There comes a time in most seniors’ lives when medical conditions, loneliness or an inability to care for oneself forces families to decide about where a senior should be living. While some families may decide that moving to a senior living facility is best, for others, staying at home as long as possible is preferable. Often that decision to remain at home can only happen with the assistance of a visiting aide or other caregiver providing 24-hour in-home care.
Senior home care can take a variety of forms, but generally speaking, it’s care provided to a senior in their 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 or 24/7 in-home care are also options that some families choose.
Is In-Home Care Better?
Consider in-home care in comparison to assisted living, where the senior moves from the family home into a new place. These locations typically offer dormitory-like rooms or private apartments. 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.
While many people presume that staying at home as long as possible is best, that’s not always the case. Each individual’s case needs to be evaluated independently, says Haidy Andrawes, center administrator at Park Vista Assisted Living in Fullerton, California. “The choice to move from in-home care into a senior living environment usually comes about when the individual’s care needs have increased or safety has become a concern.”
Safety is a key component of whether or not home care is a better option than assisted living, and installing grab bars and safety bars in the shower and other potentially hazardous locations throughout the residence to prevent falls is a major consideration. If the senior struggles to walk upstairs, installing a stair lift can be a helpful assistive device that enables them to remain in the home longer.
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 that 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 and chief nursing officer with Brookdale Senior Living, a Tennessee-based company that has more than 800 senior living and retirement communities across the United States.
However, “it may be more practical to move into a residential nursing home if the home cannot be safely modified for their physical needs, such as grab bars and steps. Additionally, the cost to own and maintain the person’s home — as well as the cost of potential 24/7 in-home care — may be financial barriers, making a residential nursing home more affordable,” explains Erica Bentley, vice president of solutions management at naviHealth, a post-acute care management and care transitions provider headquartered in Brentwood, Tennessee.
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,” Elliott 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. Change can be hard, particularly if someone’s level of cognition has begun to change, so remaining in a familiar environment for as long as possible is often preferable.
“When a person can no longer safely manage their home, personal care and medical condition or conditions, there’s a need for 24/7 care,” Bentley says. She adds that 24/7 in-home care is best suited for individuals who “can still participate in some or all of these activities but need consistent assistance to do so. This could be related to frailty, physical disabilities, memory care or behavioral health.”
Sometimes, “finances drive the decision to move,” Andrawes says. “From a financial perspective, it may be more advantageous to move into a community setting that provides multiple levels of care with skilled and licensed staff. Communities also have infection control protocols, vaccination status verification and testing requirements to follow, which are often less rigid with in-home care.”
Are 24/7 In-Home Care Costs Less Than Assisted Living?
There’s also the cost to consider. 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 in-home care. The calculus involved is highly situational and varies greatly from one senior to the next.
That said, there can be a significant financial difference between staying at home and moving into an assisted living facility. According to Genworth Financial’s 2021 Cost of Care Survey, the median monthly cost for an assisted living community is $4,500 — totaling $54,000 annually, up from $28,800 in 2004. And skilled nursing in a private room will set you back $9,034 per month, adding up to more than $108,400 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.
“Depending on care hours, with between 4 and 12 hours being typical, in-home care costs anywhere from $30 to $50 an hour in California,” Andrawes says. For 24/7 in-home care, “costs can range from $10,000 to $21,000 monthly.”
Bentley provides similar figures. “Round-the-clock or 24/7 care costs about $400 per day across the U.S. The cost varies by state, but you can expect to pay $12,000 to 16,000 per month. This will vary based on the types of care needed, such as personal care, supervision, memory care, safety or behavioral needs, housekeeping, grocery shopping or medical treatments. While this allows a person to remain in their home, the cost is higher than a residential nursing home.”
If you’re looking to cut costs, “reducing the number of necessary hours is the easiest way to do that,” Bentley says. “One common example is hiring an aide to assist during daytime hours while a family or friend provides evening and overnight care. The cost of 40 hours per week care is around $4,500 per month,” which is the same as the figures provided by Genworth.
In another scenario, “a family member or friend stays with the patient for daytime hours but the evening and overnight hours are hired out. This is the most affordable option as overnight rates tend to be lower,” Bentley says.
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, especially as care needs change. “Moving into a community can be more cost-effective in the long run,” Andrawes says.
Unfortunately, Medicare is not a payment option for this kind of at-home care, says Gregg Ratkovic, senior vice president and president of Medicare with eHealth, a health insurance broker and online resource provider headquartered in Santa Clara, California. This means most people have to pay out of pocket for this type of care. “However, depending on your circumstances, Medicare may cover things like part-time or intermittent skilled nursing care or home health aide services, physical or occupational therapy, speech-language pathology services, etc.”
Medicaid — the state-federal program that covers medical expenses for people with low incomes — does provide some financial assistance to people living in assisted living facilities who qualify for the program. However, the level and type of support varies widely depending on where you live. 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.
Bentley also warns to be careful when selecting in-home care. “You should avoid hiring individuals who are not employed by an agency. They will likely not carry the necessary insurance in the event that they or your family member is injured.”
How Long Can Home Care Last?
Knowing when it’s time to move from in-home care to a care facility isn’t a simple question. “People who require 24/7 care often have complex health conditions that will progress over time,” Bentley says. “Care in a nursing facility is a safe alternative, but it’s not inevitable. There are many at-home medical care options that are covered by insurance such as mobile urgent care, PCP visits, telehealth and physical therapy. Home palliative or hospice care is also an option when it becomes appropriate. All of this can help a person continue to live in their home and even avoid hospitalizations.”
That said, 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, it’s important to plan early and do your homework. 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.
Moving into assisted living shouldn’t be a hasty decision made under the pressure of an urgent care need. Being prepared ahead of time can offer families an opportunity to get excited about the possibilities that assisted living offers instead of dreading what’s to come.
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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Update 11/08/22: This story was previously published at an earlier date and has been updated with new information.