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Vs. Home Care
Should I Move to Assisted Living or Stay Home?

Making the choice to move into an assisted living community or to remain at home using home care services is not necessarily cut and dry. Unfortunately, there is no specific guide to use when deciding. However, there are a number of tell-tale signs to indicate a change of environment is best for a loved one. The signs are: an inability to maintain upkeep, assistance with meals, medication management, loneliness, and other issues.

This brief overview isn't intended to answer every question you'll have about making the right decision when choosing home care over moving to an assisted living community but, it can help you get started.

Instead, it provides you with a more in-depth understanding of the care options available and how home care or assisted living can have a dramatic, positive impact on you and your entire family.

6 Ways to Evaluate Senior Living Options

Assisted Living or Home Care?
Assisted Living or Home Care?

What to look at when evaluating your best living option. This quick checklist is a great place to start when evaluating assisted living and home care options. Consider the following seriously:

  1. Current Location - If you are living independently at home, remember as you age the circumstances will change. Here are a few things to consider in terms of accessibility to the current living situation: How far is it from medical facilities, mass transit--if you can no longer drive, shopping, entertainment, and other services? Can the home be modified? Are you living in one story home or will you need help climbing to the second floor? Is the yard large and in need of regular maintenance?
  2. The Level of Care Needed - If the person has a chronic medical condition that will worsen over time, the first thing is to think about is how they intend to handle health issues and mobility problems. What are the common complications of the chronic condition? Is the person at a point where they need help now and how often?
  3. Obtain a professional care assessment - A Geriatric care manager can provide a home care assessment as well as assistance with managing your situation, including crisis management, interviewing in-home help, or assisting with placement in an assisted living facility.
  4. Care Support - As you age, you will need help and assistance whether it's at home or in an assisted living community. Is the family willing to help out when you need care? If they are unable to help you out full-time, can they fill in the gap if medical needs become risky? Look at the current healthcare needs as well as the future ones too, especially if you are living with a chronic illness.
  5. Social Life and Entertainment - From where you live now, how easy is it to visit family, friends, and neighbors? What about your hobbies? It's important to remain engaged socially and maintain physical fitness. Ask yourself: If it becomes difficult to leave the home, how will you get around?
  6. Funds - Anticipated the expenses and create a monthly budget. Assisted living is costly but so are extensive home care services. Have you purchased long-term care insurance? If so, understand what it provides and does not provide. If not, check into purchasing a policy now to help offset costs. But before you sign the dotted line, remember LTC policies vary greatly. So, know what you are signing up for. Consider asking a licensed geriatric care manager to assist you.

Definitions of Assisted Living and Home Care

Define Care Options
Define Care Options

Assisted Living offers housing, personalized services, and healthcare designed to meet the needs-both scheduled and unscheduled-of those who need help with the activities of daily living like bathing, eating, toileting, medication reminders, mobility, emergency call systems, transportation and more.

Home Care offers non-medical services that help a senior live comfortably and safely at home. Services include meal preparation, medication reminders, companionship, bathing assistance, transportation, dementia care, transferring and more in which caregivers provide the needed support.

Assessing Assisted Living and Home Care Options

Whether you or a loved one is independent and wants to enjoy life surrounded by friends and peers or needs some personal help because they can no longer depend on self totally for care, an assisted living community or home care might be the right choice for their preferred lifestyle.

When researching and deciding which senior housing option is best, whether that housing is at home or in an assisted living community, make sure it covers your required level of care and that you understand exactly what both offer and the costs involved.

Assisted living

Often times, assisted living goes by other terms like residential care, retirement home, congregate care, adult care home, or adult group home. It serves adults needing help with some activities of daily living, including minor help with medications. The costs will vary according to the level of daily help required, the services you choose to join in, the size of the apartment, the number meals you want, and how often you need assistance, although staff is available 24 hours a day.

Determine how much space you will need in the new home. For example, some assisted living facilities provide apartment-style homes with scaled-down kitchens while others provide just bedrooms. Do you want to share a room are prefer your privacy? The assisted living community offer one or more group dining areas and common areas for social and recreational activities.

It's a good choice if: You don't need the round-the-clock medical care and supervision of a nursing home but you need more personal care services than are feasible at home.

What to look for in the community?

  • Do you like the location?
  • Is the outward appearance of the community attractive and homelike?
  • Is the lobby warm, welcoming and homelike?
  • Were you greeted warmly when you visited?
  • Is there good social interaction between residents?
  • Do the residents appear happy and comfortable?
  • Are you able to talk with residents about their perception of the community?
  • Do you think your loved one will feel comfortable with this group of individuals?
  • Is the staff friendly?
  • Does the community seem well designed for seniors?
  • Do the doorways, hallways, and rooms easily accommodate wheelchairs?
  • Are there adequate elevators?
  • Are handrails available?
  • Are storage areas in the rooms (closets, cupboards, shelves) easy to access?
  • Is the community well-lit?
  • Is the residence clean?
  • Are there any strong, unpleasant odors?
  • Is the temperature at a comfortable setting?
  • Are residents allowed to bring in their own furnishings?
  • Are residents allowed to bring pets?

