Choosing between assisted living and home care can be among the most common and also difficult decisions families face. When surveyed, most older adults say they want to age at home. For some, this can work.
Yet, for many others, they will need extra support to age at home safely. At a certain point, their needs may exceed the ability that home care can provide. It is at this point that considering assisted living comes into play.
Jump ahead to these sections:
- Assisted Living vs. Home Care: Types of Care Received
- Assisted Living vs. Home Care: Who Are They For?
- Assisted Living vs. Home Care: What’s the Cost and How Do You Pay for Care?
- Assisted Living vs. Home Care: How Do Admissions Work?
A lot of families can avoid stress by discussing this possibility before it arrives. Long-term planning involves discussing issues with your loved one about what they would prefer if they need help and what they can afford. If possible, visit assisted living communities so that your loved one has an idea of what they like and can expect if they have to move.
Assisted Living vs. Home Care: Types of Care Received
If there were uniform agreement among states on caregiving, this answer would be more straightforward. Simply put, you may not have much choice between home care and assisted living if the state where you live restricts what home care staff can do. By contrast, assisted living communities share consistencies in their services and the type of care they provide.
Assisted living: types of care received
As the name states, assisted living is defined as senior living that helps older adults with tasks they have difficulty with at home. Assisted living communities are licensed and regulated by state agencies, such as the Department of Health or Social Services. Assisted living communities may be loosely monitored since there is no federal standard. However, they may be more accessible and allow motorized wheelchairs and assistance with walking.
In general, these communities offer assistance with activities of daily living (ADLs), which include dressing, bathing, hygiene, and toileting. In some cases, if transferring is needed, there are staff available. When it comes to medical care, nursing staff help dispense daily medications and manage medication schedules for residents.
Meals and snacks are also provided daily. Accommodation of special diets is possible unless there are swallowing issues that may require pureed or softened foods. There will also typically be a schedule of activities that include, but are not limited to, games, movies, arts and crafts, cultural outings, and presentations.
Some assisted living facilities also provide transportation to medical appointments and intermittent nursing. While a nurse may be on staff, they may not be available 24-hours a day. Housekeeping and laundry services may also be provided as amenities. Finally, some facilities can provide Emergency Response Systems such as pendants in case of an emergency. Pull cords for emergency notification are in bathrooms.
Home care: types of care received
Home care can be the foundation of care for many families and may also provide necessary caregiver relief. Home care can delay admissions to assisted living, but this will depend on what the care staff is permitted to do by state regulation. To better understand the variability in permitted care tasks, we will start with the minimum and go to the maximum.
Most home care staff can provide companionship, bathing, dressing, transfers, and giving medication reminders but no dispensing. Some states do not allow a home care staff person to touch medications. The caregiver can only give verbal reminders to take medications. Other tasks include transportation, shopping, cooking, and light housekeeping.
Under the supervision of a nurse, home care staff in some states can provide a variety of more complex medical tasks. Home care staff can administer glucometer tests, pre-filled insulin, medication through tubes, tube feedings, can insert suppositories, and provide intermittent catheterization.
You can see the wide gap between the provision of services. Knowing what your state allows care staff to do will help you decide whether your loved one can stay at home or will need to go to assisted living. And since many of the tasks have to be supervised by a nurse, the home care agency needs to have one on staff.
If you live in a state where care staff can only do the minimum, and your loved one requires more help, you have the option of hiring a nurse. But that choice could be pricey, and the cost may outweigh the benefit.
Assisted Living vs. Home Care: Who Are They For?
Now that you can see the differences between what states will allow home care staff to do, it can clarify your choice. However, some people choose assisted living for reasons other than the level of care that they need. Listing out your own priorities regarding finding care for aging adults can help you suss out whether assisted living or home care is right for your loved one.
Who is assisted living for?
Assisted living is for older adults who need more care than can safely or affordably be provided for at home. Other deciding factors can include the following:
- State regulations: Home care in the state where you live doesn’t allow for the medical tasks that your loved one needs to stay safe.
- Caregiver burnout: If a family is providing most of the care for a loved one to save on costs, there may come a time when it may be too much for a person to manage and can lead to caregiver burnout.
- Companionship: Your loved one is isolated or lonely and wants the companionship of their peers.
