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Alternatives to Nursing Homes: Your Options, Explained

15 minute readLast updated September 21, 2023
Written by Anna Nichols, senior living writer
Reviewed by Saul Chapnick, MSWAssisted living executive Saul Chapnick has extensive experience revitalizing distressed facilities and ensuring new ones start strong.
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As your loved one ages, they may need more assistance around their home. And as time goes on, the level of assistance they need may reach a point where additional outside help makes sense. While the first option that may come to mind is a nursing home, it may not be the right choice for your loved one’s needs. A nursing home is a specific type of senior living offering a high level of care, rather than a catchall term for the various senior living options available. Read on to learn about your options for making sure your senior loved one gets the care they need.

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What is a nursing home?

Nursing home care is for people who need more advanced health care or require round-the-clock assistance with activities of daily living (ADLs). This level of care is provided in a nursing home facility, rather than at someone’s independent residence.

Nursing home care includes:

  • 24/7 supervision
  • Skilled nursing care, as needed, for people with health issues
  • Specialized care, such as for seniors with Alzheimer’s disease or other types of dementia
  • Meals>
  • Assistance completing ADLs
  • End-of-life care, such as palliative or hospice care

However, while nursing homes provide intensive care that may be needed for some, these facilities often aren’t the best choice for seniors who need some assistance but still wish to remain independent. In these cases, there are many alternatives to nursing homes such as home care, assisted living, residential care, adult foster homes, senior apartments, independent living, Medicare PACE, and adult daycare.

Nursing home alternatives for care

Depending on the level of care your loved one needs, their financial situation, and whether they want to stay in their current home, there are a variety of senior living options to consider. Below, we’ll break down different care types that may be options.

Home care

Home care refers to care that takes place at your parent’s residence. Home care is a good option for a senior who wants to remain in their own home but has some daily care needs. It can also be a temporary option, such as transitional home care when recovering from a surgery or returning home from a hospital stay.

Home care consists of homemaker services and home health aides, either of which can be used alone or in combination.

  • Homemaker services refers to help around the house. This can include light housekeeping, meal prep, transportation, laundry, help running errands, and companionship. They do not involve any direct personal care for your parent or loved one.
  • Home health aides specifically help with personal care such as ADLs, which may include toileting, bathing, dressing, oral hygiene, feeding, and incontinence care.

In addition, a parent who has health concerns or rehabilitation needs may also require some level of home health care or skilled nursing care alongside home health aides or homemaker services.

Assisted living

Assisted living is a community-based care type. Typically, an assisted living community functions similarly to an apartment community, with the added bonus of on-site assistance and care. They usually also have added social elements, such as clubs or game nights.

Some features of assisted living include:

  • 24/7 supervision or assistance available
  • On-site security and maintenance services
  • Housekeeping and laundry services
  • Meal preparation
  • On-site amenities such as gardens or pools, though this will vary by community
  • Enhanced accessibility and safety features inside personal rooms
  • Assistance with ADLs including dressing, bathing, and personal grooming

Residential care homes and adult foster homes

Similar to assisted living communities, residential care homes offer an independent lifestyle with the benefits of increased access to care. Typically, a senior will have a private room in a residential care home. Unlike an assisted living community, though, residential care homes tend to be smaller and more personal — though they may lack the larger sense of community.

Some features of a residential care home include:

  • More dedicated personal attention
  • They tend to be located in more residential areas
  • On-site staff and supervision
  • Housekeeping and laundry services
  • Meal preparation

Similar to residential care homes and assisted living communities, adult foster homes provide care to adults in a homelike setting. However, it’s important to note that this term has different meanings in different states and may often be used interchangeably with residential care homes.

For adult foster homes, in the states that differentiate them from residential care homes, they typically only have a few adults in them at a time, with most states capping this number at three to five individuals living in the home at any given time, meaning that more personalized one-on-one care can be provided. Adult foster homes can be a more individualized alternative to a nursing home, as they provide some similar benefits including 24/7 supervision.

Other services provided include:

  • Transportation to appointments
  • Help with activities of daily living such as bathing and feeding.
  • Recreational activities

Senior apartments and independent living

Senior apartments and independent living communities offer a sense of independence for seniors who want an easier lifestyle with fewer home maintenance tasks but who may not need daily assistance. For seniors who want to retain this type of independence but do need some daily assistance, home care and home health services are ways to bring that assistance into a senior apartment or independent living residence.