Meals

  • Is the food appealing and appetizing?
  • Do residents have input regarding the menu?
  • Are residents allowed to keep food in their homes?
  • Are snacks available?
  • Services
  • What laundry services are available?
  • Do residents have washers and dryers in their apartment?
  • Is there housekeeping service?
  • Are transportation services available?
  • Are there grooming services on site (beauty/barber shop)?
  • Is there access to religious services?
  • Do residents have access to shopping?
  • What kind of telephone service is available?
  • Is there an on-site pharmacy?
  • What entertainment services are available?

Care Services

  • Is 24-hour "activities of daily living" provided?
  • Will you receive a written care plan?
  • Does the community assess the residents' service needs?
  • How often are care plans reviewed?
  • What are the terms for termination of care?
  • What services are available if needs change?
  • How is payment for additional services handled?

Benefits

The senior receives:

  • Two to three meals a day
  • Assistance with eating, bathing, dressing, going to the bathroom, and walking.
  • Housekeeping services.
  • Transportation - access to health and medical services.
  • Around-the-clock security. Emergency call systems in each resident's living space.
  • Exercise and wellness programs.
  • Medication management.
  • Laundry services.
  • Social and recreational activities, and the staff available to help with needs.

At an assisted living community, new friends surround you, a supportive staff and your family, who are welcome to visit anytime. The community may have services to help with an older adult's needs; physically, mentally and socially. Prepare well for this major decision. Most adults over 65 and 70 years of age need some type of care services. It's important to ask.

Home Care

There are many types of home care services.

  • Non-medical Home Care Agency
  • Medicare-certified Home health Care Agency
  • Referral agency
  • Privately hired caregiver or a family member

Hiring a caregiver is a good option for most families however; it is important to understand the risks and benefits associated with each of the different home care service options so that you can make an informed decision when hiring help.

Home Care Options and What Differentiates Them

Private Hire - Hourly costs are lower - The family or senior is the employer and must follow local employment laws, including paying unemployment wages to the caregivers, if dismissed. The private hire caregiver is not bonded and insured. If the caregiver cannot come to work one day for any reason, the senior will be left alone unless you have a backup plan. You provide all the management like scheduling, payroll including taxes, workers comp insurance in case the caregiver gets injured on the job.

Private caregivers may not follow the same professional standards as caregivers from home care agencies. There is a risk of abuse of privileges and taking advantage of the senior.

Home Care Agency - liability falls on the agency and they are the sole employer. The home care agency manages the schedule and back-up care, payroll and taxes, workers compensation insurance and liability. The agency will hire and train the caregivers and match with the senior. Home care agencies are typically up-to-date on trends in health and wellness.

Home care agencies cost more than private hire caregivers.

Family Caregiver - Knows the senior best and provides the highest level or familiarity. Caregiving for a senior at home comes with additional responsibilities like caring for children, social and career duties--creating time pressure. The burn out rate is very high: Stress-related physical and emotional impacts like back pain, decline in health and depression. Family caregivers lack the needed training and experience which prevents the senior from receiving the best care.

Home care is an alternative to an assisted living facility. Depending on the assisted living facility, seniors are sometimes charged with upfront fees and monthly ongoing fees ranging from $2500 to $9000 per month (depending upon the facility). Home care provides a personalized solution in the home, allowing the senior to remain in familiar surroundings. Caregivers provide one-on-one lifestyle support, personal care and companionship on a flexible bases.

Benefits

It's delivered at home and offers a private place for families to gather and celebrate birthdays and holidays. Home care helps the elderly maintain their independence in a place most familiar to them. It prevents institutionalization--a place many want to avoid unless they need 24-hour care. Evidence shows that patients heal more quickly at home too.

Home care tailors the needs to each individual. Family members participate in the care too. Often times, it reduces stress for the older adult. Home care is the only way to reach some people. In many of the rural parts or dense urban areas, home care is the only form of health care available.

Home care is the most efficient form of health care. It uses the senior's own home, instructs the patient, enlists the patient's family as caregivers, cuts down on expensive travel to hospitals, and minimizes expenses.

Technology increasingly makes home care to diagnose, monitor and treat illness at a distance.

Whether you choose to remain at home or decide to move to an assisted living facility, it's important to know that the sooner you assess the current needs and how they may evolve over time, the more choices and control you'll have. By learning about the options available, you can make the choice that's right for you and ensure you enjoy a happy, healthy and fulfilling home environment as you age.

Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.