Nursing Home vs. Memory Care

Helping a Loved One With Dementia

According to the Centers for Disease Control and Prevention (CDC), dementia is not the name of a specific disease, but rather an umbrella term for the impaired ability to remember and problem-solve.1 When the loss of these cognitive abilities becomes severe enough to interfere with day-to-day life activities, it’s called dementia. Alzheimer’s disease is the most common and well-known type of dementia. It affects nearly 7 million Americans.2

Common signs of dementia include:

• Memory loss that disrupts daily life
• Confusion and difficulty in reasoning
• Mood and behavioral changes
• Challenges with coordination

Determine if the person you want to help has dementia or Alzheimer’s disease by scheduling an appointment with their primary care physician. The physician often can diagnose dementia and refer the person on to a neurologist, psychologist, psychiatrist, or geriatrician. An early-stage diagnosis can help you figure out treatments and resources to better plan for the future, whether that means moving to a nursing home or memory care center.

Nursing Homes

Nursing homes provide a wide range of health care services around the clock. Nursing homes provide more medical care than most assisted living facilities.

Typically, nursing homes offer 24-hour supervision, three meals a day, medication management, and assistance with your loved one’s everyday activities, like bathing, dressing, and going to the bathroom.

Nursing homes have a variety of residents. Hospital patients are sometimes sent for short stays to nursing homes after surgery. People with various disabilities who can’t return to a home setting remain for longer stays at nursing homes. Those with dementia may also end up staying for a long time at nursing homes. Nursing homes sometimes have special wings for their dementia and Alzheimer’s patients.

Costs

When it comes to paying for nursing homes, Medicare covers may pay for some services, like physician services and medical supplies. But, by and large, Medicare does not cover long-term stays in nursing homes. Long-term care insurance may include some coverage. Medicaid may also cover some costs for those who meet the income requirements.

Due to the comprehensive nature of care at nursing homes, they are usually fairly expensive. Nursing home costs vary by region. Some are all-inclusive, whereas others charge for specialized offerings. The median cost for a nursing home is $107,146 per year for a semiprivate room and $120,304 per year for a private room.3

Memory Care Facilities

Like nursing homes and assisted living facilities, memory care units provide seniors with assistance in the form of round-the-clock care, supervision, housekeeping, and help with daily activities like bathing and dressing.

Memory care facilities, however, differ by providing tailor-made services for people with memory loss. Staff usually receive special training to handle those with dementia and Alzheimer’s. For example, they learn how to mitigate outbursts and aggressive behaviors. A memory care facility provides therapeutic activities like music or art therapy, as well as activities that best engage residents so they can flourish while still having a form of dementia.

Memory care centers stick to planned schedules to offer structure and reassurance to those struggling with memory loss. The design and environment of a memory care home differs from that of a nursing home. Many will use pictures, color-coding, and lots of signage to enable residents to get around more independently. They offer a more homey and familiar setup to avoid further confusing residents who have left their own homes. Often brightly colored, some memory centers are designed in a circle so residents don’t get lost. People with dementia tend to walk a lot, and walking in a circle lends a sense of forward progress. With a well-structured and -designed environment, there are fewer opportunities to stop and get frustrated.

To deter their seniors with dementia from wandering off, which is a common symptom, you’ll find an environment that has the residents’ safety and security in mind. Some memory care centers will have alarmed or locked exit doors when the residents are inside and use staff as security to watch when residents are outside.

Costs

For those with dementia who are enrolled in Medicare, some costs of memory care facilities might be covered. For those enrolled in a Medicare Advantage plan, additional long-term care benefits may be covered.

These specialized memory care facilities are usually pricier than assisted living communities due to their specialized nature, but less expensive when compared to the cost of nursing homes. The median cost for a memory care facility is about $65,000 per year.4

Benefits and Drawbacks of Nursing Homes for Memory Loss

If your loved one needs medical care, nursing homes offer extensive care. These facilities usually employ physicians and registered nurses who are on call 24/7. So, if your loved one with dementia has a host of other ailments or serious medical needs, they might do well at a nursing home.

Memory care units in dedicated sections of nursing homes provide higher levels of medical care than you’ll often find in stand-alone memory care facilities. While nursing homes have some dementia patients, the care seems to be better in those facilities with a high number of dementia patients.