Some features of senior apartments include:

  • A community of residents age 55+
  • On-site amenities such as laundry rooms, fitness rooms, and game rooms
  • Transportation services

Let our care assessment guide you

Our free tool provides options, advice, and next steps based on your unique situation.

Medicare PACE

Medicare’s Program for All-Inclusive Care for the Elderly (PACE) is designed to help seniors receive their health care needs within their own community as an alternative to a nursing home. PACE may cover elements of care such as adult daycare, health care, home care, hospital stays, and transportation to PACE services.[01]

It’s important to note that PACE is not available in all states and has some restrictions for who can use the service:

  • At least 55 years of age
  • Live within the service area of a PACE organization
  • Can live safely without being in a nursing home
  • Require a nursing home level of care as certified by a doctor[01]

Adult day care

Adult day care provides a space for seniors with assistance needs to have a safe, comfortable, and engaging space during the day. This is a way for family caregivers to ensure that their loved one is cared for while they are at work, or otherwise busy. It is often a more economical choice than hiring personal home care services for extended hours during the day.

Adult day care provides:

  • Supervision
  • Assistance with ADLs
  • Structured activities and socialization

Deciding which care type is right

Ultimately, choosing the right care type depends on a variety of factors, including what your parent wants in terms of independence, the level of care they need, health concerns, the advice of their doctor, financial considerations, and more. In the chart below, we break down some of the financial and choice factors to help you and your parent plan for their care.

Type of careMedian costHow to payWho benefits most with this care type
Nursing home
  • $9,034 a month for a private room
  • $7,908 a month for a semi-private room[02]
  • Personal funds
  • Medicare, for short-term stays prescribed by a doctor
  • Medicaid
  • Long-term care insurance
  • Seniors with more advanced health issues
  • Seniors who need 24/7 care or supervision
Home care
  • $27 an hour for a home health aide
  • $26 an hour for homemaker services[02]
  • Personal funds
  • Certain aspects may be covered by Medicare, Medicaid, or VA benefits
  • A senior who wants to stay in their home
  • Someone who needs some assistance with daily activities or help around the house
Assisted living
  • $4,951 a month[03]
  • Personal funds
  • Certain aspects of care may be covered by Medicare or VA benefits
  • Medicaid waivers are available in some states
  • Seniors who wish to retain their independence
  • Seniors who need some daily assistance
  • Seniors who want to downsize their living quarters from a home to an apartment
Residential care homes and adult foster homes
  • $4,197 a month on average[03]
  • Personal funds
  • Certain aspects may be covered by Medicare, Medicaid, or VA benefits, depending on your state of residence
  • Some types of private insurance, such as long-term care insurance
  • Seniors who need more direct supervision and care
  • Seniors who want more personal care and independence than a nursing home may provide
  • Seniors who don’t need on-site medical care
Independent living communities
  • $3,170 a month on average[03]
  • Personal funds
  • Seniors age 55+ who want to downsize their home
  • Seniors looking for a community of similarly aged people
  • Seniors who don’t need daily assistance or supervision
  • Seniors who need daily assistance and have hired home care
Medicare PACE
  • A monthly premium, unless if your parent is on Medicaid[01]
  • Personal funds to cover premium
  • Seniors who need a nursing home level care but wish to stay at home
  • Seniors willing to have their care covered in multiple ways such as through a combo of home care and adult day care
  • Seniors who live in a state offering PACE

Next steps

While a nursing home may be the best option for your loved one, another option may be a better and more comfortable fit for their lifestyle if they don’t need intensive care or supervision.

After you discuss your parent’s desires with them, consider talking with a financial advisor about covering long-term care costs. Another resource is A Place for Mom’s Senior Living Advisors, who can help you plan next steps, recommend care near your parent, and answer questions you have along the way — all at no cost to your family.

Original article by Chloe Clark

SHARE THE ARTICLE

  1. U.S. Centers for Medicare and Medicaid Services. PACE.

  2. Genworth Financial. (2022). Cost of Care Survey.

  3. A Place for Mom. (2022). A Place for Mom Proprietary Senior Living Price Index.

Meet the Author
Anna Nichols, senior living writer

Anna Nichols is a content specialist at A Place for Mom, primarily focusing on nursing homes and caregiver support. Her work has involved researching senior-friendly activities in cities across the U.S., as well as reporting on the challenges of long-distance caregiving. Anna holds a degree in English and education plus a master's degree in theology.

Edited by

Danny Szlauderbach

Reviewed by

Saul Chapnick, MSW

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