Martha Aron’s aging parents had spent many years living in Florida in the winters and Colorado in the summers. As they got older and it became more difficult to travel, they sold their home in Colorado and began to live full time in Florida.
Aron’s father was approaching his 100th birthday and her mother, who is nine years younger, was diagnosed with Alzheimer’s disease and experiencing other health issues, so it became increasingly obvious that they would need help either at home or at an assisted living community.
Fortunately, they were able to afford and had purchased long-term care insurance many years before, lessening the financial burden that would be faced no matter where they chose to age.
In the end, Aron’s parents chose to remain in their home and age in place, an arrangement that would require around-the-clock home care. At home, they would be together in familiar surroundings, but if they decided to move to an assisted living facility, Aron’s mother would likely be moved without her husband to the memory care wing.
When you’re deciding with loved ones whether to remain at home with care or to move into an assisted living facility, there are many things to consider.
“First, you’ll need to assess your finances to determine what you’re able to afford, then you’ll need to consider what your care needs are and lastly consider what services and amenities are important to you,” says Kristin Morris, vice president of RiverSpring Living in New York City.
[READ: Assisted Living Checklist.]
What Is Senior Home Care?
Like Aron’s parents, many seniors want to age in their own homes and maintain their daily routines, but they need help with activities of daily living — like cooking, transportation, grocery shopping, cleaning, dressing and bathing — and companionship to combat loneliness.
Seniors can hire people to provide in-home services that are geared toward their specific needs. Some may need care for only a few hours a day to supplement the care of family members and friends, while others may need round-the-clock assistance.
If minimal medical help is needed and you can afford it, one-on-one care tailored to seniors’ specific needs may be ideal. While in-home caregivers can be hired by family members and seniors, it’s still not always easy to find help that’s available, reliable and caring.
To age in place, the home needs to be set up to make it safer. For example, walk-in tubs may be needed, doorways may have to be widened, and non-slip floors may have to be installed.
“Sometimes being cared for at home is a luxury because in addition to hiring help, home maintenance costs, utilities and other costs still have to be paid,” says Michelle Clevenger, a geriatric social worker at Northwestern Medicine.
[Read: 11 Signs Your Aging Parent Needs Senior Care]
What Is Assisted Living?
Assisted living facilities are private communities for seniors who may be having trouble living on their own and want to be in an environment that provides personal care, meals, activities and services.
Life at assisted living facilities allows seniors to have their own apartments or rooms. Staff members are available to help, but because the staff is caring for many residents, there isn’t much one-on-one intensive care.
At some assisted living communities, residents live mostly independently, and at others more help with daily tasks like laundry, housekeeping, transportation and wellness is provided.
[READ: How to Pay for Senior Living]
Deciding Between Home Care and Assisted Living
It’s common for older adults to want to stay in their own home as they age. In fact, one study showed that a majority of adults ages 50 and older (75%) wish to remain in their current homes rather than moving to an assisted living facility.
However, several barriers, including rising housing costs and home health aide shortages, have made home care too expensive and in-demand for most people who may not have the financial means to afford this type of care.
“Unfortunately, care is expensive. Not everyone has the money to stay at home with help or to go to an assisted living facility. There are fewer options for people without financial means. These individuals often depend on Medicaid funding for help at home or for nursing home care,” says Sheila Barton, a geriatric social worker at Mount Sinai in New York.
Additionally, aging in place may not be the best option for everybody.
The following may be signs that an older person isn’t safe staying in their home:
— They wander at all hours.
— Family is far away and can’t help.
— The environment is unsafe.
— Nobody is available to oversee care.
Pros and Cons of Home Care
Benefits of home care
If you can age in your own home, there are benefits, some of which include the following:
— No relocation. Seniors can remain in a familiar and comfortable environment without the need to relocate.
— Independence. For independent seniors, home aides can offer company and nonmedical care.
— Personal hiring. Seniors and families can decide on which caregivers are hired.
— Individual care needs. Seniors and families can determine and monitor ongoing and changing health requirements with aides.
— One-on-one help. The focus is totally on your loved one, and personal care is available whenever there is a health aide on duty.
— Personal care around the clock. Aides help seniors shower, go to the bathroom, eat and move from place to place without having to wait their turn.
— Duties provided. Families and aides can decide what help is needed based on individual needs and lifestyle.
— Household duties. Most home care aides also are responsible for basic household duties and maintenance like light cleaning and seeing that meals are served. They may also be tasked with running errands, dressing and helping seniors get ready for bed.
— Termination of aides. Caregivers who aren’t working out can be cancelled quickly.
— Medical and ancillary care. Occupational therapists, social workers and home health nurses can also visit at home.
Drawbacks of home care
Most seniors are resistant to having home care and to going to live at an assisted living facility. Clevenger says she’s rarely encountered an older person who wants to make any kind of lifestyle change and who isn’t anxious about having new people come into their homes or about moving to a new place to live.
“Usually, when decisions have to be made, something bad has happened,” she notes.
Some of the drawbacks to home care include the following:
— Home modifications required. Home modifications, as mentioned above, often need to be made to make a home accessible to an older person aging there. These often include getting ramps where there are stairs and steps, putting grab bars in showers and redesigning bathrooms for added space and to prevent falls.
— Ongoing property maintenance. If older people remain in their homes, they need to continue to maintain the property, including yards.
