It’s a common scenario. Mom or Dad has a fall, forgets to eat, mixes up their medications or leaves the stove on. As these incidents happen more frequently, it becomes clear that it’s time to get some help. How do you decide whether assisted living or home care is the right choice?
What Is Senior Home Care?
Home care involves a wide array of services provided in a person’s home. Most commonly, it refers to a home care aide who provides support with activities of daily living, such as bathing and dressing, preparing meals, doing laundry and cleaning, for example. Home care aides may offer socialization and companionship, and they can help around the house with tasks such as walking the dog or doing laundry. This type of home care is referred to as personal care.
Another option is skilled home care. This may involve physical therapy and other services, such as wound care for pressure ulcers and support with injections and catheters or complex medication management.
The basic goals of home care are to keep residents safe and comfortable in their homes, enable them to be as self-sufficient as possible while slowing mental and physical decline. Aides also may prevent avoidable ER visits and hospitalizations by recognizing signs of a new illness or exacerbation of an existing one. For instance, they may be helping someone up from a chair and notice that they’re wincing in pain. Or, the caregiver might uncover that the person had a fall. The caregiver can then work with the family and the person’s physician to address the reasons behind the fall and put a fall prevention program in place.
There are likely to be dozens of home care agencies in your area where you can find qualified aides. They work much like a temp agency where you contract with the caregiver through the organization, which handles payments and logistics. Your local Area Agency on Aging can offer some recommendations on home care organizations. Find yours through the federal Eldercare Locator at 800-677-1116.
Benefits of Senior Home Care
For many seniors, staying in their own homes is the biggest benefit of home care, offering comfort in familiar surroundings. With one-on-one care from home health aide, home care ensures personalized attention, as the aide is dedicated solely to the individual during each shift.
“Home care can potentially be cheaper than facility-based care if your loved one is reasonably well,” says Aaron Blight, a former home care company owner and founder of Caregiving Kinetics.
Fees for in-home care are usually based on an hourly rate, meaning the total expense depends on how many hours of care are needed. While fewer hours make home care substantially cheaper than facility care, costs increase as service hours rise.
“Eventually, home care may surpass the cost of assisted living,” Blight adds. “However, the personalized nature of one-on-one care remains a key factor for many families when choosing between the two options.”
Home care also provides other benefits:
— Companionship and interaction with others that helps prevent loneliness and isolation
— Support needed to safely maintain independence and quality of life for as long as possible
— Reduced risk of accidents such as falls or medication mismanagement
— Peace of mind for family members knowing the family member’s needs are being met
— Emotional well-being from staying in the comfort of home
[READ: When Is It Time to Move From Independent to Assisted Living?]
What Is Assisted Living?
Another option for someone who needs help with activities of daily living but does not necessarily need 24/7 care, is assisted living. These communities offer a variety of amenities and services that enable residents to enjoy independence, privacy, companionship and safety. Assisted living facilities may be luxury, hotel-like settings with a variety of dining options, fitness centers, pools and more. Or they may be a small building with a few residents in rooms or apartments, a common area and a dining room.
“Assisted living facilities are for residents who need some amount of help in activities of daily living,” Blight says. “Residents here function as independently as possible, but they rely on staff to assist with things that they cannot do on their own.”
Unlike skilled nursing homes, assisted living communities are not federally regulated, and state rules and regulations vary significantly. As a result, costs, amenities and services can differ from state to state and community to community.
Benefits of Assisted Living
Assisted living offers numerous benefits to those who can live independently but may require some help with daily living or straightforward health needs. Assisted living facilities typically offer these key services:
— Housekeeping and laundry
— Meals and nutrition
— Medication management
— Assistance with moving and getting around
— Help with personal hygiene, such as bathing, grooming, dressing and toileting
— Shopping
— Social and recreational activities
— Transportation for shopping, medical appointments, faith services and general errands
[READ Senior Home Care: Services, Costs and Tips for Aging in Place]
How to Make the Decision: Comparing Assisted Living and Home Care
Deciding between home care and assisted living can be challenging, and it requires weighing several critical factors:
Personal and health needs
Make an honest assessment of you or your loved one’s health care status, prognosis and needs.
“A big issue is the need for medication management and administration,” says Dr. Timothy Holahan, assistant professor of medicine at the University of Rochester Medical Center and geriatrician and medical director in New York. “If the only necessary support is having someone organize pills for the week and/or reminding or helping the person to take their medications at the right time, home care might be adequate.”
