Assisted Living Levels of Care

 

More than 800,000 seniors live in about 30,600 assisted living communities in the United States, according to the American Health Care Association and the National Center for Assisted Living. While these settings may appear similar from one location to the next, each resident's support needs can look very different. 

Some seniors may simply need help remembering medications or extra support with activities of daily living (ADLs). Others, including seniors with wheelchairs or vision impairment, may need increased care. Understanding the different assisted living levels of care can help if you're a caregiver trying to match your loved one with the right facility.

 

Assisted living is often the next step after independent living, with varied levels of care to support different needs. When a senior requires help with daily tasks, like cooking, cleaning, or walking safely, assisted living can support them with personalized services. Assisted living communities often also include safety features, like tamper-resistant outlets and shower grab bars, to prevent falls and injuries. 

CareScout's 2024 cost of care data indicates an estimated median monthly cost of assisted living in the United States of $6,077. Many seniors pay for assisted living out of pocket unless they have long-term care insurance coverage. Costs may increase with higher levels of care.

Learn more about assisted living levels of care to guide you in supporting your loved one's needs.

 

Seniors transitioning from independent living to assisted living settings may only need a little help remembering their medications or cleaning their homes. This assisted living level of care gives seniors as much independence as they can handle while still providing basic support. Services at this level might include light housekeeping, daily medication reminder calls, and help with laundry.

Level two gives seniors more hands-on care while balancing independent living. At this level of care, seniors may need continence support, like help with bathing and toileting, or notices for appointments, activities, or medications. 

For example, seniors might need consistent schedule reminders for community events or doctor appointments but can groom themselves and prepare meals with little-to-no help.

Level three care in assisted living includes the highest level of support with activities of daily living (ADLs). Seniors at this level often need mobility help, especially with bathing and emergencies. Besides daily support, seniors can also receive transportation to community activities, prepared meals, help with dressing, and care coordination with healthcare providers.

Some assisted living communities may also have basic memory care services at this level, like specialized routines and 24/7 supervision to prevent wandering. 

 

A senior who needs more support than assisted living can provide may benefit from other levels of care, like memory care or skilled nursing care. Assisted living may offer these services in their own facilities, but continuing care retirement communities more commonly have them on the same campus. Seniors can then transition between levels of care as their needs change.

Learn what memory and skilled nursing care entail as you weigh options for your loved one.

 

Memory care gives specialized support to people living with Alzheimer's disease or other types of dementia. People who may not be safe in a traditional assisted living community due to memory loss or behavioral changes might need memory care. Memory care facilities and secured assisted living units within a continuing care community usually include the following services:

• 24-hour security monitoring to reduce wandering risks
• Staff experienced with communication, behavior management, and other dementia-related care
• Personalized care plans
• Structured routines to reduce confusion and ease anxiety
• Cognitive games and activities
• Socialization opportunities

According to the National Investment Center for Seniors Housing & Care, the average monthly cost of memory care is $7,899. Generally, Medicare doesn't pay for living costs associated with memory care, but it may cover some medical services for people with dementia, like cognitive testing or prescription drugs. 

 

Skilled nursing care helps people recover from injuries, illnesses, and surgery. This level of care occurs in skilled nursing facilities, nursing homes, or hospitals. While usually short-term, some facilities also offer long-term skilled nursing care. 

Skilled nursing care may include:

• Prepared meals and snacks
• Socializing activities
• Physical, speech, and occupational therapies
• Medication management
• Wound care
• Medical appointment transportation
• Hygiene and toileting help
• Dietary counseling
• Dental care

CareScout estimates the 2025 monthly median cost of a semi-private room in a nursing home to be $9,555, or $10,965 for a private room. Medicare may cover skilled nursing care in some cases, such as following a necessary hospital stay or when a doctor orders necessary skilled nursing services.

 

You'll usually know it's time for assisted living when your loved one starts needing more help with ADLs. Before choosing an assisted living facility, consider how much help is necessary and whether those needs might increase with time.

Follow these steps to determine the best assisted living level of care.

• Observe Your Loved One's Daily Routine: Are they keeping up with cooking and getting dressed? Level one care might work well, but level two or three might be necessary for seniors with disabilities and those who need more hands-on care.
• Consider Emotional Well-Being: Seniors with depression may not ask for help, but you might notice signs like difficulty sleeping or irritability. Someone who's struggling emotionally may need more structure or check-ins, which could raise the level of care required.
• Schedule A Medical Check-Up: A primary care doctor can help you better understand your loved one's health needs, especially if they're recovering from an illness or injury or could benefit from rehab in an assisted living facility.
• Get Care Assessments From Communities: Once you've narrowed your list of assisted living facilities, request a care assessment from each provider. This evaluation helps you and the facility learn whether your loved one needs a little help or more intensive care.
• Plan For Future Needs: Even if your loved one is independent now, things can change. Choose a place with varied levels of care to accommodate their needs in the future.

The right assisted living level of care for your loved one depends on their physical, medical, and emotional needs. You might be juggling questions and emotions as you consider options. Know that assisted living facilities are there to answer your questions and help you through the process.

Browse the Caring.com Assisted Living resource hub to learn more about assisted living and how it can help your loved one.

 

Many facilities have three rather than five levels of care in assisted living, but some have more levels for nuanced support. In facilities with five levels, level five offers the most comprehensive services. Seniors at this level may experience severe cognitive decline and need a high degree of support.

 

No, there is not usually a level six care in assisted living, although some facilities might offer this option. The six levels of care in assisted living refer to different types of care offered. These include independent living, the three levels of assisted living care, memory care, and skilled nursing care. 

 

Assisted living facilities and nursing homes serve different needs, so one setting isn't objectively better than the other. Assisted living is a good fit for seniors who need help with ADLs, while nursing homes care for intense medical needs. If you're weighing options, consider community policies, too, like whether smoking in assisted living is allowed or if video cameras in assisted living facilities are used for extra safety.

 

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