More than 46 million Americans today are over the age of 65. By 2040, 1 in 5 Americans will be age 65 or older. A definitively aging population has many factors to consider. And a key factor will be how to plan for care in their aging years.
There are multiple options when it comes to caring for an individual living with a degenerative condition like Alzheimer’s, Dementia, Parkinson’s, or a person requiring daily care after undergoing an orthopedic procedure like hip replacement or knee surgery. Other common scenarios like navigating cancer treatment or life after a stroke also require daily and ongoing care. The two most common options are live-in care at home and assisted living care in a facility.
By reviewing a specific case, the emotional and physical needs of the couple and their family, and reviewing the financial considerations of these arrangements – it is possible to understand the costs and benefits associated with both scenarios.
Linda and Harold J. are both in their 80’s and live in the Preston Hollow area in Dallas, TX. Their adult children live out of state and due to their hectic work schedules and young families, are unable to come to visit often.
Linda has been living with several medical ailments for over 10 years – she has COPD, diabetes and rheumatoid arthritis.
Harold has been her primary caregiver – driving her to doctors appointments, managing household duties, and ensuring that Linda takes her medications on time. In the last year, Harold was diagnosed with moderate stage Alzheimer’s dementia.
Moving Harold and Linda closer to their children is complicated because uprooting them will add to Harold’s dementia-related agitation. They also have a healthy social life with friends, community members, and Temple nearby.
Due to work and family commitments, their children are unable to move to Dallas to live near them and provide the increasing daily support they will need in the coming years.
Linda and Harold wish to maintain their independent lifestyle, and live together for as long as possible. Their home is paid off and they live comfortably on a monthly budget that covers their daily needs and expenses.
Moving to an Assisted Living Facility
- Linda and Harold will be able to live together in a facility
- They will have access to 24/7 professional nursing care and periodic doctor’s visits
- Their meals, snacks, medications, laundry, housekeeping, and toiletries will all be supplied or organized by the facility, eliminating the need for Linda and Harold to drive or maintain a car
- They might have a sense of community with other seniors, organized daily activities, and easy access for their children and friends to visit them
- As their medical conditions progress, Linda and Harold will have access to help with daily activities like bathing, toileting, personal care, and medication administration if and when needed
- Assisted living facilities have suites for multi-person use that are equipped with easy access to medical grade equipment like hospital beds, oxygen, night or emergency call buttons. The suites are also furnished with accessibility features like raised toilets, walk-in showers, and others to help reduce fall risks
- For their children – they may feel more “peace of mind” knowing that their parents are able to live together in a safe environment with healthcare workers around them all the time provides a great deal of comfort
- The added benefit of being able to visit and spend time with Linda and Harold in their independent space within the assisted living facility is a great way for families to maintain a sense of connection while knowing that their loved ones are receiving the care they need
- The continued oversight of Linda and Harold having 24/7 care and access to medical professionals ensures that any changes in their medical condition, medications, or physical health will all be monitored and adjusted by nurses and doctors is also comforting to their children
- The primary con of living in assisted care is that Linda and Harold might not be able to live together if either of their conditions changes or deteriorates faster than the other. If either of them requires intensive care, then they might have to move to less independent parts of the facility (e.g. memory care unit) that has more oversight and care to match the change in condition
- Another factor is staffing inconsistency and one caregiver to many clients staffing ratios. Due to high turnovers in assisted living facilities, nurses and daily care staff come and go so it is possible to have to contend and manage new personalities and styles of caregiving with little notice if a favorite nurse or caregiver was to leave
- While a private suite allows Linda and Harold to live mostly independently, there is a lack of privacy and familiarity in an assisted living facility with a more generic space that others (nurses, facility staff) have access to as well
- While most facilities do their best to accommodate scheduling preferences for their clients, they do have to maintain a schedule to meet the needs of their staff and everyone else in the facility. Therefore, the schedule for care, meals, or toileting might not be on Linda and Harold’s timeline but what is convenient for the administration to schedule
- The cost of an assisted living facility for two people to live together is quite high