However, he notes that if someone is having problems, such as continually taking medicines incorrectly, missing doses or not getting prescriptions filled, the home may no longer be safe for them.
Assisted living services
Most assisted living facilities offer a wide range of services and amenities that are tailored to the individual, depending on their budget and need level. Before you move in, the facility will do a thorough assessment, taking into account your health and the services you need.
Besides assisting with the activities of daily living, providing meals, doing laundry, handling housekeeping and assisting with medication management, assisted living facilities provide a safe living environment with staff available 24/7 in case of emergencies.
Most facilities also provide extra services and amenities, catering not just to the physical needs of the resident but also to their social and emotional needs. The sky is the limit in terms of what can be offered, but more common on-site offerings include:
— Clubs and activities
— Concierge services
— Hair salons and barber shops
— Pet care
— Spiritual or religious services
— Transportation to appointments
Making a list of your needs and your wants when you first start looking at facilities can help you narrow down your choices faster.
Home care services
Home care services for seniors vary depending on the level of care needed and may include:
— Home health aide. A home health aide typically provides companionship and helps with activities such as bathing, dressing and eating. Many also help around the house doing tasks such as light housekeeping, laundry and meal prep.
— Skilled home care. This refers to care provided in a patient’s home by licensed healthcare professionals, such as nurses or therapists, for individuals who need specialized care such as wound care, chronic condition management or speech therapy.
Financial resources
It’s important to consider what is affordable now and in the future. This means making a detailed assessment of your finances and future earnings.
“The truth is that many people will need progressively more care, and this should be considered in weighing costs,” says Dr. Sarah Howd, a geriatric medicine specialist in Rochester, New York. She notes that even if the person and their family can afford it, 24/7 home care may not be the best solution.
“I’ve seen people who have had 24/7 care at home who don’t do well when they enter a facility because they are used to that level of attention. Suddenly not having it can be a very difficult adjustment,” Howd explains.
To help decide between home care or assisted living, you’ll need to consider how much care is necessary, how much support you’ll get from friends and families and which services and support may be necessary in the future. Factoring in all these issues, as well as what will be covered by Medicare and other insurance, will help determine the best, most personalized path.
Home care costs
If you need to pay out-of-pocket for home care, it can be costly. According to Consumer Affairs, the median cost is about $24 per hour.
“This can be affordable if you need an aide for only a few hours a day or a few days a week,” says Jesse Slome, executive director of the American Association for Long Term Care Insurance in Westlake Village, California. However, he notes that if you or your loved one need 24/7 care, it can add up to $200,000 or more over the course of a year.
Medicare Part A pays for some home health services. The emphasis here is on “health.”
The coverage is limited to skilled medical care, such as physical, occupational and/or speech-language therapy; injectable osteoporosis drugs; and durable medical equipment, such as commode chairs, wheelchairs and oxygen equipment. Part-time or occasional home health aide care may be covered, but only if you are also getting skilled nursing care. You must also be under a doctor’s care, the services you receive must be part of a physician-created and -monitored care plan and the home health agency you use must be Medicare-certified.
Note that Medicare won’t pay for the most common items people want home care for, such as 24/7 care, meal delivery, homemaker services and help with activities of daily living.
The good news is that most, or even all, qualified skilled home health services are covered, and after you meet the deductible, which in 2024 is $240, you’ll pay 20% of the Medicare-approved amount for medical equipment. Before you engage a home health agency and start receiving services, however, ask how much Medicare will pay, which services or items are ineligible for coverage and what the out-of-pocket cost to you will be.
Medicaid coverage for home care varies from state to state, but in some areas, it covers personal care assistance including bathing, dressing and meal preparation. It’s important to find out what coverage is available in your state as you are making your care decisions. For information on how to contact your local or state Medicaid office, call 877-267-2323.
There are also other payment options for in-home help. For instance, veterans with moderate or severe needs may be eligible for a monthly stipend directed toward primary family caregivers. See the VA website for more information.
In-home support may also be available from some social services organizations in your area. For instance, Meals-on-Wheels and other programs bring meals for older adults to their homes. These organizations can also provide some companionship. Contact your Area Agency on Aging for resources.
Assisted living costs
Most assisted living is private pay, which means you have to pay for care out of pocket. Contrary to popular belief, Medicare doesn’t cover most assisted living costs. As with home care, Medicare will pay for some medical services, such as physical therapy or injections provided on-site, but it won’t pay for custodial care, such as help with activities of daily living.
