Home Care or a Congregate Setting: Which is Best for your Parent?

Many children of older adults have heard their parents implore them to: "Please never put me in a nursing home!" Unfortunately, some of us find ourselves faced with a difficult decision when our parents become debilitated by disease or compromised with memory impairment issues.

Today there are congregate settings, assisted living and supportive living programs in particular, that offer alternatives to the nursing home. However, while aesthetically more pleasing than most nursing homes, these options still are often viewed by older adults to be inferior to receiving care at home. But before one can conclusively say that care provide by a paid care giver in one's own home is the best option, there are many factors to consider:

1. Home care is costly, and except when the care required qualifies for Medicare reimbursement, most home care services must be paid for privately. A good long term care insurance policy will cover home care but not many older adults own such policies. Home care, if needed 24 hours a day, seven days a week will likely cost about the same as a nursing home stay and perhaps more than assisted living.
2. The level and type of socialization your parent experiences will vary greatly from care provided at home to care provided in a congregate residential setting. In most cases when 24-hour care is needed, there will be two live-in caregivers assigned to a case. Many great friendships have been formed between caregivers and clients but the social life of the client in a home care setting will be very narrow. In a residential setting (nursing home, assisted living, supportive living, or continuing care retirement community), the person will be exposed to other older adults and staff and who can provide a rich social experience.
3. The individual attention in a home setting can provide an opportunity to focus on favorite activities but the array of cultural experiences should be broader in a congregate setting.
4. Proper nutrition can often be accessed more readily in a congregate setting but attention to favorite foods might be more readily facilitated with home care.

From my own personal and professional experience, I have found that most people wait too long before electing assisted living care. A well-run assisted living facility can offer a wonderful living experience, often in an elegant setting. The cultural activities available on-site and through scheduled outings can make for a rich experience. The dining program is often very upscale and offers great variety.

However, when a person residing in assisted living begins to requires skilled care, avoiding nursing home placement can only be accomplished by augmenting current care with paid caregivers. For those with unlimited resources this can be the best alternative.

Honoring mom and dad's wishes for end of life care is paramount. Have the conversation well before a need exists so you can be sure that you are doing the right thing for them if the time comes when they need assistance with daily activities.

Dementia Signage for the Home

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How to Get the Real Story from an In-Home Caregiver

Ah, wouldn't you like to be a fly on the wall sometimes while a caregiver is looking after mom or dad? You're not alone. Many of us rely on outside caregivers to take care of our older loved ones. Yet, we are unable to be there day-to-day to oversee how things are really going.

If you've ever wanted to make sure you're getting detailed information about your loved one's day from the helpers, follow these three guidelines:

1. Create a Sense of Teamwork. Some caregivers might be wary of the CKIC (Chief Kid in Charge), expecting you to position yourself as the big boss. Counter this expectation by creating a sense that you're on the same team. "The key is for the family caregiver to develop and express trust in the professional," says Judy Santamaria, MSPH, Director of the Family Caregiver Support Program at the Visiting Nurse Service of New York. "Establish that you are not looking to control your parent's life, but instead just want to be there to offer any support that is needed."
2. Provide Them with Medical Support and Resources. If your parent faces a specific ailment -- such as dementia, depression, Parkinson's -- "connect the caregiver to a doctor or medical professional in that specialty," says Santamaria. Include them in appointments when you can. Or, provide them with resources (e.g. online, book, seminar) on the ailment. This way, you can help them understand and better manage your parent's condition.
3. Keep the Caregiver Connected. Caring for someone else's parent can be a lonely business, especially if the parent is in frail condition or just not capable of or interested in engaging. Do what you can to make sure the caregiver gets to interact with others. "Offer companionship through social day care, or driving them to a friend's, or to your own house for visits," says Santamaria.

Since there might be particular situations in which a lucid parent instructs the professional, "don't tell my kids," you have to weigh the pros and cons of inserting yourself if you get wind of it. "In some ways, you have to respect a parent's right to self-determination and just continue to be there and offer support without trying to make caregivers feel you're trying to run their lives," says Santamaria. "That will build trust."

The bottom line is that you want to build a strong bond with caregivers so they'll feel comfortable being frank with you. Engage them with consideration and fairness. "I think most home health aides and home care staff would be happy to talk openly with you about their observations," says Santamaria. "This is true especially if they feel you'll handle that information with a level head."

Dementia Signage for the Home

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