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Nursing Homes vs Home Care

There comes a time in life when many seniors or their loved ones realize that they could use a bit of outside help, whether they want to age in place with home care or take steps to move to a nursing home. Choices such as this are never easy. Many don’t want to leave their home, while others may be seeking the socialization and 24/7 access to medical care and services that nursing home facilities offer. There are countless questions and considerations that go into making these big decisions, and this guide is here to help you feel less overwhelmed during the process. Here we discuss the differences between in-home care and nursing homes, the pros and cons of each, how much they cost and various payment options to assist you in making the best choice for yourself or your loved one.

How Much Daily Help is Necessary?

Does the beneficiary simply need someone to help around the house part-time or full-time with activities of daily living, medication reminders, provide assistance with dealing with bills or finances, or just want a companion? Does the beneficiary require a good deal of medical assistance after recovering from an injury or due to the onset of dementia? Do amenities like planned meals, on-site health care or organized activities appeal to you? Essentially, deciding how much care one needs and the level of amenities they desire are the primary questions that need to be determined before deciding between in-home care and nursing home care.

What to Expect From In-Home Care

In-home care options range from a few hours per week to 24/7 care, but most beneficiaries receive 44 hours of care or less per week. Twenty-four hour care in the home can be very costly, and in most situations this type of caregiving would come from a hospice or palliative care service. However, this can be an ideal solution for seniors looking to age in place within the comfort of their home. Basic home caregivers, such as health aides and homemakers, can stay as little or long as you need them to in order to provide companion care and assistance with activities of daily living such as hygiene, meal preparation, transportation, medication reminders, general housekeeping and much more. Skilled medical nursing professionals such as nurses, physical therapists, occupational therapists, doctors and others can provide basic services in addition to far greater levels of in-home care. Under the direction of a licensed physician, these professionals use their advanced skills to assist with wound care, IV changes and insertions, feeding tubes, catheters, injections, medication administration and other physical needs beyond ADL’s and basic mobility. Certified dementia and memory care health care providers are also available in homes, but are generally best for those with mild to moderate stages of these conditions. Many people choose in-home care over nursing home care because they enjoy the freedom of being in their own home in familiar surroundings. Many seniors report having a greater quality of life and happiness with in-home care, and statistics show that these beneficiaries actually have up to 50% fewer doctor’s visits annually. When considering in-home care, families need to decide whether to hire a caregiver privately or use an agency. Agencies do much of the legwork including finding qualified candidates, running background checks, confirming their credentials and handling the financial aspects including caregiver payments and calculating withholdings for taxes.

What to Expect from Nursing Home Care

Often referred to as convalescent homes, nursing home care can be the best option for those needing more than basic care that can be handled in traditional home settings. Nursing homes are designed to provide around-the-clock medical care and assistance for patients in a residential setting. Caregivers will assist beneficiaries with all of the ADL’s, personal care needs, mobility issues, meals, cleaning, laundry and provide skilled medical care and/or therapy whenever it’s needed. This is why so many families who feel that full-time care is needed opt for nursing home care because they offer so many services to residents and alleviate caregiver stress. Most facilities offer semi-private and private rooms, with private rooms costing a bit more than shared spaces, and some homes may have age restrictions and most don’t allow on-site cooking or pets on the premises. However, many seniors prefer the amenities in nursing homes vs home care, as convalescent centers often offer regular in-house activities such as crafts, games and fitness in addition to outings for shopping and entertainment with transportation provided. These facilities may also offer advanced memory care services that are vital in the latter stages of conditions, such as Alzheimer's and Huntington’s Disease. Those with chronic health problems, severe mobility issues or those who suffer from serious injuries may find that a nursing home is the ideal option.

Side-by-Side Comparison of Nursing Homes and In-Home Care

Nursing Home Care In-Home Care
Average Monthly Costs $6,844-$7,698 $3,813 (44 hrs./wk.)
Private Pay Yes Yes (most common)
Medicaid Limited Limited
Medicare Limited Limited
SSI/Disability Yes Yes
Veterans Benefits Yes Yes
Long Term Care Insurance Yes Yes
Grants Yes Yes
Activities of Daily Living Yes Yes
Medication Management Yes Yes
Physical/Occupational Therapy Yes Varies
Skilled Nursing Yes Varies as needed
Meal Preparation Yes Yes
Transportation Yes Varies
Social Activities Yes Limited
Housekeeping Yes Yes
Personal Hygiene Yes Yes
Continence Yes Yes
Mobility Yes Yes, but varies upon needs
Eating/Feeding Yes Yes
Dementia/Memory Care Yes Yes

Cost of Nursing Homes vs In-Home Care

The cost of nursing home care and in-home care will vary depending upon a number of factors: location, amount of care needed, and the level of care that is required. The average cost of care has a vast range between each state, with higher costs being in regions where the cost of living is higher. One might think that home care is always the least expensive option, but depending on the aforementioned factors—particularly concerning those with special needs or 24 hour care— this may not be the case. However, here are summaries of the national averages of common care levels to give you an idea of what to expect.

Nursing Home Average Costs

On average, a nursing home costs $225 daily for a semi-private room and $253 for a private room. Monthly charges range from $6,844 to $7,698 for semi-private and private rooms respectively. Annual costs range from $82,128 to $92,376 for full time nursing home care. Additional costs may be incurred if dementia, memory care or other special services are required.

In-Home Care Average Costs

The cost of in-home care will depend on the type of caregiver you are seeking and what qualifications you prefer them to have. Non-medical paraprofessionals like home health care aides that provide assistance with ADL’s, housekeeping and companionship services average $20.50 per hour, $164 daily, $4,920 monthly and $59,040 annually for 40-44 hours of care per week. Skilled medical care professionals provide similar services to health aides but can also perform more intensive services such as medication administration, wound care, physical therapy, catheter care, intravenous needs and more due to their additional qualifications. Skilled home health care provider costs average $220 daily, $6,600 per month and $79,200 annually. If you are using an agency to hire in home care, there may be about a 10-15% increase in costs, but they are generally worthwhile considering their convenience.

Paying for Senior Care

With an idea of how much nursing homes and for in-home care costs, one must give consideration to how to pay for it. Fortunately, there are several options when it comes to payment. Some using home health aides and only need a few hours per week of services may opt to pay cash, while those needing intensive care or nursing home services full time may need  financial assistance from government, state or local agencies. While their benefits and coverages vary substantially, the most popular ways to pay for nursing homes and in-home care include:
  • Medicare
  • Medicaid
  • Veterans Benefits & VA Senior Housing
  • SSI/Disability Benefits
  • Private Grants — Religious or Community Organizations
  • Private Insurance
  • Long Term Care Insurance
  • HUD Senior Housing Benefits
  • Leveraging a Home
Medicare offers limited short-term benefits for home care for those seeking in-home care and only covers medically related care costs, not ADL’s. Medicare Advantage will cover certain expenses related to nursing home care in nationally and state licensed facilities. Medicaid is an income-limited program that is more generous concerning both types of care for those who qualify. The National Council on Aging's Benefits Checkup website can help determine which benefits are available to you, and agencies and facilities also have specialists who can assist with financial questions.

Choosing What’s Right for You

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