Adults 85+ and Those With Dementia Choosing Assisted Living

“Assisted living is an important and growing option, but it’s also a very underregulated industry,” says Lingamfelter. “That creates challenges for families trying to understand what level of care they can expect, especially when residents have more complex needs like dementia.”​

Families grapple with long-term care costs

​Cost is another major concern in long-term care planning. Median long-term care costs increased significantly from 2019 to 2024, led by a nearly 50 percent increase in home care and assisted living costs, according to a separate report by the AARP Public Policy Institute.​

Assisted living is generally paid for out of pocket, unlike nursing home care, which may be covered by Medicaid once a person’s assets are spent down and they meet eligibility requirements in their state. As residents’ care needs increase, particularly for those living with dementia, costs can rise as well, often through additional services provided by aides and nursing staff. ​

At the same time, long-term care facilities face their own pressures, including workforce shortages and the rising cost of caring for older, sicker residents. For families, the result is a landscape that offers more choices than ever but also more uncertainty.​

“People are drawn to assisted living because it feels less institutional,” says Lingamfelter. “But with that shift, we need to be asking whether the system is keeping pace with the needs of the people it serves.”​

Peter Stapleton’s experience navigating housing options for his 81-year-old mother, who has progressed to moderate Alzheimer’s disease since the pandemic, highlights the difficult and often complex decisions families face in long-term care.​

His mom’s journey began with a crisis: a fall and hospitalization after a period of rapid cognitive decline during COVID-related isolation. Returning to her home in northern Virginia was no longer safe, and inconsistent in-home care, complicated by staffing shortages and his mother’s inability to accept caregivers, proved unworkable. That left a skilled nursing facility as the only viable option for her to move to. ​While the nursing home provided necessary medical oversight and stabilization, Stapleton, 56, found it a poor fit for her cognitive and emotional needs. The busy, noisy environment, which was oriented more toward patients with severe physical and cognitive decline, heightened her anxiety and worsened her dementia symptoms. That realization drove his next decision: moving her to assisted living, where the setting was calmer and more residential, better aligned with preserving his mom’s quality of life.​

But that choice introduced a new constraint: cost. The initial assisted living community carried a price tag exceeding $13,000 a month. Temporary pandemic-era discounts made it feasible in the short term, but as rates rose and his mother’s condition stabilized, the financial trajectory became unsustainable. Her savings of more than $150,000 was quickly depleting.​

Stapleton then faced a different kind of decision: how to balance appropriate care for his mom with financial sustainability. That led him to a county-supported assisted living facility with significantly lower costs. Though less upscale, it provided a comparable day-to-day experience for his mom at about $4,500 a month, of which her Social Security income pays half.​

Underlying all of this is a future concern that as his mom’s disease progresses, a return to nursing home care may be inevitable. His current strategy is mostly about trying to delay the transition until it becomes medically necessary. “I know the transition is coming,” says Stapleton. “At some point, she will be back in nursing care, and that’s something we’ll have to face when the time comes.”​​