— Social isolation. If an older person has difficulty leaving the house without help, they may not be able to maintain contact with friends and the community or do the things they once loved to do. This can cause feelings of loneliness, isolation, anxiety, depression and cognitive decline.
— Family friction. Family caregivers often become physically and mentally exhausted, especially if the care has fallen to one person. Strain between caregiver and an aging loved one can result.
— Caregiver burnout and stress. Whether it’s a family member or a hired caregiver, feelings of being overwhelmed, anxious, depressed and angry toward the person for whom care is being given can take hold.
Pros and Cons of Assisted Living
Benefits of assisted living
Because not all assisted living facilities offer the same services, careful research should be conducted before your family member goes to one.
Some benefits include the following:
— Community. Assisted living facilities are made up of a community of residents and staff. If you feel like being with other people, you can, and if you don’t, you can stay in your living quarters.
— Around-the-clock staff. There is staff on duty in an assisted living community day and night. There are aides, and many also have nurses on-site.
— Flexibility. An assisted living facility can provide short- or long-term care. Some allow older people to have a trial period living at a facility, and the living arrangement can be terminated with notice.
— Services. Some assisted living facilities provide personal care and meals, snacks, recreational facilities, theaters, gyms and more all in one location. Be sure to ask which services cost extra, because often extra services like hairdressers and activities require additional fees.
— Family relations. Often, when family members don’t have to worry about hiring aides or scheduling and managing caregivers, time spent with an aging relative becomes more enjoyable. Instead of focusing on caregiving responsibilities, family members can focus on their relationships.
— Continuous care and agreement with nursing homes. Some assisted living facilities are part of continuing care retirement communities, and residents can transition to other levels of care as they age. Others have arrangements with nursing homes when residents require more care.
Drawbacks of assisted living
When you’re researching assisted living facilities, you’ll find various kinds of residences. You should speak with people familiar with this kind of living, take a tour and make visits, and talk with others who have either lived in them or had family members who have lived in them.
Some of the things to be aware of are the following:
— Leaving home. Many older people don’t want to leave the homes they’ve lived in. They may feel uncomfortable in a new environment and need time to adjust.
— Possible staffing shortages. Some assisted living facilities don’t do what they say they’ll do because the facility is short-staffed. For example, you may be told that your loved one will be showered every day and then find out that they’re not getting showers. You’ll want to make sure that what you are being sold is what you’ll be getting.
— Maxing out. An older person can outgrow the services offered by an assisted living facility and need more care. There’s a chance that if that happens and more help is needed, you won’t be able to stay and will have to look for another living situation. Sometimes you can add on to care and pay additional fees, and in some cases, facilities will transition you to a higher intensity living situation.
— Increasing fees. Sometimes, as older people who are living in an assisted living facility become more frail, extra services can be provided, but this will cost more.
— Exposure to contagious diseases. When living in a community environment, the risk of catching contagious diseases is higher, as you are exposed to more people.
Home Care vs. Assisted Living Costs
Home care costs
The costs of in-home care depend on where you live and whether you’re hiring directly or through an agency. The national hourly average rate for homemaker services is about $33, according to Genworth and CareScout’s Cost of Care survey. For a home health aide, the average national cost is about $34.
Medicare will pay for up to five days of four hours for home health aide services in conjunction with skilled services offered by a certified home health agency. These are short-term services that end when the skilled services end.
If ongoing custodial care is needed and you have limited income, Medicaid may pay, but it will pay for only a certain number of hours and certain services. As a state-run program, Medicaid payment varies depending upon where you live.
“Many people work with elder law specialists to qualify for Medicaid,” Barton says.
Hourly rates, however, cost between $200 to $500 an hour, depending upon the complexity of the situation.
Assisted living costs
The cost to live in an assisted living facility also varies depending on location and the amount of care needed. The average median cost of assisted living, Genworth and CareScout note, is $5,900. Some of the high-end, luxury assisted living facilities can cost anywhere from more than $10,000 a month to more than $28,000 a month.
When consulting with assisted living facilities, it’s important to understand that often anything other than basic room and board will incur significant extra charges. Assisted living communities are generally paid for privately or with long-term care insurance.
It’s important to note that Medicare does not pay for assisted living. If you can’t afford either home care or assisted living, you may be able to apply for Medicaid, which will pay for some home and community-based services.
Bottom Line
In the United States, unfortunately, good home care and assisted living costs are not considered a human right but a luxury and are extremely expensive.
Some planning in advance can help to make some of it affordable, and you may want to consult a financial planner.
For those who can afford it, the choice between aging at home or in an assisted living facility will depend on who is around to help and what an older person’s specific needs are. It’s a very personal family choice, as there are pros and cons to each kind of living situation.
“When trying to make a decision, it’s important to consider the average costs over the next five years, since fees are likely to rise and your care needs may become more complex as you age and therefore more expensive,” Morris says.
Explore Top-Rated Assisted Living Communities With U.S. News
If an assisted living community is the right choice, find a top-rated one near you with U.S. News’ Best Assisted Living Communities. Nearly 450,000 survey responses from residents and their family members evaluating over 3,800 senior living communities highlight communities that have excelled in delivering high-quality services and ensuring all residents are cared for and safe.
More from U.S. News
7 Signs It’s Time to Move to a Senior Living Facility
A Guide to Senior Apartments and Where to Find Them
Assisted Living vs. Home Care: What’s the Difference? originally appeared on usnews.com
Update 08/26/25: This story was previously published at an earlier date and has been updated with new information.
