Types of senior care compared: home care, adult day, assisted living, memory care and nursing homes
This guide is general educational information, not medical, legal, or financial advice. Talk with your own attorney, financial advisor, or care professional about your situation. Elder Living Guide provides education and referrals; we are not a care provider, facility, agency, or medical practice.
Short answer: The main options differ in where care happens and how much help and medical oversight they include. Home care, home health and adult day programs support someone who still lives at home. Board and care homes and assisted living give personal care, meals and staff around the clock to people who need help with daily care but not as much help as a nursing home provides; memory care is a program or setting designed for people living with dementia; and a nursing home focuses more on medical care, with nursing care and 24-hour supervision. Start with what the person needs across the day and night, not with the name on the brochure.
Definitions and coverage facts below come from the National Institute on Aging (NIA) and Medicare.gov pages linked in each section, checked on October 18, 2026. This guide is the “kinds of care” step of our senior care planning guide. For who pays for each option, see how families pay for senior care.
Start with the day, not the setting
Medicare describes most long-term care as help with basic personal tasks of everyday life, sometimes called activities of daily living, such as dressing, bathing and using the bathroom (Medicare: long-term care). Before you compare settings, write down what your family member needs at each part of the day:
- Personal care: dressing, bathing, using the bathroom, eating
- Medications: reminders only, or someone who hands them out
- Nights: whether they get up, wander, or fall when no one is there
- Supervision: whether they can be left alone, and for how long
- Skilled care: wound care, injections or therapy that a nurse or therapist has to do
- Meals, housekeeping and getting to appointments
Our free day-and-night care needs map (CSV) has a row for each part of the day and the week, with blank columns for what goes wrong, who covers it now, and what to ask a clinician. It’s our own organizing sheet, not a medical assessment. Once it’s filled in, the table below usually narrows the choice to one or two options, and a doctor, nurse or care manager can tell you which level of care the person actually needs.
The options at a glance
| Option | Where it happens | What it usually includes | Usually a fit when | First question to ask |
|---|---|---|---|---|
| Home care (non-medical) | The person’s own home | Help with personal care, meals, housekeeping and errands for set hours | They are safe at home with help for part of the day | Which hours are hardest, and who covers nights? |
| Home health | The person’s own home | Part-time skilled nursing or therapy for an illness or injury, ordered by a doctor (Medicare.gov) | They need skilled care for a while and have trouble leaving home | Is this skilled care, and has a doctor ordered it? |
| Adult day program | A day center; home at night | Daytime activities and meals; adult day health programs add health services | A family caregiver covers evenings and needs daytime support or a break | Is it a social program or an adult day health program? |
| Board and care home | A small private home, usually 20 or fewer residents (NIA) | Personal care, meals and staff around the clock; nursing and medical care usually not provided | They need personal care and supervision in a smaller, homelike place | Who is awake and on duty at night? |
| Assisted living | Apartments or rooms with shared common areas | Meals, personal care, help with medications, housekeeping, 24-hour supervision, activities (NIA) | They need help with daily tasks and medications, but not nursing-home-level care | Which care level would they start at, and what changes the level? |
| Memory care | A program or setting designed for people living with dementia | Special programs for people with Alzheimer’s disease and other dementias (NIA) | Dementia makes safety, cueing or wandering the main concern | How are exits secured, and who responds at night? |
| Continuing care retirement community (CCRC) | One campus with independent living, assisted living and skilled nursing (NIA) | Housing that changes with the level of care needed | They are still fairly independent and want to plan for later care in one place | What does the entrance fee buy, and what happens to it if they leave? |
| Nursing home | A licensed facility with nursing staff | Nursing care, 24-hour supervision, meals, help with everyday activities, rehab therapy (NIA) | They need ongoing nursing care, or short-term rehab after a hospital stay | Is this a short-term rehab stay or long-term care? |
| Hospice (a kind of care, not a place) | Usually wherever the person lives, including assisted living or a nursing home (Medicare.gov) | End-of-life care for an illness that can’t be cured | Their doctors certify a life expectancy of 6 months or less | What will the hospice team handle, and what stays with the family or facility? |
We left prices out on purpose: they vary by provider and change often. To compare what you are quoted, use our guides to comparing assisted living fees and building a private-pay budget.
