Seniors, parents and family moves
Assisted Living vs. Memory Care in the Sacramento Region: Levels, Costs and How Families Pay
The levels of senior care in California, how each is licensed, how families pay for it and how the house fits into the plan.
What is the difference between independent living, assisted living, memory care and skilled nursing?
They are different levels of help, from the least to the most:
- Independent living. An apartment or home in a senior community. Meals, activities and transportation are often included. Personal care is usually not.
- Assisted living. Housing plus help with daily tasks such as bathing, dressing and medications. In California these are called Residential Care Facilities for the Elderly, or RCFEs. They range from large communities to small board-and-care homes in a neighborhood house.
- Memory care. Assisted living built for people with dementia, with secured spaces and staff trained in dementia care. In California, many memory care settings are licensed RCFEs that meet added dementia care rules.
- Skilled nursing. Round-the-clock nursing care, often after a hospital stay or for complex medical needs.
Your parent's doctor and the community's own assessment help decide which level fits. Needs change, so ask each community what happens if care needs grow. Maggie's post on independent living vs. assisted living covers the first two in more detail.
This page is general information, not legal, tax or benefits advice. An elder law attorney and a CPA should weigh in on the money side.
Who licenses assisted living and memory care in California?
Two state departments split the work:
- Assisted living and most memory care (RCFEs). The California Department of Social Services, Community Care Licensing Division, licenses and monitors RCFEs and continuing care retirement communities. Its Find Licensed Care search lets you look up a facility. It also runs a complaint hotline (checked October 22, 2026).
- Skilled nursing facilities. The California Department of Public Health licenses them. Its Cal Health Find tool shows a facility's license, whether it accepts Medicare and Medi-Cal, and its complaint history (checked October 22, 2026).
Look up every community you are considering before you sign anything. Read the inspection and complaint history, then ask the community about anything you find.
How much does assisted living or memory care cost in Sacramento?
It varies widely by community, room type and level of care. Memory care generally costs more than assisted living, because it needs more staff and secured space. Skilled nursing is usually the highest.
We do not publish cost figures on this page. Prices change and every community quotes differently. For a starting point, the CareScout (formerly Genworth) Cost of Care Survey lets you look up care costs by area. Then get written quotes from the communities you are considering.
When you compare quotes, ask each community:
- What is included in the base monthly rate?
- How are care levels set, and how often are they reassessed?
- What are the one-time fees to move in?
- How much have rates gone up in recent years, and how much notice do you give?
- What happens if my parent's care needs grow, or if the money runs low?
Does Medicare pay for assisted living or memory care?
No. Medicare.gov says plainly that Medicare does not pay for long-term care (checked October 22, 2026). That includes the daily help with bathing and dressing that most assisted living and memory care provide.
Medicare can cover a short stay in a skilled nursing facility after a hospital stay. Medicare.gov lists the conditions. They include an inpatient hospital stay of at least three days in a row and a daily need for skilled nursing or therapy. Part A limits that coverage to 100 days in each benefit period.
For free, unbiased help with Medicare questions, the California Department of Aging's HICAP program offers counseling at (800) 434-0222.
How do families pay for assisted living and memory care?
Most families combine more than one source:
- Private pay. Your parent's income, savings and investments. Many families pay for assisted living this way.
- Long-term care insurance. If your parent has a policy, find it now. Read the waiting period, the daily or monthly benefit and what triggers a claim. HICAP counselors can help you read it.
- VA Aid and Attendance. VA.gov says (updated May 8, 2026) these are monthly payments added to a VA pension. They are for qualified Veterans and survivors who need help with daily activities, among other conditions. The claim uses VA Form 21-2680. Your parent must qualify for the VA pension first.
- Medi-Cal. Medi-Cal can pay for skilled nursing care for people who qualify. For assisted living, the Medi-Cal Assisted Living Waiver covers assisted living services and care coordination for people with nursing-home-level needs. Applicants must be 21 or older and have full-scope Medi-Cal with no share of cost. When we checked DHCS on October 22, 2026, the waiver operated in 15 counties, including Sacramento. Placer, El Dorado and Yolo were not on that list. Ask how room and board will be paid.
- The house. Selling, renting or borrowing against it. See the next sections.
