Should we hire in-home care or insist on assisted living?

13 answers | Last updated: Oct 09, 2016
A fellow caregiver asked...

Is hiring 24 hour home care for my parents less expensive and better for them emotionally than living in an Assisted Living facility? One parent is more independent than the other. My father has dementia and will need more skilled care in the near future. My mother is not "emotionally" ready to leave her home and won't even look into assisted living. But my father's needs are more than my mother or my siblings can handle and I feel that we at least need to look into all possibilities so that we can be prepared for things to come. My mother says to wait until something bad happens and then they will move "if they have to". This doesn't sit well with me.


Expert Answers

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

Hiring in-home help is a temporary fix for a permanent problem. Dementia is always going to progress; a person with dementia is going to become less functional and more needy over time. Getting in-home help is a band-aid on the wound, and is a great deal more expensive.

In my area home care is about $18 per hour, $400 a day, $3000 a week, etc. Assisted living will start at around $3000 per month and go up in cost depending on how much space you want and how many additional services you need. It will not exceed the cost of in-home care per month.

Living in a community has many other advantages. For the person with dementia, he can spend time with others like him every day, have activities that are geared to his abilities, and you have the security of knowing that he has eaten and cannot go for a walk without someone going with him.

Your mother can stay in her home if she is not ready to leave it. Do the right thing for your father, get the best care you can while he can benefit from it. The studies indicate that the progression of dementia slows and the symptoms improve once they are in the routine of a care community. Later on, your mother can decide to move into the community at a different level, when she is ready.


Community Answers

Sandykaye answered...

Keeping a parent at home, may "be a temporary fix", but I personally feel that my mother-in-law, is happier with her son and me. This may be a "band-aid on a wound"; but I feel this is what her retirement is for, to help with the cost of her care. Here the cost is from $5.00 $12.00 per hour, but we don't need full time, and can do some things ourselves. We as family caregivers want to see personally the care given to our parents (not told by another how she is) and are willing to keep them with us as long as possible. Keeping them in an area that is familiar to them seems to be the best scenario. My mother-in-law was in assisted living while my husband and I were not able to care for her; she was put on an anxiety pill while there. We have not needed to give it to her since she has come back to live with us. While it is possible we plan to keep her here with us. She carried all of her 6 children for 9 months and was a wonderful mother, many times going without to give to her kids. This is our opportunity to give something back.


A fellow caregiver answered...

Thank you for your response to my question. Unfortunately, my older brother who lives in the same home as my parents, is not home often because of work and has no plans to do more than he has. I live about an hour away and have no room in my home for my parents. I have two children, my house is small, has stairs with full baths on the second floor, none on the main floor. We are also unable to add onto our home. We also pay the caregiving company $27/hour for 6 hours per day, 5 days per week. We tried to hire an independent caregiver, but he was unreliable and stole from my parents. In a perfect world, I would do what you do, but our lives and situations are so different. Good for you to be able to care for your mother-in-law in your home.


Father's daughter answered...

My sister and I lost my mom unexpectedly 3 years before my father. When this happened, we both asked my father to move in with us and he refused. Over the next 3 years my father's health declined. We again asked him to move in with one of us and he wanted to stay in his own home. He lost his vision and was unable to walk. We tried everything to get him to go to an assisted living. We told him that he would have people his own age to visit with (instead of being alone) but he did not want to leave his home. So, for three years, my sister and I took turns every day going to make dinner for dad and do whatever he needed. It was a difficult time. For a short period of time, we had a caregiver coming to his home for a few hours about 3x a week but eventually that stopped. During the last year of my father's life, we had to make a lot of adjustments to his home. He could no longer get down the steps and so we had French doors that opened from his dining room onto a deck that we added and had a lift added to take him down to the ground level in a wheel chair, we had to remodel the bathroom and take out the tub so that he had a walk-in shower (because he could no longer climb over the tub). His last 6 months he deteriorated even more and he still wanted to stay in his house so we hired a live-in caregiver who did the world for my father. Yes, it is expensive, but as someone else said, that's why they have money put on the side and their retirement money. We live in the Chicago area and it cost us $3,000 a month for a live-in caregiver. But most importantly, we were able to do what my father wanted by letting him stay in his own home. That's something that I will always remember is that we did what was important to him. If at all possible, please take there wishes into consideration!


A fellow caregiver answered...

Thank you for your response. Another issue though for us is that my parents did not plan ahead. They have some retirement money but lost a lot of it several years ago when the stock market crashed. They also don't have long term care life insurance. They "gifted" my brother $350,000 3 years ago for him to build a house for them, my brother and his wife to live in. His wife was going to work from home and help care for my parents. She died this past Thanksgiving from ovarian cancer. My brother is now back to work full-time and not able to care for my parents as they had all planned.

So, basically, their money is limited.


Superstring answered...

