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In every state there are licensed residential homes who offer long term care mostly to senior citizens. They are called "Adult Family Home" or "Adult Foster Home". So there are much better alternatives compared to nursing homes. But it's a best kept secret you won't find about unless you have a grandma or other relative(s) looking better care.

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Personal care and assisted living aren't alternatives to nursing homes. Nursing homes have to be able to provide a more specialized, higher level of care, in order to meet federal requirements. But yeah, if your loved one doesn't need that kind of care, definitely do not try to put them in a nursing home.

As a paramedic who has been in hundreds of AFHs, definitely not automatic.

Many are run by families who made an investment in looking after grandma, ramps, etc. and realized they could make some more money by bringing in a few other people.

This tends to have polarizing results. Best case, they take care of and love the other residents like grandma. Worst case, the other residents are absolutely third class citizen who are subsidizing the family and grandma while hovering just this side of neglect.

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