Choosing Between Assisted Living and Home Care
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Assisted Living vs. In-Home care
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Assisted living or home care? This is the question you may someday be asking yourself, and when you do you will see that selecting a type senior care is not easy. The two major types of senior care, assisted living and home care, have very different offerings so it is important to look at the advantages and disadvantages of each.

Assisted Living

Assisted living is a type of senior care that serves a specific group of seniors, particularly seniors who need assistance with some daily tasks, but are not looking for daily medical assistance. Seniors live at an assisted living community in separate or shared rooms, and generally participate as part of a community routine. Communities often provide transportation, housekeeping, laundry, and some healthcare services.

Assisted living facilities are designed for the mobility and safety of residents, and to be cost efficient in providing support and assistance. Residents in assisted living have less privacy and autonomy. Seniors may also experience emotional distress in the transition of leaving their homes and families.

Home Care

Home care is a type of elder care for seniors who would like assistance in daily tasks, but would like to do so in their own homes. Home care costs vary depending on the level of assistance needed. Care is often paid for by the hour and by type of care provided: housekeeping, personal assistance, or medical assistance. Adult day care is a separate service for seniors who need supervision during work hours and is often provides recreational and social opportunities.

With this type of care, married seniors can receive care in place, preventing a move to a community when their spouses do not need care. In-home care allows seniors to more freely choose their schedules and is more private and comfortable, however this style of care may be intrusive or burdensome on other family members.

In-Home Care Assisted Living
Advantages
  • Allows a person to "age in place" with family
  • Privacy and comfort
  • Socialization and recreation in adult day care
  • Independence and control in scheduling and routine
  • Affordable
  • 24-hour support and supervision available
  • One monthly cost (minus any)
  • Facilities designed for safety and mobility
  • Nutritional and fitness support
  • Housekeeping, laundry, meal preparation, and transportation
  • Limited on-site healthcare
  • Socialization and recreation
Disadvantages
  • High costs
  • Can be burdensome or intrusive to other family members
  • Support and supervision limited to hours designated
  • Separation from home and family can cause emotional distress
  • Low independence and control over schedule and routine

In-Home Care

Advantages

  • Allows a person to "age in place" with family
  • Privacy and comfort
  • Socialization and recreation in adult day care
  • Independence and control in scheduling and routine

Disadvantages

  • High costs
  • Can be burdensome or intrusive to other family members
  • Support and supervision limited to hours designated

Assisted Living

Advantages

  • Affordable
  • 24-hour support and supervision available
  • One monthly cost (minus any)
  • Facilities designed for safety and mobility
  • Nutritional and fitness support
  • Housekeeping, laundry, meal preparation, and transportation
  • Limited on-site healthcare
  • Socialization and recreation

Disadvantages

  • Separation from home and family can cause emotional distress
  • Low independence and control over schedule and routine

Costs and Coverage

Assisted living is typically more affordable than in home care and the all-inclusive fee often covers most bases: housing and utilities, food, daily assistance, and recreation and social opportunities. Assisted living Medicare benefits are limited to few medically-necessary health services. Assisted living Medicaid benefits include some health and support services, but room and board is generally not accepted.

Home care is generally more costly than assisted living. However, because home care is paid on an hourly-basis and costs can vary widely based on type and duration of care provided. Regardless, home care costs only cover services and do not include room and board, or many other amenities provided in assisted living. Medicare and Medicaid cover some home care services, and Medicaid covers some adult day services; however coverage with both Medicare and Medicaid is limited and varies by state.

In-Home Care Assisted Living
Housing, water, utilities, trash, etc. Not included $37,572 annually
Food Not included Included
Assistance with ADLs $64,240 annually (8-hours per day of home health aide, 7 days per week) Included
Day-time supervision and recreation $17,420 annually (adult day services 5 days per week) Included
Medicare Generally not covered Limited to some medically necessary health-related services by certified providers. Adult day services are not covered.
Medicaid Some services may be covered by certified providers; services covered vary by state. Other housing/service costs are generally not covered. Some services may be covered by certified providers; services covered vary by state. Adult day services may be covered; varies by state and eligibility.
Medigap Insurance Not covered Not covered
Long Term Care Insurance May be accepted; coverage varies by policy May be accepted; coverage varies by policy
SSI May be accepted by certified providers for eligible seniors May be accepted by certified providers for eligible seniors
Veteran’s Benefits May be accepted; varies by eligibility and state. May be accepted; varies by eligibility and state.
Private Funds, Life Settlements Generally accepted Generally accepted

In-Home Care

Housing, water, utilities, trash, etc. Not included
Food Not included
Assistance with ADLs $64,240 annually (8-hours per day of home health aide, 7 days per week)
Day-time supervision and recreation $17,420 annually (adult day services 5 days per week)
Medicare Generally not covered
Medicaid Some services may be covered by certified providers; services covered vary by state. Other housing/service costs are generally not covered.
Medigap Insurance Not covered
Long Term Care Insurance May be accepted; coverage varies by policy
SSI May be accepted by certified providers for eligible seniors
Veteran’s Benefits May be accepted; varies by eligibility and state.
Private Funds, Life Settlements Generally accepted

Assisted Living

Housing, water, utilities, trash, etc. $37,572 annually
Food Included
Assistance with ADLs Included
Day-time supervision and recreation Included
Medicare Limited to some medically necessary health-related services by certified providers. Adult day services are not covered.
Medicaid Some services may be covered by certified providers; services covered vary by state. Adult day services may be covered; varies by state and eligibility.
Medigap Insurance Not covered
Long Term Care Insurance May be accepted; coverage varies by policy
SSI May be accepted by certified providers for eligible seniors
Veteran’s Benefits May be accepted; varies by eligibility and state.
Private Funds, Life Settlements Generally accepted

Costs and amenities are yearly estimates based on 2009 national averages by the MetLife Market Survey of Long-Term Care Costs. Level of care, amenities, floor plan, location and other factors may determine a higher or lower cost.