Levels of Care

There is much confusion in the public’s minds about the differences between independent living, assisted living, what do they do and don’t do? What is memory care? What is a board and care?  What is skilled nursing? Here a quick guide, but I’d be glad to meet personally with you and your loved one, discuss the house, and just as important, discuss the different care options, and what you could expect in your new environment.  No other REALTOR® can offer this level of knowledge, service, and peace of mind.

Independent Living

Typically a 55+ community, could be senior apartments or larger community like Rossmoor

Three different types of Independent Living apartments:

1. Senior Apartments: Residents responsible for their own meals, transportation, utilities and any care needs they might require. Just like any apartment. The “most” independent option. May be required to sign a one year lease. Make sure to ask what are the terms. Residents can hire private caregivers if needed. By the way, the going rate for private caregivers is in the $25-$30 an hour range in the Tri-Valley.

2. Independent Apartments with Amenities: Typically includes an “amenity” package such as meals, housekeeping, transportation, activities, utilities paid, 24/7 staff, emergency call systems in the apartments. Generally much more expensive than Senior Apartments. Just like the Senior Apartments, residents are responsible for their own care or hiring private caregivers. A health assessment may or may not be required depending on the “facility.” These are typically month-to-month apartments, much less expensive upfront than the CCRC “buy-in.”

3. Continuing Care Retirement Community (CCRC). Stoneridge Creek in Pleasanton operates on this business model based on four levels of care. Theory is you start out in Independent Living, and if you need Assisted Living, Skilled Nursing, or memory Care you could stay on the same campus (but not the same apartment). Health assessments and age limit restrictions may be in place in some CCRC’s. The up-front costs could be anywhere from $350,000-$2,000,000 with 75% refundable after 5 years. I could advise my clients on the advantages/disadvantages of CCRC versus month-to-month.

Most independent living apartments are private pay, but there are low-income or reduced rent senior apartments, usually with long wait lists that may accept government subsidies such as Section 8. Having a home to sell does not necessarily disqualify you from qualifying for a “low-income” or “below market rent” apartment. Call Jeff to learn more about these options that could save you thousands per month.

Assisted Living

For residents that might need some level of physical assistance, such as bathing, dressing, medication management, transfers, escorts, also called “activities of daily living (ADL’s).


  • Meals, housekeeping, activities, are included as part of the “package.”
  • Nurse on staff. Nurse can be an RN or LVN. 24/7 assistance is provided by caregivers. Assisted living properties are not required to have 24/7 nurse around the clock on duty, because it’s not considered a “nursing home.”
  • Apartments could be private or shared.
  • Prospective resident must get a Physicians Report (602A) form completed by their doctor, then assessment done by staff nurse to determine care levels needed.
  • There may be limitations on what many assisted living communities can do. For example, most will not take residents that can’t self-administer insulin or other injections if required. Some assisted living communities can’t or won’t accept people who have a dementia diagnosis.
  • Unless the particular assisted community offers memory care, a resident who moves in without a dementia diagnosis and gets one later, or requires a higher level of care in the future, may have to move out. Ask what the limitations of care are.
  • Private pay. Will accept long-term care insurance if you have it.
  • May qualify for VA benefits

Skilled Nursing

Also called “rehabilitation,” or “rehab,” a skilled nursing facility (SNF) is typically the place seniors go in-between the hospital and coming home, if they’ve had a health “event” such a fall, surgery of any kind, pneumonia, urinary tract infection.


  • Meant to be short-term stay
  • Physical therapy included
  • Paid by Medicare for up to 99 days
  • May qualify for long-term care insurance if you have it
  • May qualify for VA benefits if you have it
  • Typically shared apartments. Some
  • SNF’s will have three patients to a room
  • SNF’s will accept Medi-Cal subject to space and availability
  • 24/7 nurse on staff

Memory Care

  • Must have a dementia diagnosis
  • Offers many of the same services as assisted living if needed 
  • In addition, there is typically a “secure” location
  • Activities may be specifically geared toward residents on the memory care spectrum
  • Private pay
  • Could be a larger “facility” or a smaller “board and care”
  • Board and Care is a single family home, typically for 4-6 residents that typically require higher levels of care