Home Care Assistance v. Assisted Living: Which is Better?

“Hi, my name is Jane. The social worker at my mom’s rehab facility told me I should reach out to you. What is it that you do? I’m really hoping that you can help me find some homecare assistance for my mom so that she can return to her home. She refuses to go to a nursing home, and I just can’t take care of her.”

This conversation occurs on the regular with clients and Elder Care Advocates on the Vesta Senior Network Team. Who can blame someone for not wanting to leave the home that she has lived in for 40, 50, or even more years? Honestly, I remember when my 96-year-old great-grandmother had her second stroke, and she needed more care than could be provided in her home. She sat in her chair, next to the stove that generated heat for the first floor, and looked around the living room. I watched her take in each piece of furniture, the photo of the family farm, and likely a whole host of memories. I will never forget watching her pat her stove and say, “I love my stove.“ 

As Elder Care Advocates at Vesta Senior Network, our number one priority is to get our clients the very best care possible in the safest way possible. 

For many, a good start to receiving care can happen in their home with what we call “occasional homecare assistance.” What we consider “occasional home care assistance” is a caregiver coming into the home perhaps 3 days a week for 3 or 4 hours. What we find is that a lot can be accomplished in those 9-12 hours a week. Let me give you an example. 

My husband’s aunt had lived in the family home her entire life. She, like my great-grandma, was attached to the home, and no doubt the memories. She was a single woman and consequently was also very attached to her independence. Unfortunately, she had a stroke or two, was beginning to have memory lapses, yet was still driving. She had stairs in and out of her house, as well as into the basement to do laundry. She was a very social woman, and without her car, she would have wilted. By bringing in a caregiver, we were able to:

  1. Prevent her from going into the basement and risking a fall to do laundry because the caregiver was doing it.
  2. Keep her safe from driving because the caregiver took her on errands and out to lunch each time she visited.
  3. Provide a healthier menu because the caregiver made meals while she was there that our aunt could heat up, which helped her avoid the sodium laden frozen meals she had been eating. 
  4. Help her maintain her dignity by having bathing assistance.

Very importantly, our aunt developed a relationship with her caregiver and looked forward to her visits three days a week. Equally important was the relationship we developed with the caregiver. She was a real catalyst in providing us the bird’s eye view into our aunt’s needs. Ultimately, it was with that insight that we decided it was time to take the next step to assisted living.

This sort of approach to providing home care assistance works as long as it’s sustainable. The sustainability test has 2 factors:

  1. How long can I afford it?
  2. How long can it keep me safe?

We always want to avoid someone over-spending and outliving his or her assets while still in the home. 

It’s not uncommon for people to believe that home care assistance will be less expensive than an assisted living community. This is frequently not true. The “occasional home care assistance” described in the example above, will likely run in the $1000-1250/month range. For many, that is very affordable.

However, when someone starts needing more care on a daily or even hourly basis, this model may likely become unaffordable or unsustainable. The necessary care may not be able to be scheduled to occur while a caregiver is there.

This unscheduled care might look like:

  1. Assistance getting in and out of bed
  2. Help toileting
  3. Supervision while walking
  4. Support while transferring in and out of a chair

Most home care assistance agencies want their caregivers to have “blocks” of hours for each shift. Agencies are unlikely to be able to provide just an hour of care in the morning to get someone up and going. They are also unlikely to schedule another hour at night to tuck someone into bed. Instead, they may require those “blocks” of hours to accomplish those tasks. If that’s the case, the person may now be paying for 6 hours of care per day, when they might really only need 2 or 4. More importantly, that leaves the individual alone for another 22-24 hours each day. 

We always pose the question: “Can you schedule your bathroom visits to occur during the time the caregiver is there, and only during that time? Because if you can, this model might work.” Obviously, the answer for most people is “No.” We know that a vast majority of falls and other accidents that occur at home are in the bathroom. At this point, the care at home scenario might become unsustainable because the cost of care may begin to exceed the cost of assisted living.

When is assisted living a better option than elder care in the home? 

An interesting way to look at assisted living is to look at it as sort of a co-op, or caregiver share. In an assisted living community or memory care community, residents typically have their own studio, one or two bedroom apartments. This way, they are able to maintain their privacy. Their utilities, room and board, taxes, and all the usual homeowner expenses are included in their monthly rate. This eliminates the cost of maintaining a home while paying for care. 

In addition, assisted living and memory care communities have caregivers in the building 24 hours a day. Whether someone needs help in the bathroom at 3 in the afternoon or 3 in the morning, someone is there to help. The cost savings for the care that is provided results from the fact that the individual is sharing his or her caregiver with the other residents in the community. 

Assisted living and memory care communities most often staff their caregivers based on the needs of the residents. If there is a group that requires a lot of assistance at any given time, they will receive the care they need by having more caregivers available. Likewise, if at any point the group requires less assistance, there may be fewer caregivers on that shift. If someone needs a caregiver available at intermittent times throughout the day, the only safe way to do that at home is to have a caregiver in the home 24-7. 

How much does private home care assistance cost?

Depending on whether or not the caregiver is able to sleep at night, as well as on several other factors, the cost of care can range from $300-700/day for 24/7 care. In addition to that, the individual will still have the cost of meals, utilities, and all traditional costs associated with maintaining a home. In an assisted living or memory care facility, the average daily cost is roughly $200/day . Clearly, for many, an assisted living or memory care facility is going to be the most sustainable option.

Only an individual and his or her family can ultimately make the choice that is best for them. However, utilizing the knowledge and experience that an Elder Care Advocate, like the team at Vesta Senior Network, can help a family understand their options, the sustainability of those options, and come to a decision that can provide peace of mind.