Medicaid may pay for some assisted living in some states. However, even in those instances, you have to spend down your assets before it kicks in. This means that you have to use up your money, including savings, pensions and other assets, before coverage starts.
Medicare Advantage, which is offered through private insurers, may help cover some custodial care costs, but you’ll need to check with specific plans to see what they cover and how this might help if you enter an assisted living community.
According to Genworth Financial’s 2023 Cost of Care Survey, the annual median cost for a one-bedroom at an assisted living facility was $64,200. This generally covers the cost of room or apartment rent, meals and a limited number of amenities. Add-on services such as medications, housekeeping, hair salon services or transportation to doctors’ offices usually cost extra.
As with home care, there are other potential sources of financing for assisted living. These include long-term care insurance, which can help pay for services such as physical therapy, rehab and assistance with activities of daily living in an assisted living facility. However, it is important to note that this insurance won’t pay for everything. For instance, it won’t cover the monthly rent or room and board fees.
Veterans, as well as spouses or widows/widowers of veterans, may benefit from Veterans Aid & Attendance benefits and Housebound allowance. Such veterans’ benefits can range from about $1,000 to over $2,000 per month.
Family and community resources
It’s important to be realistic about how much family and community support someone will have if they stay in their home.
“You are looking at four to five hours a day during the week for things like meals, laundry and cleaning,” Holahan says. “This is doable if you can supplement that with the help of family and friends in the evenings and on weekends. If you don’t have this support, you may want to consider assisted living.”
Slome stresses the importance of not making assumptions about what caregiving help family and friends will be able and willing to provide.
“Someone may think their daughter, brother or friend will be able to bring them meals and come on the weekends to clean house, walk the dog and make some meals. However, they may not realize that these individuals have other obligations and commitments,” he observes.
He also notes that family and friends feel more comfortable with a loved one in assisted living where the person is safe and they can just visit and spend quality time together.
Socialization is another issue to consider here.
“If you have someone who lives at home and is more functionally impaired and isolated, it is important to consider how and when they will get visitors and social support,” Holahan explains.
This can be especially challenging if the person is single, lives alone and has few or no friends or family living nearby.
“Consider if your loved one might benefit from an environment where they can socialize and engage in activities. Sometimes, people actually will improve cognitively when they are in such a setting,” Holahan says.
One compromise, Holahan suggests, might be an adult day care program. These are community-based programs where people can go for socialization, activities, meals and/or snacks during the day. He notes that these programs are best for individuals who are still cognitively intact and physically more mobile.
Personal preferences
“Most people want to stay in their home, but there may come a time when that isn’t possible. When this happens, there are some things to do that can make it easier,” Slome says.
For instance, look for an assisted living community close to friends and family, and bring in furniture, décor and personal items to make it feel like home. For pet owners, it will be important to find a pet-friendly community where they can bring their dog or cat. If someone loves gardening, seek a unit with a little yard or patio where they can have some plants.
[READ: Assisted Living Communities: Types of Rooms]
How to Find the Best Assisted Living Facilities Near You
Prior to making any decisions, Howd suggests asking, “What is going on to make you concerned? What are you noticing to suggest you or someone else needs support? If all someone needs is some support with meals and cleaning, home care may be fine,” she says.
If the issues are more complicated and the person needs more physical help with grooming, hygiene and mobility, assisted living may be a better option to keep the person safe and comfortable and prevent or delay decline.
Before you commit to any assisted living community or home care agency, do some research: What do online reviews say? What do current residents say? What are the costs, and what do they cover? Which additional or add-on costs might you reasonably incur? Follow this checklist provided by US News.
“Talk to staff and residents,” Holahan adds. “Have a list of questions to ask, including what would happen if you run out of money. I also encourage families to ask about the financial, medical and functional thresholds that may cause their family member to be unable to live there anymore. What supports, options or assistance might be available?”
“Consider assisted living that is part of a continuing care retirement community (CCRC), which has various levels of care on one campus,” says Steve Salaman, Chicago area director for Brookdale Senior Living, a CCRC with facilities nationwide. “A CCRC may make it easier if someone has to move to skilled nursing care.”
Explore Top-Rated Assisted Living Facilities with U.S. News
Begin your search for the best assisted living facility for your loved one with U.S. News’ Best Assisted Living Communities 2024. These rankings are based on data gathered from nearly 400,000 resident and family survey responses, covering over 3,500 senior living communities across the United States.
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Assisted Living vs. Home Care: What’s the Difference? originally appeared on usnews.com
