How should you compare assisted living vs. home care? And how do these services provide care to seniors? Many people consider assisted living facilities and home care agencies to be competitors.
Many families debate between home care and an assisted living facility for their parents, but this does not mean competitors. These two types of senior care provide different services.
Assisted livings vs. home care, in the end, is a fallacy because neither can provide the services the other can.
This article will discuss the differences between assisted living communities vs. home care agencies in a few key areas:
- Pros and Cons
Senior Care Services
- Your family will provide care.
- You intend to hire private caregivers.
- You plan to move your parent into an assisted living community.
For most families, option one is difficult as they raise children of their own and have a career to prioritize. Families now live further away from one another than past generations. Children will move away from home, or seniors will retire to warm climates that isolate them, making family caregiving impossible.
This trend pits assisted living vs. home care services, and there are quite a few major differences between these services.
Assisted Living Facilities (ALFs)
Assisted living communities are known as social models of care. The primary goal of an assisted living is to engage seniors and have a community. The assisted living centers around having a social atmosphere. For example, apartments are usually on the smaller side, with 300-400 square foot rooms. Enough for a bed, small living area, bathroom, and kitchenette.
Assisted living communities focus on social gatherings, with many events on the calendar each day. Bingo, dances, entertainment, and food-related events are all scheduled to have seniors interact with one another.
What an assisted living does not provide is direct one-on-one care for long lengths of time. They will help for an hour in the morning and then in the evening, but if your parent starts to need more than that, the assisted living will recommend hiring private home care services, like Minute Women.
This research is important when considering which is best for your parent. According to the AARP, the average length of stay in assisted living is two to three years. As such, assisted living may not be the best choice if your parent already needs one-on-one care.
Private Home Care
What home care provides is one-on-one direct care. You are paying to have a caregiver at your parent’s side if anything goes wrong or they have any needs. Think of a caregiver as a lifeguard, they may not always save people from drowning, but they are always on watch.
On the other hand, assisted livings can not provide the services that a home care agency can. They do not provide 1:1 care, so if your loved one has a stroke, repeatedly falls, or is no longer safe on their own, then the assisted living will talk to you about hiring an agency.
Above all, home care does not provide the social model that an assisted living can provide. We can talk, interact and bring your parent to events, but fundamentally we aren’t a social model. We are a direct care model.
There is no competition between an assisted living and home care agency for our services, as we both provide different services that complement one another.
The Costs of Senior Care
The cost of an assisted living vs. home care agency is easier to compare than the two providers’ services, but you are paying for two different services.
An assisted living facility is providing room and board, activities, and some light one-on-one care. A home care agency is only providing one-on-one care.
The average cost of assisted living in Boston is $6,100 per month. At the same time, the average cost of 35 hours of care per week over a month is $4,550. That is a significant price difference, but also recognize that the cost would be much more expensive if your loved one needed 24/7 care. When it comes to home care services, the cost can vary significantly depending on how much care is needed.
Keep in mind that if your loved one needs more than a few hours a day of help, you should consider hiring outside help from an agency. We have worked with families who moved mom into an assisted living community, sold the house, and then had a stroke. The assisted living required around-the-clock care, or she would need to leave the community and move into a nursing home.
Home Care Agency Billing – How Does It Work?
These families feel like they are throwing money out the window paying for both the assisted living and home care concurrently because their parent is no longer appropriate for the assisted living without private home care.
No one can predict the future. The point is for you to know what could happen and to stay prepared if it occurs. These situations cause people to think it’s assisted living vs. home care agencies when we are working together in reality.
Rest assure that the assisted living community assesses potential new residents before they move in. A nurse comes to the home to assess the potential resident to ensure they benefit from the assisted living communities’ services.
Home care costs charge by the hour. The more hours you need per week, the more consistency you will have with your caregiver. The fewer hours, the less consistency.
Many home care agencies have minimum hours required per block and week. Minute Women require five-hour blocks of time with a minimum of fifteen hours per week. So agencies ask for more, some less.
Understand that the fewer hours you request, the higher turnover in caregivers you will experience, regardless of the agency you decide to hire.
Assisted Living vs. Home Care – Pros and Cons
Assisted Living Facilities (ALFs)
- Social model
- Room and board
- A small amount of 1:1 care
- Lots of activities and events
- Dementia care units
- Lack of personalized care
- Must have 1:1 care for declining residents who are no longer appropriate
- COVID measures were difficult, isolating, and tough on families.
