Who Provides Care in Assisted Living, Memory Care, and Adult Family Homes
When families tour assisted living, memory care, or adult family homes, they often hear titles like caregiver, CNA, Med Tech, LPN, or RN. These roles differ in training, responsibility, and authority, and those differences shape how care is delivered day to day.
This guide explains the primary caregiver and nursing roles commonly found in senior living settings, how they work together, and why staffing structure and stability matter when choosing care.
Frontline Caregivers, HCAs, and Certified Nursing Assistants
Frontline caregivers in Washington may hold one of several designations, including:
Home Care Aide (HCA)
Nursing Assistant–Certified (NAC)
Nursing Assistant–Registered (NAR), a temporary credential
Families will often hear all of these roles referred to simply as “caregivers.” While the credentials differ, the day to day responsibilities are similar.
What they do
Caregivers provide hands-on daily care. This includes assistance with bathing, dressing, grooming, toileting, eating, mobility, and transfers. They also support routines, social connection, and safety.
Training and scope
Caregivers receive practical training focused on personal care and observation. They do not make clinical decisions independently. Their role is to provide consistent support and to report changes in condition to licensed staff. In clinical settings, caregivers work under the supervision of a nurse.
Why this role matters
These caregivers spend the most time with residents. Their consistency and familiarity with residents often determine comfort, dignity, and early recognition of concerns.
Medication Technicians (Med Techs)
What they do
Medication Technicians are caregivers who have received additional training to administer medications. In assisted living and memory care settings, Med Techs often handle routine medication passes, including oral medications, topical treatments, and other approved forms of administration.
Training and scope
Med Techs are not nurses. Their authority to administer medications exists under clearly defined protocols and, in many cases, under the delegation and oversight of a registered nurse. Certain medications or administration methods may fall outside their scope and require licensed nursing involvement.
Why this role matters
Med Techs allow assisted living and memory care communities to manage daily medication needs efficiently while preserving nursing oversight for more complex clinical situations. Understanding whether medications are administered by Med Techs, nurses, or both can help families evaluate how care is structured.
Licensed Practical Nurses (LPNs)
What they do
Licensed Practical Nurses support residents with medical needs and carry out physician orders. In assisted living and memory care, LPNs may administer medications, perform treatments, monitor health conditions, document changes, and communicate with providers.
In many assisted living settings, both LPNs and RNs carry out physician orders. The distinction between the roles is often related to assessment, delegation, and accountability rather than the specific tasks performed.
Training and scope
LPNs complete formal nursing education and hold a nursing license. They typically work under RN oversight for assessments, care planning, and delegation decisions.
Why this role matters
Experienced LPNs bring clinical skill and continuity to care environments, particularly for residents with ongoing medical needs. Their presence can strengthen day to day clinical support.
Registered Nurses (RNs)
What they do
Registered Nurses hold the highest level of clinical responsibility in most assisted living, memory care, and adult family home settings. RNs assess residents, develop and update care plans, oversee medication systems and delegation, coordinate with physicians, and supervise nursing and caregiving staff.
While both RNs and LPNs may carry out physician orders, RNs are typically responsible for clinical judgment, delegation, and overall accountability.
Training and scope
RNs complete extensive education and licensure requirements. They are responsible for ensuring that care practices meet professional and regulatory standards.
Why this role matters
RNs influence how care is delivered across the entire community. Their involvement is especially important for residents with complex medical conditions, behavioral challenges, or changing needs.
Adult Family Homes Operated by LPNs or RNs
Some adult family homes are owned or operated by an LPN or RN. When the nurse is meaningfully present in the home and actively involved in resident care, this can provide additional oversight and responsiveness.
For residents with complicated medical or behavioral challenges, an LPN or RN operated home may offer stronger clinical insight, particularly when the nurse is engaged day to day rather than serving only in an administrative role.
Resident Managers in Adult Family Homes
Some adult family homes use a resident manager to oversee day to day operations. This is an administrative and supervisory role rather than hands on caregiving.
Resident managers are often used when:
The owner operates multiple homes
The owner does not live on site
Additional oversight is needed
When experienced and engaged, resident managers can be very effective. They work under the provider’s authority, while the provider remains ultimately responsible for care.
Owner-Operated Homes vs Resident Managers: What Families Should Know
Over the years, we’ve seen meaningful differences in how adult family homes operate depending on who is present day to day.
Homes where the owner lives on site and is actively involved often offer a higher level of responsiveness and continuity. Decisions tend to be faster, communication more direct, and accountability clearer.
Homes with resident managers can also be excellent, particularly when the manager lives in or near the home and is present almost daily. This model is more common as providers grow and operate multiple locations.
There are tradeoffs. Owner-operated homes may include family members, such as children, which can affect the environment. Some residents enjoy this, others prefer a quieter setting. Every adult family home has its own micro culture, and comfort is highly personal.
Resident managers can be great to work with. They simply represent a different operating model than an owner who is consistently on site.
How Important Is Staff Turnover in Assisted Living and Memory Care?
Short answer: Very important, but context matters.
Care settings with low staff turnover often provide more consistent care, better communication, and stronger relationships between residents and caregivers. When caregivers and nurses stay for years rather than months, they know residents’ routines, preferences, and early warning signs far better.
That said, turnover is high across senior care nationwide. When a community highlights long staff tenure, such as caregivers or nurses who have been there since opening, that is worth paying attention to and asking follow-up questions about leadership, workload, and support.
Short staffing periods or role changes are common in senior care and do not automatically indicate poor quality, especially when systems for training and continuity are strong.
What families can listen for on tours
How long caregivers and nurses typically stay
Whether staff speak positively about leadership and teamwork
How care continuity is maintained when staff changes occur
Who Is Actually Responsible for My Loved One’s Care?
In most assisted living, memory care, and adult family home settings:
While responsibilities are shared across roles, the community or home as a whole is accountable for care delivery, with licensed staff providing clinical oversight.
Frontline caregivers provide daily hands on care
Med Techs or nurses administer medications
LPNs and RNs carry out physician orders
RNs are responsible for assessments, care planning, delegation, and clinical oversight
Understanding who holds responsibility at each level helps families know who to talk to when concerns arise and how decisions are made.
Who Makes Medical and Care Decisions in Assisted Living?
Medical and care decisions are typically made by a combination of
Physicians, who issue medical orders
Registered nurses, who assess needs, interpret orders, and oversee care plans
Licensed practical nurses, who help carry out those orders
Caregivers, who observe and report day to day changes
Caregivers and Med Techs do not make independent clinical decisions, but their observations often trigger reassessments by licensed staff.
Final medical decisions are guided by physician orders, with licensed nursing staff responsible for interpretation and implementation within the care setting.
Questions to Ask About Daily Care
Who provides hands-on care during the day and overnight
How many residents does each caregiver typically support
Questions to Ask About Medications
Who administers medications
Which medications require RN delegation or oversight
Questions to Ask About Clinical Oversight
How often an RN assesses residents
Who updates care plans when needs change
Questions to Ask About Staff Stability
How long key caregivers and nurses have worked here
How staff transitions are handled
What Families Should Take Away
Titles alone do not determine quality of care.
Strong care environments are built on
Clear role definitions
Appropriate clinical oversight
Stable, supported staff
A team that communicates well
Understanding how caregivers, Med Techs, LPNs, and RNs work together allows families to evaluate care settings with more confidence and fewer assumptions.
