Home Care vs. The Alternatives: How to Choose?17 minute read

17 minute read

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Updated for December, 2018

Many older Americans choose to move into some form of senior housing. But each year more and more choose to stay in their homes. It’s not a black-and-white choice, and whatever arrangement you choose, home care can dramatically expand your options.

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For many these days, the ideal approach to aging involves aging in place—staying in your home and taking the steps necessary to remain independent for as long as possible. Many are still choosing the better-known options: retirement communities, assisted living facilities, and other institutions designed to care for older people. But an increasing number of seniors are choosing to stay at home and get whatever help they need to remain there.

Aging at home comes with all the same challenges: Health and mobility issues present threats to independence wherever you live. But home care agencies—which provide all the services that come with an assisted living facility, but do so in the client’s own home—can enable a senior to remain at home throughout the aging process, and at a cost comparable to other options.

Because many seniors choose to age in place because of their emotional attachment to a particular home or community, home care can also give loved ones the reassurance that their family members are being well cared for without forcing seniors into an unfamiliar, and possibly distressing, environment—and home care can, if needed, keep seniors at home all the way through the end of life. What’s more, home care can also expand the range of options available to any senior, allowing them to choose to stay at home—or seek care outside of it—as best suits their situation.

It is important to choose a home care aide that you trust from a reputable agency for you or your loved one.

Before we talk about choosing between home care and out-of-home care, we should probably talk about the types of care available to people looking for help as they age. Roughly speaking, they fall into two main categories: the types of care you can receive in your home, and the types you can only receive by leaving home.

In-home Care

There are various kinds of help that someone can receive at home:

Home Care

Strictly speaking, “home care” covers two main types of non-medical care delivered in the client’s home: help with activities of daily living (things like bathing, eating, keeping track of medications, and mobility) and instrumental activities of daily living (essential tasks that aren’t directly related to physical needs, like preparing meals, light housekeeping, and other household chores). Many home care companies will separate these two categories into personal care and companion care or housekeeping.

Recovery Care

Home care is often thought of as something that’s provided for the long haul. Recovery care, on the other hand, involves all the same services as home care, but is provided on a temporary basis for someone dealing with an acute issue such as recovery from a surgery or an injury.

Respite Care

Another type of temporary care, respite care is home care provided when a client’s ordinary caregivers are unavailable.

Home Health Care

This type of care is also called skilled nursing care. Home health care is the provision in the home of the kinds of services usually provided in a nursing home or rehabilitation facility, such as regular changes of bandages or wound dressings, the actual administration of medication, intravenous treatment or nutrition, and other complex interventions requiring higher level nursing skills.

Hospice and Palliative Care

Hospice care involves specialized care for those approaching the end of life; palliative care involves caring for anyone suffering from an underlying disease that is regarded as untreatable. In both types of care, the aim is to keep the client comfortable: this will often require a combination of home care—to keep the client in good spirits and as healthy as possible—and home health care—to administer medication or perform any necessary medical interventions.

Care outside of the home:

Senior Living

Senior living isn’t really a form of care, or even of institutionalization. In senior living, fully able older adults who just want to let go of the responsibilities of living alone will sometimes move into a retirement community or senior housing community. This type of housing is usually designed specifically to be used by seniors, and can take the form of apartments, condominiums, or even freestanding homes. Such living arrangements almost never include the types of services covered by home care, though the communities may, by design, make life easier in general for the aged.

Assisted Living

Assisted living facilities provide room and board and some assistance with activities of daily living. But while “assisted living” is sometimes used as a catch-all for any senior housing that includes some kind of personal care, such facilities may not have medical professionals on staff in the way they would be at a nursing home.

Respite Care

Just as with home care, some assisted living facilities and nursing homes provide temporary care for a client whose main caregivers may not be available, or may need a temporary rest.

Concierge Care

Some seniors in a senior living, assisted living, or nursing home situation may require more help than the staff may want to take on, or may want to hire a dedicated caregiver who will give them personalized care. In these cases, they will often access concierge care, in which a home care agency assists them in the facility where they reside.

Nursing Home

Seniors with more serious health issues may need to enter a nursing home. These types of facilities are also known as skilled nursing facilities—and may also go by the name of long-term care facilities or rehabilitation facilities. Nursing homes provide more complex types of types of medical assistance and generally offer direct assistance to address patients’ health problems.

