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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Maintenance & Repair Services Let Seniors Keep Living At Home

Whether the need is regular home maintenance or some small remodeling job, in the past it was hard to get many companies to even come to your door. They're after the major remodel, or they clear snow only for apartment buildings. They don't want your elder's puny little upkeep jobs. However, the new entrepreneurs have seen gold in the little jobs. If we are lucky, we may even find nice people, who enjoy elders, driving the vans that pull up to your parents' door to fix that broken window screen.
It doesn't always hold true, but I do believe that people who start a small business and intend to stay in business, are often put together a bit differently than people who want to develop a large corporation. They go into the business looking forward to helping others and having personal contact with their clients. Yes, they need to make a living, and they hope to make a decent one. But they have an independent streak in them. They want to do business their way. If you find the right people, this can be the beginning of a great relationship between your elders and the company.

Background Checks and the Better Business Bureau

If you are hiring a home maintenance business to help your elder, or if they are hiring a business themselves, insist first that they show they are licensed within the state where your elders live and that they are bonded. A check with the Better Business Bureau is a good idea, too.

Make sure they have a physical address! You don't want any fly-by-night operations messing with your loved ones.

Ask for references, preferably people who live in the neighborhood near your elders.
Find out exactly what they do and don't do. Will they fix a small electrical problem, but know when to stop if something arises they shouldn't handle? Will they check city codes before they put up a fence or extend a deck?

If they don't do something themselves, say trim trees, do they have a network so you or your elders can call them and ask them to get someone reliable for that job?

This is not a deal breaker, but it doesn't hurt to ask if they would come to your elders' aid at an unconventional hour because your folks got flustered when they "smelled something funny" and they didn't know who to call? How "neighborhood" are they? Are they located fairly close by?

The idea for having a reliable home maintenance company on speed dial is that there are a ton of small jobs around any home that can arise and leave an elder feeling helpless. The man, especially, may be tempted to climb a ladder to fix a light-socket just because he doesn't know who to call for help. That can spell disaster should he fall, possibly landing him in the hospital facing surgery for a broken hip. If your folks have had one reliable company help them with the snow, the grass, and the squeaky dryer drum, they may be more willing to call them to ask how to remove snow from around their gas meter. This, in turn, could save your otherwise healthy dad from a bad slip on the ice, or a heart attack out in the cold.

A local handyman or home maintenance company could help your folks age in place while you concentrate on your own young family.

Dementia Signage for the Home
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Hiring a Handyman Can Help Your Elderly Parents

Years ago I saw a van whose driver was letting teenagers off in front of the local high school, where I was doing the same. I noted the modestly painted letters on the side of the van with the name of a company that provided "neighborhood services." I'm not sure why I noted that, as I didn't need such services at the time. But I was curious. I was caring for many elders, and I was well aware of the stress homeownership can have on people as they age.

Many elders want to keep their homes. Many are not in undue danger of falling, unless they climb a ladder they shouldn't climb. They can shovel the sidewalk after a light snow shower, but not after a blizzard. And those pesky home tasks - a dead light fixture needs fixing, the squeaky dryer drum needs to be looked, some boards on the deck need replacing or one fence post needs fixing. It's these items that make many a homeowner want to throw in the towel.

When "the husband" was younger he could take care of these things. But now, even though he's okay for the main part, his back isn't great and his doctor has put a limit on some of his activities. Or a widow who loves her garden wants to keep her house, but she can't do the fix-it jobs. The dilemma is who do you call? Most maintenance or remodeling businesses only want large jobs.

About 15 years after I first saw that neighborhood van, I became a loyal customer of the business. And, yes, my deck needs painting. They can do that next month, and fix my sump pump hose at the same time. But these days, I'd have several businesses of that type to choose from.

It's possible that the current economy may have helped spur on some of these entrepreneurial ventures. However, our aging population has also contributed to this growth. Whatever the reason, or combination of reasons, business that specialize in, um, not specializing, are growing.

Dementia Signage for the Home

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