What Are the Levels of Care in Assisted Living
Jun 02, 2025
Not every resident in assisted living needs the same type of care. Some just need a little help. Others need support all day, every day. That’s why understanding what the different levels of care are is so important.
If you’re starting or running an assisted living home, this guide will help you know exactly what to offer, what to look for, and how to support residents as their needs change.
Check out this video, too;
Why This Matters
Offering the right level of care helps you:
✅ Avoid burnout for your team
✅ Keep your residents safe and satisfied
✅ Stay compliant with state regulations
✅ Make sure your facility runs smoothly and profitably
Let’s break it down.
👶 Level 1: Supervisory Care
This is the lightest level of care. These residents can do most things on their own. They just need:
-
Medication reminders
-
Some light supervision
-
Maybe help with setting up doctor appointments
You’re mostly checking in on them and making sure they’re safe. You might have daily conversations, monitor their behavior, and just be there in case something happens.
This is perfect for residents who are still pretty independent.
🚶 Level 2: Personal Care
Now we’re stepping it up a bit.
These residents need some hands-on help with:
-
Bathing
-
Dressing
-
Toileting
-
Eating
-
Transferring (getting in and out of bed/chairs)
At this level, your staff will be helping multiple times a day. You’ll need caregivers who are trained and ready to offer support in a kind and respectful manner.
This is one of the most common levels of care in assisted living.
🛏️ Level 3: Directed Care
This is a higher level of care for residents who:
-
Can’t direct their own care
-
Might have memory issues
-
Need help with all ADLs (Activities of Daily Living)
-
Could be a safety risk if left alone
These residents might have dementia, Alzheimer’s, or other cognitive impairments. They need more supervision, more staff time, and more planning around their day.
It’s not quite a skilled nursing level yet, but it’s getting close. Your team should be trained to manage behaviors, communicate clearly, and keep residents calm and engaged.
⏳ When Residents Decline or Improve
Residents’ needs can change — fast.
Let’s talk about what to do when that happens.
If They Decline:
If a resident starts needing more care than you can legally or safely provide, you have three main options:
-
Bring in Hospice
Hospice can offer additional support to your team and the resident — especially at end-of-life. This lets the resident stay in a familiar setting without having to move. -
Discharge to a Skilled Nursing Facility
If the resident still has months to live but needs 24/7 medical care, it might be time to move them. Skilled nursing is designed for people who need constant clinical attention. -
Add Extra Services
Depending on your license, you might be able to bring in home health or other third-party providers to help with things like wound care, therapy, or injections.
If They Improve:
Yep, that happens too!
Some residents get better — physically or mentally — and they might not need the level of care you provide.
In that case, they might be a better fit for:
-
Independent living
-
Home with family
-
A less intensive care setting
If they’re bored or don’t need your services anymore, it’s okay to help them transition. That’s a win for them and you.
🎯 Quick Tips for Managing Levels of Care
Here’s how to stay on top of it all:
✅ Do regular assessments — at least annually
✅ Track changes in condition or behavior
✅ Communicate with families about what's happening
✅ Know your state’s licensing requirements
✅ Don’t be afraid to say, “This isn’t the right fit anymore”
Remember: It’s not about keeping every resident forever. It’s about giving them the right care at the right time.
Take Action Today!
🚀 Want to launch your assisted living business in the next 12 months?
✅ Step 1: Download the Business Plan Checklist to start planning.
✅ Step 2:Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.
✅ Step 3: Follow this guide, take action, and bring your vision to life!