Hospice

Hospice is a specialized facility for housing and offering care to those who are approaching the end of life: usually the care offered can only deal with the symptoms of any underlying illness, provided with the aim of making the patient as comfortable as possible.

Some of these home care agencies are starting to offer a private pay, non-medical line of services as the need to outsource care increases.

We’ve touched on the issue of costs, but how much of a factor should they be in your choice of care? Before addressing this question, it’s important to note that the choice between home care and some sort of facility is sometimes presented as black and white, but care needs can evolve, can grow, and can sometimes even decrease, and this means that those two choices—between leaving home and aging in place—aren’t always mutually exclusive.

As we mentioned above, sometimes the move to a facility only needs to be temporary, as in the case of rehabilitation. Sometimes, too, a temporary move to a facility is necessitated by life circumstances, as when a family caregiver needs a rest, or is called out of the home for work or some other cause. In this case, aging in place includes time spent away from the home.

In addition, many people move into senior living or assisted living and find that they need more assistance than the facility provides, or would like assistance that focuses on them exclusively. In that case, many people turn to home care agencies to provide them with personal care (and companionship) while in a facility. Finally, moving from the home to a facility doesn’t happen all at once, and if care is needed in the transition, a home care agency may be able to help. So as you measure the cost of home care against the cost of leaving home, you should keep in mind that it’s frequently not a simple choice between one or the other.

Why Why Many Caring Senior Services Fail
Still, while assisted living and other forms of out-of-the-home care sometimes allow a senior to socialize more freely, some seniors find it to be an isolating experience to be removed from the places and people they know best. Moreover, while the choice isn’t always black or white, it can be the case that once you go outside the home for care, there’s no going back. The family may have to sell the house to finance the move to assisted living, and even if it they don’t, the hassle of maintaining the house may become one burden too many for the senior’s family and loved ones. Home care can provide continuity and community throughout the aging process, so as you weigh the costs of in-home care against the costs of care outside of the home, it’s vital to keep the patient’s preferences in mind.

What Cost Can You Expect?

That said, expense will always be a major factor in care decisions. But as you weigh the costs of home care against the costs of care outside the home, you should be aware of some potential hidden costs to each.

Top-line Costs

First, let’s look at some average top-line costs for each type of living arrangement, using the national median costs as provided by the Genworth cost of care study.

  • Senior living—$1000-$4000 per month
  • Assisted living community/facility—$3,750 per month
  • Nursing home/skilled nursing facility—$6800 per month
  • Memory care (for those with Alzheimer’s or dementia)—An extra $1200-$1500 per month on top of other costs.

Comparing these costs to home care can be difficult, since home care is usually charged by the hour. But a standard schedule for a client with relatively limited needs might run to 10-12 hours a week—roughly $800-$1000 per month at the national average rate of $21 an hour. Someone with more intensive needs, however, could easily need twice as much time, and according to the Genworth cost of care study, full time homemaker services can reach $4000 a month.

Physical therapy and exercises prescribed by a licensed doctor may be carried out by a non-certified home health aide, and in that case, Medicare would most likely cover the costs.

Hidden Costs

Whether you choose to move out or stay at home and hire a home caregiver, there are some hidden costs to be aware of. Here are some things to look out for as you look into pricing:

Home care

Of course, the hourly rate and the amount of care needed aren’t the only expenses to consider when it comes to home care: you or your loved one will continue to have to pay rent, or a mortgage, or property taxes, for example, and other costs related to housing. They will also have to continue to pay for food.

In addition, despite being paid for by the hour, hiring a caregiver doesn’t offer complete, unfettered flexibility. For one thing, many home care agencies will require a minimum visit length—a sensible request, given that there’s always a baseline amount of effort involved in getting a caregiver into the home in terms of overhead, travel time, and transportation costs. Offices that don’t require a minimum length may increase their hourly rate if the client is seeking less than a certain number of hours of care a week. Many companies will also require clients to pay a deposit or to pre-pay for a set number of hours before providing services.

Finally, even the hourly rate for home care is likely to vary depending on geography and on the type of care the client needs, so it’s important to get an estimate from one or more home care agencies in your area before you begin to compare home care costs with the alternatives.

