What are the Alternatives to Nursing Homes for Persons with Alzheimer’s / Dementia?

Last Updated: January 04, 2023


Just because someone with dementia requires nursing-home-level care does not mean they must move into a nursing home. There are alternatives that can be a relief for people with dementia and their families. This article will explain the options that people with dementia have detailing alternatives to moving into a nursing home, costs associated with different types of care, and public assistance resources.


At Home

Losing independence and activities of daily living mean someone cannot live alone. This can be distressing for adults who consider themselves self-sustainable, but there are ways to make staying in the house easier for people as they advance through the stages of dementia. Routine and continuity are vital for managing symptoms of dementia, and staying at home may be the best choice.


Nursing Home Alternatives from Medicaid

Medicaid is health insurance that is offered to people with limited income and assets. Each state has its own programs that differ from one another, but there are three different benefits offered to Medicaid participants to aid in staying at home. They are:


Money Follows the Person

This is a program that was created to help people move from a nursing home to a more homelike, individualized “community” setting. This program offers the support services necessary to live more independently. That means that this program will help pay various costs of moving residences, adult daycare, homecare aids, in-home medical visits, and equipment or upgrades needed for your loved one to live safely and comfortably. To qualify for Money Follows the Person, you must meet the eligibility requirements for Medicaid and live in a nursing home that is “state approved” for a minimum of 60 days before applying to the program. To date, this program is offered in 36 states and the District of Columbia. Click here for a link with the contact information of the 37 Money Follows the Person programs nationwide.



The PACE program, also referred to as the LIFE program, was designed with the idea of providing support service to qualifying applicants so that they do not need to move into a nursing home. This program offers a combination of benefits that are medical and social enabling your loved one to have the support to stay in their home for as long as possible. This program helps patients by creating individualized care plans that assist in all aspects of their life ranging from doctor visits to socializing and dental care. PACE is for those who need nursing home-level care. Examples of its covered benefits are home health care aids, meal preparation, transportation, medical devices, adult daycare and more.

To qualify for PACE, you must be at least 55 years old, need nursing home-level care and live in a state that has a PACE program. While “dual eligibility” for Medicare and Medicaid is not required, the vast majority of program participants are eligible for both programs. Currently, there are 148 programs in 32 states nationwide. For more information on the PACE program, click here.


Consumer Directed Care

Consumer Directed Care is a program that lets the patient decide their care choices. Offered by states nationwide, it is referred to as many different names from state to state and the benefits vary by state as well. For example, some programs provide cash to recipients and other simply allow participants to choose their own caregivers.

The programs can help with activities of daily living from meal prep and transportation to and from medical appointments to non-medical in-home care. In many states, even some family members or spouses can be hired as in home care. The freedom to choose gives a greater quality of life and independence to your loved one. To qualify for this program, they must financially meet the requirements of Medicaid in their state and need nursing home-level care. Click here for more program information.


Caregiving by a Loved One

Caregiving by a loved one is appropriate in the earliest stages of Alzheimer’s but usually becomes too hard after about several years. This is especially true when the caregivers are elderly themselves. Caregiver stress and even burnout are major problems with dementia. Caregivers must help a person dress, bathe, and possibly even eat. Aggression and even hallucinations can become a problem. Respite care is available to provide temporary relief from caregiving duties.

Typically respite care programs, are a great free or affordable option but have the disadvantage that they might only offer a 4-hr window of care once weekly. Adult daycare, in comparison, has more consistency and is a good option to aid the workload of a caregiver.

There are a variety of programs that will pay family members to care for their loved one at home. However, not every family will be eligible for these programs and caregivers should expect to jump through a significant number of hoops to participate. Caregivers should expect only to be compensated for a limited number of hours and to be paid about minimum wage.

 Did You Know? Studies have shown caregiving causes chronic stress that affects health. It also strengthens family relationships.


Live-in Care

Live-in caregivers are a great option for someone who wants to stay at home. The two largest factors to consider are the cost and space. That means that it will probably cost about $200 per day and need to have an extra bedroom, this could be the right fit for your loved one. Live-in care is slightly less expensive than 24-hour home care because some of the cost is offset by the room and board received by the caregiver. Since it is not uncommon for elderly individuals to reside in a home with more bedrooms than residents, having an extra room could be an asset that makes financial sense.

There are rules that must be followed when hiring a live-in caregiver. You actually need two caregivers because four to five days per week is the maximum that someone is legally allowed to work. For the other two or three days, you must fill in or hire someone else with the same skills and qualifications. Caregivers must have four hours of a break every 24 hours, and an eight-hour allotment every night to sleep. Proper insurance is necessary. To hire live-in caregivers you’ll need to provide, at the minimum, liability insurance and worker’s compensation insurance in case of injury or negligence.

Possible sources of financial assistance include Medicaid and VA Benefits. There is very little non-Medicaid, public assistance available for live-in care and Medicare offers no assistance.


