This is the second installment in a series of blogs addressing planning for the future. The first installment was Aging Safely in Your Own Home: A Comprehensive Guide. Later topics will include: Legal Considerations and Aging, Nursing Home Red Flags, Is it Time for Memory Care, Caregiving from a Distance: Strategies for Nurturing From Afar, and Navigating the Caregiver Journey: Resources and Practical Suggestions..
In a matter of weeks, my mother went from being able to live alone in her home to needing 24/7 care. It was an emotional and physical scramble to set up an arrangement that 1. met her needs, 2. met our, her children’s, needs and constraints, and 3. fit her budget.
We are not alone; more often than not, these decisions seem to come as a “surprise.” We know they may come at some point but we never think it will be today. We can never know exactly how this will play out in our own lives and the lives of our family members. But thinking about it ahead of time, and making your wishes known to your family will make the process much easier when and if the time comes.
Living Independently vs Independent Living
To embark on this discussion we need to have an understanding of the options in the continuum of living and care options. So, let’s define some terms and options.
“Living independently” and “independent living” are terms that are often used interchangeably, but they can have different meanings for older adults. In this context, Living independently refers to continuing on as one always has in their own home. Independent living refers to an array of senior living options.
Independent Living
Independent living communities are for older adults who need little or no personal care assistance.
Continuing care retirement community (CCRCs)
CCRCs are designed to provide care over the continuum as needs change. Generally one needs to enter the community functioning independently. There is typically an upfront “buy in” fee in addition to the monthly fees.
Assisted Living
Assisted living settings are for individuals who require some help with their personal care (grooming, medication management, supervision, meals, housekeeping, etc.) but do not need the level of medical care provided in a nursing home. In an assisted living facility, residents typically have their own private or semi-private living spaces, such as apartments or rooms, and they may have access to common areas and amenities such as dining areas, recreational spaces, and social activities. The level of assistance provided can vary based on individual needs and facility capabilities. Trained staff members are available around the clock to offer support and ensure the safety and well-being of the residents.
Group homes (AKA Board and Care)
Board and Care facilities are a subset of assisted living. These residences are converted homes located in regular neighborhoods. Licensed 24/7 caregivers provide assistance and care for about 6 to 10 older adults, who tend to have some level of cognitive impairment.
Memory care
Memory care facilities are another subset of assisted living. In situations where cognitive impairment becomes severe older adults need more supervision and direct care to ensure their safety and security.
In-Home Caregiver vs. Assisted Living
Now that we have some terms defined, let’s look more specifically at the options for an individual who needs caregiver support. When deciding between assisted living and remaining in your home with a caregiver, there are several important considerations to keep in mind. Each option has its own advantages and disadvantages, so it’s essential to evaluate your specific needs and circumstances and discuss the options with your loved ones, healthcare professionals, and financial advisors. Ultimately, the decision should prioritize your safety, well-being, and overall quality of life. Here are some factors to consider:
Independence and autonomy
Reflect on your desire for independence and control over your daily routine. Remaining at home with a caregiver allows you to maintain a greater level of independence and make decisions about your daily activities. Assisted living, while providing support, may have some restrictions and a structured environment.
Level of care required
Assess your current and future care needs. Do you need 24/7 care? Are you ok at night but just need care during the day? Do you only need a few hours a day or a few hours a week? If you need daily or 24 hour care, you are squarely in the realm of considering assisted living vs. a live-in caregiver. If you need 24/7 care, do you have a spare bedroom for a live-in caregiver?
Safety, accessibility, and emotional attachment to your home
Consider your emotional attachment to your home. If you have lived in your current residence for a long time and have strong sentimental connections, staying at home with a caregiver can help maintain that sense of familiarity and emotional well-being.
But also consider the safety of your home environment. If your house requires significant modifications to accommodate mobility limitations or if it poses safety risks, such as stairs or difficult-to-navigate spaces, assisted living facilities often offer accessible and secure living spaces designed for seniors.
Social interaction and support systems
Assess your social needs and preferences. Assisted living communities provide opportunities for social engagement and activities with other residents, which can help combat feelings of isolation. On the other hand, if you have a strong support network and prefer the familiarity of your home and community, staying at home with a caregiver may be more appealing.
Assess the availability and willingness of family members to provide support. If you have family members or close friends who can actively participate in your care, staying at home with a caregiver may be a viable option. However, if family support is limited or unavailable, assisted living can ensure consistent care and support.
