5 Levels Of Care In Assisted Living [With Resources] blog cover on AskSAMIE.com

5 Levels Of Care In Assisted Living [With Resources]

5 Levels of Care in Assisted Living [With Resources]

 Choosing the right level of care is a crucial decision that significantly impacts the quality of life for older adults. And to make things more complicated, there are different levels of care at different types of facilities and there are also different levels of care within a facility. We are going to dive into all of that in this article so we can provide as much clarity as possible so that you can make the decision.

Key Takeaways

  • Understanding the types of care locations
  • Understanding the 5 levels of care specifically in an assisted living facility
  • Who can help you with deciding what type of care will meet the person's needs.



In my experience, selecting the appropriate level of care is a real challenge for families and professionals. You want to choose a place and a level of care that allows for the best possible level of independence, but also provides the support in the way it's needed. The biggest challenge piece is that, of course, the higher the level of care, the more expensive it is. So often times people choose a lower level of care that doesn't actually meet the person's needs to have the cost match the budget. But in this article, we hope to empower you with the information you need to make a plan that can meet all the needs at every stage.

What are the Types of Care Locations?

Before we dive too deep, I want to make sure that you know the difference clearly between the various kinds of places one can live and receive some assistance. Once you understand the care locations, then you can better understand the levels of care within a specific location called assisted living.

  1. Living at home - It's possible to pay for private duty, in-home care so that everyday activities are helped, as needed, by someone who comes into the home to provide that care. This is paid for out-of-pocket and is not covered by health insurance. It can be covered by long-term care insurance, though! There are various levels of care here, including a few hours, a few times per week— all the way up to 24-7 live-in care.
  2. Senior Apartment - Sometimes moving to an apartment in a building that only accepts those over 55 or 60 years of age can help keep someone independent. While these buildings don’t usually have personal care associated with them, being in a space that’s smaller than a house where no home maintenance or outside upkeep is required can be a game changer. In addition, the lack of stairs to manage and a more accessible bathroom layout (sometimes!) can decrease the need for care like may have been needed when living in a house. While there is no care built into these buildings, you can hire the same in home care services as you would do when living at home,
  3. Independent Living Facility - These are apartments for older adults that function the same as a Senior Apartment, but they usually offer some additional supportive services like prepared meals, apartment cleaning, or transportation. While this is still not personal care for daily activities like helping with showers or getting dressed, the elimination of cooking or cleaning can support an older adult to maintain their independence. Just like living at home or in a senior apartment, older adults can hire additional care from in home care agencies to support them with personal care tasks.
  4. Assisted Living - Even though people sometimes use this as an umbrella term for more to a place where more services are available, it refers to a particular type of care. Assisted Living refers to living in a room or apartment in a facility where there's support for daily activities like toileting, dressing, bathing, and transfers (moving your body from one place to another). While there are a variety of levels of care within Assisted Living, which we’ll dive in to below, the thing Assisted Living is not is 24/7 care. Assisted Living facilities do have staff available at all times. It's expected that residents only need help sprinkled throughout the day or at planned times, not consistently or frequently throughout the day or night. If that level of assistance is needed, skilled nursing care is required.
  5. Skilled Nursing Facility - Sometimes called nursing homes or long term care, these facilities have residents in a private or shared room with medical care and physical assistance available 24/7. Residents need help with most or all of their everyday activities or transfers because of a medical condition or limited mobility.
  6. Memory Care - A special location for care is called Memory Care. Often this is a unit within a skilled nursing facility or assisted living facility. But it could also be in a care home, a group living situation in a house dedicated to providing care for those with dementia or other memory challenges. In any of these types of memory care locations, the area is protected or locked so residents can’t wander out. And there's 24/7 assistance to help with redirecting residents to safe tasks and to help with everyday activities.

 Now that you know about the different places one can receive care and how that might look, let’s dig into the levels of care that can be provided in an institutional setting (#3-6 above) specifically.


What Are the Levels of Care in Assisted Living?

Levels of care in institutional settings (from independent living to memory care) refer to the varying degrees of support and services provided to residents based on their individual needs. These levels range from requiring minimal assistance up to intensive care for those with significant physical or cognitive impairments. Understanding these distinctions is crucial in selecting the right environment that promotes safety, well-being, and dignity for older adults.

 Level 1: Independent Living

Independent Living is designed for older adults who are largely self-sufficient and require minimal assistance. In this setting, residents enjoy a lifestyle similar to that in their own homes, with the added benefits of a supportive community.

Characteristics of Independent Living

  • Autonomy: Residents maintain a high degree of independence, managing their daily activities without significant help.
  • Community Engagement: Encouragement to participate in social activities and community events to foster social connections and mental well-being.
  • Minimal Staff Intervention: Limited to services like housekeeping, transportation, and some meal preparations.

 Services Offered

  • Recreational Activities: Programs designed to keep residents engaged, including fitness classes, arts, and crafts, and social gatherings.
  • Maintenance and Housekeeping: Regular upkeep of living spaces and common areas, allowing residents to focus on enjoying their time.
  • Transportation: Scheduled transportation services for shopping, medical appointments, and social outings.

In my practice, I've found that independent living works well for those who can manage their personal care but benefit from a socially vibrant environment that reduces the risks of isolation and loneliness.

 Level 2: Minimum Assistance for Daily Tasks

For those who need a bit more support with daily activities, Level 2 provides light assistance while still promoting a high degree of independence. One can achieve this livelihood of care in an Assisted Living Facility or in an independent apartment with the additional support coming a few times a week from an in home care agency.

