There are several factors to consider when evaluating home care vs. nursing home care. The total cost of care is certainly a consideration (read The Cost of Home Care in Massachusetts to learn more about that), but the needs of the client and his/her family are ultimately what determine whether home care makes more sense than nursing home care – or not.
Consulting with licensed home care agencies in your area, and then touring various nursing home options, will give you a better idea of which option best meets the needs of your loved one.
The following are some questions to ask yourself when weighing the options of home care vs. nursing home care.
Is It Safe To Remain At Home? (i.e. is the home accessible)
The individual’s safety is the first priority and should trump the resistance to transitioning or moving to a nursing home or assisted living community. Since mobility and minimizing fall risks are so essential to senior wellbeing, the home must be made safe and accessible.
Seniors should have:
- A single-level area in the home that accommodates their sleeping, bathroom/toileting, living room/social needs without stairs or hazardous thresholds.
- Flooring that can be navigated via wheelchairs, canes, or walkers.
- Bright, motion-sensitive lighting and plenty of it to make up for vision loss and night blindness
- Cupboards and closets that are organized with the things they use most in reach without bending or getting up on a stool or stepladder
- No area rugs or area rugs that are securely fastened to prevent ridges, wrinkles, or looped corner/edges
- Bathroom spaces that are easily navigated with a wheelchair/walker
- Grab bars near toilets and shower (shower seat and hand-held faucets are ideal)
- Secure railings and wheelchair accessible ramps replacing stairs at entries/patio doors
Visit the AARP’s guide on Aging-Friendly Home Improvements for more suggestions about making a home safe and accessible. If it isn’t possible due to the home’s age or design, it’s probably safer to move to a single-story accessible apartment or transition to a nursing home.
Are There Acute, Long-Term Medical Needs?
Most home care providers provide companionship and personal care assistance, as well as other services centered around basic, day-to-day needs such as meal preparation, laundry, housekeeping, etc. Outside of medication reminders, however, home care aides are not able to provide medical assistance.
If your loved one requires temporary medical assistance or wound care after hospital discharge, part-time home health care aides may be available to take care of that. Speak with healthcare providers for more information about whether or not a home health service can be brought in temporarily.
For example, most home care professionals are not legally allowed to perform or take care of:
- Symptom monitoring/diagnosis
- Medication monitoring/adjusting
- Wound care
- IV changes and insertions
- Feeding tubes
- Catheter care
- Injections (including insulin for a client with diabetes)
- Medication administration (although home care aides can provide medication reminders, the client must be able to take the medication on his/her own)
If the client has long-term healthcare needs, a nursing home or post-acute care center is typically the better option. Nursing homes have licensed nurses and physicians on-site, 24/7, as well as CNAs who can monitor the patient’s health and implement the most necessary treatments or interventions on-site.
Does The Client Require Acute Memory Care? (dementia, Alzheimer’s, etc.)
Does your spouse or parent have Alzheimer’s or another dementia-related condition? Home care is certainly a good option to provide qualified care and supervision during the early- and mid-stages of dementia. This allows more time and flexibility to choose a good memory care center or nursing home that accommodates the needs that arise as patients progress into later stages of dementia.
If you opt to keep your spouse or loved one at home for the duration, make sure you work with a home care agency that is experienced with memory care and who keeps their staff up-to-date with the latest research on dementia and Alzheimer’s care.
Diet, exercise, music and reminiscence therapy, social engagement, and games/puzzles are all important parts of keeping the neurons firing to slow-down the progression of the disease. If you hire a less-qualified caregiver, your loved one may be sitting stagnant all day, leading to a faster progression and decline.
Is Your Parent Social and/or Enjoy Outings?
There is no doubt that social engagement is essential to senior wellbeing. Remaining engaged with a variety of people, (friends, family, peers, children, etc.) minimizes the risk of senior depression and anxiety, and also slows down the progression of memory loss.
Whether you choose a licensed home care agency, or you decide to make the transition into a nursing home, work with agencies or facilities that prioritize human contact, group activities, and daily socialization.
Is A Pet Part Of The Equation?
If your loved one has a beloved cat or dog, it’s a serious consideration – especially if s/he lives alone.
Never underestimate the importance and legitimacy of a senior’s relationship and level of affection for his/her pets. If you feel that the home is a safe place, it can be made accessible, and there are no serious medical needs, it might be worth bringing qualified care in for the duration of the pet’s life unless you can find a facility that allows pets.
If that isn’t possible, work as diligently as you can to find a loving home for the pet, and allow time for your loved one to come to terms with it, process the transition, and grieve. If you aren’t able to find or afford a place that allows pets, see if there is one with a resident pet or two or that works with local volunteer agencies to bring service dogs/cats onsite for loving and petting.
Choosing Home Care vs. Nursing Home
If you are undecided, starting with a home care agency can be a good baby step into the planning and adjustments that will be necessary if it turns out your loved one is best served by a nursing home.