evaluation for mental health challenges or loss of memory or reasoning ability
Once staff at the assisted living facility have evaluated the senior, they can draw up a personalized care plan that caters to their specific needs.
You can also bring in a geriatric care manager to aid in the assessment process, says Jenny Munro, a gerontologist with Home Instead, an Honor Company headquartered in Omaha, Nebraska.
Geriatric care managers have varied educational and professional backgrounds with a specialized focus on issues associated with aging, Munro adds. Through consultation, assessments, care coordination and advocacy, these senior care professionals can help develop the right approach for your loved one.
How Assisted Living Levels of Care Affect Cost
Generally speaking, the more care you need, the more it will cost. But there is broad variation in pricing depending on the type of facility, location and which services are used.
CareScout’s 2024 Cost of Care Survey found the median cost of assisted living in the U.S. to be $5,900 per month.
The National Investment Center for Seniors Housing and Care similarly reported in December 2023 that assisted living totals about $6,000 monthly or more than $72,000 annually, while care in a memory care unit clocks in at nearly $7,900 per month or almost $95,000 per year.
But these are just averages, and your costs could be higher if you’re in a more expensive geographic location, such as New York City, or if you need more hands-on support.
Explore Top-Rated Assisted Living Communities With U.S. News
To aid you in your search to find the best assisted living facility near you, visit U.S. News’ top-rated assisted living communities. Nearly 450,000 survey responses from residents and their family members evaluating over 3,800 senior living communities highlight communities that have excelled in delivering high-quality services and ensuring all residents are cared for and safe.
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Assisted Living Categories and Levels, Explained originally appeared on usnews.com
Update 08/13/25: This story was published at an earlier date and has been updated with new information.
