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The Decision No One Wants to
Make: Senior Care at Home or in an Institution?
By Coker Day
If
you're like most families, you have (or will someday soon) come to a crossroads
where you'll have to accept the fact that your elderly parents can no longer
live independently and will need professional help - perhaps not skilled
nursing care - but some kind of assistance with basic living that can't be
provided by family members.
Chances are you or your parents have been
independent most of your adult lives and you feel uncomfortable in the new
roles you find yourselves in. Once you've recognized that the need exists (and
that's a big step for most families), the next question is where should the
care be provided: at home, in a skilled nursing or assisted living facility? Of
course, there's no single right answer for everyone, but there are some key
questions you can ask that will lead you to the right one for you and your
family. Let's discuss a few of those questions and some of the solutions for
each one.
What level of care will they need?
Sometimes a
doctor or geriatric nurse case manager determines exactly what kind of care a
patient needs if there's been surgery, then rehabilitative care, and so on. Or
just as often our parents get too old or weak, perhaps from arthritis, to care
for themselves, and we have to rely on our own judgment that they need help.
Some telltale signs: poor housekeeping, poor nutrition, poor hygiene.
If
they need skilled medical care, including injections, wound care, tube feeding,
etc., they probably need to be in a skilled nursing facility or have skilled
nursing care at home. But if they need help with meals, dressing and bathing,
etc., they can either be in an assisted living facility or have in-home
assistance from a professional agency.
What can you afford to pay?
For many this may be the deciding factor. If your parents need care
around-the-clock, institutions are almost always less expensive than in-home
care. But if hourly or daily assistance is sufficient, in-home care is usually
less expensive than a nursing or assisted living facility. And yet,
surprisingly, Medicare, Medicaid and most long term care insurance policies
tend to provide coverage primarily for institutional care, although that's
beginning to change with private insurance. Still, many people believe that
Medicare picks at least half of the cost of long term care, when in fact, it
pays very little (only after acute care, like surgery). That's why it's a good
idea to look into long term care insurance and to be sure it covers both
institutional and home-based care.
What are your parent's wishes?
One can't ignore the emotional impact decisions like these have on the
entire family, which is why it's a good idea to discuss these issues before the
need arises, when cooler heads can prevail. (Parents: this means you should
make your wishes known to your children.) Clearly, the vast majority of us
prefer to stay at home. But there are seniors who may feel lonely and would
prefer being in an assisted living facility, to the surprise of their children,
in some cases.
In an assisted living facility, seniors have access to
round-the-clock care, if they need it, the companionship of people their own
age, meals prepared for them or the option, sometimes, to prepare their own,
all without the burdens of owning property.
At the same time, if they have
a period when they do need private duty nursing and the facility can't provide
it, you or they can always engage the services of an outside adult care service
company. At home, of course, they have familiar surroundings, generally more
contact with friends and family and often more independence. An in-home
caregiver can provide personal, one-on-one attention and build a close personal
relationship that's hard to find in an institution.
Whatever decision
you make, the most important thing you can do is to bring everyone who will be
affected by it into the room. Then lay out all the options, list the pros and
cons of each and arrive at a decision as a family. You and your parents will be
much happier if you come to a decision they feel they had a major role in
making and are assured they won't be placing a burden on anyone.
Coker Day is founder and president of DayBreak Adult Care Services
Inc., an in-home care services company serving the Midlands and Lowcountry with
offices in Lexington and Charleston, S.C. |
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