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Assisted living vs. nursing home vs. home care

How to choose the right living situation for your aging parent

Profile picture of Jami Barnett, Ph.D.
by Jami Barnett, Ph.D. ConsumerAffairs Research Team
granddaughter sitting with her arm around her grandmother

You have to consider several factors, including finances, health care needs and personal preference, 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 gives your loved one reassurance that 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 type and cost of the services your loved one needs.

Compare senior housing options

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.

Assisted living facilities

Assisted living facilities are designed for individuals who need hands-on support with daily activities but not 24/7 care. Seniors living in an assisted living facility usually cannot live alone for safety reasons, like fall risks or other concerns, but are otherwise fairly independent.

Many assisted living facilities offer certain wards for memory care patients, such as those with Alzheimer’s disease or dementia. Assisted living professionals provide general support, including dressing, bathing, eating and housekeeping, but not full-time medical care.

Types of assisted living services

  • 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 and assisting with oxygen tanks, prostheses or other self-administered medical devices)

Cost of assisted living: $40,000 to $50,000 per year

Nursing homes

A nursing home is a health care facility designed for seniors who require 24/7 monitoring and care. Nursing homes provide a wide range of services, including medication management, daily help, skilled nursing and on-site therapy. Nursing homes are a good option for individuals who need help not only with routine activities, like using the restroom, but also specific medical services, such as respiratory care or physical therapy.

Types of nursing home services

  • 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

Cost of nursing homes: $85,000 to $95,000 per year

In-home care

In-home care is a type of health care service that brings wellness into the comfort of a home. With in-home care, individuals can find more independence and increased safety levels through the help of a trained caregiver. Depending on the level of care needed, these caregivers stay in the home anywhere from a few hours a day to 24/7. Caregivers offer assistance with things like meal preparation, chores, running errands and medication administration.

In-home care is usually best for those who don’t require specific nursing support but do need help with daily activities. For example, those who use a wheelchair but are otherwise fairly healthy may benefit from in-home care.

Types of in-home care services

  • Meal delivery
  • Help with self-care (bathing, grooming and dressing)
  • Medication monitoring
  • Minor health care services (checking and tracking vitals and 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

Cost of in-home care: $10 to $30 per hour

Skilled nursing facilities

Skilled nursing is a type of medical care administered by a licensed health professional, like an occupational therapist or registered nurse. Skilled nursing may be required for a short period of time, such as after a surgery as a form of rehabilitation, or in a long-term capacity for patients with chronic medical conditions.

Skilled nursing can happen at home or within a larger nursing home facility, depending on the needs of an individual. While most people would prefer to stay at home for the remainder of their lives, the cost of skilled nursing combined with updating a home with items like stair lifts and walk-in tubs may be too much. In this instance, it might make more financial sense to utilize the many benefits and established foundation of a nursing home for safety and security.

Types of skilled nursing services

  • Custodial care like bathing, eating, etc
  • General wound care
  • Occupational therapy (coordination or memory help)
  • Nutrition therapy (personalized diets and nutrition training)
  • Physical therapy (rehabilitation support)
  • Medication support
  • Medical supplies
  • Social services
  • Post-hospital care
  • Hospice and respite care
  • Close supervision and security

Cost of skilled nursing care: $8,000 or more per month for a private room

elderly woman getting her blood pressure taken by a nurse

Professional care vs. caring for elderly parents yourself

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 saying it now 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 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. 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 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 the location, they could also use public transportation or a rideshare service.

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 health care. 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 develop 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.

elderly woman walking with the help of her daughter

Bottom line

Deciding 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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Profile picture of Jami Barnett, Ph.D.
by Jami Barnett, Ph.D. ConsumerAffairs Research Team

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.