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Assisted Living Vs In-Home Care: 5 Ways to Help You Choose What's Best

Updated on August 14, 2017
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A former Certified Nursing Assistant & mother, who made many final care decisions for her grandfather & is now caring for her own parents.

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In youth we learn; in age we understand."

— Marie Von Ebner Eschenbach

There comes a time in all our lives, when the tables turn and we go from being our parents children to our parents caregivers. When that day comes, there will be a great deal of challenges placed before you, none of which are going to be easy for most adult children, or their elder parents.

One of those decisions for most of us, will be whether or not to step back into our parents lives more permanently, and care for them either in their homes or in ours -- or to find the best nursing home, assisted living home, or independent living community.

There are rarely any 'right' answers when it comes to these fleeting moments. Only we as caregivers, doing what we feel is best for our parents, as we know they've done for us all our lives.

So with that in mind, I've written this hub to hopefully help those of you in this particular position, to sort out what the best choice is for your parents: with you or with professionals?

What brought you to this article?

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Are you Able & Willing to care for them?

For some, the idea of not being there to care for their parents as long as they possibly can, is blasphemous. For others, it's super scary to worry about not being able to provide the right kind of care for their parents, or of what their lives might become like if they get consumed in managing their aging parents growing needs. This is why, before going further, the first thing you must decide is; Are you Willing AND Able to care for your parents? If you, your decision becomes a bit easier.

Are your Parents mostly independent or Dependent?

Do your elder parents need someone else to just about everything for them, or would they forget to take care of themselves without someone constantly there to remind them?

Are your parents still mostly cognitive and clear-thinking? Or do they swing in and out of being lucid, confused or catatonic?

Are either of your parents bed ridden, stuck in a wheel chair, or in need of a great deal of physical care?

If your parents are at a point in their lives where they are far from being independent, especially if they really do need a lot of physical care or psychological management. If that's the case, the first thing to think about, was your answer to the first decision maker -- are you willing and able to care for them? You wouldn't be the first to care for parents with very large mental and physical needs and survive it. So if great need doesn't scare you away, then your decision is already a little more easy.

If on the other hand, you're either afraid that your parents might get hurt in your care, or you're not sure you could maintain your sanity and self-care while providing your parents with everything they need and deserve -- then it might be time to consider looking into facilities where your parents can get the care they need, especially if their needs are beyond what you're capable of providing.

When my mom called and asked me if I would care for my aging grandpa, I set aside everything I really wanted or felt & was ready to do all I could, more for her than for him, but with two kids of my own plus work & needing sleep, I couldn't solve the problem of how we would keep him from escaping in the night, as he'd done on occasion. Nor was I sure I could handle him when he got violent, as he did at times. It was those two things that brought us to decide on finding him a good nursing

— Amanda Carter
A light-hearted comic about getting older
A light-hearted comic about getting older | Source

Is there enough money?

This question can go either way.

Do you have enough of an income to pay for a nursing home or assisted living? Have your parents put away any money for elder care? Is there anything coming in from social security or any other source?

Alternatively, do you or your parents have enough of an income or a nest egg to support all of you if you all move in together, so that you can care for their daily needs?

Regardless of your choice, choosing to care for your parents in one of your homes, can be a spendy proposition on it's own. Likewise, nursing homes and assisted living facilities are often absolutely outrageous -- especially if your parents need a lot of supervision or physical care, and that's on the cheap side of things where the quality of care is horrid.

If your parents were able to save up enough retirement or end of life funds to cover their care in such places, or you are financially well off enough to provide that money, and they need care that you can't or choose not to provide, then a care home of some kind might be the best option for your parents. Otherwise, if finances are one of your heaviest factors in your decisions, then you'll want to sit down and do all the math. In most cases, being your parents primary caregiver is often much more affordable than elder care facilities.

What are your parents wishes?

Many children caregivers find themselves so overwhelmed or anxious about their aging parents "condition", that they forget to consider what their parents actually want. If they can still make the decision, or if you talked to them when they were still able to make such a decision, and they want to stay home, or if they'd prefer to go into assisted living -- then that helps in making this decision.

What is your parents current life expectancy?

