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Assisted living facilities are a great option for older adults with varying degrees of independence, but who still need support throughout the day. Be it medication management, help with activities of daily living (ADLs) or providing recreation options, assisted living provides a number of benefits and forms of assistance for seniors.
“Assisted living facilities are designed to create a safe, comfortable environment where seniors can maintain a level of autonomy,” explains Esther Cromwell, president and co-founder of Avendelle Assisted Living in Raleigh, North Carolina.
While the support provided by the facilities is tailored to individual needs, there are, most commonly, three assisted living levels of care, adds Cromwell. Here, senior care experts explain what each level entails and offer insight on which level may be right for you or your loved one.
Key takeaways
- Assisted living levels of care range from basic to advanced, allowing facilities to support residents with varying physical, cognitive and medical needs.
- Choosing the right care level involves an assessment that considers medical needs, social preferences and overall health to create a personalized plan.
- Costs increase with care level, with advanced or enhanced services like memory care and skilled nursing requiring higher staff involvement and medical oversight.
- Some seniors may eventually need more support than assisted living can provide, making it important to ask about transition options early on.
What are assisted living levels of care?
No two assisted living facilities are exactly the same, and each one offers different care plans to accommodate the varying needs of the residents, but typically, the three assisted levels of care are:
- Basic.
- Intermediate.
- Advanced.
Level 1: Basic care
The basic level of care is for older adults who are largely independent, but require some help with ADLs (this can even be simple reminders). Services may include help with:
- Getting dressed.
- Bathing.
- Grooming.
- Medication reminders.
- Transportation.
- Basic housekeeping.
“Residents at this level often participate in social and recreational activities, but do not require extensive medical support,” notes Cromwell.
Level 2: Intermediate care
At this level, residents require more assistance with daily activities and may have more complex health needs. According to Cromwell, in addition to the basic care services, intermediate care often includes:
- More hands-on help with mobility.
- More intensive medication management.
- Regular monitoring of chronic conditions.
- Coordination with external health care providers for therapies or treatments.
Level 3: Advanced care
This level is for seniors with significant health issues or those requiring 24-hour supervision and support. Advanced care plans may include:
- Comprehensive personal care.
- Frequent health monitoring.
- Assistance with all daily activities.
- Specialized care for conditions such as dementia or Alzheimer’s.
“Staff at this level are typically trained to handle more complex medical needs,” notes Cromwell. “Additionally, the environment may be designed to accommodate residents with higher levels of physical or cognitive impairment.”
| Levels of assisted living care | Support may involve: | Price |
| Level 1: Basic | Some help with ADLs | $ |
| Level 2: Intermediate | More help with ADLs; mobility help; chronic condition support; coordination with care team | $$ |
| Level 3 Advanced | 24-hour supervision; assistance with ADLs; specialized care for conditions such as dementia or Alzheimer’s | $$$ |
It’s important to note, however, that while basic, intermediate and advanced are the three most common assisted living levels of care, some facilities may break theirs out differently. “The levels of care in assisted living vary depending on the state and the facility, though most have between two and six,” explains Merle Griff, founder and chief executive officer of SarahCare, and host of the podcast “Caught Between Generations.”
Here, Griff gives a sample breakdown of what a facility with five levels of assisted living care may look like:
- Level 1. For independent seniors who do not require assistance.
- Level 2. For seniors who may need daily reminders or minimal help.
- Level 3. For those who require moderate assistance with ADLs.
- Level 4. Provides a higher level of care with more intensive support.
- Level 5. Involves full assistance with daily activities.
What are assisted living enhanced services?
Enhanced levels of care in assisted living facilities, or “advanced services,” refer to specialized supports that go beyond the basic in order to address more complex health and cognitive needs, notes Cromwell. “These services are designed to provide higher levels of care for residents who require more intensive or specialized attention,” she explains.
The level “enhanced services” falls into depends on how a facility breaks down its assisted living levels of care. That being said, enhanced senior services at assisted living facilities can include:
Medication management
This may include setting up medication schedules, refilling prescriptions and/or monitoring for side effects or interactions. “This is particularly important for seniors managing multiple medications or those with memory issues who might struggle to manage their medications independently,” says Cromwell.
