As loved ones age, families often face difficult decisions about how to best meet their needs. One of the primary choices is between home care and assisted living. Both options provide support, but social needs, cost, physical demands and available support networks all factor into the decision.
“I think that both of those are great options, and it depends on the family,” said Ginny Helms, president and CEO of the advocacy organization Leading Age Georgia.
The key differences between home care and assisted living are significant. For families who wish to support a loved one at home, home care offers the flexibility to bring in professional help for partof the day while allowing the relative to remain in their own environment. It is often more suited for individuals who need assistance with daily tasks but don’t require 24-hour supervision, Helms said. However, home care is not without challenges.
“Many times, caregivers want to stay at home, and families may want that as well, but when needs outstrip the family’s ability to provide, assisted living can be a better option,” Helms said.
Staffing shortages sometimes mean families may not be able to meet their loved ones’ needs right away. Helms said adult day care services can be a middle ground for those who need additional support without the full-time commitment of assisted living. These services allow seniors to engage in social activities, which can help ward off depression and give caregivers a needed break.
Financial considerations
Although assisted living occupancy levels are not at full capacity since the COVID-19 pandemic, the question remains: Can families afford it?
In Georgia, Medicaid does not cover assisted living, meaning families must pay out of pocket if they choose this option. But Catie Ramp, president and CEO of the Georgia Senior Living Association, said families may be surprised as they look closer at the numbers. Home care can often appear more affordable than assisted living; however, Ramp said piecemeal services for home care can add up, making it less cost-effective in some cases.
“There’s been research released … that says assisted living far outweighs the cost of home care,” she said.
Ramp advises families to ask questions about the services offered and understand the costs associated with home care and assisted living. And be specific. Ask about everything from giving medication to changing sheets and washing dishes.
“Knowing fully what services are being paid for is really important,” Ramp said. “Be sure to know the services they provide and which ones are covered or come at additional cost.”
Finding the right fit
Helms and Ramp agree that evaluating the quality of care in assisted living facilities is crucial. Helms advises asking about the model of care, staffing levels, and turnover rates.
“When you visit, have a meal to see if the food is good. And observe the people,” she said. “Are people smiling, engaged, and doing things or just sitting around? I want to know if people in there are smiling.”
Another consideration is the individual’s social life. Assisted living facilities often provide opportunities for seniors to participate in activities such as exercise classes, field trips, and religious services.
“You don’t have to do any of those things, but those are options,” Ramp said. “We know that COVID showed significant signs of depression, which correlates directly with dementia after social isolation.”
For home care, Ramp advises asking whether the company offers consistent or rotating caregivers.
Adjusting to a new home
Once the decision is made — whether it’s for home care or assisted living — there will be an adjustment period. Families can ease this transition by helping the new caregivers get to know the person they’ll be supporting, Helms said.
“The more (families) can do to help the community get to know that person, what makes them happy and brings a smile to their face, the better,” Helms said. This can include informing caregivers about the senior’s preferred routines, favorite foods, and personal interests.
Ramp said familiar items can also make the transition smoother.
“If your mom has always had a nightstand next to her bed for the last 40 years, make sure she has a nightstand next to the bed in her (new) apartment,” she said.
Small touches, like a favorite blanket or cherished family photos, can make a big difference in helping the senior feel at home.
For many families, the decision between home care and assisted living is not straightforward.
“The reality is that both of them are good steps,” Ramp said. “You have to know the right step for you and your family members.”
Helms advocates for a person-centered approach, focusing on the senior’s individual needs rather than viewing them as just another occupant.
“Wherever you choose needs to be about the person and it needs to not be more investor- developer-oriented,” she said.
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