Levels of Care Explained: Independent Living to Nursing Homes, and What Tennessee Licenses Each As

Levels of senior care in Tennessee

Key point: The level is set by how much hands-on help and nursing your parent needs, and Tennessee licenses each level differently.

What a good provider should make clear: A level of care matched to your parent's daily needs and safety, at a community licensed for that level.

Common mistake: Choosing by the name on the sign rather than the licence behind it.

Questions to ask: Which licence do you hold, and which of my parent's needs would that licence not allow you to meet?

The levels side by side

The Tennessee Health Facilities Commission's facility search lists these licence types separately, among them Assisted Care Living Facility, Home for the Aged, Adult Care Home and Nursing Home, so you can check which licence a building holds.

Independent living

Independent living is an apartment or cottage in a community built for older adults, usually with meals, housekeeping, transport and activities included or available. Nobody comes to help your parent bathe or dress as part of the rent, and nobody manages their medications.

It suits a parent who is managing daily life but is isolated, struggling with a house and garden, or no longer driving. It does not suit a parent who is falling, missing medications or getting confused, because nothing in the rent covers that.

Some Memphis-area communities offer independent living, assisted living and memory care on one campus, and a few are full life plan communities that add a nursing home too. That lets a parent move between levels without changing community. Ask which levels are on site and whether a move between them is guaranteed or depends on availability.

Assisted living (Assisted Care Living Facility)

Assisted living is the level most families mean when they say "care home". Your parent has a private or shared apartment, eats in a dining room, and staff help with the daily activities they can no longer manage: bathing, dressing, grooming, using the toilet, moving around, and taking medications.

In Tennessee, assisted living communities hold an Assisted Care Living Facility licence from the Tennessee Health Facilities Commission. The Commission's July 2026 bed report lists 31 of them in Shelby County, ranging from residences licensed for 12 people to communities licensed for more than 150.

What assisted living does not do is provide round-the-clock skilled nursing. There may be a nurse on staff for oversight, assessment and medication management, and home health agencies can come in for specific skilled tasks, but a resident who needs a nurse at the bedside every day usually needs a nursing home.

Each community decides which needs it can meet within its licence. Two communities with the same licence can give different answers about the same parent. That is why the first question on any call should be whether they can meet your parent's needs, not what the apartment looks like. Our guide to how communities assess care needs explains how they decide.

Memory care (secured beds in an Assisted Care Living Facility)

Memory care is a secured unit for people living with Alzheimer's disease or another dementia whose safety needs go beyond ordinary assisted living. The doors are locked or alarmed so residents cannot walk out unnoticed, the layout is built to reduce confusion, and the staff are trained to care for people with dementia.

In Tennessee, memory care units sit inside Assisted Care Living Facilities: the state's bed report counts them as secured beds. Of the 31 licensed communities in Shelby County, 23 report secured beds. A handful are memory care only. Apple Grove and Quail Ridge, for example, have every licensed bed secured.

Some nursing homes also run secured dementia units, for residents who need both a secure setting and skilled nursing.

Not every community that advertises "memory support" has a secured unit. Our memory care guide covers the signs it is time, what a secured unit should look like, and how it differs from a memory programme inside ordinary assisted living.

Residential homes for the aged and adult care homes

Tennessee also licenses smaller settings. A Home for the Aged provides room, board and personal services such as supervision and help with daily routine to a small number of residents, without the medication administration and level of care an Assisted Care Living Facility provides. An Adult Care Home is another small-home licence the Commission lists separately.

These can suit a parent who mostly needs company, meals and someone around, and who would be overwhelmed by a large community. They are not a substitute for assisted living when a parent needs help with medications or hands-on personal care. Ask exactly what the staff are allowed to do under the home's licence.

Skilled nursing (nursing home)

A nursing home provides round-the-clock care by licensed nurses and nursing assistants, under a physician's direction. It suits a parent who needs daily skilled nursing: complex wound care, injections, tube feeding, frequent monitoring, or help with almost every daily activity including transfers that need two staff.