Memory care
These units, explains Griff, are secured areas within assisted living facilities, designed for seniors with dementia or other cognitive impairments where safety is a primary concern. “Residents in these units require a higher degree of assistance,” she notes.
Skilled nursing care
Some assisted living facilities offer skilled nursing care, which according to Cromwell, can include ”wound care, injections, physical therapy or the management of chronic health conditions that require ongoing medical oversight by licensed nurses or therapists.”
Behavioral health support
Some assisted living facilities may offer enhanced care for residents with mental or behavioral health issues, such as depression, anxiety or psychiatric disorders. “This might include regular counseling, psychiatric care and the development of personalized care plans to manage and treat these conditions within the assisted living setting,” notes Cromwell.
Palliative and hospice care
Enhanced care can also include palliative or hospice services for residents with serious, life-limiting illnesses. Both services, Cromwell notes, involve a health care team that offers personalized physical, emotional and spiritual support.
What do different levels of assisted living care cost?
For quick reference, the average daily cost of assisted living, according to the latest data from Genworth and CareScout, is $194 — but prices can vary widely.
Not surprising, the higher the level of care (aka the more support required), the higher the cost. Each facility has different price points, based on a number of factors, including location, but generally, basic care is the most affordable, and rates go up from there.
“As residents require more assistance, such as more frequent health monitoring and intensive medication management, the cost rises, reflecting the increased level of staff involvement and services provided,” notes Cromwell. “The highest costs are associated with advanced or enhanced care, which includes 24-hour supervision, specialized services like memory care for individuals with dementia or Alzheimer’s and skilled nursing care.”
How can I determine the right assisted living level of care?
The right level of assisted living care is something that’s decided by a team of professionals. The process is also referred to as developing a personalized care plan.
“Usually, an interdisciplinary team — which may include social workers, nurses, physicians, pharmacists and other medical staff — conducts an assessment,” says Griff, adding that the facility typically selects the team members responsible for this evaluation, but family input is taken into account, as well.
“These levels of care ensure that assisted living facilities can cater to a broad spectrum of needs. They allow residents to age in place while receiving the appropriate level of support as their conditions change.”
— Esther Cromwell, president of an assisted living community
In addition to the evaluation, Cromwell notes, medical history and current health conditions are reviewed, along with the resident’s social needs and preferences. This, she notes, can influence the type of environment that would be most supportive.
Cromwell also adds that the level of care is regularly re-evaluated to adjust to any changes. “These levels of care ensure that assisted living facilities can cater to a broad spectrum of needs,” notes Cromwell. “And at the same time, they allow residents to age in place while receiving the appropriate level of support as their conditions change.”
What if the level of care needed exceeds assisted living?
Let’s say a resident in assisted living is set to have their level of care re-evaluated. They are already at the highest level of care, but their needs are increasing. Perhaps their previously simple medication regimen has gotten more complex due to a condition requiring injections, frequent medical care or closer monitoring.
Or maybe they’ve become a safety risk to themself or others, adds Sondra “Sam” Cradduck, gerontologist, psychologist and owner of The Living Room, a non-medical senior home care agency in Phelan, California.
Assisted living communities serve many older adults with varying needs, but there may come a time that you or your loved one will be more comfortable in a living situation that can meet increasing needs, such as a new community with more enhanced services, a nursing home or a skilled nursing facility.
Because it is possible that you or your loved one will exceed the levels of assisted living care at the community you choose, either temporarily or permanently, it’s important to anticipate that and ask questions early. Here are some examples.
- If the assessment shows a resident’s needs exceed what the community can provide, how much notice will be given and how long will you have to find alternative living arrangements?
- If a resident requires more care temporarily (like rehab due to a fall), will they be able to stay while they receive services or return once they’ve recovered?
- Are you allowed to bring in outside resources, such as a caregiver, to supplement your or your loved one’s care?
At the end of the day, seniors deserve to get the care they need, and that may mean finding an alternative living situation. By anticipating and answering these questions early, you can ease future transitions.
With additional reporting by Elise Ramsbottom.
