When a family first hears the words memory care, they usually picture a locked ward. What I see on my tours across Long Island is closer to a small neighborhood inside an assisted living community, with its own dining room, its own staff and a calendar built around people who cannot keep track of a calendar.
Memory care is assisted living designed for people with dementia. It includes a secured setting, higher staffing, help with daily tasks, medication management, meals and a structured day. It does not include hospital level medicine or daily skilled nursing. Knowing where that line sits is the difference between a good placement and a repeat move.
Memory care is assisted living built for dementia
Memory care is a form of assisted living, not a form of nursing home. In New York it runs under the same State Department of Health licensing as assisted living, with an added special needs certification that covers residents with dementia.
The benefits are practical. Residents are safer because the doors are secured and the staff count is higher, families get their evenings back, and the resident often does better than at home because the day has a shape again. I explain the model in my memory care overview for Long Island, and I hold a dementia care certification, so this is the part of my work I know best.
What is included every day
The monthly fee in memory care bundles housing, care and programming into one arrangement, and the day is far more hands on than in standard assisted living. Here is what is inside the fee at nearly every program I tour, and what is not.
| Included in memory care | Not included |
|---|---|
| A secured neighborhood with alarmed or coded doors and a safe outdoor space | Hospital level medical treatment |
| Aides around the clock at a higher ratio than assisted living | Daily skilled nursing such as wound care or IV therapy |
| Help with bathing, dressing, toileting, eating and moving around | Physical rehab after a hospital stay |
| Medication management by the community’s nurse | Physician visits |
| Three meals, snacks and hydration rounds, with cueing at the table | Personal items such as incontinence supplies, in most buildings |
| Structured activities built for cognitive ability, music, movement, sensory programs | Private companions or one on one sitters |
| Housekeeping, laundry and linen service | Hospice, which comes in from an outside agency |
The secured space is what families notice first. The staffing is what matters most. In a good program the same aides work the same neighborhood every day, so they know that Dad gets agitated before dinner.
What is not included
Memory care is not a hospital and it is not a nursing home. If your parent needs daily bedside nursing, a feeding tube or ongoing IV treatment, memory care cannot meet that need and will say so at the assessment. Rehab after a fall or a stroke happens in a skilled nursing facility first.
Medical care is coordinated, not delivered. The community’s nurse manages medications and watches for changes, but the doctor is still your doctor. Hospice can come in through an outside agency when the time comes, so many residents never have to move again. For how the medical line is drawn, read my post on assisted living versus skilled nursing.
Who needs it: the signs Mike looks for
Someone needs memory care when dementia, not frailty, is the thing that makes living at home or in standard assisted living unsafe. A diagnosis of Alzheimer’s disease, vascular dementia, Lewy body dementia or frontotemporal dementia is the starting point, but the stage and the behavior decide the setting. Talk to the doctor about the diagnosis, the stage and whether it is hereditary before you tour.
These are the signs that tell me a family should be looking at memory care rather than regular assisted living, even when your parent insists nothing is wrong:
- Wandering or exit seeking, even once; see my post on dementia wandering.
- Needing cues to eat, bathe or dress, rather than just help with the physical task.
- Agitation or confusion in the late afternoon, which I describe in my post on sundowning and how memory care can help.
- Leaving the stove on, mixing up medications or letting strangers in.
- A caregiver at home who is exhausted, sick or frightened.
Early stage dementia does not always mean memory care right away. Some people do well in assisted living for a year or two, ideally in a community that also has a memory care neighborhood for later. That is the 18 to 24 month planning I do on the first call.
Staffing and training: what to ask about ratios and dementia certification
Staffing is what you are paying for, so ask about it directly. Memory care should run a higher aide to resident ratio than the assisted living floors in the same building, on every shift including overnight, and the aides should have dementia specific training beyond the basic state requirement for special needs units, including how to handle hallucinations. Confirm the current training rules with the community, then ask what they do beyond them.
The questions I ask on every tour
- How many aides are on this neighborhood on the day shift, the evening shift and overnight, and how many residents live here?
- Is there a nurse in the building 24 hours, or on call overnight?
- What dementia training do aides complete, and how often is it refreshed?
- How long have the memory care director and the aides been here?
Turnover is the honest answer behind every ratio. A stable staff with a slightly lower ratio beats a great ratio on paper and new faces every month.
How memory care is priced on Long Island
Memory care costs more than assisted living in the same building because of the staffing, the training and the secured design, and it is priced in one of three ways. Some communities charge one all inclusive monthly rate. Some charge a base rate plus a care level set by a nurse’s assessment. A few charge a base rate plus a menu of individual services. I do not publish dollar figures, but I can tell you which model a community uses and what tends to move the number: the room type, the care level and whether incontinence care and medication management are inside the base rate or added on.
Medicare does not pay for memory care rent. Families use savings, long term care insurance, VA Aid and Attendance for eligible veterans and surviving spouses, and life insurance conversions. Medicaid helps only through the Assisted Living Program, which has limited beds, so confirm the current rules before you count on it. Ask me for current numbers for the communities you are considering, and see my post on what the monthly cost of memory care covers.
Free standing vs inside an assisted living community
On Long Island and in Queens there are about 47 memory care programs. By my count 42 of them are neighborhoods inside a larger assisted living community and 5 are free standing buildings devoted entirely to dementia care.
A neighborhood inside assisted living suits a couple with different needs, a resident early in the disease who may use the main dining room for a while, and families who want one building for the whole journey. A free standing program suits someone further along, since the entire building is designed for dementia and nobody feels set apart. I keep lists on my Nassau County memory care and Suffolk County memory care pages.
How to choose: my tour checklist and how to reach me
Choose with your eyes and your nose, not the brochure. Visit at lunch, and visit again in the late afternoon when behaviors peak and staffing is thinnest. On every memory care tour I look for the same things:
- Residents who are up, dressed and engaged, not parked in front of a television.
- Aides who know residents by name and talk to them at eye level.
- A secured outdoor space that is actually used.
- Clean, calm hallways with no strong odors and no shouting.
- A care plan process that includes the family, with a meeting on the calendar.
- A contract that spells out what triggers a care level change.
I do this work for families across Nassau, Suffolk and Queens, and my help is free; communities compensate the advisor when a family moves in. One call to understand the diagnosis, personality, location and finances, then tours together, help with offers and paperwork, and follow up after the move. Assisted Living Locators of Long Island is at 42 Prospect Ave, Glen Cove, NY 11542. Call me and we will plan the tours.
Questions readers ask
Is memory care a locked facility?
The doors are secured with codes or alarms so residents cannot leave unaccompanied, but it is not a locked ward. Residents move freely inside the neighborhood and its outdoor space, and families come and go as they please.
Does memory care include a doctor?
No. The community’s nurse coordinates care and manages medications, and many buildings host visiting physicians, but your parent keeps his or her own doctor and that doctor directs treatment.
What dementia training should memory care staff have?
At minimum the training New York requires for special needs units, plus a recognized dementia care program and regular refreshers. Ask how often training is repeated and how long the aides have worked there.
Can someone with early dementia go to regular assisted living first?
Often yes. Many people do well in assisted living for a time, ideally in a community that also has a memory care neighborhood so a later move happens down the hall rather than across town.
Read next
Watch: Mike explains
Dementia Care: Assisted Living or Memory Care — How to Choose
Your parent has dementia — do they need memory care, or can assisted living still work? It's one of the most consequential decisions a...
Next step: see Mike’s guide to memory care on Long Island, or browse the Long Island community profiles.