You know the time is coming when you or your loved one will require assistance, what is the best option for that care?
Introduction
Aging, while it happens inevitably to all of us, is no easy task. Losing the ability to perform tasks we used to do with ease can lead to fear and frustration. Knowing your options for assistance in the future can help smooth the transition for both the person requiring the assistance and the loved ones in their life. The following is the comparison of nursing homes versus in-home care. The differences, the benefits of each, the costs associated, how it’s typically paid for, and the different impacts Covid-19 has had on each. Having this knowledge can help you choose the route that will best fit your needs and desires.
What is a Nursing Home?
A nursing home is a facility for individuals who require assistance with daily tasks, in healthcare we call it activities of daily living or ADL’s. Nursing aids and skilled nurses are on staff in most nursing homes 24 hours a day. The living quarters can be shared or private rooms. Usually, there are organized activities for the residents, and meals are provided in a dining room or to the private quarters. The arrangement or feel of each nursing home varies from home-like to hospital-like. Some nursing homes also have specialized units that care for seniors with memory problems, these units are usually locked down to help keep the residents safe from wandering.
What is In-Home Care?
Home care services (which should not be confused with home healthcare services) are when a home care aid comes into the home to help with ADLs. They are not usually medical professionals and do not provide medical treatment or care. They do help with hygiene, meal planning/prep, transportation, medication reminders, general housekeeping, and are a friendly companion. The home care aide is scheduled according to the needs of the person, a few hours a day or week up to 24 hours a day. This type of service can be organized privately or through an agency.
Home healthcare services are when a physician orders a skilled medical professional, such as nurses, physical therapists, occupational therapists to provide medical services in the home such as wound care, IV changes, feeding tubes, catheters, injections, and physical needs beyond the level of basic ADL’s and mobility. This is generally arranged through a home health company.
Benefits of Nursing Homes
Nursing home benefits revolve mostly around being in an organized community with many things available in-house. There is usually 24/7 medical assistance by a nurse available and around-the-clock help with ADLs by aides. Meals being planned, prepared, and served to the residents can be a huge positive. Also, there is the social aspect, most nursing homes have organized activities such as game times, movie times, craft times, music times, trivia times which many residents participate in and have great fun. There is also the ability to make friends and have a social life.
Benefits of In-Home Care
In-home care benefits revolve mostly around being able to keep the person in their familiar environment. With age and especially with dementia, being in familiar surroundings are key to reducing anxiety. Having one-on-one care customized to the individual and based on a comfortable routine can be very reassuring. There is also the encouragement of independence that comes with in-home care. With a home aide’s attention being only on one person there is the ability to know their client better, see the strengths and weaknesses, and know when to promote independence. According to statistics, those who receive in-home care also have 50% fewer doctor visits annually.
The Cost of Nursing Homes Vs. In-Home Care
Nursing Home Costs
The cost of staying in a nursing home varies from state to state. There is also the difference between using a private room or a shared room. The national average for a shared room is $93,075 annually and for a private room $105,850.
In-Home Care Costs
The cost of in-home care likewise varies from state to state. The total is additionally dependent on how many hours a week the home care is needed which can be customized according to the need rather than a flat 24/7 rate like a nursing home. The national average for home care is $4290 a month or $51,480 annually.
Who Pays?
Private Insurance
Regular insurance policies typically do not cover home care, however, there are cases in which an individual has long-term insurance which is designed to cover senior care. The coverage does depend on the insurance provider, the specific policy, and the age of the person when they signed up for the policy. Usually, the insurance will not begin to cover care until assistance with at least two ADL’s is needed.
Medicaid
Home care can be covered by Medicaid for seniors who qualify both financially and medically. The senior will need to be evaluated medically to prove that they need the level of care they are receiving. The qualifying factors for receiving coverage of care vary from state to state.
Medicare
Medicare does not cover long-term care. There are circumstances in which it will cover short-term nursing home care. However, it maxes out at 100 days. In-home healthcare will be covered with some limitations and only as long as some requirements are met. For example, the senior must be considered homebound, must be under the care of a physician who has a home health care plan, and must receive services from a Medicare-certified home health care agency.
Aid and Attendance Benefit
This is a benefit that is available to eligible veterans and their spouses. It is an extra monthly payment that veterans may receive in addition to their regular monthly VA pension. The intention is not to directly cover the cost of care but is an added monthly income for those who require the extra help.
Life Insurance
Although most think of life insurance as a policy intended to assist the loved ones of the beneficiary following their death, there are cases in which it can be used to pay for long-term care, in-home care included. The policies are typically referred to as a hybrid and the specifics of what is covered varies.
Depending on the insurance company’s rules, a person with standard life insurance can sometimes surrender their policy for a cash payment. Or there is sometimes an option to sell a policy to a third-party group. With both options, the cash payment will be less than the original death benefit.
Reverse Mortgage Loans
A reverse mortgage is an option to finance long-term care for adults aged 62 and older. It’s converting part of the home’s value to cash. Most of the time the money is not taxed. This is an option for seniors who are not ready to leave their homes and are wanting in-home care. Keep in mind the loan does need to be repaid when the last surviving borrower passes away or moves out of the home.
Private Funding
Private pay is always an option for those who have the means to do so. For someone who only needs a few hours of care a week, this option could be much more feasible than someone who requires full-time care. When moving toward requiring 24/7 care a nursing home would be more financially affordable.
What Impact Has Covid-19 Had on Nursing Homes and In-Home Care?
Covid and Nursing Homes
Unfortunately, nursing home residents were hit particularly strongly from Covid-19. Most nursing home residents are elderly and have underlying health care conditions putting them at higher risk. Living in a community environment also increased spread. Family members of loved ones in nursing homes were in most cases unable to visit. Many had concerns about their loved one’s physical health, mental health, and quality of care. Shockingly, statistics say 40% of covid deaths were from nursing homes and other assisted living-type facilities. Sadly, most residents had to be quarantined in their rooms, many times alone with very limited interaction with staff members. This led to loneliness, increased confusion, and depression. Those with memory issues could not understand the process going on and why they could no longer see their family.
Covid and In-Home Care
In-home care faced a different set of challenges but had some positive changes as well. In some cases, families, or the seniors themselves refused caregivers to come to decrease contact with outside people. Other times it was the caregiver who was afraid and wouldn’t show up to work. For the most part, however, patients receiving in-home care were healthier and safer due to quarantining at home. The desire to decrease the load on the hospital system encouraged physicians to seek in-home care for their patients more than in the past. This led to increased attention on in-home care and has created a desire to grow the industry and make it stronger.
Conclusion
It is best to start early when planning for your future care. Aging will have stressful moments and those who have planned tend to transition much smoother. Even if it’s not quite time for their services, start reaching out to nursing homes or in-home care agencies; meet some of the staff, take a tour, find out their process of getting started, and get yourself comfortable with your decision. You and your family will be very glad that you did.