Assisted Living, Nursing Home, or Memory Care: What the Levels Actually Mean in Georgia and Who Pays for Each

Imagine a son touring three places in a week because his mother is being discharged on Friday. One calls itself a personal care home. One calls itself assisted living. One calls itself a skilled nursing facility. The brochures look remarkably similar. The prices are wildly different.

Nobody explains the difference, because everybody in the building assumes he already knows it.

He does not, and neither do most families, and the distinction matters enormously, because the level of care determines who pays.

The Levels, Plainly

Independent living is housing, not care. Apartments for older adults, usually with meals, activities and someone at a desk. If your mother needs help bathing, this is not it.

Personal care homes and assisted living are where most Georgia families land first. Georgia licenses these separately, and assisted living communities are permitted to provide somewhat more, including certain nursing services, while personal care homes are generally smaller. Both provide help with daily living: bathing, dressing, medication reminders, meals, laundry, and staff on site around the clock. What they do not provide is continuous skilled nursing.

Memory care is assisted living built for dementia. Secured exits, staff trained in dementia behavior, structured routines, higher staffing ratios. It is a setting, not a separate license category, and it costs more because of the staffing.

Skilled nursing facilities, which everyone calls nursing homes, provide twenty four hour licensed nursing care. Wound care, IV medication, feeding tubes, rehabilitation after a hospital stay, management of serious and unstable conditions. This is the top of the ladder and the only level that is medical in the full sense.

What Each One Costs in Georgia

These are statewide figures, and metro Atlanta runs above them.

Assisted living averages roughly $5,000 a month.

Memory care generally runs higher than assisted living, commonly in the $5,200 to $6,500 range.

A nursing home semi-private room runs about $8,800 a month. A private room is closer to $9,400.

In-home care runs roughly $28 to $29 an hour, which sounds modest until you do the arithmetic. Eight hours a day, seven days a week, is more than $6,700 a month, and twenty four hour coverage at home is more expensive than any facility on this list. Families are consistently surprised by that, because home feels like the cheap option and it is not, beyond a certain number of hours.

Now the Part That Decides Everything

Here is what I most want you to take away. Who pays depends almost entirely on which level of care it is.

Medicare pays for skilled nursing, briefly, and nothing else on this list. After a qualifying inpatient hospital stay, Part A can cover up to 100 days in a skilled nursing facility, with days 1 through 20 covered in full and a daily coinsurance from day 21 through 100. Coverage ends when daily skilled care is no longer needed, which is usually long before day 100. Medicare pays nothing toward assisted living, personal care homes or memory care. Nothing at all.

Medicaid is the main public payer for long term care, and in Georgia the nursing home benefit is the well established path. Medicaid has income and asset rules and a five year lookback at transfers. Georgia also operates waiver programs intended to support care in community settings rather than nursing homes, but those programs have their own eligibility criteria and, importantly, waiting lists. They are worth asking about early rather than assuming they will be available when you need them.

Veterans benefits can help across several settings. VA Aid and Attendance is an income supplement for wartime veterans and surviving spouses who need help with daily living, and because it is paid as money rather than tied to a facility, it can be applied to assisted living and in-home care in a way Medicare cannot.

Long term care insurance depends entirely on the policy. Most modern policies cover assisted living and home care as well as nursing homes, but older policies sometimes only pay for skilled nursing. Read the policy before you assume.

Private pay covers everything, and funds most assisted living in this state.

The Trap Families Walk Into

A family chooses assisted living because it is cheaper, warmer and less institutional, which it genuinely is. They pay privately. Two or three years later the money is substantially gone, the parent’s needs have increased, and now a nursing home is required at roughly $8,800 a month with far less left to pay for it.

That is the sequence I see most often, and the problem is not that assisted living was the wrong choice. It usually was the right choice. The problem is that nobody planned for the level after it.

The five year lookback means the planning that protects a family has to begin well before the money is gone. Starting that conversation while a parent is comfortably in assisted living is early. It is not too early.

How To Compare Places Honestly

Ask what happens when needs increase. Specifically: at what point would you ask us to move out? Every assisted living community has a ceiling, and you want to know where it is before you move in rather than during a crisis.

Ask whether they accept Medicaid, and under what circumstances. Many assisted living communities do not. Some nursing homes accept Medicaid only for residents who entered paying privately. Ask directly and get the answer in writing.

Ask what is actually included and what is billed separately. Levels of care, medication management and incontinence supplies are commonly extra, and the quoted monthly figure is often a starting point rather than the real one.

Read the admission agreement before anyone signs, and look specifically for responsible party language. A family member who signs in the wrong capacity can become personally liable for the bill.

Three Things To Carry With You

The level of care determines the payer. Medicare covers skilled nursing briefly and covers assisted living not at all.

Home is not automatically the cheaper option. Past roughly six hours a day it generally is not.

Plan for the level after the one you are choosing. The families who do well are the ones who looked ahead one step while there was still time and money to work with.

This Is Educational, Not Legal Advice

This is being presented for educational purposes only and nothing here should be treated as legal advice. What applies to you is very fact specific to your circumstances. I am licensed in Georgia and Michigan only, and this area of law changes frequently. If you are outside Georgia, take the foundation here and go find a wealth protection attorney in your jurisdiction.

Your Next Step

If you are touring places this month, or paying privately and wondering how long the money lasts, that is worth a conversation before the decision is made. We offer a complimentary 15 minute Strategy Session with one of our non-attorney team members. Call 404-549-5001 or schedule online at elderlawgeorgia.com/contact. Fifteen minutes is usually enough to tell you whether there is something worth doing and how quickly it needs to happen.

   

Looking to find an experienced estate lawyer in the Georgia area who is skilled in asset protection and estate plan preparation? Shannon Pawley is an attorney in Georgia with expertise in estate planning and asset protection. Shannon can provide assistance with creating an estate plan to include making a will and how to establish a trust properly. If you have questions about asset protection or questions about making an estate plan, reach out to Shannon and she will be glad to help answer all the estate planning questions you might have!