Support Provided

  • Medication Reminders: Staff makes sure that residents take their medications as prescribed, which is crucial for maintaining health and managing conditions.
  • Housekeeping Services: More frequent cleaning and laundry services to support those who find these tasks challenging.
  • Encouragement for Social and Recreational Activities: Proactive efforts to engage residents in community activities to enhance their social life and mental health.

 Managed Health and Mobility Issues

  • Minor Impairments: Suitable for residents with minor mobility issues or health conditions that require regular monitoring but don't severely limit independence.
  • Mobility Support: Assistance with walking aids and minor physical support during daily activities.

 This level is ideal for those who need a little help to stay on top of their health and daily routines but still maintain some level of independence.

In my experience, many older adults need this level of assistance but don’t actually make a plan to get it. Struggling at this stage without the proper support can result in falls and limiting their lifestyle to just the things they must do instead of the things they want to do. If appropriate support is not established, the likelihood that mental and physical health declines over the coming years is high.

 Level 3: Standby Assistance

Standby Assistance means residents need more assistance with daily activities but don't require constant supervision. One can achieve this level of care in an assisted living facility or by hiring daily in home care assistance.

 Increased Care Provided

  • Daily Living Activities: Assistance with dressing, grooming, bathing, and other personal care activities.
  • Emergency Response: Systems and staff available to respond quickly in case of emergencies, providing peace of mind to residents and their families.

Cognitive Challenges and Support

  • Cues and Reminders: Regular reminders and prompts to help residents with daily tasks, enhancing their ability to live as independently as possible.

Supportive care is particularly beneficial for those experiencing early stages of dementia or who have mobility issues that require regular assistance.

Level 4: Hands-on Assistance

Comprehensive Assistance caters to residents who require significant help with most activities of daily living due to physical or cognitive impairments. One can achieve this level of care in Assisted Living or Memory Care. Sometimes this feel of care can be achieved at home with a full-time, live-in caregiver, whether that’s a family member or someone hired.

 Hands-On Support

  • Activities of Daily Living (ADLs): Extensive help with bathing, dressing, eating, and toileting.
  • Access to care 24/7: Continuous oversight to provide safety and well-being, particularly for those with advanced health issues.

 Health and Memory Impairments

  • Intensive Health Management: Regular health monitoring and management of chronic conditions by trained healthcare staff.
  • Memory Care: Specialized programs and environments designed to support residents with significant memory impairments.

 This level is for individuals who need more intensive care to manage their day-to-day lives. It can be very challenging to provide this level of assistance at home, and depending on the situation, it may make more sense to move into Assisted Living or Memory Care.

 Level 5: Total Assistance

Intensive Care Needs represent the highest level of support available in an institutional setting, often required for residents with severe physical or cognitive disabilities. The level of care can be achieved at a skilled nursing facility, long term care, or assisted living with additional hired assistance.

 Extensive Care Provided

  • Complete ADL Assistance: Total assistance with all activities of daily living, including feeding, mobility, and personal hygiene.
  • 24-Hour Nursing Care: Continuous medical support and supervision to manage complex health conditions.

 Specialized Services

  • Memory Care Units: Dedicated areas with specialized staff trained to handle severe dementia and Alzheimer’s disease.
  • Therapies and Rehabilitation: Regular physical, occupational, and speech therapy sessions aimed at improving quality of life and managing symptoms.

 This level is essential for those who need round-the-clock care. In my experience, having specialized and intensive support can make a big difference in the quality of life for residents with significant needs.

How to Choose the Right Level of Care

Selecting the appropriate level of care involves a thorough assessment of your loved one's needs. Here are some tips to guide you:

Assessing Needs

  • Conduct a Needs Assessment: Evaluate the physical, cognitive, and emotional needs of the senior. This can be done through consultations with healthcare providers and by observing daily activities.
  • Consult Healthcare Providers: Discuss with doctors, nurses, and occupational therapists who can provide insights into the level of care needed.
  • Use Resources: Tools like AskSAMIE’s On Demand Assessment can help identify the specific needs and recommend suitable care levels.

Discussing Options

  • Family Meetings: Hold discussions with family members to consider everyone’s input and concerns.
  • Visit Facilities: Connect with a senior care advisor in your area to tour various assisted living facilities. Advisors from companies like CarePatrol and OASIS are key because they offer their service free to you, plus they have an intimate knowledge of all the facilities in your area. This means they can help you narrow down your options to the few that'll be just right for your person, helping you understand the services and care levels offered.
  • Consider Future Needs: Plan for potential future needs by considering a facility that offers multiple levels of care to avoid future relocations.

 Choosing the right level of care guarantees that your loved one receives the support they need while maintaining as much independence as possible.

Need Help Navigating Care Options? We Can Help.

Understanding the different levels of care and gaining assistance with living is crucial to ensuring that your loved one receives the appropriate support. If you need assistance navigating these options, the AskSAMIE team is here to help. We offer expert advice tailored to your specific needs, guaranteeing that you make informed decisions for your loved one's well-being.

In my practice, I've seen the difference that appropriate care levels can make in the lives of older adults. Whether you need help assessing your loved ones needs or connecting with a local advisor to help you choose the right facility, reach out to us at AskSAMIE for personalized support and guidance.

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Brandy Archie, OTD, OTR/L, CLIPP

Dr. Archie received her doctorate in occupational therapy from Creighton University. She is a certified Living in Place Professional with past certifications in low vision therapy, brain injury and driving rehabilitation.  Dr. Archie has over 15 years of experience in home health and elder focused practice settings which led her to start AskSAMIE, a curated marketplace to make aging in place possible for anyone, anywhere! Answer some questions about the problems the person is having and then a personalized cart of adaptive equipment and resources is provided.

She's a wife, mother of 3 and a die-hard Kansas City Chiefs fan! Connect with her on Linked In or by email anytime.

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