There comes a time in most seniors’ lives when medical conditions, loneliness or an inability to care for oneself force families to make a decision about where a senior should be living. Often a decision needs to be made between staying at home with the assistance of a visiting aide or other caregiver or moving to an assisted living facility. Each decision is an intensely personal one, and families must consider many factors when trying to make the right decision.
Senior home care can take a variety of forms, but generally speaking, it’s care provided to a senior in his or her own home. Typically, services include assistance with activities of daily living, such as bathing, dressing, toileting and household tasks such as cooking, cleaning and running errands. Many families hire an agency that sends a caregiver to the home for several hours each day or a few times a week, depending on the senior’s needs. A live-in caregiver is another option that some families choose.
Assisted living is like senior home care in that it usually covers activities of daily living, but the senior moves from the family home into a new place. These locations may be like a dormitory or private apartments and some are situated in sprawling or very swanky campuses that can cater to a wide variety of needs and preferences. Assisted living facilities typically have staff on site round-the-clock to assist in the event of an emergency and help keep seniors safe. Most offer meals, either in room or in a communal dining hall, and these communities tend to offer activities and social events for residents.
Which Option Is Right?
“It’s not that one option is always better than another,” says Eleonora Tornatore-Mikesh, chief experience and memory care officer at Insp?r, a new senior living community in Manhattan. “It all depends on the situation.” And each family will have to consider its options and do its own homework to determine what’s right.
Both senior home care and assisted living have their pros and cons. In deciding which is the best option, you’ll need to consider carefully your loved one’s needs and preferences and weigh those against your financial resources and safety concerns.
Anna-Gene O’Neal, division vice president of Brookdale Health Services Hospice, which provides home health, hospice and private duty home care services, agrees that there’s no one-size-fits-all answer to this question. “Staying at home, which many think would always be preferable, must be evaluated on a person-by-person basis, based on both physical as well as social elements.” These factors include, but are not limited to:
— Access to care as needed.
— Ability to manage bathing, dressing, medications and food access and preparation.
— Connections to other people and basic socialization.
Safety is a key component of whether or not home care is a better option than assisted living, says Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company. If a senior is planning to remain in the home, Varano recommends installing “grab bars and safety bars” in the shower and other potentially hazardous locations throughout the residence to prevent falls. “If they can’t walk upstairs, a stair lift can be a helpful assistive device.” Similarly, if cognitive problems such as dementia or Alzheimer’s disease are beginning to surface, installing extra locks or latches that make wandering out of the house and potentially into danger more difficult can be helpful adaptations, which make staying in the home safer.
If these needs can be met, then “staying in one’s home is always desirable,” says Kim Elliott, senior vice president of clinical services with Brookdale Senior Living, a Tennessee-based company that has more than 800 senior living and retirement communities across the United States. Moving to an assisted living community might not need to be a consideration until such time as the senior’s safety or socialization situation changes. “The goal of assisted living is to enhance the individual’s life,” she notes, so trying to stay home can be a worthwhile aim until quality of life begins to suffer.
In some ways, aging in place at home offers a lot of benefits. “Staying at home means there are no adjustments necessary. It provides a person with the feeling of independence. Care comes to you,” Elliott says. There’s also a “level of independence and comfort of familiar surroundings,” O’Neil adds. Change can be hard, particularly if someone’s level of cognition has begun to change.
The Importance of Socialization
On the flip side, “there’s a potential for isolation and loneliness” when staying at home, Elliott says. “A person, or their family, will still have responsibilities,” such as cooking, shopping and maintaining the home, which can entail paying bills, doing yard work and so on. “Also, care is not always available at the exact time of need. In an assisted living community care is available 24/7.”
That hands-on, 24-hour access to care and support is one major advantage an assisted living community typically has over home care, Tornatore-Mikesh says. “In home care, you don’t have access to that 360-degree view of care and socializing. There’s not a lot of programs viable outside of one-on-one activities in the home setting.”
The socialization factor is a major one and shouldn’t necessarily be overshadowed by other factors, Tornatore-Mikesh says. “If you’re around like-minded people and you’re socializing with others in a book club or a golf club or whatever your interest is, that plays a role in living a healthier, longer life with fewer ailments. There’s substantial research from the NIH that shows that socialization is important for health. And it can be very hard to create adequate socialization opportunities at home.”
