Memory Care vs. Assisted Living: What Is the Difference?

In California, assisted living communities and board and care homes are licensed as RCFEs, the state's licence category for residential care homes that serve older adults. They are non-medical homes that provide a room, meals, housekeeping, supervision, help with medication and hands-on help with bathing, dressing and getting around.

Memory care is the same kind of licensed home, set up for people living with Alzheimer's disease or another dementia. The Alzheimer's Association calls these special care units or memory care units and describes them as settings designed around the needs of people with dementia, often a floor or wing inside a larger building. Some homes, large and small, offer special services for residents with dementia.

California Advocates for Nursing Home Reform (CANHR) points out that "memory care" is a marketing term, not a legal one. That is why two homes using the same words can offer very different things, and why the questions you ask matter more than the label.

The differences are usually in the building, the staffing, the daily routine and the price. The Alzheimer's Association notes that a memory care unit may or may not be locked, so do not assume. Ask to see how the doors and the yard work.

Three rules in the Health and Safety Code are worth knowing before you tour.

• Written disclosure. Under section 1569.627, an RCFE that advertises or promotes special care, programming or a special environment for people with dementia must describe those features in its plan of operation and give that information to the public on request. It covers the home's philosophy, assessments, admission, program, staff, staff training, physical environment, how changes in condition are handled, and how it measures success.
• Dementia training in every RCFE. Section 1569.626 requires 12 hours of dementia care training for direct care staff, six before working independently with residents and six within the first four weeks, plus eight hours each year. This applies to all RCFEs, not only memory care.
• Secured perimeters. Section 1569.698 allows an RCFE that cares for people with major neurocognitive disorder to use secured perimeter fences or locked exit doors if it meets added safeguards set in regulation. The same section says admission stays voluntary, or with the consent of the resident's legal conservator.

Only a doctor can diagnose dementia or say what stage a person is in. What families and caregivers can do is notice changes. The National Institute on Aging says that in the moderate stage of Alzheimer's disease, more intensive supervision and care become necessary. The Alzheimer's Association says that in the middle stages, 24-hour supervision is needed to keep the person safe.

These can be signs that it is time to talk with the doctor and with the home about whether the current setting still fits:

• Wandering or getting lost
• Restlessness, agitation or anxiety, often in the late afternoon or evening
• Sleeping during the day and being up and restless at night
• Trouble with multistep tasks such as getting dressed, even with reminders
• Withdrawing from meals and activities the person used to join
• Staff telling you they are having trouble keeping up with redirection and supervision

Usually, yes. CANHR notes that specialized services such as dementia care cost more, and that it is common for homes to charge higher rates for them. Any such charge has to be stated in the admission agreement.

Prices vary widely by home, room type and care level, so ask each home for its dementia rate in writing and what would cause it to rise. Our guide to board and care costs in California explains how monthly rates are usually built, and the tour checklist has the pricing questions to bring with you.

Start with the state record. Every memory care home or unit should appear on the state's facility search as a licensed RCFE, and our guide on checking an RCFE licence shows how to read what you find. If the names confuse you, RCFE vs. assisted living sorts them out.

Then ask each home for its written dementia program description, how many staff are on each shift, how staff respond when a resident is upset or wants to leave, and what would make the home say it can no longer care for your relative. The Alzheimer's Association also suggests visiting more than once, at different times of day, including a mealtime.

Hamssa Benrekia is a senior living placement specialist based in Torrance. She talks with you about your relative's care needs, health conditions and monthly budget, then shortlists homes that fit, whether that is assisted living or memory care placement, and goes on the tours with you. She cannot diagnose or tell you which level of care is medically needed, but she knows many local homes and their owners. Contact Hamssa to talk it through.