Comparing Memory Care & Nursing Homes: Differences in Care, Costs & Medicare’s Benefits
It’s estimated that 70% of Americans age 65 and older will need, on average, two to four years of long-term care. That care can be provided in a number of settings, but for people with dementia the two most common are nursing homes and assisted living facilities specializing in memory care. There are many differences between the two settings, which are detailed below, but the main difference is that memory care communities are exclusively for people with dementia while nursing homes are for anyone with medical issues and care needs that make living at home impossible.
The Basics: Memory Care vs. Nursing Homes
Both memory care and nursing home residences provide room, board, healthcare, and personal care. Both nursing homes and memory care facilities are intended for people who cannot live at home because of medical needs. What differentiates them is the type of specialized care they provide.
The services provided in a nursing home are comparable to a long-term stay in the hospital, which means nursing homes normally offer less privacy than memory care because residents need continuous care. Nursing home staff are trained to help residents with the Activities of Daily Living (mobility, bathing, dressing/grooming, eating, toileting), but they are not necessarily trained to care for people with dementia, while memory care staff have received specialized training. The physical memory care facilities are also specialized, designed specifically for people with dementia, whereas nursing homes are designed more like a hospital where efficiency of care is the top priority. And both places usually offer activities for residents, but activities in nursing homes don’t always work for people with dementia. For example, classic movies or cooking classes are entertaining for most adults, but frustrating for someone with dementia.
Cost is another difference between the two and an important factor that needs to be considered in long-term care. Memory care can be advantageous because it is less expensive, but there are additional costs for extra care provided. Nursing homes provide constant care that does not change as the disease progresses.
When Dementia Patients Should Choose a Nursing Home
If your loved one has a debilitating medical issue in addition to dementia, a nursing home may be the only option. Assisted living is state-regulated, and in many states memory care communities cannot admit someone who is unable to walk from room to room, evacuate by themselves in an emergency, cannot self-administer medications, or needs medical equipment to breathe or eat. Because of this, someone who has multiple medical problems may not be eligible to live in a memory care facility.
Nursing homes offer long-term living and care solutions. Some also accept patients who are short-term residents that are rehabilitating from an accident or staying in the hospital.
Both nursing home care and memory care are expensive, but there is more public financial assistance available for nursing home care than there is for memory care, thanks to Medicaid. Medicaid will cover the full cost of nursing home care for eligible applicants, including room and board. Medicaid will not pay for room and board in memory care, although it can provide long-term care services and supports for memory care residents who are enrolled in a Home and Community Based Services (HCBS) Waiver, or Aged, Blind and Disabled (ABD) Medicaid (also known as regular Medicaid for seniors) Unfortunately, due to how the system is designed, many people with dementia end up in a nursing home because it can be challenging to get financial assistance from Medicaid for those living in memory care communities.
When Dementia Patients Should Choose Memory Care
If a person with dementia is still able to complete all of the Activities of Daily Living on their own (mobility, bathing, dressing/grooming, eating, toileting), and they don’t have any other health issues that require significant care (like remembering to monitor insulin levels for diabetes patients), then a memory care facility should be able to provide the level of care they need and would usually be a better option than a nursing home, as long as the senior or their family can afford it.
There are certain activities that can slow the advancement of dementia that are available in memory care but not in nursing homes. For instance, walking outside at regular times of the day has been shown to help people with dementia, so many memory care residences have secure outdoor areas while many nursing homes discourage going outside.
People with dementia present specific challenges, including delirium and aggression. Memory care staff are trained to handle all of the challenges dementia might present, but that isn’t necessarily true in nursing homes.
Nationwide regulations state that staff who work with dementia patients must have undergone a certain number of training hours annually. Staffers who work with people who have dementia on a daily basis will be more skilled in proper communication techniques like approaching from the front, remaining patient, and anticipating dropped words.
Comparison Table: Differences Between Memory Care & Nursing Homes
| Memory Care Residences vs. Nursing Homes for Persons with Alzheimer’s / Dementia | ||
| Memory Care | Nursing Home | |
| Level / Type of Care Provided | Care for people in every stage of dementia including assistance with ADLs, medication management, and therapies proven effective for symptoms (like music). | Residents receive all levels of medically necessary care and non-medical care, such as personal care assistance with the Activities of Daily Living. |
| Activities and Therapies | Activities that relieve dementia symptoms are typically brief and relaxing. Maintaining a routine is extremely important in memory care. Socialization and exercise are encouraged. Therapies can include art, pets and music. | Nursing home residents are often unable to leave for health reasons, so staff will offer optional activities within the residence, like musical events, games, or movie nights. Socialization is encouraged but may be limited for non-ambulatory residents. |
| Building and Rooms Design/Layout | Dementia-specific designs include hallways that run circular so wanderers don’t encounter dead ends, common areas for socialization, secured outdoor areas for walking, bright paint on walls, and special locks and monitoring devices. | Natural lighting and outdoor views make the spaces less institutional. Rooms might need more square footage for medical equipment. Making spaces easier to navigate encourages autonomy. |
| Freedom of Movement | Because of wandering, memory care facilities will have doors with special locks to keep residents from leaving in a confused state. Increased surveillance also limits wandering. When compared with a nursing home, residents experience greater freedom within the residence, but less so outside the residence. | To encourage health and feelings of dignity, residents are as autonomous as possible. Mobile residents may be able to leave with staff, family or friends. |
| Average Number of Residents | Medium-sized communities house between 11 and 25 people. Larger memory care residences usually do not have more than 100 residents. | Usually larger than memory care, averaging more than 50 to 200 residents per nursing home. |
| Staff Training | Dementia-specific staff training is required annually which includes communication techniques to minimize anxiety, coping with aggression, understanding delirium, etc. | Staff includes registered nurses and medical professionals. Nursing home staff who work directly with people with dementia usually must have completed dementia-specific training, but this is not true for all staff working in the residence. |
| Costs | The average cost of memory care in the U.S. in 2024 was $7,139/month ($85,668/year), according to the 2024 Cost of Care Survey from Genworth and CareScout. Prices can vary significantly from state – the cost in Massachusetts in 2024 was $10,960/month, while in Mississippi it was $5,379/month. | The average cost of a shared nursing home room in the U.S. in 2024 was $9,277/month, and for a private room it was $10,646/month. The prices can vary greatly by states – in New York a shared nursing home room in 2024 averaged $14,722/month, while in Missouri it averaged $6,357/month. |
| Medicare & Medicaid Benefits | Medicare will not cover any of the cost of memory care or assisted living. Medicaid will cover some long-term care for eligible memory care residents in most states, but it will not cover room and board.
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Medicaid will cover all essential long-term care nursing home expenses for qualified applicants, including room and board. Medicare will not cover ongoing long-term care in nursing homes. It only covers up to 100 days of rehabilitative care in nursing homes. the full Medicare will pay part of the cost for up to 100 days. |
| Use of Antipsychotics? | Antipsychotics are used in memory care but are discouraged because of side effects. Staff should be trained to calm an anxious resident using communication rather than drugs. | Antipsychotics are discouraged but more commonly used in nursing homes than memory care to control disruptive behavior. |
| Possibility for Eviction | Memory care evictions are legal if the admissions and retention policies are not violated by the residence. The most common reason for eviction is that the resident requires a higher level of care than can be provided. | Nursing home evictions are legal if the admissions and retention policies are not violated by the residence. Lack of payment and dangerous behavior are the most common reasons for eviction. |
| Who Gets In | People with dementia, usually in the middle and later stages of the disease. | Non-ambulatory patients who require full-time nursing care, need help with more than one activity of daily living, and cannot live independently. |