Decision guides
Choosing care, one calm step at a time.
Weighing home care, assisted living, memory care or PACE? Work through these five steps. Your answers are saved on this device only.
Include your person in the decision
As far as they are able, let them help choose. Ask what matters most: staying home, being near family, privacy, a pet, faith, the food, a garden. Use it as the tiebreaker.
When it's urgent
If a hospital discharge is forcing a fast decision, ask for the case manager or social worker the same day. A temporary choice is fine — you can keep comparing.
Step 1
Needs check
Mark the level of help needed today. Be honest — families often underestimate needs because they are quietly filling the gaps.
Daily personal care
Bathing or showering
Dressing
Eating
Using the toilet / continence
Getting in and out of bed or a chair
Walking or getting around safely
Running a household
Taking medications correctly
Cooking and nutrition
Managing money and bills
Driving or getting to appointments
Housework and laundry
Using the phone / staying in touch
Safety & health
Falls (any in the last 6 months?)
Memory, confusion or getting lost
Wandering or leaving home unsafely
Being alone at night
Skilled care (wounds, injections, oxygen, tube feeding)
Loneliness or isolation
What your answers suggest
Mark a few items above and suggestions will appear here.
General information, not medical advice. Ask their doctor too.
Step 2
Care options & who pays
Medicare does not pay for long-term custodial care — ongoing help with daily activities. Use this as a starting map, then confirm with each plan.
Home care (non-medical)+
Aides come to the home for companionship, errands, meals, bathing, dressing and supervision. Hourly, up to 24/7.
- Good fit when
- They want to stay home, the home is safe or can be made safe, and needs are predictable.
- Medicare
- Generally no, unless part of a Medicare Advantage plan's extra benefits (limited).
- Medicaid
- In many states, through home and community-based services or waiver programs. Waitlists are common.
- Other sources
- Private pay, long-term care insurance, VA benefits.
Home health+
Short-term skilled care at home ordered by a doctor: nursing, physical, occupational or speech therapy.
- Good fit when
- Recovering from a hospital stay, surgery or a new diagnosis. Not ongoing daily help.
- Medicare
- Yes, when a doctor certifies the need and the person is homebound. Part-time and intermittent.
- Medicaid
- Yes, in all states.
- Other sources
- Private insurance, Medicare Advantage plans.
Adult day program+
Supervised daytime program with meals, activities and sometimes health services. Some specialize in dementia.
- Good fit when
- They live with family who work or need a break, and would benefit from structure and social time.
- Medicare
- Generally no.
- Medicaid
- Often through state waiver programs.
- Other sources
- Private pay, VA, long-term care insurance.
Assisted living+
Residential community with an apartment, meals, activities and help with personal care and medications. Staff on site 24/7.
- Good fit when
- They need daily help and oversight but not continuous nursing, and isolation or home upkeep is a problem.
- Medicare
- No for room and board or personal care.
- Medicaid
- Some states help pay for services (not room and board) through waivers.
- Other sources
- Mostly private pay; long-term care insurance; VA Aid and Attendance.
Memory care+
Secured residence or wing with staff trained in dementia care, structured days and closer supervision.
- Good fit when
- Dementia is causing wandering, unsafe exits, distress, or needs beyond what home or assisted living can manage.
- Medicare
- No for room and board or personal care.
- Medicaid
- Same as assisted living; varies widely by state.
- Other sources
- Mostly private pay; long-term care insurance; VA.
PACE+
A Medicare and Medicaid program that coordinates all medical care and long-term services through one team and a day center, while the person lives at home.
- Good fit when
- They are 55+, live in a PACE service area, are certified by the state as needing nursing-home-level care, and can live safely at home with support.
- Medicare
- Yes. PACE is a Medicare and Medicaid program.
- Medicaid
- Yes. People with Medicaid usually pay no monthly premium.
- Other sources
- Medicare-only enrollees pay a monthly premium for the long-term care portion, plus Part D.
Skilled nursing+
Licensed nursing care around the clock, short-term rehab or long-term care.
- Good fit when
- Medical needs require nurses 24/7, or rehab after a hospital stay.
- Medicare
- Short-term skilled care after a qualifying hospital stay, limited days with a daily copay after day 20.
- Medicaid
- Yes, for long-term care once financially eligible.
- Other sources
- Private pay, long-term care insurance.
Hospice+
Comfort-focused care for a serious illness, delivered wherever the person lives, with support for the family.
- Good fit when
- A doctor expects six months or less if the illness runs its usual course, and the focus has shifted to comfort.
- Medicare
- Yes, under the Medicare hospice benefit.
- Medicaid
- Yes.
- Other sources
- Most private insurance.
Get free, unbiased help with coverage
SHIP offers free Medicare counseling in every state. Your Area Agency on Aging handles waivers and benefits screening. See an elder law attorney before spending down assets — Medicaid has look-back rules.
Step 3
The questions to ask
Check questions off as you call and visit. Red flags are the things that should make you pause.
Home care
Home care can mean a few hours a week or round-the-clock help. Most families hire through an agency (handles screening, payroll and backup; highest rate), a registry (ask who handles taxes and replacements), or directly (most control, but you may be the employer).
Questions to ask an agency0/12
During the first two weeks, watch for0/6
Red flags
- ✕ Rates quoted only by phone, with nothing in writing.
- ✕ Vague answers about who employs the caregivers or who carries liability insurance.
- ✕ A new caregiver nearly every visit, with no plan for consistency.
- ✕ No supervisor visits or care plan updates, especially after a hospital stay or change in condition.
- ✕ Pressure to sign a long contract or pay a large deposit upfront.
From the inside
Ask for the agency's caregiver turnover rate and its no-show rate in the last quarter. Good agencies track both and will tell you. Also ask who your single point of contact is, and get their direct number.
Step 4
Compare side by side
Name up to three options, score each from 1 (poor) to 5 (excellent) right after your visit, and total the real monthly cost.
| Visit scorecard | Option A | Option B | Option C |
|---|---|---|---|
| Meets their care needs now | |||
| Can meet needs as they change | |||
| Staff warmth and respect | |||
| Staffing levels and consistency | |||
| Cleanliness and safety | |||
| Food and dining | |||
| Activities and social life | |||
| Location for family visits | |||
| Communication with family | |||
| Transparency on fees and policies | |||
| How our person felt there | |||
| Our gut feeling | |||
| Total (out of 60) | 0 | 0 | 0 |
| Monthly costs | Option A | Option B | Option C |
|---|---|---|---|
| Base rate (rent, or hourly rate × hours) | |||
| Care level / care package fee | |||
| Medication management | |||
| Incontinence and personal supplies | |||
| Transportation | |||
| Laundry, housekeeping, extra services | |||
| Second-person or overnight fees | |||
| Other | |||
| Insurance, VA or Medicaid paying | |||
| Their monthly income available | |||
| Total monthly cost | $0 | $0 | $0 |
| Monthly gap (savings or family) | $0 | $0 | $0 |
| Savings available | — | — | — |
Compare real costs, not base rates
Ask communities what the average resident pays in total, and how often residents move up a care level in their first year.
Step 5
Family decision meeting
Get everyone on the same page, ideally with your person in the room. Agree on the decision, a backup plan, and who does what next.
Adapted from the New Caregiver Choosing Care Decision Guides. General information, not medical, legal or financial advice. Licensing rules, program names and coverage differ by state and plan.