I tried both with my husband who has physical disability and dementia, after he was hospitalized for a fall and dehydration. Four weeks in a supposedly high-end assisted living facility with supposedly specialized dementia care was a nightmare. Residents were not cared for as contracted, and rather than being helpful to me (I couldn't care for him anymore myself) I became even more exhausted trying to get the services I was paying for. He was frightened, angry, and wanted to go home the entire time he was there. The promised exercise, physical therapy, activities were a joke. Visiting nurses were a joke. Rather than healing, his minor wounds sustained in the fall became infected with MRSA, which wasn't identified and treated until after I got him home. One of the competent staff (there were some, but they were terribly overworked) advised me to add private caregivers after two weeks and identified appropriate helpers (two big strong men who alternated 24-hour shifts), and he began to improve physically and mentally and his scrapes even began to heal (since he was no longer left lying in wet diapers)--they were able to soothe him to sleep rather than the staff sedating him. I brought him and his private caregivers home after another two weeks of frustration with the facility. Although while he was there he couldn't ever figure out what the assisted living facility was or where it was or why he was there or what town we were in, or even that we owned a house nearby, the instant we brought him home he became oriented and gave the caregiver a tour of the house! and he has improved by leaps and bounds since then (about 6 months ago). I got him off the Ativan they either gave him or stole from him (the medication records never did match properly), stopped giving him Seroquel (supposedly for agitation, but he's less agitated without it), he stopped being incontinent, and we don't need the caregiver to sleep in our bedroom with us anymore to keep him from falling. He still has dementia, still has the caregivers (even though he doesn't think he needs them, he does). It costs me 50% more to have a caregiver with him 24 hours a day, but it's worth every penny. He was a wonderful provider and I can't think of a better way to use the money he so prudently set aside. Although he's forgotten that we saved for this on purpose and is angry that we have to have "somebody living here telling us what to do all the time" and worries about what it's costing, I am profoundly grateful for his foresight. I vote for keeping your loved one at home! If you or your loved one can afford 24 hour caregiver, the effective hourly rate is far less than if you pay hourly. The only way an assisted living is going to work to help YOU is if you don't go there, and I saw too many residents whose families didn't come. When we left, there were a half-dozen residents I'd gotten to know (yes they were demented, and I doubt they remember me) who I wish I could have brought home with me. I went back to clear out his room, and one woman said to me when I told her I'd taken my husband home, "You are doing what Jesus commanded us to do! You give us all hope!" Yes, it's a great big hassle living with him, but I loved him for many years and I still do. (My parents, on the other hand, WANTED to move into assisted living and got it all set up in advance for themselves without depending on me--they had time to identify and study the alternatives and make a good decision which worked out well for them.)


3generations answered...

We've done all of the above with my Dad. He and Mom lived with my family (including our 3 kids) for almost 10 years. But shortly after Mom died of cancer last summer, Dad's dementia went severely downhill. It became a safety issue for him and our family. We moved him first to an apartment in an assisted-living community. He never really seemed to settle in there, and began having "wandering" problems. So, we hired in-home care to spend 3 days/week with him there - above and beyond the regular assisted-living services. They were wonderful, but Dad's dementia just kept showing new symptoms until the assisted-living staff insisted Dad have a full med/psych assessment. The doctors concluded Dad must live in a "structured" environment, with a "wander-management" program. So, he now lives in a nursing home meeting that criteria. My point is that sometimes difficult decisions have to be made. Having a parent living at home with family is wonderful when it works. I wouldn't trade those 10 years for anything. But it affects more than just that parent's well-being; it affects everyone in the household...and family members not even in the household (like you). Talk to your brother and see if he will help with this decision. Good luck.


A fellow caregiver answered...

Thank you!


Steve - st. louis answered...

I have to agree with the daughter who said to take the parent's wishes into consideration. My mother does VERY well at home with a Live-in Caregiver and I know that she would not get the attention she needs in any facility (they would probably have to strap her down since she likes to be on the move - she would die much sooner). She knows her home and putting an advanced Alzheimer's patient in a new unfamiliar environment unless ABSOLUTELY necessary will only shorten their life. The expert answer tends to lean towards the cost but that savings brings a price (a $3000 per month facility is not going to provide high quality care). Nothing can replace one on one care with a qualified, loving Caregiver. And we pay a daily flat rate which is much more affordable than hourly rates as described in the first answer.

If the money is available and it is safe to do so, take the time to find a good home-care company and at least try it for a while before moving your parent to a facility. When the time does come, make sure it is a reputable place and visit as often as possible to make sure your loved one is getting the proper care.


Improvelife answered...

I am a practicing Occupational Therapist for 10 years. I see these types of situations all the time considering ALF's or non skilled home care. Every family and situation is different. I have treated patients who are not social and were unhappy living in ALF's. It is hard to leave their homes. Take into consideration that you can use a caregiver part time and increase the hours at home as needed. As your parent declines, lets not forget about hospice at home. This is paid for by medicare, therefore you would not be out as much at this point depending on your parent's need. Every situation must be personalized to the family and patient, personality, finances, relationships etc. Hope this is helpful.


Pom answered...

Hello, I read all of your answers and was impresssed. I think it is very important to remember that all family situations are different and no one thing will work for everyone. But I am curious, have you considerd Adult Day Care? A social adult day care offers a supervised environment with social interaction with people of similiar age groups and diagnosis. If you visit the National Adult Day Services Association website they provide informtiaon that compares cost of home care, assist living, nursing homes, and adult day care. You can use adult day care in combination with home care or the assistance of family members providing care. Best wishes in your search for what works best for your family! Peace of Mind Social Adult Day Program


Stllinda answered...

Also, many agencies that provide in home care offer a different 'hourly' rate for clients needing live-in care. Often times rates are about $5 per hour less expensive.


Cemetarykat answered...

Why not go to a near by homeless shelter and look for a woman or man depending on preference that might be open to an exchange of room/food and neccesities. In exchange for caring for your parent. Many today are homeless that are perfectly capable of caring for the elderly . The homeless shelter manager could easily identify which ones might be feasible answer to your problem. You'd be helping someone else stand back up while helping yourself too!