- The median cost of assisted living is approximately $4,300 per month per person with add-on costs for 2 people, daily services like bathing, toileting, cleaning, special diet considerations, trips to doctors/hospitals etc – it usually adds up to approx $15,000-20,000 per month for a couple like Linda and Harold
- The most significant benefit to live-in care is Linda and Harold’s ability to age in place in the comfort and familiarity of their own home that they know in and out and have positive memories in
- Aging at home also allows to them to receive assistance and care in the privacy of their own home, at their set schedule and convenience while remaining a part of their greater community and neighborhood
- Live-in caregivers provide 24/7 care and companionship that can be very helpful for seniors who live with isolating progressive conditions like Alzheimer’s, Dementia, or Parkinsons
- For Linda and Harold’s children, the primary benefit is peace of mind knowing that their parents are aging safely and comfortably in the environment of their longtime home and neighborhood
- The added benefit of having access to their childhood home, being able to visit their parents with their children, and not having to follow visiting hours or schedules like an assisted living facility might implement are helpful when wanting to plan extended visits
- Live-in caregivers can also provide direct feedback to Linda and Harold’s children if any changes occur in their condition or if they require any resources or support
- Although their home is comfortable and familiar to them, Linda and Harold will have to consider retro-fitting their home with any medical equipment (chair lift, hospital bed) necessary to their conditions, removing furniture or cords that pose a fall risk, and even renovating bathrooms to improve accessibility as they age
- While live-in caregiver agencies thoroughly vet and match their caregivers to the family’s they care for, there can be differences in personality or temperament that might need intervention or change in the first few months. Linda, Harold, and their children will need to be prepared to overcome these potential setbacks by interviewing and hiring a new set of caregivers if needed
- Live-in caregivers also have to be managed like members of staff with Linda, Harold, or their children being their employers and having to pay them, manage tax commitments, and hire overlapping care for any vacations or paid time off
- Although Linda and Harold’s home is paid off and they have a comfortable monthly income to live on, they will have to consider additional monthly expenditures in addition to paying for their live-in caregivers
- Linda and Harold will also have to pay for any renovations to help make their home safe and accessible for themselves as they age. They will also have to have ensure that there is a separate bedroom and bathroom for their caregiver to be able to live with them while maintaining their own privacy and space
- Typically, a couple like Linda and Harold can get rid of their car and car insurance expenses and rely on their live-in caregiver to drive them to places when needed. But they will still need to budget monthly home maintenance costs, and expenditures like grocery, medication, utilities etc
- Typically good quality live in home care will cost around $10,000 – $14,000 in the Dallas Fort Worth area
The pros, cons, and financial considerations for Linda and Harold make it apparent that there is considerable cost to both scenarios. While assisted living provides greater peace of mind to Linda and Harold’s children, aging in place at home with their independence, dignity and familiar surroundings is more appealing and palatable to Linda and Harold and live in care at home is the option that they finally end up going with.
When they both go into the aging at home option “eyes wide open”, they know that while aging in place sounds wonderful, the fact remains that managing live-in caregivers and the external costs of maintaining their home will be additional work that they are prepared for, and an option that their children support to help the parent enjoy personalized care instead of an assisted living facility that offers standardized and less personalized care.
Both options have their pros and cons – And the final decision on what is right is a highly personal and specific one requiring a lot more info and analysis into the specific care needs, family content, financial, and emotional support structures.
With over 17 years of expert experience providing live-in and in-home care to families across Dallas and Ft. Worth and ranging from Arlington, Southlake, Preston Hollow, Highland Park, Plano, McKinney, Allen and Friso – Care Mountain is well-versed in understanding the nuances and specifics of every family’s needs and decisions on how to decide between in home live in care versus assisted living options.We in fact work closely with many of the well know assisted living facilities (e.g. Juliette Fowler, James West Center for Dementia Care, The Villages of Dallas) across the Dallas and Fort Worth areas and help manage transitions of care across facilities and home, and vice versa.
Contact us and we will be happy to help you in this difficult, highly personal and critical decision for you or your loved ones.