home care vs assisted living

TMF27

My mom has Alzheimers and my dad has dementia. I'm trying to decide whether to place them in an assisted living facility or hire 24/7 home health care in their home. They live in NY and I'm in MA. Does anyone have experience with either? I'm trying to think of a list of pros and cons. Thanks.

harshedbuzz

@TMF27

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

Some thoughts and questions:

Are you their sole decision-maker? Is there a compelling reason for them to remain in NY?

Do they have LTC policies? Do they have assets to fund care?

IME, long distance caregiving is extremely difficult. As the disease progresses, the POA/healthcare should ideally be close enough to have eyes on the PWD regularly to make sure care is good and to meet the ambulance at the ED when the PWD is transported there.

I would not attempt 24/7 in-home care from a distance as there are too many ways this could go sideways in the form of untrained aides, no-shows, and theft. We had all 3 when dad had in-home caregivers providing respite for mom.

Depending on the area COL and availability of caregivers, this could add up fast. I'm in the Philadelphia suburbs where agency aides run about $40/hr. You may also find overnight, holiday and care for 2 PWD results in higher costs. You could hire via care.com which would likely cost less but then you'd be doing background checks, payroll, increasing their liability insurance, and covering PTO and vacations either yourself or with other aides.

My neighbor's second wife did keep her mom in a home with a live-in aide couple. When they married, she bought the house he'd adapted for his late wife who used a wheelchair. It worked well for her because she was local and covered the aide's days off and hired short term help for vacations.

A MCF would be simpler if you could find a good one. I would suggest moving them near you into a MCF. You'd be local to visit and keep an eye on things.

HB

CaliforniaGirl-1

Big factors in our decision were:

• Temperament - our LO is social and the increasing dementia and advancing age led to her being isolated at home. We felt she would enjoy being part of a community and able to make friends while she was able.
• Assured continuity of care - at a distance and even if we were close we would be always looking for substitutes if caregivers were ill or left. My LO really needed 24 hour care with no gaps
• Safety of the environment - concern about wandering, fires, getting hurt, financial abuse, home safety and ability to get medical care
• Cost - as expensive as MCF and AL are 24/7 care especially if you have people who are trained in dealing with pwd it can be even more expensive
• Location - moving our LO into care allowed us to move her closer where we get to see her more often
• Potential for abuse or neglect. This concern is everywhere but home in another state with one or 2 caregivers we felt our LO was vulnerable

I am not going to claim it has been perfect or effortless. But it has worked for us and our LO.

H1235

Welcome. Assisted living and memory care can sometimes have a waiting list. I agree with other, I don’t know how you could possibly manage their care from out of state. You didn’t say what stage they are in. Some places offer assisted living in one wing and mc in another. This allows for an easier transition when Al is no longer enough. In my experience Al is just a bit of assistance. Staff generally has less training and experience. They usually do an assessment to see if the person is a good fit. If they are going to need a lot of help or are at risk of wandering off, you may want to consider mc. I also agree that a facility offers a chance to talk and interact with peers their age. At home mom sometimes didn’t even change out of her pajamas. Once we moved her ( she did not want to move) she made friends and participated in activities. It was good for her.

[Deleted User]

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harshedbuzz

Cobbling onto what @[Deleted User] said, overseeing a PWD care in their own home is like staring a new business in which you are the CFO as well as being in charge of HR, physical plant and procurement in another state.

TMF27

Thank you, thank you for your thoughtful responses. I really appreciate them; they helped me make my decision.