24-Hour Home Care

This option typically involves three caregivers that are hired to share the duties of caring for your loved one. They might take 12-hour shifts or split the time by working eight-hour shifts to stay alert. The difference between this and traditional live-in care is that this option is more expensive. You will need to pay hourly rates instead of daily ones. Depending on the area of the country in which the individual resides, the hourly rate for home care is between $15 and $30. The disadvantage to this approach is that it means less consistency for the person with dementia. In comparison, an advantage is that it is easier to find caregivers through home care agencies instead of finding a live-in caregiver. Working through a home care agency also eliminates the logistics associated with hiring an employee directly. That means details like insurance and payroll.

Help is available. There are resources from Medicaid, VA benefits , and a small portion of Medicare through the PACE / Life program or Medicare Advantage program that will provide financial help for home care.


Combining Home and Adult Day Care

Adult day care, also called “Alzheimer’s Day Treatment”, makes days more interesting and productive for your loved one with dementia. All the while allowing caregivers to still go to work or take a much-needed break. This option is usually available during normal business hours. Adult daycare provides seniors a home away from home with nutritious meals, activities including social games and exercise, health and personal care, and even behavior management and therapies. Adult daycare costs approximately $75 per day or $1,575 per month (based on 21 workdays per month on average). An advantage is that the cost is less expensive than home health care, and many daycares accept Medicaid and VA benefits. Options sometimes include transportation to and from their location, and staff can often take your loved one to their doctor appointments.

There can be many potential options that are offered through the daycare which is very helpful. An example is that there might be transportation available for an extra cost. You will want to be very clear on all charges, including optional fees, before placing your loved one in adult day care. Also, be sure to specifically ask whether the staff is trained to handle dementia symptoms and what the staff-to-resident ratio is (a good ratio is around 1-to-5). Because routine is so important for a person with dementia, the transition to daycare might be difficult. Seniors often resist at first, but after a while become very happy with their time in adult daycare. A good idea to get used to it is taking your loved one once or twice per week, for about three or four hours at a time until they are comfortable.


Outside the Home

When living at home becomes too difficult or unsafe, as dementia advances into the middle and later stages, moving out of the house and into a specialized community will become necessary. Planning for this should begin as soon as there’s a diagnosis before moving becomes necessary so that your loved one can provide input on which residential care option is best for them.


Adult Foster Care

Adult foster care is a level of care for people with illnesses including dementia that lies somewhere between staying at home and moving into a nursing home. Adult foster care homes typically serve two or three seniors, so it feels more familiar and personalized. Meals, activities, and help with activities of daily living are provided in adult foster care, but usually not medical care. For this reason, adult foster care is not appropriate for people in the late stages of dementia. Adult foster care does not need a staffer awake at all times, unlike assisted living. The industry is regulated by states, so rules vary. The cost of adult foster care is typically between $2,000 and $4,000 per month. Medicaid and VA benefits might provide financial help.


Board and Care Homes

Board and care homes, like adult foster care, are a good choice for people who need caregiving but want to live in a smaller, cozier residence. Also called “group homes” or “residential care homes,” these are houses with senior- and dementia-friendly upgrades for safety and mobility, as well as staff trained to provide health and personal care. There are usually less than 10 residents in a single board and care home. The cost often runs between $3,000 and $5,000 per month, and Medicaid and VA benefits programs may be able to help.

Board and care homes are best for people in the early and middle stages of dementia, who don’t necessarily need 24-hour supervision. Meals, snacks, and housekeeping will be taken care of, but there will probably be less structured activities and socialization in a board and care home. It is necessary to investigate the home thoroughly to ensure a good match with your loved one before signing a move-in contract. Free assistance is available to help families locate board and care homes that meet their loved one’s needs and budget. Start here.


Assisted Living

Regular assisted living is usually with residents in a studio or apartment-style living with basic assistance that includes help with activities of daily living. These communities are not specifically designed for people with dementia, but in the early stages, it might be a good fit. Residents in assisted living need to have some independence, but the community will provide meals in a cafeteria or common eating area, structured activities, and help with medical issues including transportation to and from doctor’s appointments. Supervision is provided 24 hours per day, with someone awake at all times.


Memory Care

Memory care is assisted living specifically for people with dementia. Other common terms for memory care include Alzheimer’s Units and Dementia Care Units. Memory care may be a wing of an existing assisted living community, or an entire residence. The most important aspect of memory care for people with dementia is that staff is specifically trained to communicate with and assist people who have dementia. Because of this, memory care is the best option for someone with Alzheimer’s disease or dementia who cannot stay at home. For more on the differences between memory care and nursing homes – including a comparison table with costs, staff training, and eviction policies click here.

 Did You Know? The families of dementia patients can get free assistance finding, touring, and negotiating with Memory Care residences. Click here to start.


The Green House Project

The Green House Project is an alternative to traditional assisted living, memory care, and nursing homes. Currently this is available in 32 states with 359 homes nationwide. These residences are similar to board and care homes, for less than 10 residents in a more intimate setting. Seniors who move into Green House Project homes share common areas but have their own rooms and bathroom. There are no structured activities. This requires a higher level of independence and means the home might not fit for someone in the later stages of dementia. These homes have small staff-to-resident ratios, and staff is trained to deal with the health and personal care needs of people with Alzheimer’s and dementia. The homes are designed to be state-of-the-art in terms of energy efficiency and smart technology like adaptive care devices and senior-friendly computers. Costs are similar to a nursing home, making this an expensive option for your loved one. To find a home, visit the company’s website here.