Help at home: when it fits and when it stops fitting
Medicare notes that long-term care services can be provided at home, in the community, in assisted living or in a nursing home. Help at home fits while the person is safe between visits. It starts to stop fitting when the gaps between visits become the risky part of the day: nights, falls when no one is there, or missed medications. Our guides on signs a parent may need help at home and questions to ask before hiring in-home care cover this stage.
Home care vs home health: not the same thing
Families often hear “home care” and “home health” as one service. They aren’t, and the difference decides who may pay.
- Home health is health care at home for an illness or injury: part-time or intermittent skilled nursing, physical, occupational or speech therapy, and medical social services. Medicare covers it for people who need part-time skilled care and are “homebound,” meaning leaving home isn’t recommended or takes a lot of effort and help. A doctor or other provider must see the person in person, order the care, and a Medicare-certified home health agency must provide it (Medicare: home health services).
- Home care, sometimes called personal care or custodial care, is help with bathing, dressing, meals, shopping and cleaning. Medicare doesn’t pay for 24-hour care at home, homemaker services unrelated to the care plan, or personal care when that is the only care the person needs. A home health aide is covered only part-time and only while the person is also getting skilled nursing or therapy.
So when a hospital or doctor sets up home health after a stay, ask when it is expected to end and what help will still be needed after that. That gap is usually where home care, family help or another setting comes in.
Adult day programs: social and health programs
An adult day program gives daytime structure while the person keeps living at home. Some programs are mainly social; others, often called adult day health programs, add health services. Medicare lists adult day health care among the long-term care services it doesn’t pay for, so ask each program how it is paid for. Medicare’s home health page notes that someone can still get home health care if they attend adult day care. For Veterans, VA’s respite care program can pay for a Veteran to attend an adult day health care program while a family caregiver takes a break. Day programs can also work as a regular break for any caregiver; see our guide to respite care for family caregivers.
PACE: nursing-home-level care while living at home
The Program of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program, available only in some states, for people who need nursing-home-level care but can live safely in the community with PACE’s help. To join, a person must be at least 55, live in a PACE organization’s service area, need a nursing-home level of care as certified by the state, and be able to live safely in the community with that help. A PACE team coordinates care, and services can include adult day primary care, home care, personal care, therapy, prescription drugs and transportation to the PACE center (Medicare: PACE). If it is offered where your family member lives, it is worth asking about before deciding a move is the only option. Costs are covered in our paying for care guide.
Board and care homes: small, with staff around the clock
The NIA describes board and care homes, also called residential care facilities or group homes, as small private facilities that usually have 20 or fewer residents. Rooms may be private or shared, residents get personal care and meals, and staff are available around the clock, but nursing and medical care usually are not provided at the home (NIA: long-term care facilities). The NIA adds that Medicare doesn’t cover these costs; Medicaid may cover part, depending on the state and eligibility. Because these homes are small, ask exactly who is on duty overnight and what happens if your family member later needs more care than the home provides.
Assisted living vs memory care: fit questions
The NIA notes that some facilities offer special programs for people with Alzheimer’s disease and other types of dementia. The label on the door matters less than how the setting handles the person’s day. These are fit questions for your tour, not clinical tests:
- Does your family member need secured exits or specific supports for wandering?
- How much cueing do they need for meals, hygiene and orientation across the whole day?
- What happens at night: who responds, and how quickly?
- Are activities designed for cognitive support, or is it mainly a social calendar?
Write down what you actually see on each tour so you can compare. Our guides on when to tour memory care and what to bring on a care tour help you keep notes consistent. If the family disagrees about which setting fits, hold a short family meeting about changing care needs before the next tour, and leave medical judgments to clinicians.