- Expenses: If home care becomes too expensive, assisted living might be more affordable for things like 24-hour care or several hours a day to keep a loved one safe.
- Organizing care: For older adults who need many hours of care per week, that can mean many caregivers coming in and out of the home. Also, turnover, no-shows, and personality conflicts are common issues in the home care industry, making it challenging to manage care.
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Who is home care for?
Home care is for older adults who want to stay home for as long as possible, and preferably until the end of life. The ideal candidates for home care (taking into consideration state regulations) are those who wish to have the following needs managed:
- Simple tasks: People who need help with simple everyday tasks like cooking, shopping, and transportation.
- Respite: Caregivers provide respite for family caregivers. Home care is valuable for families who need scheduled breaks. Home care scheduling is very flexible, and staff can accommodate the needs of the family.
- Cost: Older adults who can’t afford assisted living and want to manage their care needs with in-home caregivers.
- Companionship: People with dementia who want to avoid memory care and rely on caregivers for cognitive activities and companionship.
Assisted Living vs. Home Care: What’s the Cost and How Do You Pay for Care?
Assisted living and home care are both privately paid unless you have a long-term care policy. Many long-term care policies will pay a daily rate towards the cost of either assisted living or home care. However, it is essential to remember that costs of home care and assisted living will vary from state to state and community to community.
Assisted living costs
According to Genworth, the monthly median cost of assisted living in 2019 was $4051. This cost is probably more in line with the “base” cost and will depend on where you live. A base cost is the flat monthly rate you pay for assisted living. If your loved one requires assistance such as bathing or dressing, that price will go up.
Other factors include the size and location of the room. For example, as is the case with apartments, premium rooms might have views or greater accessibility to the elevators. Many assisted living communities offer everything from studios to two-bedroom units.
Most older adults who own their homes end up selling them to help finance the cost of assisted living, or they use retirement funds. In special cases, states have Medicaid Waiver programs that can help pay for assisted living if someone qualifies for Medicaid and nursing home care. The program aims to keep people out of nursing homes by providing services to the resident in assisted living.
Home care costs
Genworth reports the hourly monthly median cost of care in 2019 to be $22.50 an hour. Again, that cost per hour depends on several factors, such as how many hours you need and where you live.
Most home care companies charge less per hour the more hours you schedule. Home care companies also have overnight rates and 24-hour rates that will end up less per hour.
Assisted Living vs. Home Care: How Do Admissions Work?
The admissions process for an assisted living facility can be a bit more complicated than home care. These differences tend to boil down to the type of care needed and complexity.
Assisted living admissions
A nurse from the assisted living community will do an in-person evaluation for admission. This evaluation’s primary purpose is to make as certain as possible that the facility will provide an adequate amount of care for the potential resident. The nurse may require extensive medical records and a doctor’s order. If medical complexities are too great, the nurse may recommend a nursing home.
The other deciding factor for admissions is whether your loved one has dementia. People with cognitive impairment can do well in assisted living. However, if your family member has advanced dementia, the nurse may suggest memory care. Many assisted living communities have memory care units on site.
Home care admissions
Home care admissions will depend entirely on what home care caregivers can do under state law. Often, a home care admissions person will need to manage the expectations of the family. If your loved one needs diabetic checks, dispensing medications, or catheter care, and the caregiver can’t perform these tasks, it might not work out.
As long as the caregivers can perform the tasks you are asking for, they can take you on as a client. The only other possible reason for denying admission might be because your loved one has dementia with aggressive behaviors. However, in most cases, a home care agency can be willing to try and meet your loved one’s needs.
The Differences Between Assisted Living vs. Home Care
There are many considerations to keep in mind when assessing the possibility of assisted living versus home care. It is also important to remember that the process may not be linear or predictable. Situations can change rapidly, requiring a shift in care.
However, at the core of your decision should be your loved one’s wishes, especially if they are the ones who will be receiving the care. Work together to arrive at the best decision for the moment and stay flexible if you can.
- “Long-Term Services and Supports State Scorecard.” AARP, www.longtermscorecard.org/
- “Cost of Care Survey.” Genworth Financial, www.genworth.com/aging-and-you/finances/cost-of-care.html