Got questions? Drop them in the comments below! ⬇️
Show full transcript 👇
Transcript
00:00:03
hey friend it is Brandon Gustafson with Assisted Living investing excited to have you here with me on the channel today our topic for our live today is going to be what are Assisted Living levels of care what do those look like um why do they matter and why you should be caring about what those Assisted Living levels of care are so excited to have you here with me on the channel um today as we get going if you have um any questions as we go along make sure type those in so we can get to those here at
00:00:32
the end of the of the um of the session of the live session so I can answer those questions for you I want to also remind you that uh you can get a free business plan checklist by going to Assisted Living investing. netb checklist we're going to have a ticker going across the bottom there um so make sure you go and grab that free resource and if you watch this on YouTube we will have all of the links um to everything that I give away for free on there as well so make sure you go and grab that
00:00:59
information for yourself um I'm going to go ahead and share my screen let's add that up here okay and tried to do a different virtual background now you can just see my last name there a little bit that's fine um I'm G to work through this um while I'm working in a basement for probably the next for the foreseeable future um and you're just going to have to deal with weird stuff in the background it's better than construction stuff behind me anyways um excited to have you um like I mentioned
00:01:29
our our call today we're going to be or our I guess not call but our topic for today is what are Assisted Living levels of care and you can get that access to that business plan checklist by going to assist living investing. netb checklist um and go ahead and download that and it will help you kind of get started on your business plan creating that is going to be the base of everything that you need to do um as you get started on your investment Journey so uh with that said I'll give you a little bit of
00:01:55
background on who I am and you know why why you should listen to me um so my name is Brandon Guston I own two assisted living facilities um I live in Utah one of my facilities is in Idaho one is in Colorado so I operate those remotely um have gone through that process have secured over one and a half million in FDA funding have a masters in healthcare administration and um also have worked in the healthcare industry for over a decade so have done a lot of kind of work and things here in the industry um I've owned my facilities now
00:02:24
for over close to four years is is what we're getting to so um have have a lot of experience there if you're new here if you're just like new to the channel and new to the idea of Assisted Living type in newbie down below um and if you have been here for a while and you're you know you want to correct me or give some input to people um type in operator down below just so I can get a feel for who is watching in here um so we can help you along the way um let us get now into the topic for our call today or I
00:02:53
keep calling it a call for our video today so um what are those levels of care so often times most facilities are going to have three to four levels of care sometimes there's going to need to be a level five it it really depends on how um how things are structured um inside of a facility and and really what it says is they're used to help assist the assess a resident their needs um and and that's going to help you set the rates for for what you're going to be charging them for a bed raid um it's
00:03:24
also if you're going the Medicaid route um and I talk a lot about Medicaid on this channel so if you're interested in learning more about Medicaid type in Medicaid down below and we'll send you some links for some of the Medicaid videos that I have um but it will still help you raise those Medicaid rates for people as well so there's actually uh some really good benefits to doing these assessments and identifying the level of care that a resident needs um it's going to let you identify as well if you need
00:03:52
more staff if you need to do a high level of care if somebody needs to be discharged from your facility and go to a higher level of care uh because they need skilled nursing or something along those lines so um these are the types of things that you just really want to pay attention to um it's worth it to take the time and do this especially when somebody new comes into the facility other times when you want to do these assessments and identify where they're at from a level of care perspective is
00:04:17
at least annually and when there's when you see a significant change in the level of care you are providing um so you know somebody has a fall somebody goes to the hospital for to the emergency room for something and they come back and they have regressed um or or have improved significantly one of those two things you want to do a reassessment and make sure that you are um providing the level of care that is appropriate to the to the resident um and and then you're getting compensated fairly for the the amount of service
00:04:49
that you are providing them so those are the the types of areas where you want to do this at um and we're going to dive into the different levels of care what they mean and kind of what fits into that and you as as an operator uh as an administrator um you are going to be able to kind of identify what your levels of care are um and and build these tools if you're interested in in learning more about assessments how they work and how I do them at my facility just type in assessment down below and
00:05:16
I'll take that as a sign that uh you all want a session you know one of these live sessions or uh another video that goes deep into assessment tools um it's something that we're actually going to be going into a little bit in our Mastermind program as well so if you're interested in learning more about that go to assisted living investing. netmaster and you can learn about that uh or go to schedule a free strategy call with me and we can chat about and see if it's a good fit for you or not
00:05:40
okay so now let's get into the levels of care I'm just going to go through three levels of care here um but like I mentioned there there could be anything from three to five levels of car it's really how you want to structure these things and these are not hard and vest rules these are more guidelines for you to follow and and just kind of be aware of as you're looking at your residents and the type of care that they need and the level of care that they need to be at so a level one resident um is is
