home care vs assisted living

TMF27 · October 4

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 · October 4

@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 · October 4

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 · October 4

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.

ARIL · October 5

We did not technically “choose” home care over AL, but because of circumstances over which I had no control, we tried home care for about a year (nothing close to 24/7, except for one hard and very expensive week). I had most of the issues mentioned already (payroll, taxes, erratic schedules, time off, people leaving unexpectedly); I was trying to manage all this alone from multiple states away, with lots of visits while working full time, etc. I hired privately for a while, then worked with an agency (the agency was better). It was all tough; my stress level was off the charts; I didn’t sleep much.

When a crisis came and made AL suddenly possible, the situation was safer and better almost right away. One AL and two MCs later, I’ve dealt with a wide range of possibilities.

You have been given excellent advice already. I will only echo the point that this is a progressive, degenerative disease with no cure, and it is really hard to deal with it from a distance for very long. The PWD needs a lot of direct attention even with aides or AL staff involved. (Who meets the ambulance at ER? is the most extreme situation I have yet faced. Fortunately that was me, after a long-distance move for my PWD.) I recommend moving the LO close to the POA—if you can—while that is feasible.

If the choice is a straightforward one between 24/7 home care and AL, AL is going to be better in most cases for most people, for all the reasons others have mentioned. Expense. Quality of care. Companionship of an age cohort. Many eyes on the situation.

Wishing you all the best.

harshedbuzz · October 5

Cobbling onto what @ARIL 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 · October 5

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

home care vs assisted living

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