There comes a time in most seniors’ lives when medical conditions, loneliness or an inability to care for oneself force families to make a decision about where a senior should be living. Often a decision needs to be made between staying at home with the assistance of a visiting aide or other caregiver or moving to an assisted living facility. Each decision is an intensely personal one, and families must consider many factors when trying to make the right decision.
Senior home care can take a variety of forms, but generally speaking, it’s care provided to a senior in his or her own home. Typically, services include assistance with activities of daily living, such as bathing, dressing, toileting and household tasks such as cooking, cleaning and running errands. Many families hire an agency that sends a caregiver to the home for several hours each day or a few times a week, depending on the senior’s needs. A live-in caregiver is another option that some families choose.
What Is Assisted Living?
Assisted living is like senior home care in that it usually covers activities of daily living, but the senior moves from the family home into a new place. These locations may be like a dormitory or private apartments and some are situated in sprawling or very swanky campuses that can cater to a wide variety of needs and preferences. Assisted living facilities typically have staff on site round-the-clock to assist in the event of an emergency and help keep seniors safe. Most offer meals, either in room or in a communal dining hall, and these communities tend to offer activities and social events for residents.
Which Option Is Right?
“It’s not that one option is always better than another,” says Eleonora Tornatore-Mikesh, chief experience and memory care officer at Inspīr, a new senior living community in Manhattan. “It all depends on the situation.” And each family will have to consider its options and do its own homework to determine what’s right.
Both senior home care and assisted living have their pros and cons. In deciding which is the best option, you’ll need to consider carefully your loved one’s needs and preferences and weigh those against your financial resources and safety concerns.
Anna-Gene O’Neal, division vice president of Brookdale Health Services Hospice, which provides home health, hospice and private duty home care services, agrees that there’s no one-size-fits-all answer to this question. “Staying at home, which many think would always be preferable, must be evaluated on a person-by-person basis, based on both physical as well as social elements.” These factors include, but are not limited to:
- Access to care as needed.
- Ability to manage bathing, dressing, medications and food access and preparation.
- Connections to other people and basic socialization.
Safety is a key component of whether or not home care is a better option than assisted living, says Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company. If a senior is planning to remain in the home, Varano recommends installing “grab bars and safety bars” in the shower and other potentially hazardous locations throughout the residence to prevent falls. “If they can’t walk upstairs, a stair lift can be a helpful assistive device.” Similarly, if cognitive problems such as dementia or Alzheimer’s disease are beginning to surface, installing extra locks or latches that make wandering out of the house and potentially into danger more difficult can be helpful adaptations, which make staying in the home safer.
If these needs can be met, then “staying in one’s home is always desirable,” says Kim Elliott, senior vice president of clinical services with Brookdale Senior Living, a Tennessee-based company that has more than 800 senior living and retirement communities across the United States. Moving to an assisted living community might not need to be a consideration until such time as the senior’s safety or socialization situation changes. “The goal of assisted living is to enhance the individual’s life,” she notes, so trying to stay home can be a worthwhile aim until quality of life begins to suffer.
In some ways, aging in place at home offers a lot of benefits. “Staying at home means there are no adjustments necessary. It provides a person with the feeling of independence. Care comes to you,” Elliott says. There’s also a “level of independence and comfort of familiar surroundings,” O’Neil adds. Change can be hard, particularly if someone’s level of cognition has begun to change.
The Importance of Socialization
On the flip side, “there’s a potential for isolation and loneliness” when staying at home, Elliott says. “A person, or their family, will still have responsibilities,” such as cooking, shopping and maintaining the home, which can entail paying bills, doing yard work and so on. “Also, care is not always available at the exact time of need. In an assisted living community care is available 24/7.”
That hands-on, 24-hour access to care and support is one major advantage an assisted living community typically has over home care, Tornatore-Mikesh says. “In home care, you don’t have access to that 360-degree view of care and socializing. There’s not a lot of programs viable outside of one-on-one activities in the home setting.”
The socialization factor is a major one and shouldn’t necessarily be overshadowed by other factors, Tornatore-Mikesh says. “If you’re around like-minded people and you’re socializing with others in a book club or a golf club or whatever your interest is, that plays a role in living a healthier, longer life with fewer ailments. There’s substantial research from the NIH that shows that socialization is important for health. And it can be very hard to create adequate socialization opportunities at home.”
Medicaid will cover some costs. “In most states, Medicaid – the state-federal program that covers medical expenses for people with low incomes – will provide some financial assistance to people living in assisted living facilities who qualify for the program,” Shea explains. “The level and type of support varies widely depending on the state you live in.” You’ll have to do your own research to figure out whether assisted living will be cheaper than living at home and how you’ll pay for that.
How Long Can Home Care Last?
As needs change, a senior’s ability to continue living at home may change too. For many people that means there will come a time when they must move into an assisted living community or nursing home setting. Knowing when is the right time to move can be a tricky question that’s “different for everyone,” Elliott says. “Assisted living should be considered when the safety of an older person becomes a factor.” For example, “if they are susceptible to a fall, taking the wrong medications, experiencing weight loss from unhealthy eating or the inability to cook or developing cognitive deficits,” then it might be time to start thinking about moving into an assisted living community.
Mental health issues, such as feelings of isolation, loneliness and depression, may also prompt a move. “Loneliness has the same impact on mortality as smoking 15 cigarettes per day,” Elliott says. Indeed, a 2018 survey from the health insurer Cigna noted that roughly half of all Americans feel lonely, but “88% of those who have daily in-person interactions say their overall health and mental health are good or excellent.”
In other cases, when a senior develops multiple chronic medical conditions that require frequent doctor’s appointments to manage, “it may be time to move into assisted living to make care more accessible,” Elliott says. The simple logistics of having access to health care on site can cut out a lot of back and forth to doctor’s offices.
Moving a loved one into assisted living can be a difficult decision and challenging transition. “We have many sons and daughters who feel guilty about moving a parent into assisted living, but later come back and tell us it was the best thing for their mom or dad,” Elliott says. “Adult children often have more trouble with the transition than the parent. Assisted living can bring a new lease on life with an active setting, new friends and new hobbies.” And because services in assisted living are available at all times, “you have peace of mind that someone is always there to assist when needed.”
In all things related to senior care, Varano says it’s important to “plan early and do your due diligence. This will decrease feelings of guilt and stress. Moving into assisted living is a new chapter in someone’s life.” Being prepared ahead of time “offers an opportunity to get excited about it instead of dreading it,” she says.
Knowing that their own wishes have been heard and honored as much as possible will also make a world of difference in how a senior feels about a move to a new home – if and when the time comes.
Assisted Living and Quality of Life
Elaine K. Howley, Contributor
Elaine Howley began writing for U.S. News in 2017, covering breast cancer and COPD. Since … Read more
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