As the American population continues to age — more and more baby boomers are moving into their 70s and 80s — families are increasingly tackling the challenging question about how to most effectively meet the needs of aging and potentially medically fragile family members, many of whom want to remain in their family homes for as long as possible. Often, this question (about where to live and how to care for family members) comes down to deciding between home care (or home health care), with varying levels of intervention and assistance, versus assisted living or nursing home facilities.
People frequently assume that the services that they or a family member can receive from home health care perfectly mirror the services that are provided at an assisted living facility — therefore, they frame the question of deciding between the two options as comparing apples to apples. For example, does it make more sense to hire a care assistant to come in and assist your mobility challenged older family member in their own home or does it make sense to have these services under the auspices of assisted living? However, experts in the industry are quick to caution that this is often not true. The two care options can and do differ dramatically. And these differences shape which clients are best suited for home health care and which clients would do best in an assisted living facility — while simultaneously recognizing that not all assisted living facilities are created equally. There are substantial differences in quality, as well as in the range of services that are offered.
Differences Between In-Home Care vs Assisted Living
Generally, assisted living facilities are meant for older individuals who are still able to function at a relatively high level — they may simply no longer be able to stay in their own home. For example, they may struggle with home or lawn maintenance or it may be increasingly challenging for them to navigate flights of stairs. However, these senior adults require relatively little one-on-one care. Assisted living facilities are not set up to address more significant medical concerns — and they may not be able to adapt to clients’ needs as the clients age or experience more significant challenges.
A situation that works for an individual at 80 may no longer be the correct choice at 90 — and this may require a relocation to another facility, such as a nursing home, that has more care options. Instead, assisted living facilities are largely targeted at individuals and families who are looking to ensure that their family member is in a safe living environment where help is available when needed. For example, an assisted living facility may offer peace of mind to families whose loved ones live in cold and snowy climates. Instead of having to venture out in a snowstorm to go to the grocery store or a restaurant, the client simply walks down the hallway to a dining facility that is full of healthy and nutritious options.
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Choosing Home Care or Assisted Living
Assisted living facilities are intended to provide peace-of-mind and reduce potential risks. These facilities may also be great options for seniors who are suffering from loneliness or depression in their own home, which is one of the most frequently overlooked, but potentially physically and psychologically detrimental challenges for many older Americans. Assisted living facilities manage to tackle this challenge by offering shared meals as well as a wide range of communal activities. The best facilities ensure that these activities align with individuals’ preferences, as well as their individual abilities and needs. Flexibility and options are extremely important.
But, assisted living facilities may not be the perfect answer for all seniors
Given these issues and potential hiccups, assisted living facilities are not always the perfect answer for every client and/or family, even though it is an option that works well for many people. However, for those who it does not work for, there is another option that may work — home health care.
For some older Americans, home health care may better suit their needs
Home health care may be a great alternative for patients who still want to remain in their own homes, but need a little bit of assistance to make this wish a reality — particularly if their family members are geographically remote or unable to provide hands-on assistance. This option is also preferred to assisted living when a senior may have more urgent medical concerns (or other issues) that requires one-on-one assistance or regular input from a qualified medical provider (depending on the client’s individual medical needs, the home health care company many assign a nurse/provider with specific expertise in that area).
Even with home health care, there is a broad range of needs that the medical professionals may be addressing — from cancer to diabetes as well as dementia. Also, some patients may only need an hour or two of assistance every day, whereas other patients may need 24/7 care. Another thing that differentiates clients is the duration for which they will need care. Some clients will only need short-term care, for example, following a fall or a broken bone. On the other hand, some clients will need palliative care or other longer-term options. This flexibility to adjust to different clients’ needs is one of the greatest benefits of choosing the home health care option — and yet, it is something that families may overlook when making care decisions (be it because of stress or a lack of information or concerns about money and finances. All of these factors and more may complicate the decision-making process when it comes to long-term care options).
Homecare and Assisted Living: Pros and Cons
In addition to the issues mentioned above, there are other differences that set the two care options apart. There may also be a dramatic gap in the cost of in-home care vs assisted living. These gaps, however, are not universal and may depend on a wide range of factors that are not easily captured in a single article or assessment.
The Cost of Assisted Living
Although assisted living costs vary significantly based on the area of the country where one lives and the services that the facility offers, most assisted living facilities cost in the range of $5,000 per month — but, some of these assisted living facilities charge a fixed fee per month. While other facilities offer clients and their families a smorgasbord of services priced in an a la carte manner (although this pay as you go option may be tempting for many families, it can often lead to significantly higher costs than what we see in other pricing options).
But what about Home Health Care?
Alternatively, home health care is generally billed on a per hour basis. If the patient does not need extensive services, home health care may be cheaper — since you or your family are only contracting for only the services that you directly need. However, the costs can quickly spiral, particularly if the medical problems you or your loved one are facing are complex or likely to change over time.long-termmportant to remember that both home health care costs and assisted living fees generally must be paid from a patient’s pocket — these costs are not reimbursed by insurance companies. However, some long term care insurance or other supplementary insurance policies may have provisions to cover this type of care — extending more care options to lower or middle income families (where previously, assisted living and home health care tended to be options only for the wealthiest families around us).
Make sure to have the important conversations
No matter what option a patient and family ultimately choose for their care it is important that families have conversations about these options — and that these conversations realistically address the older family member’s true health situation. It is often difficult to admit that a mother or father is aging or experiencing challenges. But, burying one’s head in the sand will not help the situation — it will only delay the inevitable decisions that need to be made, while ultimately compromising your loved one’s quality of life. Transparency will help ensure that the right decisions are made. And these conversations should not only be between the client and their family, it should also extend to the client’s long-term care providers who can provide the best perspective on long-term health trajectories. Furthermore, these conversations should also include the home health care companies and assisted living facilities that you are considering. It is important that you and your family members are comfortable with the staff who are going to be an integral part of your life moving forward.