How do I work out how much help my person needs?

Start with a list, not a label. The National Institute on Aging (NIA) lists the kinds of help people get at home. Personal care comes first: bathing, dressing, grooming, using the toilet, eating, and moving from a bed to a chair. Then come household chores, meals, handling money, health care such as medicines and wound care, rides, and safety, including help after a fall. Walk through a normal day. Mark what takes help and how much. An assessor, a doctor or an agency will ask you for that list anyway. [1]

Is needing help with two daily activities the line for more care?

Not as a national rule, and we have fixed this page. You will hear the "two activities" line a lot. It is real in a few places. Tax-qualified long-term-care insurance pays when a person needs help with two of six daily activities. Federal researchers at ASPE also count a major need as help with at least two. But for Medicaid and care facilities, each state sets its own test. CMS says the need for nursing facility services "is defined by states, all of whom have established NF level of care criteria." Ask your state program for its own test. [2, 3]

Where to start › Kind of care

What kind of care does my person need?

Q: Who decides the level of care?

A trained assessor. Not a website, and not the family alone. A doctor or nurse, a hospital discharge planner, a care manager, or an assessor from your state or Area Agency on Aging can look at the whole picture: what the person can do, their memory and thinking, their medical needs, and what the caregiver can handle. Our directory can show you facilities and their public records. It cannot decide who qualifies or where someone should go, and neither can this page. [2, 4]

You do not need a diagnosis to think this through. The real question is how much help daily life takes now, and specifically, help with what. Make that list. Only you know if walking is hard, if pills get missed, or if eating has dropped off. Everyone you talk to next will ask for this kind of information.

The everyday-tasks list

The National Institute on Aging (NIA) lists the kinds of help people get at home. It is a good place to start:^[1]

Personal care — bathing, dressing, grooming, using the toilet, eating, and moving around, such as getting out of bed and into a chair. Professionals call these "activities of daily living."
Household chores — housecleaning, yard work, grocery shopping, laundry.
Meals — shopping for food and cooking it.
Money — paying bills, filling out health insurance forms.
Health care — giving medicines, wound care, help with medical equipment, physical therapy.
Rides — getting to the doctor or the store.
Safety — safety features in the home, and help after a fall or other emergency.

Trouble with chores and money usually shows up before trouble with personal care. That is why a missed bill or a fridge full of spoiled food is often the first real sign.

One thing the checklists leave out: the caregiver's limits count too. Maybe the caregiver is not sleeping. Maybe they cannot safely lift or turn the person. Maybe they are worn down by behavior that comes with memory loss. Any of these is a fair reason to change the care plan. What is called respite care, a short break for the caregiver, exists for exactly this. NIA lists respite as one of the supports for staying at home.^[1]

About the "two activities" rule

Where the two-activities test is real: a tax-qualified long-term-care insurance policy generally pays when a person needs a lot of help with two of six daily activities, or needs close watching because of severe memory or thinking problems. See LTC insurance. Also, federal researchers at an office called ASPE count a person as having a major need for long-term care when they need help with at least two daily activities, or need watching because of severe memory or thinking problems, and the need is expected to last at least 90 days.^[3]

Where it is not the rule: Medicaid and care facilities. CMS, the federal Medicaid agency, says the need for nursing facility services "is defined by states, all of whom have established NF level of care criteria."^[2] In plain words, each state sets its own test. Your state's test decides what your person qualifies for. The only way to know it is to ask for it.

Roughly, this points to one of three settings

These are not hard lines. An assessment sets the real level of care. As a rough map:

Mostly independent, needs some help at home → help at home
Needs someone around and help every day, but not constant medical care → assisted living & personal care homes
Needs skilled medical care around the clock → nursing-level care
Memory changes are the main worry → memory changes & dementia care

Who does this assessment: a doctor or nurse, a hospital discharge planner, a care manager, or an assessor from your state or Area Agency on Aging. They look at what the person can do, their memory and thinking, their medical needs, and what the caregiver can handle. NIA also describes geriatric care managers, who will work with you to build a care plan.^[1] Our directory shows facilities and their public records. It cannot decide who qualifies or where someone should go.^[4]

Free local help. Your Area Agency on Aging will talk through your choices with you for free. Find yours through the federal Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov (run by the Administration for Community Living).^[4] To learn about the four kinds of local helpers and what each one does, see Who helps me locally.

Sources and what they support

Sources checked 2026-09-19 using AI-assisted editorial research. This is a source check, not a clinical assessment.

National Institute on Aging, aging in place: growing older at home. Supports the full inventory of home-based help used here — personal care with its listed activities, household chores, meals, money management, health care, transportation and safety — and that in-home support may be short-term or long-term, and its mention of respite and of geriatric care managers who help build a care plan. This is practical guidance on what help exists; it is not an assessment tool and sets no threshold for any program.
CMS, Medicaid nursing facilities. Supports the quoted statement that the need for nursing facility services is defined by states, all of which have established level-of-care criteria, that these services are required for eligible people aged 21 or over, and that coverage applies only in a facility licensed and certified as a Medicaid nursing facility. It establishes that the criteria are state-set; it does not tell you what any state's criteria are.
HHS / ASPE, Long-Term Services and Supports for Older Americans: Risks and Financing, 2022 (official GovInfo copy). Supports that this federal research defines a significant long-term-care need as needing help with at least two activities of daily living, or supervision due to severe cognitive impairment, expected to last at least 90 days. That is a definition used for modelling a population. It is not an eligibility rule for any benefit and does not decide what care anyone needs.
Administration for Community Living, Eldercare Locator. Supports the referral route to a local Area Agency on Aging for free options counselling. An Area Agency on Aging navigates options; it does not diagnose, determine Medicaid eligibility, or decide placement.

Removed in this pass, for want of a source as a national rule: that needing hands-on help with two or more basic daily tasks is the common line at which around-the-clock care and many Medicaid programs come into play. The two-activities test is real in specific places — tax-qualified insurance policies and federal research definitions — and this page now says which, rather than presenting it as a general threshold.

Where to go next

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