- COVID – good testing, but many different people in and out of the building
Private Home Care
- Provides direct 1:1 care
- Can help keep mom out of the nursing home
- Lifeguard assistance, always there in case emergencies occur
- COVID – Can see parents and visit when you like
- Moderate hours are less expensive than ALFs
- Get to stay in their home
- Fewer people in and out of the home compared to ALFs
- High-hour cases are expensive
- Lack of social engagement compared to ALFs
- COVID – Less testing
- COVID – not guaranteed to reduce infection
The real question is which is better for your parent and where do they want to age? In the end, the decision of assisted living vs. home care services isn’t about which is better than the other. There are pros and cons to assisted livings vs. home care services, as some wish to stay home while others want to be in a social community.
Senior housing was battered by the pandemic, leaving seniors forced into isolation for extended periods. Imagine being alone in a 250 square-foot room for twelve months, feeling like you are in prison.
That is how hundreds of thousands have felt over the last 16 months. These buildings exist to entice their residents into the community to interact, be social, and enjoy others’ company. All that backfired when the pandemic started.
While hopes are high, there is still a reason for concern.
Signs are pointing to a status quo for 2021 with continued lockdowns, social distancing, and restrictions. A rally in senior housing is unlikely this year.
How Is Senior Housing Going to Adapt?
Senior housing has been expanding and building new communities for decades. In the Boston area, there are multiple communities per town. Many of these communities are only 50-70% occupied. In other words, every third or fourth community could consolidate into other communities.
The future isn’t so bright.
COVID will continue for 2021, potentially leaving 2022 as a full recovery year (hopefully). If the vaccine is only 80-90% effective, this leaves 10-20% of people who can still get sick. Who do you think those “people” will be?
At-risk seniors, the very seniors who reside in senior housing communities.
If COVID becomes similar to the flu, where annual vaccinations for new variants are required, does this mean there will be outbreaks each winter?
The fear of annual outbreaks, deaths, and mandatory isolation will cause families to reconsider if senior housing is right for them, slowing their recovery or even preventing it from ever happening.
Additionally, if the vaccines are effective but not perfect, seniors are likely the population that will indefinitely be at-risk each winter when the outbreaks occur.
Recovery for these communities is not guaranteed, and I propose consolidation and contraction are likely to occur before an immediate bounce-back. There will be a hangover effect of families who are still apprehensive about moving their at-risk parent into a community.
What family wouldn’t be concerned about their loved one moving into senior housing after what has happened in the last twelve months?
- Indefinite isolation
- Not seeing your parents for months
- Risk of death
- Dying alone
- The mental and physical decline from isolation and lack of exercise
So there is going to be a lot to consider when deciding what the right move is. Especially for the traditional side of senior housing.
The Challenges of Dementia
For many families whose parents have dementia, the decision is a bit easier. They can’t care for their parent anymore, and they know the disease is only going to progress and make things harder. Moving their parent into a community that specifically focuses on that disease provides everyone with a better quality of life.
Additionally, their parent has a disease that is going to cause them to die. Many with dementia may no longer recognize their own family, and their quality of life is already suffering. So the risk of dying from COVID is somewhat mitigated because they are on that journey already.
While that might sound terrible to say, you would be surprised at how many families are relieved when their loved one dies after a decade-long journey with dementia. I have heard numerous times, “My mom died a long time ago. I was caring for the body.”
For the traditional side, it is going to be a long road ahead. Those families have more options, and many seniors who in the past were open to senior housing are now refusing and wish to age in place no matter what.
Senior housing has a long road ahead before it reaches the light at the end of this tunnel. In the meantime, we can find you a caregiver that can provide your mom or dad with quality care right at home. Above all, we provide peace of mind that someone is there to watch over your parents.
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We received a private home care call from a possible client that needs 1-on-1 care for his 100-year-old mother, who fell and broke her hip. She is dealing with a discharge from a rehabilitation facility in three days, and the family is completely overwhelmed to the point of not being able to make a decision.
When speaking with this gentleman, it was clear he knew nothing about the options of private home care services or any services for that matter. I find that so many families are unaware of their options when a crisis like this occurs.
There are many options for senior care; adult day, VNA, Medicare, assisted living, senior housing, independent living, and nursing homes all provide personalized support.
So I wrote up what I thought everyone must know about senior care services so that if something happens, you have a solid understanding of your options.
Private Home Care Costs
1. Most private home care involves out-of-pocket expenses.
2. Private insurances generally will not cover the cost of home care.
3. Veterans Aid & Attendance is an option many people do not consider. VAA can reimburse up to $2,000 per month of home care costs!
