Choosing the right living arrangement for an aging parent or spouse can feel overwhelming. In Michigan, it used to be that there were just small group homes and nursing homes. These days, there are several types of residential care settings that serve older adults in Michigan, each with different levels of support, supervision, and medical care. As an elder law and estate planning attorney in Troy, Michgian, families often ask me about the differences between small adult foster care homes, larger assisted living communities, memory care facilities, and nursing homes. Understanding how these facilities are licensed and what kinds of care they provide is an essential first step in making informed decisions.
Let's take a closer look at each option.
Adult Foster Care (AFC) Homes: Small, Residential, and Personal
Adult Foster Care homes in Michigan are typically small, home-like settings—often in converted single-family homes—licensed to care for anywhere from 1 to 20 residents. Most homes care for 4 to 6 individuals.
License and Oversight: AFC homes are licensed by the Michigan Department of Licensing and Regulatory Affairs (LARA) under the Adult Foster Care Facility Licensing Act. Facilities are categorized based on capacity and level of supervision:
- Family Homes (1–6 residents and the person holding the license lives on-site)
- Small Group Homes (1–6 residents, but the person holding the license is not required to live on-site)
- Large Group Homes (7–20 residents)
They are not considered medical facilities, but they are licensed to provide 24-hour personal care, supervision, and protection. Staff help with assistance with the activities of daily living including meals, bathing, grooming, dressing, mobility, and medication reminders—but not with skilled nursing tasks like injections or wound care.
Assisted Living Facilities: Larger Settings with More Amenities
The term “assisted living” is widely used but not officially defined or licensed as such in Michigan law. Most facilities that market themselves as “assisted living” are actually licensed as Homes for the Aged (HFA) if they serve residents aged 55 and over and provide room, board, and supervised personal care.
License and Oversight: HFAs are also licensed by LARA and are typically larger than AFC homes. They may house dozens—or even over 100—residents in apartment-style settings with common dining, housekeeping, and recreational services. Like AFC homes, HFAs provide assistance with activities of daily living (ADLs) but cannot provide ongoing skilled nursing care unless arranged separately through a third-party home health provider. Assisted living facilities may have more staff than Adult Foster Care Homes.
Memory Care Units: Specialized Care for Dementia and Alzheimer's
Memory care is not a separate license category in Michigan, but many HFAs and AFCs operate secured memory care units or specialize in serving individuals with dementia. To some extent, the term “memory care” is a marketing term. For the most part, memory care means having staff who are trained and experienced in caring for people with dementia and providing a protective environment.
What Makes It Different? These units are designed to reduce wandering, manage difficult behaviors, and provide structured daily routines. Staff receive training specific to Alzheimer's and other types of cognitive impairment. However, because the underlying license is still either AFC or HFA, medical and nursing care remains limited. It is important to know that many elders living in assisted living facilities that do not market themselves as memory care units have dementia and receive sufficient care.
When evaluating memory care options, it's critical to ask what staff training is required, how behavioral needs are managed, and whether third-party medical services are regularly brought in.
Skilled Nursing Facilities (Nursing Homes): Full Medical Care
Nursing homes—also known as skilled nursing facilities (SNFs)—are the most medically intensive residential care setting.
License and Oversight: These facilities are dually licensed and federally certified, regulated by both LARA (State of Michgian) and the Centers for Medicare & Medicaid Services (CMS, a federal agency of the United States government). Nursing homes must meet federal standards under the Social Security Act if they want to participate in Medicare or Medicaid.
In addition to providing assistance with the same activities of daily living that Adult Foster Care Homes, Assisted Living, and Memory Care units provide, Nursing homes provide 24-hour care from licensed nurses and certified nursing assistants (CNAs). They can manage wound care, IV therapy, ventilators, feeding tubes, and rehabilitation after hospital stays. For example, if an elderly lady falls, breaks her hip, and needs physical therapy after being in the hospital, that care is going to be provided in a skilled nursing facility. For patients with complex or unstable medical conditions, this is often the only appropriate option.
Traditionally, skilled nursing facilities have been more hospital like in their apperance and there were often two people to a room. In recent years, some skilled nursing facilities have developed more pleasant surroundings similar to assisted living facilities while still providing a nursing home level of care.
Summary: Key Differences at a Glance
Facility Type |
Licensing Agency |
Level of Care |
Medical Staff on Site? |
AFC Homes |
LARA |
ADLs, personal care & supervision |
No |
Assisted Living/HFA |
LARA |
ADLs, personal care & supervision |
No |
Memory Care Units |
LARA |
Dementia-specific helps with ADLs, personal care & supervision |
Sometimes |
Nursing Homes/SNF |
LARA & CMS |
ADLs, personal care & supervision, skilled nursing and medical care |
Yes (RN/CNA) |
What's Next?
It is important to know how these facilities charge before moving a senior citizen who needs care into the facility.
In a future post, I'll describe how each of these settings charge for care—and which payment sources may be available, including Medicaid, VA benefits, and long-term care insurance.
Questions About Long-Term Care Planning?
If you or a loved one is considering a transition to a care facility, it's wise to start with a legal plan that addresses finances, benefits eligibility, and future health care decisions. I help families in metro Detroit make sense of their options.
If you're ready to explore your options, I invite you to reach out. You can use the “contact us” form or call my office directly at (248) 469-4261. During our initial conversation, I'll answer your preliminary questions and gather some background to determine whether your situation is a good fit for my services. From there, you can decide whether to schedule a full consultation.
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