It's no one's favorite aspect to think about, but in this time in you and your parents lives, you're not going to get around it. And when it comes to thinking about whether or not it's time for your parents to live in a nursing home or other assisted living facility, life expectancy often makes a huge difference in your parent's needs. Care needs for your parents last few months or weeks, can be dramatically different then what they might need over 2, 3, 5, 10 or more years. I know I certainly wouldn't want to spend ten or more years of my life, in an old age home. Especially if I didn't physically or mentally need to be there for safety or medical reasons. So if you're parents are still mostly independent and just need a little help here and there, and you're willing to be there for them, there might not be a need for assisted living.

On the flip side, the more dependent and closer to death your mother or father is at this time, the more difficult their daily care will likely be, and that doesn't even include your own emotional challenges. It's in these looming moments when professional care is often opted for, as many adult children of the past few generations are not as emotionally or financially prepared for in depth end-of-life care as prior generations were.

If you already have HIPPA access or powers of duress, now is the time to reach out to your parent's medical team and try to determine what they think your parent's current life expectancy is. It's not a fun conversation to have, but a necessary one when considering whether or not your mom and/or dad needs professional care or not.

Likewise, if it's not yet time for you to have or get HIPPA access or POD, and you're just trying to plan ahead or you're in a place where you're able to wait on making this decision but feel or know you will need to make it fairly soon, this is something you should be considering in your planning. If you've been fairly close with your parents up unto this moment, you probably intuitively know in advance when your parent is nearing their sunset days, even as much as years in advance or even before they're really aware of it. Though whether or not you trust your intuition, it's still better to be as sure as anyone can be, and to work out how you'll get access to your parents medical team and be as prepared as possible for their final needs. This will mean either talking with your parents and getting that HIPPA access and/or POD if they're still able to give it you, or if they're not, talking with your parents medical team to help them determine that your parents are no longer able to make healthy decisions for themselves and need you to do so.

Regardless of your current level of access to your parents medical team, considering and/or gaining access to their current life expectancy, will help you determine what would help them most in terms of care homes versus in-home care with you.

Source

Hello Death, I am so glad you're my friend...

You have come often lately for family & friends, leaving your notes to let me know that you're always there.

I see you in the seasons & feel you about.. Reminding me to look again to see that I love life & choose it again and again..."

— Passage from "Hello Death" by Penelope Bucket

Death... the next Great Adventure...

It just won't forever be ignored. One day it'll really happen; your Mom/Dad will die. How you think you'll handle that final moment, ultimately determines the path your decisions take in how you'll help your parent get there. Making this difficult decision now, will prevent future care decision delays. To get it over with, ask yourself now, what would be worse; Your parent possibly dying alone & scared in a strange facility when you're away? Or being there when your parent dies in your care?

Decisions.. Decisions...

Sometimes laying everything out in front of you in as concise a manner as possible, can help you to really clarify what the best choice for the moment is. In this table, I've tried to do just that, and provide you with a dual table of things to consider when it comes to sending your parents to some type of care facility or to care for them yourself.

TIP: Make your own table or pro/con list that includes your particular situation with your aging parents.

Move Parent into Care Facility
Care for Parent in my/their Home
I'm not willing & don't want to be caring for my parent until their final days.
I am willing & want to be the one caring for my parent until their final days
I don't have the physical, mental and/or financial ability to care for my parent the way they need to be care for.
I do have the mental, physical and/or financial ability to care for my parent the way they really need
My Mom/Dad didn't have a preference, prefered a care facility or we didn't get to talk about it before they were no longer able to express their preference..
It is or was my Mom's/Dad's preference or wish to be able to live out their final days in their own home or with me/family
My Mom/Dad are still mostly independent & just need some reminders or help with a few regular activities, but I'm not willing or am unable to help with the rest.
My Mom/Dad are still mostly independent & just need some reminders or help with a few regular activities that I'm willing/able to help with.
My Parent is often not lucid & frequently has bouts of violence or aggression that I'm not able or prepared to manage.
My Parent is often not lucid or occassionally has bouts of violence or aggression, but I'm prepared to manage those moments & find ways to keep everyone as safe & happy as possible.
My parent is still mostly calm, lucid & able to make most of their own decisions, but I'm not willing or not able to help with the rest.
My parent is still mostly calm, lucid & able to make most of their own decisions. I'm willing/able to help with the rest.
My Mom/Dad are mostly dependent & require a lot of physical and/or psychological care around the clock that I'm not willing or am unable to manage.
My Mom/Dad are mostly dependent & require a lot of physical and/or psychological care around the clock, but I'm willing and/or able to figure out how to manage their needs
My parents medical team still expects them to live for another 5-10 years & I'm not willing or am unable to care for them in the ways they need for such a long time.
My parents medical team still expects them to live for another 5-10 years & I'm both willing & able to care for them in the ways they need longterm.
My Mom's/Dad's medical team doesn't expect them to live longer than 1-5 years & I'm not willing or am unable to care for them in the ways they might need over that short period.
My Mom's/Dad's medical team doesn't expect them to live longer than 1-5 years & I'm willing & able to care for them in any way they need over that short period.
I don't think I could handle watching my parents get closer to dying or actually dying while in my care & would be more comfortable with that happening in a facility...
I don't think I could handle finding out that my parent died alone & possibly scared in a facility when I wasn't there & would be more comfortable being there for them when the time comes...
When I'm an elder close to my own death, I would want my kids to send me to a care facility.
When I'm an elder close to my own death, I would want my adult kids to care for me in my own home or move me into their home.
This isn't a complete list of all the things one might want to think about, hence the suggestion to make your own list. If you have kids to consider, a demanding job, your own serious health problems, or anything else that will make a difference in t