Medi-Cal rules on assets and the house are complex, and estate recovery can affect what heirs receive. Talk with an elder law attorney before you sell, transfer or retitle anything.
Should you sell the house to pay for assisted living or memory care?
Selling turns the equity into cash for care. It also ends the carrying costs of an empty house. It is often the right choice when care is likely to be long term.
The tax rules may help. IRS Publication 523 has a rule for people who move into care. If your parent lived in the home as their main home for at least 12 months in the five years before the sale, time in a state-licensed care facility can count toward the two-year residence test for the home sale exclusion. Their CPA can confirm how it applies. See capital gains and stepped-up basis.
Renting the house can help with monthly costs, but it makes someone a landlord and can change the tax picture. Keeping it for the kids runs into Prop 19. Our blog posts on what to do with Mom's house when she moves to assisted living and paying for memory care with her house compare the choices.
Many families also need money before the house sells. Ask the community whether it will hold a move-in date while the home is in escrow, and talk with Maggie about bridge options.
Can a reverse mortgage help pay for care?
Sometimes, but usually not for a permanent move. A reverse mortgage (HECM) requires the borrower to live in the home. Under HUD's HECM rules, more than 12 months in a row in a health care facility counts as a permanent move, and the loan becomes due.
Where it can fit is when one spouse stays home while the other moves into care. It can also help pay for in-home care so a parent can stay longer. If your parent already has a reverse mortgage, call the servicer now and ask for the timeline in writing.
Our pages on reverse mortgages and what happens to heirs and spouses explain the rules. A reverse mortgage is a loan with real costs, and it requires counseling with an independent HUD-approved counselor first. Loan questions go to Maggie as a mortgage broker.
Do you get paid for recommending a care community?
No. Some senior placement services are paid by the communities they recommend. Maggie takes no placement or referral fees from any community or care provider, ever. When we suggest a community, it is because of what we saw.
Maggie holds a B.S. in Health Care Administration. She also completed the RCFE (Residential Care Facility for the Elderly) Certification Course. She can help you know what to ask on a tour and plan the sale around the move-in date. The choice of community stays with your family.
If your parent might rather stay home with changes, see home safety and aging in place.
How do you get started planning care and the house?
Start with two calls: an elder law attorney about authority and Medi-Cal, and a CPA about taxes. Then get a price for the house as it sits, so the numbers are real when you decide.
The free Well MOVED™: Where to Next? guide compares the housing choices side by side. Our Well MOVED™ page explains how we handle the move and the sale.
When you are ready, tell us what is happening or call Maggie at (916) 549-3131.
Frequently Asked Questions
Is memory care more expensive than assisted living?
Generally yes, because memory care needs more staff, dementia training and secured spaces. Costs vary by community and care level, so get written quotes and compare what each one includes.
What is an RCFE in California?
A Residential Care Facility for the Elderly. It is California's license for assisted living and board-and-care homes, and many memory care settings. The Department of Social Services, Community Care Licensing Division, licenses and monitors them.
Does Medicare cover memory care?
No. Medicare.gov says Medicare does not pay for long-term care. It can cover a limited skilled nursing stay after a qualifying hospital stay, up to 100 days per benefit period.
Does Medi-Cal pay for assisted living?
Through the Assisted Living Waiver, for people who qualify. It is for people with nursing-home-level needs and full-scope Medi-Cal with no share of cost. When we checked in October 2026, it operated in Sacramento County but not in Placer, El Dorado or Yolo counties.
Can VA benefits help pay for assisted living?
VA Aid and Attendance is a monthly payment added to a VA pension for qualified Veterans and survivors who need help with daily activities. The pension must come first. A county veterans service office can help with the claim.
How do I check a facility's complaint history?
For assisted living and memory care, use the CDSS Find Licensed Care search. For skilled nursing, use CDPH's Cal Health Find. Read the reports and ask the community about anything you find.
Do you take referral fees from senior communities?
No. Maggie takes no placement or referral fees from any community or care provider, ever. Your family chooses the community.
Will selling Mom's house for care cost her the home sale tax break?
Not necessarily. IRS Publication 523 lets time in a state-licensed care facility count toward the residence test if she lived in the home at least 12 months in the five years before the sale. Her CPA can confirm.
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