8 Alternatives to Nursing Homes

Last updated on August 10th, 2023 at 07:01 pm

Nearly 70% of U.S. adults who reach age 65 will eventually need long-term care. However, many of these older adults do not need the full level of care offered in nursing homes, have limited finances, seek more privacy than is available in traditional adult care spaces, or simply do not feel ready to leave their homes. 

If any of those concerns ring true to you, you may want to consider these nursing home alternatives. There are ways for older adults in any situation to receive compassionate, individualized care in a living situation that suits them.


1. Home Care

Home care allows older adults to age in place and receive the assistance they need from the comfort of their own home. In this style of care, the caregiver visits the care recipient at their home whenever they need care, often on a daily or weekly basis. 

Home care can include a wide range of services. Many older adults receive minor to moderate medical assistance, in addition, to help with dressing, hygiene, moving around the house, and transportation. Home care providers also provide household tasks such as meal preparation and cleaning. 

While home care does not provide the same level of socialization and community activities as assisted living, older adults who use this service still benefit from the caregiver’s companionship. Home care recipients also tend to enjoy more consistent care with less likelihood of staffing changes.

At an average of $5,815 per month in Washington State, home care tends to be substantially less expensive than a nursing home and roughly on par with assisted living. Families who have trouble affording this cost may be able to receive assistance through Medicare PACE, Medicaid HBCS, or other programs.


2. Assisted Living

Assisted living communities are often a great option for older adults who prefer a balance of privacy and community. Residents live in private apartments but have easy access to shared meals, activities, entertainment, and transportation. 

In assisted living, community members receive help with daily living tasks and have access to 24-hour on-call assistance. Caregivers can help with dressing, toileting, bathing, and eating as needed. The community also provides healthcare monitoring and medication management services to help everyone stay healthy.

However, assisted living is not intended for people who require constant medical care. Adults with extensive medical needs may need a more care-focused living situation. 

In Washington State, assisted living cost an average of $5,500 per month in 2019, which is substantially less than the cost of the average nursing home. Facilities in expensive urban areas such as Seattle typically cost more, while facilities in less in-demand areas may be more affordable.


3. Medicare PACE

Medicare Program of All-Inclusive Care for the Elderly (PACE) programs offer a combination of services to individuals who would otherwise need to be in a nursing home. These programs allow older adults to continue living in their homes or with their family members while receiving moderate levels of long-term care. Commonly used services include adult day primary care, prescription drugs, physical therapy, emergency services, home care, meals, social work counseling, and transportation to the PACE center, among others. 

In PACE programs, a team of healthcare professionals works with the older adults and their families to ensure they are getting the kind of coordinated care they need. These professionals typically work with only a few families, so they get to know each patient well. However, PACE enrollees are often required to use a PACE-preferred doctor, which may restrict the enrollee’s ability to stick with a doctor they already know and trust.

Anyone with either Medicare or Medicaid who is age 55+ lives in the service area of a PACE organization needs nursing home-level care as defined by the state, and can live safely in the community with help from PACE is eligible for the program. A person can leave PACE at any time.

Care recipients with Medicaid do not have to pay monthly premiums for the long-term care portion of PACE. Care recipients who have Medicare but not Medicaid must pay monthly premiums for both long-term care and Medicare Part D drugs. There is no deductible or copayment for any drug, service, or care approved by the care recipient’s health care team.


4. Medicaid HBCS

Medicaid Home & Community-Based Services (HBCS) Waivers provide a variety of care services and non-medical support for Medicaid recipients. Like Medicare PACE, Medicaid HBCS is designed to help older adults and other population groups who would otherwise require nursing home care to live at home or with their families.

In Washington State, there are several Medicaid waiver programs intended to help certain populations access healthcare, mental healthcare, disability accommodations, and more. The Community Options Program Entry System (COPES) is designed to enable low-income older adults with minimal assets to receive nursing home-level care. Benefits can include adult day care, assisted living, home health care, home delivered meals, and more.

