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Assisted living vs home care

How to choose the right living situation for your aging parent

Last Updated 9/11/17
by Jami Barnett, Ph.D. ConsumerAffairs Research Team
Daughter with senior mother

Housing options

You have to consider several factors (finances, health care needs and preferences) when choosing where your aging loved one should live. Although seniors have many different living options, most people choose an assisted living facility, a nursing home or in-home care.

Before making any decision about where your loved one should live, talk to them. Find out what they want their daily life to look like and what would make them happiest.

Their ideal situation (retiring to Hawaii, for example) might not be feasible, but having an honest conversation about their preferences will reassure your loved one they still have control over their life. Research shows people are more likely to be happy with their surroundings in a care facility if they had some control in the decision to move there.

After talking to your loved one about their preferences, you can make a decision together based on the types and costs of the services your loved one needs.

Nurse taking blood pressure

Services offered

Choosing a place to live should be a two-sided conversation. First, consider the services your loved one needs and talk it over with them. You might disagree; for example, you might think mom needs someone to prepare meals for her because she’s started ordering a lot of takeout, but she might simply be tired of cooking after years of preparing meals for her family. Talking about needs helps ensure you don’t pay for unnecessary services.

Specific services vary by facility, but here’s a rundown of the offerings you’ll typically find in different care settings:

Assisted living facilities

  • Help with self-care (bathing, grooming and dressing)

  • Meals

  • Transportation to doctor’s appointments

  • Housekeeping

  • Social activities

  • Fitness classes or programs

  • Emergency call system (similar to a medical alert system)

  • Medication monitoring

  • Minor health care services (checking and tracking vitals, assisting with oxygen tanks, prostheses or other self-administered medical devices)

Nursing homes

  • All services provided at an assisted living facility

  • Regular assessment by registered nurses (RNs) or doctors

  • Treatment for ongoing illnesses of all kinds

  • Physical and occupational therapy

  • Memory care (including architectural design, food choices and more) for dementia patients

In-home care

  • Meal delivery

  • Help with self-care (bathing, grooming and dressing)

  • Medication monitoring

  • Minor health care services (checking and tracking vitals, assisting with oxygen tanks, prostheses or other self-administered medical devices)

  • Medical alert system

  • Periodic assessment by RNs

  • Housekeeping

  • Transportation

  • Physical and occupational therapy

  • Companionship

Senior going over bills

Costs

The cost of a care facility, whether it’s an assisted living facility or a nursing home, varies greatly by facility. There’s no quick answer about which option is most affordable; some research shows assisted living facilities are cheaper than in-home care, and other research shows in-home care is cheaper.

To figure out which option is most affordable, you’ll need to contact the assisted living facilities or nursing homes you’re considering to get pricing information. For an accurate price, meet with someone onsite to go over how much Medicaid, Medicare or private insurance will cover.

Next, make a list of the monthly expenses your loved one could eliminate if they moved into a care facility. Remember to include your best estimates of the following:

  • Rent or mortgage payment

  • Property taxes

  • Home maintenance costs

  • Lawn care or landscaping costs

  • Homeowners or renters insurance

  • Homeowners association or condo fees

  • Security system bill

  • Utilities

  • Grocery budget

  • Medical alert system fees

  • Housekeeping services

  • Home health aide visits

  • Fitness program or gym membership

  • Other (Review your loved one’s bank or credit card statements to see where else they frequently spend money.)

After you have information about their monthly expenses, you can determine whether it would be cheaper for your loved one to stay at home or move into a care facility.

Senior and daughter holding hands

Other considerations

The services your loved one needs and the cost of getting those services might be among the most complex factors in deciding between aging in place and moving into an assisted living facility or nursing home. However, you shouldn’t discount the following considerations:

Your capabilities

If you’ll be the primary caregiver, think about your capabilities. Ask yourself whether you can provide all the care they need, long term. It may be difficult to admit to yourself and your loved one that you can’t fully take care of them yourself, but doing so will be better for everyone in the long run.

If you and your loved one decide they should age in place or move in with you, remember to care for yourself too. Use respite care services when you need a break, join a support group for caregivers and consider talking to a counselor to get emotional support for yourself.

Location

Consider how far you live from your loved one and whether they’re willing to relocate to be close to you. If they live far away and don’t want to move to a new city, then a care facility might offer a safer environment simply because of the supervision it provides.

If your loved one lives near you and is moving to a facility, make sure distance won’t prevent you or other friends and relatives from visiting them regularly.

Community

Talk to your loved one about their social life. If they feel isolated or lonely, moving into a care facility might help them feel more connected since these facilities have regular social activities for residents.

If your loved one is highly involved with their existing community or social groups, discuss ways for them to remain involved, even if they move into a facility. Depending on the facility's rules and your loved one’s health, they may be able to keep a car at the facility so they can drive themselves to social events. Depending on location, they could also use public transportation or a rideshare service to get around.

Centralized services

The more care your loved one needs, the more complicated their home care is for you to manage. For example, you may have to call separate providers for problems with housekeeping, meal services and healthcare. If all of these things were a problem while they were living in a care facility, you’d probably only have to contact one person. Having a centralized service may lessen the stress for both you and your loved ones.

If you and your loved one decide they should remain in their own home or live with you, consider hiring a geriatric care manager. These professionals can help you find qualified providers, understand health care costs and better address your loved one’s needs.

The future

It’s important to remember that as your loved one ages, they’ll need more advanced care. Your initial conversation on what arrangements they prefer is a good time to discuss long-term care if they get dementia or become otherwise incapable of making their own choices in the future.

Continuing care retirement communities (CCRCs) have senior apartments, assisted living facilities and nursing homes all on the same property. If your loved one expects to eventually need nursing home care, moving into a senior apartment at a CCRC might make more sense than renovating their home to age in place.

Seniors laughing together at table

Conclusion

Figuring out where someone you love should live as they grow older can be emotionally draining, and not knowing what’s going to happen often feels scary. Both you and your loved one will feel better when you make a choice together and proceed with your plan.

Whether you decide they should move into a care facility, move in with you or age in place, there are plenty of service providers to help you through the process. Once you have these services in place, your loved one can focus on being more social and enjoying their life.

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Jami Barnett, Ph.D., is an experienced researcher, and she believes consumers have a right to clear and honest information about products. In her role at ConsumerAffairs, she thoroughly researches products and companies by interviewing experts, reviewing research studies, reading governmental regulations and investigating customer service responses. Her work gives consumers the information they need to make smart purchasing decisions.

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