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What Are the Five Levels of Care in Assisted Living?
Date Updated: January 3, 2025
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Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
The five levels of care in assisted living are designed to support seniors as their care requirements increase. With no national regulation of care levels, assisted living facilities set their own service packages to meet diverse needs, ranging from minimal daily support to full assistance with everyday tasks.
Lower Levels of Care
Although exact service provision varies among facilities, levels one and two in assisted living help seniors who need limited everyday support. Level one commonly includes housekeeping and domestic chores, such as cleaning, laundry and building maintenance, alongside meals and scheduled leisure activities. At this stage, individuals mostly live self-sufficiently, and some continue driving and socializing off-site.
Level two builds on level one, typically including minimal hands-on assistance with activities of daily living to enable seniors to live independently. This level of care generally suits those who need basic help, such as fastening buttons on clothing or opening containers. Seniors may also benefit from local transportation and medication reminders.
Moderate to Higher Levels of Care
As seniors’ needs increase, assisted living facilities provide more intensive one-on-one support with personal care and other activities of daily living. At level three, older adults often need moderate support with two or more daily tasks. Examples include getting out of bed and maintaining personal hygiene. Care increases through level four, with residents needing more extensive hands-on attention. Some communities also offer in-house therapies. Level five is the highest care level in many assisted living communities. At this stage, most older adults can’t perform many tasks themselves, and aides usually extend full support with:
- Bathing
- Grooming
- Toileting, including continence management
- Dressing
- Eating
- Moving around the community
- Transferring to and from bed
Depending on the facility’s licensing and staffing, services at this level may also include medication administration, rehabilitation therapies, intermittent nursing care and therapeutic meal plans. If a senior’s needs develop, they usually require more intensive nursing home care.