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When Home Care Isn’t Enough: Shifting to Senior Residential Care

Most seniors want to remain in their own homes for as long as possible (more than 75% of adults age 50 and older, according to a 2024 survey by AARP), and home care can often provide the extra support needed to make that happen.

As health needs change, however, there may come a point when occasional help at home no longer provides enough support. Recognizing when that shift occurs can be difficult for families, especially when changes happen gradually or loved ones live far away.

“This is often one of the most emotionally challenging decisions for families, and there’s no one-size-fits-all answer. The most important factors to consider are the level of medical care needed, safety and quality of life,” says Dr. Steve Landers, New York City-based president of Landers StratAGEy.

[Read: How to Manage Sibling Conflict Over Care of Elderly Parents]

What Are the Primary Levels of Senior Care?

The primary levels of care after home care include assisted living and nursing home care. Each step offers a higher level of support to match evolving health, safety and daily living needs.

Home care support

Home care offers flexible, non-residential support that can be adjusted over time, making it a practical option when early challenges arise but full-time supervision or medical care isn’t yet needed.

This type of care focuses on safety and help with the activities of daily living (ADLs), such as:

— Grooming

— Mobility

— Eating

— Dressing

— Toileting

Other tasks may include:

— Meal preparation

— Light housekeeping

— Medication reminders

— Transportation

— Companionship

By stepping in gradually without disrupting routines, home care can improve safety and independence while reducing stress for seniors and their families.

[READ: Understanding the Different Roles of In-Home Care Providers]

Assisted living communities

Assisted living is a residential care option designed for seniors who need support with daily tasks but do not require round-the-clock skilled medical care. These communities offer different levels of care that can be adjusted as a resident’s needs change:

— Lower levels: Residents at these levels of care require minimal support and supervision for most tasks but may need help with more complex ADLs.

— Higher levels: Moderate and advanced levels provide increased hands-on care and supervision for seniors who need more support but do not yet require a nursing home-level of care. This advanced level of care includes help with ADLs, more involved medication management, 24/7 staff availability and enhanced safety oversight.

— Memory care: Some assisted living communities offer dementia care, including structured routines and staff trained to work with people living with Alzheimer’s disease and dementia in a residential, nonclinical environment.

“Choosing the appropriate assisted living community for your loved one can make such a difference for their mental, physical and social well-being,” says LaShuan Bethea, the executive director of the National Center for Assisted Living.

[READ: Home Care vs. Assisted Living: 2026 Costs, Pros & How to Choose]

Nursing home care

A nursing home, also called a skilled nursing facility, provides continuous medical care and supervision for people with serious health conditions or significant functional limitations. It is designed for individuals who can no longer be safely cared for at home or in assisted living.

Nursing homes provide services such as:

— IV therapy

— Wound care

— Catheter management

— Oxygen therapy

— Incontinence care

Many facilities also offer specialized dementia or behavioral care or short-term rehabilitation services, with full-time nursing oversight and coordinated medical management.

[READ: Nursing Home Requirements: Who’s Eligible?]

Signs It’s Time to Transition From Home Care

If there are noticeable differences in how your loved one is able to function day-to-day, a move from home care to a higher level of care may be in order. Typical signs include the following:

Physical health and mobility signals

— Accidental falls or other balance-related issues

— Weight loss, dehydration or poor nutrition

— Recent hospitalizations or emergency room visits

— Chronic conditions or new medical issues becoming harder to manage at home

Cognitive and behavioral changes

— Episodes of confusion, memory loss or consistent forgetfulness

— Home safety concerns, such as leaving the stove on or doors unlocked

— Difficulty managing medications correctly

Emotional well-being and social life

— Isolation, depression or withdrawal from social activities

— Changes in personal hygiene or appearance

Household and daily management

— Neglected household tasks, such as laundry, cleaning or home maintenance

— Struggling with ADLs

Your loved one’s day-to-day caregivers can be a valuable resource when making this decision, as they can offer firsthand insight into current health needs and whether it’s becoming harder for your loved one to live safely at home.

