Memory care vs. nursing home

The one question that decides it

Memory care and nursing homes both provide 24-hour care, and many residents in each have dementia. The difference is medical.

A memory care unit is an assisted living setting built around supervision, routine and dementia-focused activity. A nursing home is a licensed health care facility built around round-the-clock nursing. So the deciding question is simple to ask, if not always easy to answer: does your loved one need a licensed nurse available every day, around the clock?

If the answer is no, memory care is usually the better home: more freedom, a more residential feel, and a lower price. If the answer is yes, a nursing home is the safer choice, even though it costs more.

Side-by-side: memory care vs. nursing home in Florida

Sources: CareScout 2025 Florida data, Fla. Stat. 400.23, 429.178, 429.07, Florida Medicaid LTC.

What Medicare really covers in a nursing home

Families are often told “Medicare will cover the nursing home,” and then surprised. According to Medicare.gov, Part A covers skilled nursing facility care only after a qualifying inpatient hospital stay of at least three days in a row (observation days don’t count), for up to 100 days per benefit period. In 2026 you pay nothing for days 1-20 after the Part A deductible of $1,736, then $217 a day for days 21-100, and all costs after day 100.

Medicare doesn’t pay for long-term custodial care, which is what most people with dementia eventually need. Long-term nursing home stays are paid privately, through long-term care insurance, or through Medicaid.

Paying for either one with Florida Medicaid

Because few families can pay $124,000 or more a year for long, Medicaid is the payer for many long-term nursing home residents. Florida’s Statewide Medicaid Managed Care Long-Term Care program covers both nursing facility care and assisted living services for people 65 and older (or adults with disabilities) whom the state’s CARES unit finds need nursing-home level of care, and who meet financial rules.

Community-based slots often have a waitlist, so start early: contact your local Aging and Disability Resource Center or the Elder Helpline at 1-800-96-ELDER. An elder law attorney can explain how assets and income are counted.

Who each option is for

Memory care vs nursing home: our pick by scenario

• Walks well, wanders, no major health issues: memory care.

• In memory care, now bedbound with a pressure wound: nursing home, or ask whether the ALF can bring in hospice if your loved one qualifies.

• Hospitalized after a hip fracture: short-term rehab in a nursing home (Medicare may cover it if the three-day inpatient rule is met), then decide between memory care and home once therapy ends.

• Late-stage dementia, comfort is the goal: talk to the doctor about hospice, which can be provided at home, in an ALF or in a nursing home.

Warning signs it’s time to move from memory care to a nursing home

• The ALF says your loved one no longer meets its continued-residency criteria.
• Needs a two-person or mechanical lift for transfers.
• Pressure sores, repeated infections or wounds that need daily nursing.
• Choking or aspiration; see dysphagia.
• Repeated hospital trips over a few months.

How to compare facilities in Florida

1. Check the FloridaHealthFinder Nursing Home Guide: AHCA rates nursing homes with up to five stars based on 30 months of inspection results, compared within each region.

2. Visit twice, once at mealtime and once in the evening.

3. Ask how residents with dementia are kept engaged during the long afternoon hours.

4. Ask the memory care community, in writing, which care needs would require a move to a nursing home.

5. Ask both about hurricane evacuation and generator plans.

How families combine options

Families sometimes keep a private companion visiting several times a week in either setting. In a nursing home, staff are focused on medical tasks; a companion can spend unhurried time reading aloud, playing familiar music, helping at meals, and noticing changes the family should raise with the nurse. Our blog on late-stage dementia care covers what comfort looks like near the end.

Where Dementia Companions fits, and where it doesn’t

We don’t provide skilled nursing or residential care. We do offer live-in companion care at home from $375 a day, which some families use to bridge the time before a move. Where we help is before a move (keeping your loved one safely at home longer), during the transition, and as a familiar visitor afterward, at $35 an hour for 40+ hours a week (call us about shorter schedules). For the cost side, see dementia care costs in Florida and Florida Medicaid.