A 2023 study that included 13,909 U.S. facilities serving about 3 million residents with dementia showed better dementia care in nursing homes that had 90 percent of residents with dementia than those with a lower proportion of residents with the condition.5 So, keep that in mind as you visit and research nursing homes.

A drawback of choosing a nursing home with a dedicated dementia unit: About 87 percent of nursing homes struggle with staffing shortages.6 Low wages and burnout for workers plague the industry and hamper the ability of nursing homes to attract, hire, and retain good staff.

Early or Late Stages of Dementia

If your loved one is in the early stages of dementia, a nursing home without a memory care unit may be OK. The personnel at nursing homes can help with grooming, dressing, bathing, and other daily living tasks that might be impacted by dementia. If your loved one is frustrated or down about the changes in their life, acknowledge their feelings and do what you can to enlist help. Validation goes a long way, as does making sure they feel heard.

But nursing homes aren’t designed for those who are cognitively challenged. If your loved one has a more advanced case of dementia, it’s probably more prudent to choose between a nursing home with a dedicated memory care unit and a stand-alone memory center. Otherwise, it can be dangerous for your loved one due to the specific kind of structure and care they need.

What to Look for in a Nursing Home or Memory Care Facility

Here are some things to look for regarding memory care for the special person in your life, whether you’re investigating a nursing home, assisted living facility, or stand-alone memory facility. Ask if the facility has:

• Stations that let residents do or recreate daily activities from their younger years, like office work and child care
• Intimate dining environments so people sit around dining tables rather than sit in rows in a large cafeteria
• Engagement of the senses (smell of a cake baking in the dining area, sounds of music from childhood)
• Consistency in patterns and objects (for example, those with dementia who see what appears to be wood may become alarmed when it doesn’t feel like wood)
• Safe indoor and outdoor spaces for active wandering
• Lighting that is consistent and even
• Nice views that allow for natural light and/or a nature view
• Thermal comfort to reduce or eliminate hot or cold drafts

Look for a ratio of no more than five staffers per resident, or you run the risk of your loved ones spending most of their time in front of the TV. A healthy ratio of 5-to-1 or better also means more staffers on hand to detect anger triggers such as hunger and pain. Early detection and stable routines reduce the risk of blowups.

Financing Memory Care

Untrained family members often shoulder the burden of care for those they love with memory loss. When it comes to financing the care, reverse mortgages might provide cash for home equity and allow care of your loved one in their home. But be aware that the homeowner will be penalized for moving into a facility if it’s for a year or more.

When caregiving at home or caregiving in general isn’t possible, paying to live in a nursing home or memory care facility is unfortunately an expensive proposition. Medicare doesn’t cover much, and there are limited memory care communities that accept Medicaid, resulting in extensive wait times for Medicaid beds.

Besides using your private assets, long-term care insurance can be a solution. Some carriers reimburse for the cost of memory care. Look into your policy and coverage, including waiting periods and limitations.

Nursing Homes vs. Memory Care: A Comparison Chart

Finding a Facility Near Me

To find a nursing home with memory care or stand-alone memory care facilities nearby, you can begin with our SeniorLiving.org directory or the Administration for Community Living’s Eldercare Locator.

Here are suggested steps to take:

1. Use our directory to find options in your area.
2. Get recommendations and references from your friends, family, health care providers, and local senior care centers.
3. Once you find facilities near to your loved one’s town or your town, see which ones seem like a fit and create a short list.
4. Go online and research each facility’s accreditation and ratings.
5. Then, visit each place in person before making an informed decision. We suggest you visit every place you’re considering a few times, including at least one surprise visit. (Look for active engagement versus passive engagement, such as people just propped up to watch TV.)
6. Follow up by talking to the directors of each facility, and ask what they offer for those with dementia. Also, ask how they deal with common dementia-related behaviors such as aggression. For instance, understaffed nursing homes may turn to psychotropic drugs to keep residents sedated if they have been aggressive.

Don’t forget to trust your gut. If you have a good feeling and the place ticks all the boxes, go with that. Even if the place is rated highly but something does not seem right or the people there don’t seem happy, trust your instincts.

Whether you decide on a nursing home or memory care center, both are long-term choices that can support someone with dementia as well as their families and friends.