“Care providers can spend meaningful time with patients and really get to know them. They see how patients live, from what’s in their refrigerator to whether there are trip hazards or how they manage their daily routines,” Landers says.

Understanding the Financial Costs of Senior Care

While caring for a loved one at home may be the most affordable option at first, increasing health needs and care demands can make it less cost-effective over time.

Keep in mind: Medicare

does not pay for long-term care. Medicaid, however, does cover long-term care and currently pays for 63% of nursing home residents, which accounts for over one-third of overall Medicaid spending, according to KFF.

There are other ways to pay for senior living facilities, such as:

— Life insurance policies

— Long-term care insurance

— Savings and investments

— Veterans benefits

While your budget is a critical part of the senior care decision-making process, knowing your loved one is receiving the care and support they need not only adds to their quality of life and longevity, but it can bring peace of mind to families as well.

More from U.S. News

Assisted Living Levels of Care: A 2026 Guide to Categories and Costs

CCRCs vs. Assisted Living: 5 Key Differences to Help You Choose

What Is a Long-Term Care Facility? Types and Costs

When Home Care Isn’t Enough: Shifting to Senior Residential Care originally appeared on usnews.com

Update 05/29/26: This story was previously published at an earlier date and has been updated with new information.

Democrats zero in on Nevada and South Carolina to kick off 2028 presidential primary calendar