Applicants must be at least 65 years old or disabled, financially qualified for Medicaid, and require assistance with at least two Activities of Daily Living. There is some flexibility for higher-income individuals with unusually high recurring medical expenses.


5. Adult Foster Care

Adult foster care programs, also known as adult family homes or boarding homes, offer a family-oriented living experience in a private residence. In this type of program, 1-6 adults live together, share meals, and receive personal care in a private residence. While there are fewer opportunities for social interaction compared with assisted living, the environment feels more comfortable for some older adults.

Adults foster care typically includes assistance with medications, toileting, bathing, and household chores. However, medical care is generally not offered. Adults who need moderate or extensive medical care on a daily basis may need a different care setting.

In most cases, adult foster care is less expensive than nursing home care or assisted living. The Medicaid COPES and Personal Care programs provide financial support for Medicaid recipients who need this type of care.


6. Respite Care

Respite care is a supplement to care provided primarily by family members. These programs allow primary caregivers to take a break from their care responsibilities so they can run errands, relax, go out of town, or go to work. 

There are several types of respite care. Some programs provide care within the care recipient’s home, while others are located in senior living communities or adult daycare centers. Regardless of the location, respite care offers the same services that the primary caregiver provides, including bathing and hygiene assistance.

Respite care can cost anywhere from $110-300 per full day depending on the location and types of services needed. Keep in mind that respite care generally does not include medical care, although care provided by a home care aide can include services such as performing injections and monitoring illness. Respite care in assisted living communities generally costs more than in-home respite care.


7. Continuing Care Retirement Communities

Continuing Care Retirement Communities (CCRCs) may be a good option for older adults who wish to remain in the same community as their care needs change. Many residents start out living independently, then transition to assisted living-style care or skilled nursing later on when they require more medical care.

Most adults in CCRCs live fairly independently. They may receive personal assistance with housekeeping, transportation, and hygiene and have the option to receive more extensive care later on if needed. In addition to care, CCRCs provide recreational activities and social events, with some providing off-site trips such as fitness classes and worship opportunities.

A downside of CCRCs is that they can be more expensive than other adult care options, although it varies from community to community. Many CCRCs require residents to pay a hefty entrance fee which can range from a few hundred thousand dollars to over $1 million, as well as several thousand dollars per month in service fees. Other communities do not require an up-front fee but may charge higher monthly rates. 

Keep in mind that there are several types of CCRC contracts that can affect the overall price and payment schedule for care. An extensive life-care contract typically includes the full range of services for high up-front and/or monthly fees. On the other end of the spectrum, a fee-for-service contract includes a lower initial fee but requires residents to pay the full market rate later on for whatever care services they require, such as assisted living or memory care. If you choose a CCRC, be sure to read the contract closely before committing.


8. Adult Day Care

Adult daycare provides a place for older adults to socialize and receive care while family caregivers are at work during the day. This care option works well for situations where family members don’t want to leave the care recipient alone during the day or where the care recipient wants to regularly spend time with others.

Most adult daycare centers focus on medical assistance and entertainment, including outings, crafts, movies, and other activities. Adult daycare also typically includes meal preparation and transportation. This care option is among the least expensive at an average of $1,441 per month in Washington State.


In Summary: Nursing Home Alternatives

  • Home Care
  • Assisted Living
  • Medicare PACE
  • Medicare HBCS
  • Adult Foster Care
  • Respite Care
  • Continuing Care Retirement Communities
  • Adult Day Care


Finding a Nursing Care Alternative in Western Washington

Nursing homes may seem like the go-to option for caring for older adults, but they’re far from the only option. If you live in Western Washington and need help finding a care program that meets your needs, contact Sunrise to learn about your options. We help individuals who are older and/or disabled find solutions such as adult family homes, geriatric transitions programs, home care, and more.