As America’s population ages, assisted living communities are playing an increasingly central role in long-term care, particularly for older adults living with Alzheimer’s disease and other forms of dementia.
For the first time, a larger share of residents in assisted living than in nursing homes now have Alzheimer’s or dementia. In 2022, 44 percent of those residing in assisted living had Alzheimer’s or dementia, compared with 41 percent in nursing homes, according to a new report from the AARP Public Policy Institute. More than 1 million people live in assisted living settings, and about half are age 85 or older, a group that increased sharply by 28 percent, from 408,000 in 2020 to 522,000 in 2022.
“The growth reflects both the expansion of assisted living communities nationwide and a known preference for more community-based services, where individuals with dementia who remain physically capable are staying in these settings longer, delaying a move to nursing home care until it’s medically necessary,” says Paul Lingamfelter, a policy adviser for long-term care with the AARP Public Policy Institute.
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Traditionally, assisted living has served older adults who need help with daily activities, such as bathing, dressing and medication management, but do not require the intensive, round-the-clock medical care provided in nursing homes.
Increasingly, assisted living communities, particularly memory care units, are caring for individuals with cognitive decline, including those with Alzheimer’s and related dementias. Memory care units are typically connected to or part of assisted living communities and are not subject to the same federal regulations as nursing homes. The growing reliance on assisted living reflects a broader preference among older Americans for community-based care over institutional settings.
The shift also raises complex questions about oversight, affordability and quality of care. Unlike nursing homes, which are subject to federal regulation, facilities designated as assisted living and memory care units are governed by inconsistent rules at the state level, leading to a wide variation in staffing requirements, training standards and reporting practices when caring for a vulnerable population.