Assisted Living, Memory Care, and Skilled Nursing: What's the Difference

These four terms describe different levels of care. Knowing the differences, and who pays for each, helps families find the right fit as needs change.

What is assisted living?

Assisted living is for older adults who need more care than they can get at home but do not need nursing home care all day and night, according to Health in Aging. Most homes offer staff on duty 24 hours a day, housekeeping and laundry, meals and activities, help with bathing and dressing, help with medicines, and transportation. Staff may not include skilled nurses on site. Each state licenses assisted living homes, and the rules differ by state. Homes in the same state can offer very different services.

What makes memory care different?

Memory care assisted living cares for older adults with dementia. Health in Aging says these homes work much like nursing homes but focus on the special needs of people with dementia. Some assisted living homes have a memory care unit inside them instead of a separate facility.

For the final stages of dementia, see How Does Dementia End? What Families Can Expect. For visiting someone who no longer recognizes you, see What to Do When a Parent With Dementia No Longer Recognizes You.

What is skilled nursing?

A skilled nursing facility is a nursing home with 24-hour medical care, according to Health in Aging. Medicare.gov says nursing homes are for people who usually need 24-hour care, and can provide long-term, or custodial, care with daily activities.

What is a continuing care retirement community?

A continuing care retirement community offers several levels of care, often on one campus, such as houses or apartments, assisted living, memory care, and skilled nursing, according to Health in Aging. People often move into independent living first and shift to more care later. Most require a large entry fee, which may or may not be refundable, plus a monthly fee that rises with the level of care. Health care may be covered under one of three payment plans: all-inclusive, fee-for-service, or modified coverage that pays for long-term care up to a set amount.

A quick-glance comparison. See the sections above for detail on each level of care.

How do the costs compare, and who pays?

In general, assisted living costs less than a nursing home. Health in Aging reported a median of $4,500 a month for assisted living in 2023, charged monthly like rent. Most people pay for assisted living themselves, and long-term care insurance may help. Some states use Medicaid to help people with very little income and savings. Medicare does not cover assisted living, according to the Administration for Community Living.

Medicare covers skilled nursing facility care only after a hospital stay of at least three days in a row as an inpatient, according to Medicare.gov. Time in observation does not count. Medicare pays in full for days 1 to 20. For days 21 to 100, you pay $217.00 a day in 2026. After day 100, you pay all costs. Some sites still show last year’s $209.50. Medicare does not cover custodial care when it is the only care needed. See Medicaid Considerations for Long-Term Care.

How do I know which level of care is needed?

It comes down to the care a person actually needs. A doctor, a social worker, or a geriatric care manager can assess this. The National Institute on Aging describes a geriatric care manager as a licensed nurse or social worker who can identify needs and help form a plan.

How do I check a facility?

The Administration for Community Living suggests reviewing state licensing reports and contacting your state’s long-term care ombudsman to ask about complaints. Medicare also offers a Nursing Home Compare tool. Visit in person and ask detailed questions.

What do we still not know?

Terms and offerings vary by facility and state, and costs vary widely by region.

This is general guidance, not medical, legal, or financial advice. Every family’s situation is different; a doctor, social worker, or attorney can advise on yours.