Nursing homes also provide short-term rehabilitation after a hospital stay. Medicare can cover a skilled nursing stay of up to 100 days per benefit period after a qualifying inpatient hospital stay of at least three days, with the full cost covered for the first 20 days and a daily coinsurance after that. Medicare does not cover long-term custodial care in a nursing home or assisted living.

Nursing homes that take Medicare and Medicaid are inspected under federal rules as well as state ones, and their inspection results and staffing are published on Medicare's Care Compare site.

Staying at home with help

Home care is the alternative many families try first. A home health agency, which Tennessee licenses, can send nurses and therapists for skilled care at home, often covered by Medicare for a limited period after an illness. Non-medical home care agencies send aides for bathing, meals, housework and companionship, paid privately by the hour.

Home care works well for a parent who needs a few hours of help a day and has family nearby. It gets expensive and fragile when a parent needs someone present around the clock, or at night, because round-the-clock home care costs far more than assisted living and depends on aides turning up every shift.

Adult day programmes fill the gap for a parent living with family: daytime care and activity while the family works. Some assisted living communities in Shelby County are licensed to offer adult day care alongside residential care.

Which level fits your parent?

Work through these in order and stop at the first that is true.

1. Your parent needs a licensed nurse every day, or two staff to move them safely: start with skilled nursing.
2. Your parent has dementia and wanders, gets lost, or cannot be left alone safely: memory care.
3. Your parent needs hands-on help with one or more daily activities, or cannot manage medications: assisted living.
4. Your parent needs supervision and meals more than hands-on help: a residential home for the aged, or assisted living at its lowest care level.
5. Your parent manages daily life but is isolated or struggling with a house: independent living, perhaps with home care.

Needs change. A parent who fits assisted living today may need memory care or a nursing home in a year or two. When you compare communities, ask what happens when needs grow, and whether the community has the next level on site.

How the levels compare on cost

Cost generally rises with the level of care. Independent living is mostly rent and services. Assisted living adds care, priced by level. Memory care costs more than assisted living in the same community because of staffing. Nursing homes cost the most, though Medicare covers short rehab stays and TennCare covers long-term nursing home care for people who qualify financially and medically.

Who pays changes too. Medicare does not pay for assisted living or memory care. TennCare's CHOICES programme can pay for care services in an Assisted Care Living Facility for people who qualify, but not for room and board. Our guides to what assisted living costs and how families pay go into the detail.

Questions to ask any community

• Which licence do you hold, and what is your licence number?
• Which of my parent's needs would your licence not allow you to meet?
• Do you have secured memory care beds? How many?
• If my parent's needs grow, can they stay, move to another level on this campus, or would they have to leave?
• Is there a nurse on site, and during which hours?
• Do outside home health or hospice agencies come in when needed?

How the levels show up across the Memphis area

The licensed communities are not spread evenly. Most of Shelby County's Assisted Care Living Facilities sit in a band running east from Midtown through East Memphis to Germantown, Collierville, Cordova and Bartlett. Memphis proper, outside East Memphis, has fewer, and Millington, Lakeland and the north of the county have very few. Arlington has one large community with memory care.

Across the state lines, DeSoto County in Mississippi and Crittenden County in Arkansas license assisted living under their own state agencies, so they do not appear in the Tennessee registry. Families living in Southaven, Olive Branch, Horn Lake, Hernando, West Memphis or Marion often compare communities on both sides of the line. If you are doing that, check each community's licence with its own state.

Life plan communities with several levels on one campus are a small group in Memphis. A few of the larger campuses in East Memphis and Germantown offer independent living, assisted living and memory care together, and some add nursing. If you expect your parent's needs to change over the next few years, ask early which levels each campus has and how residents move between them.

Where hospice fits

Hospice is not a level of residence; it is a kind of care that comes to wherever your parent lives, for people with a life expectancy of six months or less if the illness runs its normal course. Medicare's hospice benefit pays for the hospice team, medicines and equipment related to the terminal illness, but not room and board in assisted living. Tennessee also licenses residential hospices. Many assisted living and memory care communities work with hospice agencies so that a resident can stay in a familiar place at the end of life. Ask whether the community allows that, and whether it requires a particular agency.