00:06:08
going to be there's little supervision little to no supervision in fact um the other thing I wanted to point out um and I had this thought on on the last side and it just left me um is you're going to do this for a bunch of different types of things so you're going to assess um our resident on their ability to dress themselves on their ability to bathe themselves um toileting you're G to have you know all the ADLs that you do say there's 20 of them you want to assess them on each thing so for one you
00:06:39
know maybe they can toilet just fine so they're a level one and toileting but they have really hard time um you know buttoning their shirt and and getting dressed in the morning and so that's a level two or a level three so you're going to kind of individually um assess them on each of these things and then you typically use like a point system um that goes level one to level four four or five um and then you have based off of how many points they have you have like a dollar amount and this is how you
00:07:05
um set your rates um so if you want me to dive deeper into that uh again type in assessment and we can uh do a session on this but we're going to focus back on this what is a level of care and kind of what does it what does it mean now level of care level one is like I mentioned little to no supervision they can do the thing mostly by themselves um there may be some assistant like really basic assistance with some of those ADLs um and typically when you're doing that kind of you know you're
00:07:36
assessing them overall you're going to say you know you fall into the bucket of a level one level two level three each ADL is going to have its own separate thing but you kind of group them into a thing and say you're a level one resident a level two resident based off of what they need um because these level one types of residents they just don't need that much help just a little bit of guidance maybe some prompting hey go put your shirt on you know uh do you need to go to the bathroom just prompting types
00:08:01
of things is what you can see with a level one level of care you're just meeting those basic needs making sure that they don't um have any issues and fall um into bad habits and things like that it's really what you want to do a level two uh resident is going to be somebody where you are providing um some more Hands-On assistance so let's go to the the example of toileting um so level one resident they can go by themselves maybe you just have to prompt them hey do you need to go use the restroom um it
00:08:32
it's it's getting kind of stinky do you need to go use the restroom that kind of a thing it's been a couple hours do you need to go to the restroom you just drink a bunch of water um that kind of a thing level two is um you know helping them go to the restroom um maybe wiping them cleaning them up um that type of a thing U making sure you're just kind of standing out there just in case they they were too fall um maybe they're not a fall risk but you just want to you know make sure that they're okay this is
00:08:57
a level two um type of an example um with twist toting so you want to provide a little bit of Hands-On assistance you're there you're you're kind of interacting with them and helping them out through the ADL that they have ADL as activities of daily living um there's still going to be some resident autonomy there though um like you know maybe they just need help finishing wiping or or something along those lines they can go by themselves and and you're just there to give them some support if they need
00:09:22
it um some of these motor skills are where you can find this getting into place where they're level two maybe they need some assistance washing their hair while they're bathing um or washing the body or or things like that or uh doing some dressing you know doing buttons tying shoes those types of things you're a little bit more Hands-On and helping out the residents this is a level two now let's get into a level three so this is you know as a whole a level three resident is they need help with multiple
00:09:52
ADLs but in here um you might need to have two people there let's say they they have trouble getting out of bed um or they've fallen and they can't get up and you need to have two people there to lift them this is what is called a two person left um so you're doing those those types of things um the staff is completing most if not all of the ADLs for the resident they're feeding them they are completely bathing them they're helping know maybe they can't use the restroom anymore they're on a catheter
00:10:23
they're changing the catheter those types of things uh are are what kind of falls into a level three and maybe even level four depending on how you want to structure um the way that you're doing your your ADLs um you know this could could fit into any of those levels and and how you want to structure these I'm keeping this really simple and just doing three levels of care here though um so you want to just kind of look at what that that's going to look like for for you and for your residents and when
00:10:50
I say what we do in our facilities actually we actually do five levels here um and I'm going to bump this over to additional levels of care um we actually do we do a zero to four point scale so zero means they can do everything by themselves it's kind of what what I was talking about with level one level four is we have to do everything for them and so they kind of fit in that most residents um in our facilities are sitting like at a level one overall they're like a level one resident or a
00:11:19
level two resident is kind of where they fit in there and then there there might be one or two ADLs that they're up to a level three type of assistance but they might also have some where they're just level zero um level zero if they do it by themselves level one is like prompting level two is we're doing a little bit level three is we're doing a lot and level four is we do everything for them that kind of gives you an idea of how we do it at our facility you can structure these um however you want
00:11:43
these additional levels of care are special assistance you know I mentioned maybe you're changing a catheter um or you need some you hire a nurse to to go and do that type of a thing um you are um just you're you're very very handson um in in helping people do things uh so you can see what that looks like and that for us and our facilities would be a level four level of care um when you get to this point where they are needing more assistance than you can provide at your assisted living and this happens
