Senior housing:
Retirement, assisted living, nursing homes

With some 20% of  Americans now being age 65 or older, the senior housing market has grown into an enormous industry.  The industry's structure is based on specific LEVELS OF CARE.  Every facility has one or more levels.  These are (a) retirement living, (b) assisted living (AL), and (c) nursing home care.  Together, these form a "continuum of care."  

Facilities offering retirement living do not require any licensure.  They cater to adults who are independent in both basic self-care (bathing, dressing, etc.), and in community dwelling skills such as driving and bill paying.  Services generally provided include meals, housekeeping, and activities, but no health services such as passing medications.

Assisted living is designed for individuals who, although able to walk on their own, need consistent assistance with basic self-care (bathing, dressing, toileting etc.), or who, due to mild cognitive decline, need to have their medications passed to them. 

Since the 1980's, a specialized form of assisted living, known as assisted living dementia care (ALDC), has also become popular.  Unlike regular AL, ALDC features (a) exit doors secured with an electric lock, (b) very full activity schedules geared to the ability of residents with dementia, (c) consistent prompting of residents to use the toilet every two hours, and (d) specially trained staff.

Assisted living facilities are required to be licensed by the state as such.  In most states, additional licensure requirements must be met before they can advertise as a dementia care setting.

Nursing facilities must also obtain state licensure as such.  Nursing facilities provide much more intensive nursing care and medical monitoring than AL.  Services include all meals, total assistance, as needed, with: eating, bathing, dressing, toileting, incontinence care, transfer from bed to wheelchair, administering medications, etc.

As in AL, some nursing facilities offer special units for dementia sufferers.  These units cater to the very confused, incontinent, yet mobile dementia sufferer.  Their staff training and activity programming are tailored to the needs of these very challenging residents.