Types of Care
Care Options for a Person With Dementia
What Are the Care Options for a Person With Dementia?
Dementia care usually moves through several settings as needs grow: help at home from family and in-home care aides, adult day care and respite to give caregivers a break, then memory care or a nursing home when supervision is needed around the clock, and hospice near the end of life. NIA describes Alzheimer's as moving from mild to moderate to severe stages, with more intensive supervision needed by the moderate stage. Medicare covers hospice and some short-term medical care but not long-term custodial care, so families combine private pay, Medicaid, VA benefits and long-term care insurance.
Dementia Care Changes as the Disease Progresses
Dementia care isn’t one decision. It’s a series of them, made as the person’s needs change. The National Institute on Aging (NIA) describes dementia as the loss of thinking, remembering and reasoning to the point that it interferes with daily life. It ranges from a mild stage, when it first affects how a person functions, to a severe stage, when the person depends on others for everything.
Alzheimer’s disease is the most common form. Others include vascular, Lewy body, frontotemporal and mixed dementia. NIA says there is currently no cure for any type, which is why planning matters: the help that works today will likely need to grow.
Only a doctor can diagnose dementia or say what stage it’s in. If you’ve noticed changes in memory or thinking, start with a primary care visit. Once there’s a diagnosis, this guide walks through each type of care, when it tends to fit, and who pays.
Care Options by Stage
NIA describes Alzheimer’s in stages. Other dementias follow their own patterns, but needs generally grow the same way: from reminders, to supervision, to hands-on help with everything.
| Stage (NIA) | What families often see | Care options that often fit |
|---|---|---|
| Mild | Memory loss that disrupts daily life, getting lost, trouble with money and bills, taking longer with daily tasks | Family help, part-time in-home care, adult day care, legal and money planning |
| Moderate | NIA says more intensive supervision and care become necessary: wandering, restlessness in the late afternoon or evening, sleep changes, trouble dressing | More hours of home care, adult day care, respite care, memory care |
| Severe | The person cannot communicate and depends completely on others for care | Memory care or a nursing home, with hospice near the end of life |
The care options guide asks about supervision, wandering, help with daily activities and caregiver strain, then shows which settings fit.
Help at Home: Home Care and Home Health
Most people with dementia live at home for at least part of the illness. NIA separates two kinds of help that families often confuse.
Home care sends an aide to help with bathing, dressing, light housekeeping, errands and company. Aides are usually not medical professionals and can come for a few hours or stay overnight. NIA says Medicare and private health insurance generally don’t cover this nonmedical care, though long-term care insurance may.
Home health care is part-time medical care ordered by a doctor, such as nursing or therapy after an illness. NIA says Medicare covers it on a limited, short-term basis through Medicare-certified agencies.
The home health vs home care guide explains what Medicare pays for each.
As dementia progresses, home safety becomes a bigger part of care. NIA notes that many people with Alzheimer’s wander away from home. Its suggestions include an ID bracelet, an extra lock placed high or low on the door, a door alarm, and never leaving a person with a history of wandering alone.
Meals and Care Managers
Two more services can fill gaps. Meal services deliver meals to the home daily or weekly; NIA notes that the drivers don’t help with cooking or feeding, and that some programs are free or ask for a donation, while others charge. A geriatric care manager, usually a licensed nurse or social worker, assesses needs, makes a care plan and finds local services. NIA says they can be especially helpful when you live far from your parent. They charge by the hour, and Medicare and Medicaid don’t pay for them.
Adult Day Care and Respite for the Family Caregiver
Caring for a person with dementia often takes more than one person can give. NIA says asking for help shows strength, not weakness.
Adult day care offers a safe setting with trained staff during the day, with activities, exercise, meals, personal care and basic health services. Some programs provide transportation. NIA says it tends to cost less than in-home or nursing home care. Medicare won’t pay for it, but Medicaid and other government programs may.
Respite care gives the main caregiver a break, from a few hours to several weeks, at home, in a facility or at an adult day center. For a person in hospice, NIA says Medicare covers most of the cost of up to five days in a row of respite in a hospital or skilled nursing facility.
The GUIDE program. CMS’s GUIDE dementia care model, which began July 1, 2024 and runs for eight years, serves people with Medicare who have dementia and don’t live in a long-term nursing home. Participating programs offer care navigation, a 24/7 support line, caregiver training and respite, which CMS reimburses up to $2,500 a year per eligible person. Ask the person’s doctor whether a GUIDE program operates nearby.
For more free and low-cost help, see caregiver support programs.
Antipsychotic Use Below the National Median: Nursing Homes by State
CMS Care Compare lists 7,044 nursing homes in this group (antipsychotic use below the national median) across 51 states and territories, data from August 2026. Pick a state for its nursing homes, cities and senior care rules.
Memory Care and Assisted Living
When a person needs supervision around the clock, many families look at residential care. NIA notes that some facilities offer special programs for people with Alzheimer’s and other dementias. These memory care units usually sit inside assisted living communities and add secured exits, staff with dementia training and structured activities. Each state sets its own rules for them.
Regular assisted living can work in the earlier stages for a person who doesn’t wander and can still take part in daily life with reminders. Memory care vs assisted living explains when each fits, and the memory care guide covers state rules and costs to ask about. Most families pay for both settings themselves; Medicare doesn’t pay for assisted living.
Nursing Home Care for Advanced Dementia
A nursing home may be the right setting when dementia comes with complex medical needs, or when a person needs skilled nursing every day. Federal rules require every certified nursing home to give a resident who has dementia the treatment and services needed to keep their highest practicable physical, mental and emotional well-being.
