At Home vs. ‘A Home.’

         One of the most challenging situations a family can – and likely will – encounter comes when a loved one eventually needs long term care. Not only are there the immediate emotions that flare up like a sudden wild fire, but also financial and logistical issues that present themselves. Very often, the elephant in the room eventually becomes: Should mom or dad receive long term care at home, or be placed in a care facility?

 These days many folks are opting to remain at home and bring help in. And there are logical reasons for this. Firstly, they are still in their own established and comfortable surroundings. This is a powerful thing: Having a degree of independence creates a feeling of having some control. It represents the ability to “circle the wagons” on familiar ground. The dignity and quality of life in such cases is greatly improved. Also, depending upon where they live, many state agencies offer incentives to remain in the home when possible to alleviate the stress on already burdened healthcare facility system. And if it is determined that a skilled nursing need exists, the price of a home healthcare aide may be covered by Medicare insurance with no out of pocket cost to the family.

On the downside, many people find that the family home may simply not be designed for someone with substantial custodial care needs, and it may be prohibitive, or even implausible to re-engineer it so. In those cases, a loved one might need a more specialized setting. Also, if a family chooses to provide all, or just some of the care, they soon find out just how unrelenting a job it truly is. Between follow up doctor visits and the daily needs themselves, it soon becomes clear that caring for a loved one can instantly become a full time occupation with very little – if any – down time. If Medicare does not cover the cost of a health aide (should no need for skilled nursing exist) a family can opt to either privately pay an agency, or an individual care giver directly. But as was touched on in a recent blog post, there are special concerns to be aware of when privately paying an aide directly that might make it a deal-breaker when all is said and done.

Long term care facilities, (i.e. Nursing Homes) despite their often inaccurately stereotyped image, offer the conveniences of a staff and amenities that some families may find difficult to provide with limited financial and logistical resources. They also offer more immediate access to medical attention should a loved one develop symptoms not quickly recognized by family unfamiliar with medical diagnosis. The staff of a nursing home is trained, paid, and experienced in dealing with issues related to long-term healthcare. Should the health situation of a resident begin to deteriorate, they are set to switch gears and swing into motion.

On the downside, many nursing homes are understaffed, or the staff works a grueling schedule. This may mean – in worst cases – that the residents do not always get the immediate attention that they might at home. Sometimes patients are left in their rooms or lined up in wheelchairs in the halls. Dovetailing with this is the very real psychological issue that many families report of their loved one rapidly going “down hill” and “not lasting long” in a nursing home, due to the loss of autonomy and the disconnect with the outside world. The loved one feels that they have been “abandoned to strangers” and left in a place that they neither understand, nor wish to be. Also to be borne in mind: Sometimes certain benefits packages that can be applied to in-home care cannot be applied equally to facility care. This needs to be determined before making irrevocable decisions.

Obviously this article cannot offer a ‘best answer’ decision for each case, since the options available – and laws governing them – vary place by place and situation by situation. What might work for one might not work for all. But a key part of the decision making process should include touring at least some facilities to get an idea of what they offer. And if a literal, physical tour is out of the question for some reason, many facilities now have custom, fully interactive Virtual Tours that can assist future clients in getting to know them. It is as close to being there as possible when one cannot actually be there! Also, networking with others, getting in contact with the local State Agency on Aging, the Veterans Administration (if applicable) and seeking an attorney who specializes in elder-care will certainly fill in many of the blanks. Most importantly, everyone needs to speak with the loved one who is at the center of all of this, if that is possible. After all, it is THEIR life that we are all talking about.