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:
- 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.
- 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.
- 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.
- 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.
Bill Lowe, CMSS President (wlowe@cmsschicago.org)
Chicago Senior Living
Assisted Living
in Chicago