Long Term Care at home vs. in a Facility


As a baby boomer, perhaps in your 50‘s or 60’s, you’ve learned not to be surprised when an aging parent gets afflicted with health issues. In fact, as the years roll by, you tend to acquire a resigned outlook to bad news of this sort. Thus let us say that on this day you get a call from the Case Manager at the skilled nursing facility where your 83-year old Mom is undergoing rehabilitation. They said it had been a mild stroke, and after a 3-day stay in hospital, she’d been discharged to this center. Anyway, the hard news is that they’re going to discharge her the following day.

Families in Awkward Transitions

The Case Manager gently prods you to find out what plans you have made for your Mom. Is she going to live at home, in which case have you arranged for caregivers to look after her? When you tell her that you are still undecided between home and an assisted living facility, she is taken aback. These are matters that should not be left to the last minute –or the last day. You suddenly feel a cold sweat down your back. What are you to do? Will it be at home or in a facility? And if at home, who will take care of her?

Placing a Parent in an Assisted Living Facility (ALF)

ALFs tout their services with arguments as follows:

  • Everything is done for the resident

  • RNs and Licensed Practical Nurses (LPNs) always available

  • The residents get to socialize with other peers

  • The residents have daily “activities” sessions

  • They congregate for a main dinner in the dining hall

  • Family members get to visit at any time

  • Fixed costs with no surprises

On the negative side, your mother would be one of 20 or more residents serviced by the same CNA or LPN at any given time, and a lot of complaints emanate from lack of personal attention. On the plus side, two of their arguments have merit, the first about fixed costs: the family would know in advance what the monthly would be. The second is about socializing with peers. This is a significant plus, particularly when your loved one thrives in such an environment. The fact that they have an activities program is also helpful.

Beware though of the parent who puts you to a lot of trouble to find the right ALF for her, only to end up hating it and throwing a tantrum wanting to go back home.

Caring for a Parent at their Home

Caring for a parent at their home is invariably going to be your parent’s first preference and probably the easiest choice for you as well. At the very least, the home is familiar ground for seniors, and you won’t have to worry about them not liking it. In addition, in view of the possible beginnings of dementia, you have been advised that it would probably be best for your Mom to be at home, even if until she regains some of her strength and wits.

On Hiring an Agency

You never thought it would be that easy to set up home care services, or that they could provide the care as quickly as all that. You called, and the person you spoke with asked for some basic information about your mother, as well as some questions about your her prior career, what her hobbies had been and any other input you might contribute that would help the agency pick just the right caregiver for her.

You do have to decide on a specific schedule (number of hours a day and whether you will need five or seven day services each week). However, a home care agency would allow you to make schedule changes -even to stop services altogether- without giving notice.

A Care Manager (or Care Coordinator) would get back to you and describe a caregiver that they’ve selected for you. If you like the description, you may ask to interview that person at the agency’s office or at your mother’s home or yours. This interview is free of charge and the agency would accommodate your request willingly.

On hiring an agency, you want to satisfy yourself that:

  • The person you’re talking to is pleasant and sensitive to your needs

  • They’ve been in business for at least 3-5 years

  • They have a plentiful roster of caregivers who live close to your parent

  • They screen their caregivers thoroughly including criminal background and reference checks

  • Their costs are reasonable for live-out (by the hour) or live-in (by the day) services

The Costs of Homecare vs. Facilities

  • An agency would charge $22-$25/hour for CNA-type services if you need live-out services (by the hour)

  • If you need live-in services (by the day), the rate would come to $240-$260 a day, i.e. per 24-hour period

  • The cost of full-time live-in attendance would be roughly the same as that of a comfortable -though not most expensive- ALF

Again, the huge benefit of home care versus facilities rests with the fact that your Mom would remain in her own home and would be looked after by one caregiver. You can therefore expect the level of care to be more attentive and personalized.


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