How to Decide Between Assisted Living or Home Care

The following article was written by Lauren Zimmerman, CEO at AEC Living, a group of independently operated senior living communities and a Medicare-approved rehabilitation agency designed to serve the needs of seniors in the East Bay.

Elderly or otherwise disabled Alameda residents that reach the point where they require supervisory care, housekeeping and prepared meals essentially have two options at their disposal. They can move into an assisted living facility or they can remain at home and hire a home care specialist (or enlist a family member) to take care of them. To help make a better-informed decision, it’s helpful to look at the pros and cons to each approach.

Assisted Living

For those unfamiliar with the term, assisted living for elderly or disabled people provides housing, care, nursing oversight, housekeeping and prepared meals as needed. Residents are still fairly independent but get help with specific tasks involving personal care, such as showering, shaving, getting haircuts, etc. Assisted living assumes an individual is not bedridden and doesn’t require 24-hour care. It offers seniors a chance to focus on the living that’s most important to them and get help with life’s more burdensome chores.

When evaluating an assisted living facility, it’s important to consider:

Does the facility provide the right level of care? Many offer different care levels; for example, some assisted living options offer specialized memory care for individuals suffering from Alzheimer’s or dementia. These individuals require different care options from someone who simply has a difficult time walking and grooming themselves.

Does the facility under evaluation have the proper licenses and certifications for each level of care? Assisted living facilities are regulated and should have the appropriate license and training of staff required for different levels of care offered.

Does the facility treat its residents with respect? Does it foster a sense of belonging? One of the greatest silent dangers for the elderly and disabled people is isolation, and an assisted living facility should be a step in helping prevent isolation. Living in close proximity to a peer group in a welcoming and engaging environment is a good first step in keeping people active and interested.

Lastly, does assisted living fit in the budget? Costs can vary greatly from one assisted living facility to another even within just a few square miles. To help defray costs, some families are investing in long term care insurance; and there may be other assistance available from Medicaid or the Veterans Administration. While assisted living may initially appear more expensive than home care on paper, one factor that many fail to consider is the cost required to maintain the home in which the person wishes to reside. For example, what happens when word arrives that the roof needs to be replaced, or it’s discovered that there’s dry rot, termite damage and mildew in the garage, or the plumbing needs to be upgraded? These maintenance costs can add up quickly. Other costs could include quality of life issues, such as loneliness or being stuck on just one level of a larger two-story home.

If the house is in good condition, and budget is a factor, or even if the person in need simply wants to stay in their house, home care might be the best option.

Home Care

As the name implies, home care is for those in need of personal assistance who wish to live at home and either hire a professional caregiver or enlist a family member or close friend to take care of their daily needs. A benefit to receiving care in a personal home is a strong sense of familiarity and a connection with the community. It’s also possibly paid for.

When planning for home care, the two options available include using a friend or family member to perform the required duties, or hire a professional home care provider. There are pros and cons to each of these approaches as well.

Using a family member or close friend for home care

The advantages of using a family member or close friend is that they are most likely well known to the person in need of care, can typically be trusted with running the home on a day-to-day basis, and generally don’t require the same cash outlay as professional caregivers. The downside to this approach is that the assumed duties could prove to be overwhelming over time and lead to caregiver burnout, which produces health risks of its own including depression, coronary heart disease, and hypertension. This happens when the friend/family member becomes more concerned with the person they’re helping than monitoring their own medical needs. Burnout can also give way to extended family conflict and resentment. Also, friends/family don’t typically hold the specialized licenses that come with professional home caregivers and may not be experienced with the emotional demands that come with caring for a person in need of elder care. Sometimes it’s nice for a daughter or son to simply be that—and visit on those terms instead of as a caregiver.

Using a home care agency

Using a home care agency makes sense in the event the friend/family member is unable or unwilling to provide the required support and/or lives a great distance from the person in need of care. Home care agencies should be licensed, and their team of caregivers should receive regular training on the various physical and psychosocial needs of those in their care. They can also make sure the home is safe by monitoring for objects in and around the home that could cause bodily injury.

These caregivers are trained to take care of a person’s personal needs, such as shaving, bathing or reminding them to take their medicine(s). Additionally, they provide companionship to reduce feelings of loneliness in the event the person in need of care is unable to leave the house or accept visitors. Caregivers from a home care agency can also do light household chores, like laundry and light cleaning duties, to make sure the home remains a safe and healthy environment. Lastly, home caregivers can be less expensive than selecting an assisted living facility or hospital.

A benefit to using a home care agency is they will assume liability should the worker fail in his/her duties and/or prove to be truly distrustful. However, home care is considered non-medical and there are some services, like injections and medication management, that they cannot provide.

Making the right decision for senior care depends on being informed of all options. And perhaps more importantly, because this is a big decision, take the time to plan, sit down in advance with the person who may shortly be in need of care, and use the opportunity to set realistic expectations for care and get buyoff from all parties, before making a final decision.