Cost
Evaluate the financial aspects of both options. Assisted living facilities typically involve monthly fees that cover housing, meals, and care services. In contrast, the cost of a caregiver at home varies depending on the level of care needed, hours required, and local rates. Consider your budget and explore financial resources such as long-term care insurance.
Hiring a caregiver through an agency can provide flexibility when the caregiver needs time off but agency rates can be very expensive. It will be more economical to find a caregiver through friends and family. If you do not go through an agency, you will need to ensure you have appropriate insurance if the caregiver sustains an injury while working in your home. If you own a home, you should be able to add a rider to your homeowners insurance policy. You will also need to comply with any state and local payroll rules for domestic employees.
Helpful Checklists
Finally, once you have made your decision about which option is best for you, checklists can help you break down this process to make sure you’re not leaving anything to chance or leaving any question unasked.
Checklist for Hiring an In-Home Caregiver
Click the link above for a detailed checklist and consider the following:
- What are the care requirements: personal, household, companionship, health care, transportation, specific ailment expertise. Write a job description.
- Are you compatible with the prospective caregiver and can you trust them? Make sure there is an in person interview that includes your loved ones or close friends. You will spend a lot of time with this person. If you want company are you compatible? If you want private time will they respect that? The article referenced above has an extensive list of possible interview questions.
- Conduct a background check prior to hiring: get written approval to conduct a background check, contact prior employers, obtain copies of IDs, obtain copies of any applicable certifications, if appropriate verify driver’s license and auto insurance.
- Will the caregiver be an employee or contractor (discuss with your accountant or attorney). How and when will the caregiver be paid? How will time off be handled: coverage, pay?
- Ensure you have appropriate insurance coverage in the unfortunate event of an injury.
- Execute a written agreement detailing the above expectations.
- Do you have valuables in the home that you may want to consider moving to another location? You may trust this person but sometimes keeping honest people honest is the safest bet.
A Checklist for Moving to Assisted Living
Click the link above for a detailed checklist and consider the following:
- Tour the facility and note the following:
- Is the facility bright, clean and odor-free?
- Do residents seem happy and engaged?
- How do staff and residents interact?
- How are the grounds and buildings maintained?
- How does the place make you feel?
- Speak with as many people in the facility as you can. An excellent way to interact with and observe the staff is to ask to have lunch at the facility.
- Check state safety records. Contact your state health department of social services office to find out about the track record of an individual facility in the state. Ask for a copy of their most recent state survey. If a facility will not share with you the most current survey results, run far, far away. This is a huge red flag.
- Get the details about fees and services. What is included (and not included).
- Find out about policies: coming and going, pets, visitors.
- Ask about staffing levels and on site health care options.
- Are services tiered so that an aging resident can stay in the community as health needs change?
- Ask about activities and resident enrichment opportunities. Including spiritual needs.
- Are transportation services available?
- Try the food! When and where are meals served, and what sort of variety is available? Can residents cook for themselves in their rooms or units? Can the community cater to special dietary preferences or needs?
REFERENCES
Did you find this topic interesting? Below are some more in depth articles.
Independent vs. Senior Living: Understanding the Pros and Cons – U.S. News
What Is Independent Living? Benefits, Types And Costs – Forbes
Group Homes: A Small-Scale Option for Assisted Living – AARP
Memory Care: Specialized Support for People With Alzheimer’s or Dementia – AARP
Choosing the Right Time to Move into a Continuing Care Retirement Community – U.S. News
Assisted Living vs. Home Care: What’s the Difference? – U.S. News
How to Hire a Caregiver – AARP
Checklist for Hiring an In-Home Caregiver – Senior Safety Reviews
A Checklist for Moving to Assisted Living – U.S. News
Joanne Bedwell, PT is the Resident Blogger at Be Active Be Well. She lives and works in San Francisco with her husband and two (almost) grown daughters. Having over 25 years of experience as a PT, she sees clients in their homes and teaches fitness classes in person and virtually.
DISCLAIMER: This article contains information that is intended to help the readers be better informed regarding exercise and health care. It is presented as general advice on health care. Always consult your doctor for your individual needs. Before beginning any new exercise program it is recommended that you seek medical advice from your personal physician. This article is not intended to be a substitute for the medical advice of a licensed physician. The reader should consult with their doctor in any matters relating to his/her health.
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