Doctor giving patient prescription medicare

Senior Living

If you’re just moving out of your home into a senior living community, your hidden costs will likely be relatively minor compared to the finances of selling your home and either paying rent or buying a new unit. At the same time, you should consider these potential expenses:

  • Will you need home care in the place you’re moving, or have additional expenses for transportation? This is a definite possibility, particularly if you’re going to be out of range of your ordinary support networks.
  • Moving can be an expensive process in itself: if you’re downsizing, are you certain that moving into a smaller space will save you enough in the short or medium term to compensate for the cost of a move?
  • If you’ve got more belongings than space, will you be selling them or giving them away? Or will you hope to keep them accessible by putting them into storage? This could be a significant additional expense to be aware of.

Assisted Living

If you’re moving into a facility that will provide you with assistance with some of your activities of daily living, there can often be hidden costs here, too. Here are some to look out for:

  • Many assisted living facilities quote a monthly rate based on the resident taking advantage of a reasonable number of assistance services. But some adopt an à la carte approach, giving a top line number based on the cost of occupying a room, with services like dressing or bathing assistance listed as extra and coming at an additional cost. Before entering assisted living, try to make a list of the services that you’re likely to need, and then make sure either that those services are included in your flat rate for your living space or come at a reasonable additional cost.
  • The same sometimes holds true for meals: if you’re expecting to eat in the dining room, make sure that you fully understand all the costs involved, and that those costs fit into your budget.
  • As is true for senior living, moving and storage come with its own expenses, and these costs should be included when you’re making the decision to seek care outside of the home.

Nursing Homes

Skilled nursing facilities tend to vary much less in terms of the services offered, and you can expect for most of your expenses to be included in the top line number. There are still costs associated with giving up a home, however, and you should be aware of these. And keep in mind: residence in a skilled nursing facility is very expensive. Medicare only provides coverage for a limited time, and Medicaid only provides assistance after a patient has significantly reduced the assets they have available.

In the end, of course, choosing the care that’s best for you or your loved one involves many more considerations than just the cost. But as you make your decision, it’s important to realize that the cost of care itself involves a lot of variables, and both in the short term and the long term, bringing care into the home—even full time home care—can be a highly competitive option for those who want to age in place.

Whatever choice you make—and even if you approach aging with the belief that leaving home is inevitable—there’s a good chance that you’ll need to age in place for some length of time. What’s more, there are a number of situations where aging in place with the help of home care actually makes more sense than the alternatives. Particularly when you calculate the emotional toll of leaving a home of many years, or of leaving a much-loved community, choosing an institution can come with some hidden costs that make home care the better bet.

If you’re choosing between home care and assisted living arrangements, understand that neither is a perfect fit for all situations, and you may end up using some combination for some length of time. If you do have to choose, choose carefully to get the care that best fits your needs.

Here are some sample worksheets for estimating the cost of various types of care. These will give you a ballpark figure for how much care will cost the first year: use them as you decide what type of care will best suit your needs.

Home care costs
Housing:
Monthly mortgage/rent: ___
Homeowner’s insurance: ___
Property taxes (per month): ___
Home maintenance costs (per month): ___
Monthly utilities (power, gas, water): ___
Other living expenses:
Monthly food budget: ___
Transportation: ___
Care:
Hours needed per week: ___/7 * 30
(Times local median rate: ___)
Average monthly cost: ___

Total monthly expenses during the first year: ___

Senior living costs
Housing:
Monthly mortgage/rent: ___
Homeowner’s insurance: ___
Property taxes (per month): ___
Home maintenance costs (per month): ___
Monthly utilities (power, gas, water): ___
Other living expenses:
Monthly food budget: ___
Transportation: ___
Care:
Hours needed per week: ___/7 * 30
(Times local median rate: ___)
Average monthly cost: ___
One-time expenses:
Moving costs: ___/12

Total monthly expenses during the first year: ___

Assisted living costs
Monthly cost of residence: ___
Living expenses:
Food (if not included): ___
Care (if not included in residence cost):
Housekeeping: ___
Drug management: ___
Personal care: ___
Other: ___
Other living expenses:
Storage (if applicable): ___
Transportation (if not provided): ___
One-time expenses:
Moving costs: ___/12

Total monthly expenses during the first year: ___