Currently, it is estimated that 70% of Americans 65 and older will need long-term care. On average, most need long-term care from 2 to 4 years. When families need a long-term home for their loved one with dementia, the choice often comes down to memory care (assisted living specifically for dementia and Alzheimer’s) or a nursing home. This page will help you understand the difference, to make the choice easier.
The basic difference between nursing homes and memory care is that memory care is exclusively for people with dementia while nursing homes are for people with almost any medical issue that makes living at home too difficult. Nursing homes offer a more clinical, hospital-like setting while memory care is more home-like.
Both types of residences combine room and board with healthcare and personal care. Nursing homes are for people who cannot live at home because of medical needs, and that is also true for memory care. The difference is specialization.
The services provided in a nursing home are more comparable to a long stay in the hospital. Nursing home staff will be trained to help with the activities of daily living that dementia patients often find themselves unable to accomplish in the middle and later stages of illness. Activities of Daily Living include bathing, grooming, dressing, eating, and more. Nursing homes are typically less private than memory care because of residents’ need for continuous care.
Nursing homes aren’t specifically designed to care for people with dementia, whereas every aspect of a memory care facility is meant to help people with the acute needs that come from Alzheimer’s disease and related dementias. Memory care homes are also known as “assisted living with memory care,” “dementia care,” or “Alzheimer’s care.”
A nursing home will probably provide activities for residents (do not move into a home that doesn’t have structured activities), but they might not be right for your loved one. Classic movies or cooking classes, for example, are entertaining for most adults but someone with dementia would find them frustrating. And because sticking with routines is more important for people with dementia, scheduling and structure are emphasized in memory care.
Cost is also a 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 one has to factor in the extra costs. As a need for more care increases, so can the bill. Nursing homes do provide a constant level of care that is unchanging for the most part as the disease progresses.
If your loved one has a debilitating medical issue in addition to dementia, a nursing home may actually be the only option. Assisted living is state-regulated, and in many states memory care communities cannot admit someone who is nonambulatory (unable to walk from room-to-room or evacuate in an emergency), cannot self-administer medications, or needs medical equipment like tubes to breathe or eat. Someone with many medical problems may, therefore, not be eligible to live in memory care.
Nursing homes offering the long-term living and care situation you’re looking for might also accept shorter-term residents who are rehabilitating from a bad accident or stay in the hospital. This is called “skilled nursing care.”
While both nursing home care and memory care / assisted living are expensive, there is greater financial assistance for nursing home care. While Medicaid can and does often assist in paying for memory care, receiving these benefits is more complicated than nursing home care, waiting lists are common and Medicaid will not pay for room and board in memory care. An unfortunate reality is that many persons with dementia end up in a nursing home because it is too logistically challenging to get financial assistance from Medicaid for memory care.
There are interventions and activities that can slow the advancement of dementia, and these aren’t necessarily the kinds of programs a nursing home provides. For instance, walking outside at regular times of the day has been shown to help people with dementia for multiple reasons, including beneficial exercise, but a nursing home might discourage going outdoors while memory care residences typically have a secure area for exactly this purpose. Another example is music: A nursing home probably allows playing songs in rooms, but someone with Alzheimer’s needs to be encouraged to listen to music for therapeutic benefits. This involves being approached and spoken to in a gentle manner, and probably at certain times of day. Memory-care staff are usually better trained and more skilled at these interactions.
People with dementia present other specific challenges, like delirium and aggression, that nursing homes may not specifically train employees to deal with. A nursing home that houses residents with many types of medical problems might handle aggression in a person with dementia by applying chemical or physical restraints.
What percentage of staff is specially trained to help people with dementia? In a memory-care residence, the number will be close to 100%, while in a nursing home it will be much less. Regulations in almost every state explicitly say that staff who work with people with dementia must be trained a certain number of hours annually on dealing with dementia. In memory care, it is easier to be assured that these guidelines are followed. Staffers who work every day exclusively with people who have dementia will be more skilled at proper communication techniques, like approaching from the front, remaining patient, and anticipating dropped words.
Administrators, like the activities directors, in nursing homes may not be specifically trained for dementia, whereas in a memory care home they almost certainly will be.
Design-wise, memory care will decorate based on what’s best for people with dementia. Because residents with dementia may easily become stressed and confused, memory care units emphasize relaxation by creating gathering areas like a TV room. The walls are typically painted with bright colors, and there is a lot of natural light (which has been demonstrated as slightly therapeutic).
Subtler things you might see in a community that exclusively serves residents with dementia is a fishtank in the eating area, because people with dementia often lack appetite and watching fish swim can stimulate appetite.
The cost of memory care differs nationwide. In 2022, it averaged $5,430 monthly. This can change dramatically across the United States with a low of $4,000 in Georgia to $12,000 in Washington D.C.. Medicare does not pay for memory care and depending on what state you are in; Medicaid will pay for part of it.
|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).||Most residents receive intermediate-level care they cannot get living at home. Usually this is medical (IVs, catheters, etc.) or functional (help with ADLs like dressing and eating).|
|Activities and Therapies||Activities that relieve dementia symptoms are typically brief and relaxing. Maintaining routine is extremely important in memory care. Socialization and exercise are encouraged. Therapies can include art, pet, 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 night. 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. Residents who are mobile may be able to leave as they please with staff, family, or friends.|
|Average Number of Residents||Medium-sized communities house between 11 and 25 people. Larger memory care residences usually won’t have more than 100 residents.||Usually larger than memory care, averaging more than 50 – 200 residents per nursing home.|
|Staff Training||Dementia-specific staff training is required annually and includes communication techniques to minimize anxiety.||Staff includes registered nurses and medical professionals. Nursing home staff who work directly with people with dementia usually must have completed dementia-specific training, though this will probably not be everyone at the residence.|
|Costs||Average cost of memory care in the US for one month in 2022 is $5,430. Regional differences are significant and extend from Georgia costing $4,000 to $12,000 per month in Washington DC.||Average cost of nursing-home care in the US in 2022 for one month is $8,000 to $9,000 depending if it is a shared or private room. Regional and state differences extend from a monthly low 6,000 in Missouri to a high of $32,000 in Alaska.|
|Medicare & Medicaid Benefits||Medicare will not cover any of the cost of memory care or assisted living. In some states, Medicaid will pay for a portion of the monthly cost.
|Medicare will pay part of the cost for up to 100 days. In 2022, days 1 to 20 are fully covered with zero copay and days 21 to 100 have a copay of $194.50 daily. Medicare is not intended for long term care. Medicaid, on the other hand, will pay for 100% of the cost of nursing home care for those who are financially qualified.|
|Use of Antipsychotics?||Antipsychotics are used in memory care, but should be discouraged because of side effects. Staff should be trained to calm an anxious resident using communication rather than drugs.||Antipsychotics are discouraged but more common 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 common reasons for eviction.|
|Who Gets In||People with dementia, usually in the middle and later stages.||People who are non-ambulatory, require full-time nursing care, need help with more than one ADL, and generally cannot live at home because of a medical issue.|