That contact with others can also inform improved medical care, she says. “The care team in an assisted living community can take a coordinated approach and collaborate to come up with the best comprehensive plan. The coordination of care in a setting like Insp?r includes dietary concerns and working with your physician, a psychologist, social workers, music therapists and others. All of those services are rarely available in a home care setting.” If such services are available, they’re usually only a one-time or short-lived involvement at home, but in a community, the contact and care is ongoing and can be easily adjusted as needs change.
Paying for Senior Care
Figuring out how to pay for senior care can be a major issue for many families. Retirement savings, the sale of the family home, private health insurance, veteran’s benefits and long-term care insurance are all potential sources of funding to pay for this type of care. The calculus involved is highly situational and varies greatly from one senior to the next.
It’s important to note that there can be a significant financial difference between staying at home and moving into an assisted living facility. A 2018 survey conducted by Genworth Financial found that the median monthly cost for an assisted living community is $4,000 — totaling $48,000 annually. By comparison, long-term care by a home health aide tops $4,195 monthly or more than $50,300 annually. And skilled nursing in a private room will set you back $8,365 per month, adding up to more than $100,000 per year. Prices can vary a lot depending on where in the country the community is located and which services a senior is using.
On the other hand, hiring a visiting home care aide or live-in care can also get expensive. Although millions of family members provide unpaid care to older relatives around the country every day, when we’re talking about professional caregivers, fees can range widely. Hourly rates may tend to fall between $15 and $25 per hour or $150 to $300 per day, depending on how the care contract is structured, the state you live in and what kind of services are being provided. Bottom line: Home-care options can end up being just as expensive or more so than moving to an assisted living facility depending on a range of factors, and it’s important to do your due diligence to determine what you’ll have the financial reserves to pay for.
“In addition to important decisions about where a loved one will receive the best care, it’s important to consider the costs associated with that care and to understand what insurance — most likely Medicare — will and will not cover,” says Andrew Shea, vice president of eHealth, Inc.’s Medicare sector. eHealth is a private, online health insurance exchange based in Santa Clara, California. “Medicare does not cover the cost of or help to pay for assisted living arrangements.” This means that people generally must pay either out-of-pocket or with the help of long-term care insurance, he says.
Medicaid will cover some costs. “In most states, Medicaid — the state-federal program that covers medical expenses for people with low incomes — will provide some financial assistance to people living in assisted living facilities who qualify for the program,” Shea explains. “The level and type of support varies widely depending on the state you live in.” You’ll have to do your own research to figure out whether assisted living will be cheaper than living at home and how you’ll pay for that.
How Long Can Home Care Last?
As needs change, a senior’s ability to continue living at home may change too. For many people that means there will come a time when they must move into an assisted living community or nursing home setting. Knowing when is the right time to move can be a tricky question that’s “different for everyone,” Elliott says. “Assisted living should be considered when the safety of an older person becomes a factor.” For example, “if they are susceptible to a fall, taking the wrong medications, experiencing weight loss from unhealthy eating or the inability to cook or developing cognitive deficits,” then it might be time to start thinking about moving into an assisted living community.
Mental health issues, such as feelings of isolation, loneliness and depression, may also prompt a move. “Loneliness has the same impact on mortality as smoking 15 cigarettes per day,” Elliott says. Indeed, a 2018 survey from the health insurer Cigna noted that roughly half of all Americans feel lonely, but “88% of those who have daily in-person interactions say their overall health and mental health are good or excellent.”
In other cases, when a senior develops multiple chronic medical conditions that require frequent doctor’s appointments to manage, “it may be time to move into assisted living to make care more accessible,” Elliott says. The simple logistics of having access to health care on site can cut out a lot of back and forth to doctor’s offices.
Moving a loved one into assisted living can be a difficult decision and challenging transition. “We have many sons and daughters who feel guilty about moving a parent into assisted living, but later come back and tell us it was the best thing for their mom or dad,” Elliott says. “Adult children often have more trouble with the transition than the parent. Assisted living can bring a new lease on life with an active setting, new friends and new hobbies.” And because services in assisted living are available at all times, “you have peace of mind that someone is always there to assist when needed.”
In all things related to senior care, Varano says it’s important to “plan early and do your due diligence. This will decrease feelings of guilt and stress. Moving into assisted living is a new chapter in someone’s life.” Being prepared ahead of time “offers an opportunity to get excited about it instead of dreading it,” she says.
Knowing that their own wishes have been heard and honored as much as possible will also make a world of difference in how a senior feels about a move to a new home — if and when the time comes.
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