Assisted living vs a nursing home
According to the NIA, assisted living residents usually live in their own apartments or rooms and can get meals, help with personal care and medications, housekeeping, 24-hour supervision and activities; a few levels of care are typically offered, and residents pay more for extra services. Nursing homes, also called skilled nursing facilities, focus more on medical care: nursing care, 24-hour supervision, meals, help with everyday activities, and rehabilitation such as physical, occupational and speech therapy. If your family member needs ongoing nursing care, not just help and supervision, ask assisted living staff directly whether they can meet that need, and get the answer in writing. Our explainer on what assisted living care levels mean shows how these needs turn into prices.
Short-term rehab is not the same as long-term nursing home care. Medicare Part A covers a skilled nursing facility stay only after a qualifying inpatient hospital stay of at least 3 days in a row, and only when a doctor has decided the person needs daily skilled care such as therapy or IV medications. Time spent under observation or in the emergency room before admission doesn’t count toward the 3 days, and Part A limits this coverage to 100 days in each benefit period (Medicare: skilled nursing facility care). Medicare says long-term care is different from skilled nursing facility care and doesn’t pay for it. If a parent is in rehab now, ask the facility early what the plan is when skilled care ends; our planning guide covers what to do after a hospital stay.
Continuing care retirement communities
The NIA describes continuing care retirement communities, also called life care communities, as campuses that offer independent housing, assisted living and skilled nursing care in one location. Where a resident lives depends on the level of care they need, and someone who can no longer live independently moves to assisted living, gets home care in their unit, or enters the community’s nursing home. Most CCRCs charge a one-time entrance fee, which may be relatively expensive, and a monthly fee after that, and residents pay most of these costs themselves. Our suggestion: before paying an entrance fee, get the contract and ask in writing what the fee covers, whether any of it is refunded, and what happens to the monthly fee when care needs change. Our guide to reading an assisted living contract lists questions that apply here too.
Hospice is a kind of care, not a place
Medicare describes hospice as end-of-life care for people with illnesses that can’t be cured. It starts when the hospice doctor and the person’s regular doctor, if they have one, certify a life expectancy of 6 months or less. Hospice care can usually be given in the person’s home or in the facility where they live, such as assisted living or a nursing home, so choosing hospice doesn’t mean moving. Medicare doesn’t cover room and board, though, so someone who lives in a facility still pays for that (Medicare: hospice care). Ask the hospice and the facility, together, who handles what day to day.
How to check a facility before you tour
States license assisted living communities and nursing homes, and the rules differ from state to state. Before a tour, ask the community which license it holds for the level of care your family member needs, and ask to see its most recent inspection results. For nursing homes, the NIA points to Medicare’s Care Compare tool to find and compare nursing homes and other health care facilities. Your local Area Agency on Aging, which you can find through the federal Eldercare Locator, can tell you how to check a license where you live, and LongTermCare.gov explains long-term care options and planning. If you are comparing nursing homes, our guide on how to choose a nursing home walks through the star ratings, the inspection report and two visits.
Still unsure? Next steps
- Fill in the day-and-night care needs map and bring it to the doctor or a care manager.
- Search the federal Eldercare Locator to reach local services for older adults.
- For who pays for each option, read our guide to how families pay for senior care.
- For every stage in order, use our senior care planning guide.
How this page is made
Carter Hockinson, editor, checked this guide against official sources: the National Institute on Aging (long-term care facilities), Medicare.gov (long-term care, home health services, skilled nursing facility care, hospice care and PACE), VA (Respite Care), and the Administration for Community Living (Eldercare Locator and LongTermCare.gov). Those pages were checked on October 18, 2026, and re-checked on October 19, 2026. The Care Compare link is the one the NIA page points to; we don’t quote anything from that tool. The table, the fit questions, the first questions to ask, and the day-and-night care needs map are our own ways of organizing the official information, not medical assessments.
Elder Living Guide provides education and referrals. We are not a care provider, facility, agency, or medical practice. Questions: snlepore@gmail.com. Read how our guides and contact requests work.