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For many older adults and their families, assisted living can feel like the next logical step when daily tasks become more challenging. But the high expense places it out of reach for many people, with the national average cost for a month of assisted living in 2025 reaching $6,200, ranging from $9,600 in Massachusetts to $5,666 in Texas, leaving only about 1.4% of older Americans living in these facilities today. Fortunately, alternatives to assisted living exist that can provide sufficient support, often at a much lower cost.
Why Alternatives to Assisted Living Matter Financially
“Medicare doesn’t cover most of the costs associated with assisted living, so those expenses must be paid out of pocket or by other means,” said Daniel Davis, NCOA Associate Director for Integrated Care. “Most people prefer to stay in their homes and communities for as long as possible, and with the right support, that may be more realistic than you think,” Davis explained.
The Eight Options Worth Exploring
Alternatives to assisted living include in-home care, respite care, adult day programs, PACE, Medicaid home and community-based services, adult foster care, structured family caregiving, and home safety modifications.
In-Home Care as an Alternative to Assisted Living
In-home care allows older adults to receive regular, hands-on assistance without having to move to a residential facility, ranging from a few hours of help each week to around-the-clock assistance with bathing, dressing, meal preparation, medication reminders, and transportation. Most private health plans don’t cover non-medical home care, though Medicare covers certain skilled home health services when specific requirements are met, and some states, including Washington through its WA Cares program launching July 1, 2026, are developing public long-term care insurance options.
Respite Care for Family Caregivers
Respite care provides family caregivers a temporary break while ensuring their relative continues to receive safe, compassionate care, ranging from a few hours to several days and delivered at home, through adult day programs, or in residential settings. Ongoing direct-care workforce shortages have affected the availability of professional respite services in some areas.
Technology and Home Modifications Among Alternatives to Assisted Living
Safety monitoring devices, including medical alert systems, fall detection sensors, and GPS tracking for people with dementia, can help older adults live independently while giving families peace of mind, though these tools should be selected in consultation with the older adult to respect their privacy and preferences. Home safety modifications like grab bars and walk-in showers can also prevent falls, with the CAPABLE program shown to save more than $30,000 in medical expenses by reducing hospital stays.
Adult Foster Care’s Smaller-Scale Model
Adult foster care allows an older adult to live in a smaller, home-like setting receiving 24/7 support from trained caregivers, typically serving only a small number of residents for more personalized attention. This option is generally less expensive than assisted living or nursing home care, with costs paid privately, through long-term care insurance, or Medicaid in certain states.
Adult Day Health Programs and PACE Within Alternatives to Assisted Living
Adult day health programs provide supervised care, social activities, meals, and health services during daytime hours, with participants returning home in the evening, offering relief for caregivers who work during the day. PACE, or Program of All-Inclusive Care for the Elderly, helps older adults receive medical care and long-term support services while living in the community, often built around a day center offering primary and specialty care, prescription drugs, therapy, and dental care.
PACE’s Current Geographic Limitations
PACE is currently available as a Medicaid benefit in 33 states and the District of Columbia, though self-pay options exist outside that framework, and enrollees don’t need to be on Medicare or Medicaid to participate, though what they pay depends on their coverage status.
Medicaid HCBS and Structured Family Caregiving Among Alternatives to Assisted Living
Medicaid Home and Community-Based Services programs help eligible older adults receive care outside nursing homes, covering services like personal care assistance, home health aides, meal delivery, and home modifications, though eligibility rules and enrollment caps vary by state, making waiting lists common. Structured family caregiving, a Medicaid program supporting relatives who provide unpaid care, typically requires the care recipient to live with the caregiver and can offer financial stipends of roughly $40 to $70 per day along with training and care coordination.
Why State Variation Matters for These Programs
Both structured family caregiving and PACE are not available in every state, meaning families need to contact their state Medicaid office or use tools like Medicare’s PACE search function to determine which of these alternatives to assisted living are actually accessible in their specific location.
What This Range of Alternatives to Assisted Living Means Going Forward
There’s no one-size-fits-all solution when it comes to long-term care, with some older adults thriving with just a little extra help at home while others eventually need more comprehensive, structured support. Given the significant cost gap between assisted living and options like adult foster care or Medicaid HCBS, families exploring long-term care decisions early may find substantially more choice and flexibility than they initially expected, particularly by consulting resources like a local Area Agency on Aging, a geriatric care manager, or a state SHIP counselor.
What to Watch Going Forward
As Congress considers legislation like the 21st Century ROAD to Housing Act’s Whole-Home Repairs pilot program, and as more states explore public long-term care insurance models following Washington’s WA Cares launch, families weighing these alternatives to assisted living may find an expanding range of funding sources and program options becoming available in the coming years. Given the persistent gap between assisted living costs and what many families can afford, continued growth in Medicaid HCBS waivers, PACE geographic coverage, and structured family caregiving programs will likely remain an important policy area to watch for older adults seeking to age safely in their own homes and communities.
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