4. Veterans, their spouses, or widow is eligible for VAA.
5. Long-Term Care Insurance can cover home care costs.
6. Some private home care companies can bill your LTC insurance company directly, so you do not wait for reimbursement.
7. Private home care costs add up quickly but are usually less expensive than other hospitalization and rehabilitation costs, especially if out of pocket.
8. If you are interested in finding out the cost of assisted living, nursing homes, and adult day centers in your city, see the Genworth Cost for Care Study.
9. Though unlikely, look at your private insurance company to see if they reimburse the cost of elder home care.
10. Medicare and Medicaid usually do not cover long-term care costs of private home care, and there are limits to how much they cover in nursing home rehabilitation centers.
Types of Private Home Care
11. Respite care is available for short durations of time.
12. Hourly care is generally in blocks of 3-4 hours to twelve hours shifts.
13. A night sitter is available where the caregiver is awake (hourly cost) or asleep (flat-rate).
14. The transportation service is not a taxi. When we drive seniors to their homes, escort them to their event or meeting, and then move them home safely.
15. Live-in care is the most economical way to maximize the amount of care you get for the cost of private home care.
16. Twenty-four hours a day, hourly shifts (usually split between two twelve-hour shifts) are the most expensive private home care but provides maximum coverage.
17. VNA or Medicare Home Care provides home health aides, nurses, physical therapists, and occupational therapists.
18. However, this therapy generally only lasts an hour a day, a handful of times a week.
19. VNA or Medicare home care is not a substitute for private home care. They exist to supplement each other.
20. Aides provide non-medical home care for patients. Nurses can provide medical care.
21. Private home care works with adult daycare, assisted living facilities, and nursing homes. (You can read more about working with other senior care options here.)
22. There are companion caregivers. These aides provide supervision, meal preparation, and companionship services.
23. Caregivers should all be background checked, reference checked, driving history checked, interviewed, and trained before being placed in a case. Ask if they are.
24. Home health aides provide more personal care, such as hygiene and cooking, while also able to help with basic companion tasks.
25. Nurses are needed for medication administration, wound care, IVs, and diabetes management.
26. Aides and companions are often hourly workers, but there are flat rates for overnights or live-in care.
27. Nurses are commonly paid on a per-visit basis but are there to do only one task no matter how long it takes.
28. The majority of caregivers, aides, and nurses are female.
29. Caregivers are there to provide care at a moment’s notice. They can clean up after meals but are not there to be a house cleaner.
30. Many caregivers come from other countries but are still required to speak clear English.
31. If working with an employment agency, you should expect your caregivers to be insured, trained, and bonded.
32. Caregivers can work with seniors in their home, assisted living facility, or nursing home.
Private Home Care Scheduling
33. Private home care provides very flexible care options that meet your needs.
34. It is challenging to fill cases that are less than the minimum 20 hours per week. The reason for this is caregivers are doing this for their livelihood and are looking for consistent work. Having less than 20 hours a week means the likelihood of the caregiver looking for another case and leaving increases.
35. The more hours you request, the more caregivers are interested in the case, and the more consistent caregivers are.
36. The fewer hours for a case, the harder it is to fill the case.
37. There can be cost differences between weekend shifts and weekday shifts. It depends on the home care agency.
38. Aides do get overtime pay if they work over forty hours a week. So large (40+ hours a week) cases require multiple caregivers to prevent this from occurring.
39. Cases can take a few minutes to a few hours to fill. It all depends on how many aides are interested, how quickly they return our calls, and how desirable the case is.
40. Agencies can change schedules from week to week. Predictable schedules are more common, but fluctuating schedules are not uncommon.
41. A fluctuating schedule does require more caregivers than a set scheduled case.
42. Emergencies happen, and things change quickly. You will not be at fault for something you can not control, but please let us know if things change as soon as possible.
Private Home Care Responsibilities
43. Private home care companies can take checks, credit cards, or bill trusts.
44. Upfront deposits are common in private home care cases. Depending on the payment method, this can change the sum of the deposit.
45. Most private home care companies want to meet with families first. This introduction is partly to inspect the condition of the household.
46. Contracts can change from company to company, but because of the nature of caring for people who are sick or injured, there should not be a binding agreement for a set amount of time or overall cost.
47. Home health aides should not touch medication (they can provide medication reminders) because of the liability involved in making a mistake.
48. Speaking of liabilities, home care companies will insist that lifting a person’s total body weight requires two people to prevent injury.
49. More than likely, you will be charged to reimburse mileage if a caregiver provides transportation for errands for a senior in the caregiver’s car.
50. We are here to help in any way we can. Our first goal is to find the proper care for you or your loved one, whether with us or with someone else who’s a better fit.