One quality measure families with a loved one living with dementia often check is how often long-stay residents receive antipsychotic medicines, which CMS tracks for every home. The national median is 13.37% of long-stay residents, and 7,044 nursing homes report use below that median (CMS data from August 2026, measures for 2025Q2 to 2026Q1). State pages link to these lists, as in Texas nursing homes with low antipsychotic use. The antipsychotics guide explains what the measure means and what to ask.
Use the nursing home finder to see star ratings, staffing and inspection results for every home near you. Veterans can also ask about VA Community Living Centers, some of which offer special dementia care.
Hospice and End-of-Life Care
In the severe stage, NIA says people may spend most or all of their time in bed as the body shuts down. Hospice focuses on comfort rather than cure and can be given at home, in a nursing home, in assisted living or in a hospice facility.
Medicare covers hospice when a hospice doctor and the person’s regular doctor certify a life expectancy of 6 months or less and the person chooses comfort care. Two details surprise families:
- Medicare doesn’t pay room and board, so a resident in memory care or a nursing home still owes those costs.
- NIA notes that once hospice is chosen, medicines intended to treat Alzheimer’s are no longer covered.
The hospice care guide covers eligibility and how to choose a provider.
Who Pays for Dementia Care
| Type of care | Medicare | Medicaid | Other payers |
|---|---|---|---|
| Home care aides | Generally not for nonmedical care | Through state waiver programs, where offered | Long-term care insurance, VA, private pay |
| Home health | Limited, short-term care from certified agencies | Covered, with rules that vary by state | Private insurance rarely |
| Adult day care | No | May help through state programs | Some long-term care insurance, private pay |
| Memory care or assisted living | No | Some states pay care services through a waiver, not room and board | Long-term care insurance, VA services, private pay |
| Nursing home | Short skilled stays only | Long-term care for eligible people | VA Community Living Centers, insurance, private pay |
| Hospice | Yes, but not room and board | May cover | VA, private insurance |
Read the payment guides for details: Medicaid waivers for home care and assisted living, VA long-term care and long-term care insurance.
Where to Start This Week
- Talk with the person’s doctor about the diagnosis, what to expect and whether a GUIDE program is nearby.
- While the person can still take part, put a health care power of attorney and financial power of attorney in place. See legal and financial planning.
- Call the Eldercare Locator at 1-800-677-1116 to reach your local Area Agency on Aging for home care, adult day and respite options.
- Call NIA’s ADEAR Center at 800-438-4380 for free information about Alzheimer’s and related dementias.
- If you’re a caregiver feeling overwhelmed, call or text 988 any time.
Frequently Asked Questions
What Is the Difference Between Alzheimer's and Dementia?
NIA describes dementia as a loss of thinking, remembering and reasoning that interferes with daily life. Alzheimer's disease is the most common form. Other forms include frontotemporal, Lewy body, vascular and mixed dementia. Care options are much the same for each, though a doctor may suggest different approaches by type.
Is Dementia a Normal Part of Aging?
No. NIA says dementia is more common as people grow older, with about one-third of people age 85 or older possibly having some form, but it is not a normal part of aging, and many people live into their 90s without signs of it. If you notice changes in memory or thinking, talk with a doctor.
Can Someone With Dementia Stay at Home?
Many people do, especially in the earlier stages, with help from family, home care aides, adult day programs and respite care. NIA notes that caregiving often exceeds what one person can give alone, and that asking for help is a sign of strength. Home safety steps, such as locks and door alarms for a person who wanders, matter more as the disease progresses.
What Is the GUIDE Program?
GUIDE is a CMS dementia care model that began July 1, 2024 and runs for eight years. It serves people with Medicare who have dementia and don't live in a long-term nursing home. Participating programs offer care navigation, a 24/7 support line, caregiver training and respite, which CMS reimburses up to $2,500 a year per eligible person.
Where Can Family Caregivers Get Free Help?
Start with the Eldercare Locator at 1-800-677-1116, which connects you to your local Area Agency on Aging. NIA's ADEAR Center answers questions about Alzheimer's and related dementias at 800-438-4380. VA's caregiver support line is 855-260-3274. If you feel overwhelmed or in crisis, call or text 988. See caregiver support programs.
Does Medicare Pay for Adult Day Care for Dementia?
No. NIA says Medicare will not pay for adult day care, but Medicaid and other government programs may help, and some long-term care insurance plans pay part of the cost. Read the adult day care guide for how programs work.
More on Types of Care
- Memory CareSecured dementia care in assisted living and nursing homes, state rules and how to pay
- Assisted Living vs Nursing HomeHow the two settings differ in care, rules and who pays
- Memory Care vs Assisted LivingWhen a person with dementia needs a secured memory care unit
- In-Home CarePersonal care, homemaker help and how Medicaid and VA pay for it
- Home Health vs Home CareThe difference between Medicare home health and paid personal care
- Adult Day CareDaytime programs, health services and coverage
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.
Sources
- NIA: What Is Dementia? Symptoms, Types, and Diagnosis
- NIA: What Are the Signs of Alzheimer's Disease?
- NIA: Getting Help With Alzheimer's Caregiving
- NIA: Coping With Alzheimer's Behaviors: Wandering and Getting Lost
- NIA: Long-Term Care Facilities: Assisted Living, Nursing Homes, and Other Residential Care
- CMS: Guiding an Improved Dementia Experience (GUIDE) Model
- Medicare.gov: Hospice care
- Medicare.gov: Long-term care coverage
- eCFR: 42 CFR 483.40, behavioral health services in nursing homes
- VA: Community Living Centers
- CMS Provider Data Catalog: Nursing Home Provider Information (August 2026)