As you can see, most of the things to consider when deciding if it's time..

..for one or both of your parents need professional care, or if they can stay with you, hinges on whether or not you're willing & able to be there for them. Regardless of what you finally choose, it's not going to be easy & either decision will require a great deal of life-shifting on your part. So there are no ultimately right answers or rules. Only your willingness & ability to be involved in addition to what you think is best for your parents.

For Further Consideration...

When it comes to your aging parents situation or needs, it's rare to find someone else who's already gone through what you will go through. This is part of what made it difficult to decide what might help you most in the meat of this hub. My hope is to help you get started or get a little further than you started out & to keep in line with that thought, I've decided to add some more elements for you to consider, should you already be beyond the aspects in the main part of this article.

Resources:

  • How much help do you have? Are you an only child, or do you have any siblings or any other family that can help you care for your parents or take on the main part of their care if or when you can't?
  • If you're financial resources are low & your parent wasn't able to save any funds (or they've been spent on their other care needs already), are there any options for them or for you to receive government or charity assistance? Whether you've decided to care for your parents or have them cared for elsewhere, there are usually programs or charity resources that are willing to help them get the funds they need for proper care. If there isn't enough for one circumstance over the other, then the choice that will offer them the best care due to financial resources, is probably the better choice.
  • If you're leaning towards having your parent move into a facility, are there any quality care homes or communities around you that you'd be comfortable leaving your parents in? Reports of elder abuse, neglect or unsanitary environments are not uncommon & need to be avoided. Even just decent care is difficult to find, especially in the larger and/or cheaper facilities. Make sure you do your due diligence & locate a care facility with good reviews, a truly caring staff, a low caretaker-to-elder ratio, proper sanitation & plenty of activities/trips they can participate in. Your parents deserve it.
  • If you work a full-time job that regularly requires you to leave your home, how will you provide your parents with care when you're working?

Relationships:

  • Do you have children? Do you think you can handle talking to them about their grandparents pending death? Do you think they can handle seeing your parents decline in health and/or die? Do you feel able & willing to care for both your kids & your parents needs at the same time? Alternatively, could you explain to your kids why their grandparents have to go into a care home & couldn't live with you?
  • Are you married or in a serious long-term relationship? Is your relationship in a healthy place right now? Has your partner said they are willing to help you, or do you believe they would? Are you willing to possibly lose your relationship to care for your parents if it comes down to it, or alternatively -- are you willing to lose any final moments with your parents or not fulfill their needs & wishes in order to save your relationship if you need to?
  • What kind of interpersonal relationship do you have with your parents? Can you get along with them regularly or 24/7 if needed, or are you willing to care for them even if you don't really get along? Will your parents let you help them when they need it, or are you willing to help them when they need it even if they say they don't want it?

Other/Misc:

  • What does your Mom's/Dad's doctor think is best for them?
  • If you have other non-sibling family members who knew your parent well and/or knows what's going on with your Mom/Dad right now, are you interested in hearing their opinions or thoughts on what's best for your parents? Would you be more or less interested if those family members are willing to help with your parents care in either situation?
  • Does your parent have a pet that they are very attached to, or whom is a service animal in any form? If you're leaning towards caring for your own parents, are you willing to care for their pet as well? Likewise, if you're leaning towards moving your parents into a facility, are there any that will accept their pets as well?

What decision will you make?

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Are you in the process of making this decision for your parents? Or have you already been through it? Either way, share your experiences or thoughts here. It wi

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