Choosing Between Home Care and Assisted Living
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There may be no more stressful decision than deciding between assisted living and home care for an older adult. How and when this decision is made is based on many factors. Research shows consistently that older adults prefer to remain at home, if they can. Let’s take a look at the pros and cons of assisted living and home care, and what to consider. Keep in mind that there is no one right answer for everyone.

Evaluating a Home Care Agency

As people age, they often require more help to stay independent and avoid long-term care like a nursing home. This can be due to a number of circumstances. The most common reasons a family may need help with their healthcare or activities of daily living are the following:

  • A fall. Falls are the leading cause of death and disability for people over the age of 65.
  • Chronic illness. Any chronic illness can get worse with age. This includes, but is not limited to: neurological disorders, heart conditions, diabetes, post stroke, etc.
  • Cognitive disorders. Dementia and Alzheimer’s disease can be devastating and often get worse over time. This may require help with bathing, cooking, medication reminders, transportation, laundry, and housekeeping.

Benefits of Home Care

The main benefit of home care is that a family member is able to remain in the comfortable surroundings of their home. People feel safe in their own homes. There is a certain comfort level and feeling of control that comes with being home. There are other benefits that you may not have even considered like:

  • Flexibility. Any kind of assisted care is a difficult transition to make. Bringing a paid caregiver into the home offers flexibility. Start low and go slow! A caregiver can start with a few hours a day of assistance and this can increase through time to allow for an adjustment period.
  • One-on-one attention. A caregiver is assigned and that person is committed. They devote themselves to your family member during the time they are scheduled.
  • Personalized care. You can work with the care team to create the exact type of care your loved one desires. This can combine their physical and emotional needs. Favorite foods or activities can be incorporated so your loved one can continue to enjoy the things they love.

Cons of Home Care

Home care is not without its own challenges, but most of those can be managed with some education and preparation.

  • Caregiver turnover. Recognize that the caregiver you like so much may move on, or your loved one may request a change. Often, a new caregiver brings a different perspective and can be a very positive experience.
  • Cost. The price of home care may eventually exceed what you or your family member can afford.

Evaluating an Assisted Living Community

Assisted living is congregate housing that offers assistance with activities of daily living. Meals are included, along with medication dispensing, housekeeping, transportation, and limited nursing. Any of the circumstances that contribute to the need for home care can also lead to assisted living placement. Some people decide to move to assisted before they need it, and others wait until the last minute. Usually this is due to cost and a desire to remain at home.

Benefits of Assisted Living

For family members that are actively involved in caregiving, assisted living can relieve much of the stress involved. This is often because:

  • There is someone available 24 hours a day to provide assistance
  • Many assisted living communities have physician services that will come to your family member to provide healthcare on-site
  • Socialization opportunities and activities are plentiful

Cons of Assisted Living

Assisted living does have drawbacks as well. These include:

  • Price increases. Assisted living costs can soar when your family member needs more care. In most cases, the more care someone needs, the higher the cost assisted living rates go up every year regardless of care needs.
  • Lack of individual attention. Although aide service is available, the staff to resident ratio may not be adequate. There can be significant wait times to get assistance.
  • Lack of choice. You don’t get to choose your neighbors, when to eat dinner or whether or not you’re allowed to have a pet. Moving into assisted living is moving into a ready-made social community and often a one-size-fits-all model.

Tips for Comparing Costs

Comparing costs of home care with assisted living is complex. That is because costs for both are often dependent on where you live. Costs also depend on the number of hours you need home care. Conversely, assisted living pricings depend on the community and the level of care that is needed. At some point, the cost of home care may exceed what the highest level of assisted living would cost. You also have to take into account what your loved one values most when it comes to receiving support as they age. Speaking to a Care Advisor can help you determine how many hours of care you might need and which option is best for yourself or your loved one.

Tips for Having a Discussion with Your Loved One

Having a discussion with your loved one about care may be one of the most difficult and critical conversations you will ever have. Starting things off on the right foot and with the right attitude will save time and stress later. Keep the following in mind:

  • Ask what your family member wants. Amazingly, this question is often not ever asked. Fighting against what your loved one wants is a losing battle.
  • Show respect. You surely have your agenda and want to make your views known! Still, respect and acknowledge the views and concerns of your family member.
  • Work as a team. Collaboration is the hallmark of cooperation.
  • Be willing to compromise. You may not get everything you want, but staring with something is better than nothing. For example, you can start with a little bit of care each day with the idea of building upon that care later.

There is no one size fits all when it comes to deciding between home care and assisted living. Changing circumstances may dictate a flexible attitude. Remember, engaging your family member in the process is critical to everyone’s success and well-being.

About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of Choose Your Place: Rethinking Home as You Age (November 2020) and of Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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