(CNN) — Nevada and South Carolina are the leading contenders to be recommended to head Democrats’ 2028 presidential primary calendar, according to conversations with members of a powerful panel within the Democratic National Committee.“I have to say at this point it’s probably 50-50,” said one member of the DNC’s Rules and Bylaws Committee granted anonymity to speak on private deliberations. “This is going to be a tough one.”The panel is gathering in Washington, DC, this week to select up to five states for its early primary window, capping months of aggressive lobbying by states looking for a prime spot on the calendar. The committee will recommend a slate to the full DNC to consider as soon as next month.The RBC member said the panel is zeroing in on two scenarios that would seek to strike a balance between states with large Black and Latino voting blocs.In one scenario, Nevada would lead the calendar, followed by South Carolina, Michigan, New Hampshire, and another southern state — most likely Virginia.In the other, South Carolina would go first, followed by Nevada, New Mexico, Michigan and New Hampshire. Moving New Mexico, which has a sizeable Latino population, into the early window alongside Nevada would be a sort of “consolation prize” for the Latino community losing out on prominent representation in the first primary state, the RBC member said.“I think that a lot of people are thinking about that kind of counterweight,” they said.Nevada’s backers have pointed to the state’s diversity, strong labor unions and status as a competitive battleground state as reasons why Democrats should give it the top slot.“If Nevada goes first, it’s a strategic decision for our party as we work to build a coalition that we know we need to build to win back the White House in 2028,” Nevada Democratic Party chair Daniele Monroe-Moreno told CNN. “Nevada is that proving ground for national candidates, period.”The state’s allies have stressed that they don’t just have a sizeable Latino voting bloc, but a population that includes Black, Asian American and Pacific Islander, Native American and White working-class voters.“We’ve been clear at every step, this is about reaching a broad coalition of diverse voters, not elevating or prioritizing any voice over another,” Nevada Sen. Catherine Cortez Masto and Rep. Steven Horsford wrote in a Wednesday letter to RBC members obtained by CNN.The New York Times first reported on South Carolina and Nevada’s emergence as the front-runners.South Carolina was moved first in 2024 at the behest of former President Joe Biden. Advocates for keeping it in the top spot have pointed to a wave of Republican-led attacks on Black electoral power, including an unprecedented mid-cycle redistricting push and the Supreme Court’s Callais decision that weakened the Voting Rights Act. They’ve argued maintaining the state’s current position would underscore the importance of voting rights for the Black community.The state’s surrogates have also pointed to its history of picking eventual Democratic primary winners, including in 2020 when Biden’s South Carolina victory rescued his stalled presidential bid.“We’ve just been telling the history of South Carolina in this process, how our voters have always gotten it right,” said Christale Spain, the chair of the South Carolina Democratic Party and an RBC member.While Nevada and South Carolina are contending for either the first or second slots, it’s not clear how the rest of the slate would pan out.“There are about a billion computations out there,” said another RBC member, who said they would prefer Nevada and South Carolina in the first two slots but had not heard the lineups described by the first member.Two other sources, a third RBC member and a person familiar with the panel’s thinking, said Virginia and New Mexico are likely competing for a fifth slot on the calendar.An aggressive, yearslong lobbying campaignFor decades, both Democrats and Republicans led their presidential nominating calendars with the Iowa caucuses and the New Hampshire primary. More recently, South Carolina and Nevada claimed the next spots on the Democratic calendar, before the rest of the states jump in on or after Super Tuesday.But ahead of the 2024 presidential primaries, Democrats decided to require states to apply for early window slots each cycle. The DNC voted to make South Carolina the first primary state during the 2024 cycle at the request of then-President Biden.This time around, there’s no national figure putting their thumb on the scale, RBC members say. That’s kicked off months, if not years, of lobbying by state parties and their allies.Nevada, which has two members on the RBC, has been the most aggressive in its campaigning, several RBC members told CNN.Nevada Democrats have held receptions for DNC members at party gatherings this year — including ahead of this week’s meeting. Monroe-Moreno said members of the state’s congressional delegation would attend a Wednesday reception. Supporters such as former Health and Human Services Secretary Xavier Becerra, who is running for governor in California, and Latino groups such as CHC BOLD PAC have publicly backed the state’s bid.“I don’t know if anybody’s been lobbying harder than Nevada,” said Spain, adding that she and Monroe-Moreno are friends and the calendar battle hasn’t become personal. “Of course, we’re Southern, so we took a different approach.”Allies of South Carolina have been publicly and privately lobbying members of the committee, arguing that the party must keep its commitment to Black voters. In a nine-page letter sent to RBC members earlier this month and obtained by CNN, former DNC Chair Jaime Harrison – a Biden ally and South Carolina native – wrote that history will judge whether “the Democratic Party had the courage to keep faith with the voters who had so faithfully kept faith with it.”New Hampshire and Iowa’s longshot bids The former longtime front-runner states, however, aren’t going down without a fight.Ray Buckley, the New Hampshire Democratic Party chair who also sits on the RBC, has been personally pitching his state to other members of the committee. His party has given out free swag, including dozens of copies of Granite State resident Ken Burns’ most recent book, at the RBC’s January meeting in Puerto Rico.“We’ve been focused on having conversations one-on-one with committee members, and we’re encouraged by how those have been going,” Buckley said in a statement to CNN.But those entreaties have failed to sway some members of the committee.“There doesn’t seem to be any appetite at all, except maybe Ray Buckley, for New Hampshire to go first,” the first member said, adding that some RBC members wanted to exclude the state from the early window altogether.Iowa no longer has any members on the RBC, but state party chair Rita Hart has been calling committee members, asking them to delay a decision on the calendar until after the November elections. Iowa Democrats are running competitive races for governor, US Senate, and three US House seats, contests that could make their bid for an early window slot more competitive.“We’ve heard from several states that have suggested it’s unwise to do this now,” Erin Moynihan, a senior communications adviser for the Iowa Democratic Party, said in a statement to CNN. “We’ve said all along our focus needs to be on winning in November.”But RBC members told CNN there’s little interest in delaying. The second committee member said they received two calls from the Iowa chair after the state had made its pitch to the panel, but sent both to voicemail.“There’s literally nothing Iowa could do or say to get me to vote for them,” the member told CNN in a text.The-CNN-Wire™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.
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