Care options

The main types of care

In-home care brings help to your loved one's current home. It can range from companionship and chores to personal care such as bathing and dressing. Home health care, which is skilled medical care ordered by a doctor, is a separate service.

Independent living offers private homes or apartments in a community, often with meals, activities, and housekeeping, for people who do not need daily personal care.

Assisted living, as the National Institute on Aging describes it, is for people who need help with daily care but not as much as a nursing home provides. Residents usually have their own apartment or room, with meals, help with personal care and medications, and staff on site around the clock.

Memory care is a secure setting designed for people living with Alzheimer's disease or other dementias, with staff trained in dementia care. It may be a separate building or a unit within assisted living or a nursing home.

Nursing homes, also called skilled nursing facilities, focus more on medical care. NIA notes they typically provide nursing care, 24-hour supervision, meals, help with everyday activities, and rehabilitation services.

Researching places

Medicare.gov Care Compare lets you look up nursing homes, home health agencies, and other providers, including ratings and inspection information. Your state may also publish information on licensed assisted living. The Eldercare Locator can connect you to local help.

Visiting and comparing

NIA recommends visiting several places in person and asking for detailed information about costs and what is included. Ask each community for a written list of fees and a copy of the contract to read at home. Our comparison tool lets you enter the quotes you receive so you can see them side by side.

Paying for care

NIA notes that Medicare generally does not pay for long-term stays in assisted living or nursing homes. Medicaid and long-term care insurance may help depending on eligibility and the policy. Ask each place what payment sources they accept, and talk with an elder law attorney about Medicaid planning.

Easy-to-miss details about paying for care

General information only. A free SHIP Medicare counselor, the facility's business office, and an elder law attorney can tell you what applies.

• Medicare generally does not pay for assisted living room and board or long-term custodial care.
• Medicare generally covers skilled nursing rehab only after a medically necessary inpatient hospital stay of at least 3 days in a row. Time under observation or in the emergency room does not count, even overnight. Ask the hospital in writing whether your loved one is inpatient or under observation. See Medicare.gov: inpatient or outpatient hospital status and skilled nursing facility care.
• Medicare Advantage plans use provider networks and may need approval first. Check that a rehab facility or home health agency is in network before admission. See Medicare.gov: compare Original Medicare and Medicare Advantage.
• Medigap is easiest to buy during a one-time 6-month window that starts when someone is 65 or older and has Part B. Later, insurers may be able to refuse or charge more, except in certain guaranteed issue situations. See Medicare.gov: when can I buy Medigap.
• Signing up late for Part B or Part D can mean a penalty that lasts as long as the coverage. See Medicare.gov: avoid late enrollment penalties.
• Read any admission agreement before signing. Federal rules generally do not let a nursing home require a family member to guarantee payment from their own money, so be careful signing as responsible party. Ask whether an arbitration clause is optional. You can ask an elder law attorney to review the agreement. See the CFPB guide on caregivers and nursing home debt.
• Long-term care insurance usually has an elimination period, a waiting time before benefits start. Call the insurer early and ask for the claim rules in writing.
• If a relative will be paid to give care, ask an elder law attorney about a written caregiver agreement before payments start, because Medicaid may treat unwritten payments as gifts.
• VA pension, including Aid and Attendance, has its own look-back on asset transfers, generally 3 years. Be wary of anyone who charges to apply or sells products to help someone qualify. See VA.gov: pension rates and the look-back and use a free VA accredited representative.
• Working caregivers may qualify for unpaid, job-protected leave under the Family and Medical Leave Act. Some caregivers may also qualify for tax rules on dependents, dependent care, or medical expenses (IRS Publication 501, 503, and 502). Ask a CPA what applies.

Next step, before listing

Get matched with a trusted local real estate agent (free)

If the home may be sold to help pay for care, or your loved one wants to buy something smaller or more accessible, an agent who works with families in care transitions can help you plan the timing.

A good local agent can help with:

• Experience working with older adults, families, and estates
• Pricing the home to fair market value, which matters for Medicaid, taxes, and any family sale
• Coordinating with the executor, the person with power of attorney, or the attorney
• Deciding whether to sell as-is or make repairs first

Before you list, finish the checks: the Medicaid look-back and fair market value, any reverse mortgage, power of attorney or executor authority, the deed and title, and vacant home insurance.

Request a free agent match

Free to your family, in any state. We'll review your request and follow up. See the referral disclosure at the bottom of this page.

What to do first

1. Write down what help your loved one needs day to day, and talk with their doctor about the level of care.
2. Learn the difference between each type of care so you can narrow the list.
3. Look up nursing homes and home health agencies on Medicare.gov Care Compare.
4. Call the local Area Agency on Aging through the Eldercare Locator for local options.
5. Visit at least a few places and bring the same list of questions to each.
6. Collect written fee lists and contracts, then compare them in our comparison tool.
7. Talk with an elder law attorney before applying for Medicaid or transferring assets.

Common questions

What is the difference between assisted living and a nursing home?

Assisted living helps with daily activities and medications in a more residential setting. Nursing homes provide more medical care, including 24-hour supervision and nursing care.

Does Medicare pay for assisted living?

According to the National Institute on Aging, Medicare generally does not pay for long-term assisted living or nursing home stays. Check with Medicare and any other coverage your loved one has for specifics.

How do we check the quality of a nursing home?

Medicare.gov Care Compare shows ratings and inspection results for Medicare and Medicaid certified nursing homes. Visiting in person and talking with residents and families also helps.

Is Kinhaven paid by care communities?

Kinhaven aims to work for your family. Any referral or sponsorship relationship is disclosed to you before you make a decision, and Kinhaven does not take referral fees or sponsorship from providers that bill Medicare or Medicaid.

Should I sign the admission agreement as responsible party?

Read it first. Federal rules generally do not let a nursing home require a family member to guarantee payment from their own money. Ask whether any arbitration clause is optional, and ask an elder law attorney to review the agreement before you sign.

Will Medicare pay for rehab after a hospital stay?

Generally only after a medically necessary inpatient stay of at least 3 days in a row. Days under observation do not count. Ask the hospital whether your loved one is inpatient or under observation, and check Medicare.gov.

When to bring in a licensed professional

Kinhaven handles the organizing. These decisions call for someone licensed:

• Your loved one's doctor or a geriatric care manager to assess the level of care needed.
• An elder law attorney for Medicaid planning, contracts, and powers of attorney.
• A financial advisor or CPA to plan how care will be paid for over time.
• The facility's admissions or financial office for exact fees and accepted payment sources.

Sources and further reading

• National Institute on Aging: Long-term care facilities
• National Institute on Aging: How to choose a nursing home or other long-term care facility
• Medicare.gov Care Compare
• Eldercare Locator, a public service of the U.S. Administration for Community Living (1-800-677-1116)

Links go to public government resources. Kinhaven is not affiliated with these agencies.