Assisted Living or In-home Care? This Can Often Be a Difficult Decision for Your Loved One

At some point, many people reach a time in their lives where they need help with day-to-day living. Elders often have unique emotional and medical needs that must be assessed. There are many things to evaluate when determining whether in-home care or an assisted-living residence is the most appropriate option.

A major difference between in-home care and an assisted living is that the latter requires relocation and adjustment to a new setting. Some elders may enjoy the social or community aspect, while others may find it quite difficult to adjust to the more controlled and structured environment. Since every situation is different, a careful analysis that balances your loved one’s needs, desires, and financial resources must be performed.

When determining whether in-home care or an assisted-living residence is most appropriate, it is often advisable to enlist the services of a qualified geriatric-care manager. This person can assess whether your loved one will be able to manage at home and what kind of support with be required. It is imperative to consider both the elder’s physical and cognitive limitations.

A geriatric-care manager will assess how the elder functions at home and may suggest modifications that will allow the person to remain at home. For example, the geriatric-care manager will consider whether or not your loved one needs assistance with making meals and managing medication. The modifications may include removing throw rugs, adding grab bars, and making the home wheelchair-ready if necessary. Also, the care manager or the elder’s physician may assist in determining what day-to-day care the individual requires. Input from family members should be integrated into the evaluation as well.

Finances often limit the range of options in creating the ideal situation, and a financial planner or elder-law attorney may be of assistance in determining the most appropriate option. If your loved one would prefer to remain at home, associated costs may include things such as home upgrades, caregivers, maintenance, rent or mortgage payments, and real-estate taxes. Assisted-living residences generally do not accept Medicare, Medicare supplemental insurance, or Medicaid. Typically, the residents must provide private payment. In some circumstances, long-term-care insurance may be used for both in home care and assisted-living residences, if the elder has such a policy.

In-home care is often the preferred choice of elders and their families because it allows the elder to continue to live independently in the comfort and privacy of their own home, surrounded by loved ones, memories, and familiar belongings. Home-care agencies can provide a wide array of services, so it is advisable to engage an agency to provide a home-care health worker because, if a problem arises, the agency will be able to furnish a replacement worker quickly.

In the event that an elder is still physically able to reside at home, but requires assistance with everyday tasks, such as meal preparation, housekeeping, mail sorting, personal care and grooming, transportation, transferring from bed to chair to toilet, and other tasks, in-home care may be needed.

Residing in their own home, regardless of what assistance they require, may help elders retain a feeling of independence. Unfortunately, depression is common among the elderly, as well as the feeling of helplessness that often triggers depression. Continuing to reside at home may lessen that feeling and make the elder more comfortable. Another benefit of bringing help to your loved one’s own home is companionship, and in the event that the elder is suffering from dementia or Alzheimer’s, remaining in familiar surroundings may help them remain calm. One point of consideration is the cost, as the average in-home healthcare worker typically charges around $20 an hour.

What Then?

Despite an elder’s desire to reside at home, it may not be in their best interest. Relocation outside the home may be the only safe, feasible option, because remaining at home may be lonely and isolating. Furthermore, other family members may be under significant stress in their role as caregivers for the elder. Ultimately, it may be a great relief to relinquish the home and all of the responsibility that accompanies home ownership. Also, knowing that care is available at all hours, and more assistance is available if necessary, can be very reassuring.

An assisted-living residence is a home away from home, designed to provide custodial care in a setting that resembles a personal residence. Assisted-living facilities have small apartments that residents may furnish with their own personal belongings, and sometimes they can even bring pets. Additional amenities include a common dining room, a nurse’s office where prescription drugs are dispensed, and activity rooms for socializing. The actual services that will be provided vary by facility.

One distinct advantage of assisting-living residences is that the level of care may increase as needed. For example, adding services like assistance with medication, dressing, bathing, eating, and others may be available. Oftentimes, the facility may have dedicated floors or wings for those residents with Alzheimer’s or other forms of dementia. These secured living areas prevent the wandering that often accompanies certain types of dementia.

Residents pay a monthly fee that generally covers full meal service, around-the-clock certified nursing assistance, transportation to and from shopping and medical appointments, and scheduled recreational events held both on and off site.

Although the decision whether to remain at home or move to an assisted-living facility is often difficult, with the proper information and a clear idea of your loved one’s needs, you should be able to select the option best for the elder. Although the decision may be dictated by medical needs, family availability, and finances, the peace of mind from knowing that your loved one is being cared for in a secure and safe environment is paramount. v

Todd C. Ratner is an estate-planning, elder-law, business, and real-estate attorney with Bacon Wilson, P.C. He serves as the co-chair for the Alzheimer’s Association Tri-County Partnership and is a member of the National Academy of Elder Law Attorneys and the Estate Planning Council of Hampden County. He is also a recipient of Boston Magazine’s Super Lawyers Rising Stars distinction from 2007-2011; (413) 781-0560; baconwilson.com/attorneys/ratner_2