00:12:12
from time to time and it could be a couple of things one it could be that they have dementia and they are really struggling and as an assisted living facility if you're not a locked facility you probably like you can have people that are in early stages of dementia um up to a point but there's going to come a time where they are a risk for leaving the facility and running away um and you don't want to you don't want to deal with that as an assisted living um just the liability of it and so that's where you would
00:12:42
shift them over to memory care now you could have memory care and assisted living inside of your same your same home that's very possible um but it's something that if if they're dealing with some of those struggles and they need that memory care um type of type level of care then you're going to want to maybe discharge the from your facility and and admit them over to a Memory Care Facility or possibly they need extra assistance um nursing care like round the-clock nursing care or a
00:13:10
lot more nursing care than you are providing inside of your Assisted Living because in Assisted Living you're typically going to have an RN that is there uh you know once a week doing some of these assessments and checking in on things and seeing how things are going but they're not really there to provide all of the Care that your residents need and and at some point your residents May get to the point where they need that you can bring in hospice hospice can come in and they can help out with that
00:13:35
a little bit to keep them inside of the home especially if they're at end of life and you don't want to disrupt them um and they would rather pass inside of of your facility um then that's something that you want to take into consideration the hospice might be the thing that you need to do to bring in the extra support to help your staff that's a possibility but if they are severely declining and they still have a significant amount of life left we to months left and you can see that they're
00:14:02
going to need more assistance you might want to discharge them and get them into a skill Nursing Facility so those are kind of the ways that you want to handle um some of these you know some of those situations um when it comes to they may need to just move to a different level of care you could also get residents who they come into the facility and they improve drastically to the point that you're not doing anything and and they're kind of bored because um people are you know they're not as active as
00:14:30
they would like them to be and maybe they need to get discharged and put into an independent living um so they still have a little bit of support and things like that but you're not really um doing much work there and I have a video on Independent Living uh if you want to search through the the channel um you can go and find that as well or if you're interested in learning more just type in independent and I can do something on that um specific to that and put it in my queue so um that's
00:14:54
that's kind of some of the things that you you want to go through as you're looking at levels of care and where people are at so as we get into this um I'm going to I know I've got at least one question here if you have other questions then uh go ahead and type those in uh if you're watching after the fact type them in as well uh and while you are typing questions then make sure you like the video subscribe and ring the bell so you get notified when we go live on Tuesdays and put out our our
00:15:16
other long form videos on Thursdays so you get you know all the the information that you need there and uh if you're interested in in some of the assistants get the business plan checklist that I've got scrolling down um below and also get business planning guide which is going to give you the base of everything you need there's five phases that I teach um business plan is number one and the business planning guide is the easiest way to get started but if you need some extra support and things
00:15:40
as you're going through check out The Mastermind program at assisted living investing. netmaster and that will you know I give it's a year-long program get in there can really help you out in moving things along and if you'd like to learn a little bit more about what that looks like and how it works if it's a good fit for you I do free strategy sessions uh where we really dive deep and and make sure it's a good fit you can sign up for that at us listed living investing. net strategy so I I've got a
00:16:03
question in here by Silver Wings Ministry um to say um I have uh I have to go to another client will this be available in a couple hours um on the recording or please send it thanks Lon ah Lon Lon is great Lon is awesome I had a conversation with him on Saturday yes Lan um we will post this so it'll be in the Facebook group it'll also be on YouTube um so we'll make sure and I'll I'll probably send you an email send you to follow up with you on a couple of things so um thanks for for putting that
00:16:28
in there um but yeah if there's any other questions make sure you type those in down below I hope this information was helpful for you though and that gave you a little bit of guidance as as you're moving things along on your investment Journey here and just the understanding of what it takes to um to run one of these homes especially as it gets to uh the point where you're just trying to figure out how do I um know how do I work with uh different types of residents and the level of care and
00:16:57
things like that um hope that this has been beneficial for you um to to give you that guidance and help you along your path along your journey to to understanding what that looks like and um yeah you know here at Assisted Living investing. net we're here to help beginners like you launch their Assisted Living business in the next 12 months uh I love doing this I love helping people giving them guidance uh trying to create some time and Financial Freedom for you so if that is the person uh if you are
00:17:24
that person make sure you reach out to me at Assisted Living investing. net strategy get the free business plan checklist um and want to remind you that it doesn't take a lot just a little bit keep going keep making progress step by step by step I promise if you do and you're consistent and persistent at doing that you're going to be successful thanks for watching and have a great day
Download Your FREE Calculator
Stay connected with news and updates!
Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.
We hate SPAM. We will never sell your information, for any reason.