The choice between in-home care and assisted living is rarely an easy one — especially when it’s your partner, spouse or parent who’s been diagnosed with Alzheimer’s. You may be unsure whether you’ll be capable of caring for a person in the later stages of dementia; while, at the same time, you may be worried about disrupting your loved one’s life (and yours) by moving them to an unfamiliar facility.
Weighing the pros and cons can help you take the first steps toward making the right decision. You’ll want to consider the costs of a facility, versus the expenses of adding safety and accessibility modifications to a home — as well as the increasing amount of time you’ll be dedicating to your loved one’s care as the disease progresses. A third option is to hire a professional in-home caregiver; though that, too, can be expensive.
Here, we’ll examine the upsides and downsides of each possibility — so you can make an informed decision that’ll give your loved one an optimal quality of life.
Residential facilities handle all the details, but quality of care can vary.
An assisted living facility (ALF), also known as a residential care facility or retirement home, offers a lot more independence than you might expect. Many ALFs offer private bedrooms, bathrooms and kitchens — and unlike a nursing home, an ALF doesn’t place residents under staff supervision, or require them to follow a daily schedule. What’s more, many ALFs offer group activities that provide plenty of opportunities for socializing.
The goal of a well-managed ALF is to support your loved one’s independent lifestyle as much as possible, for as long as possible. As your loved one begins to need more assistance with activities of daily living (ADLs), on-site staff can handle housekeeping, laundry, meal preparation and other essential tasks. In the later stages of Alzheimer’s, professional caregivers can also assist with bathing, dressing, using the restroom, and making sure the prescribed medication schedule is followed.
In short, an ALF aims to take care of all the practical details, freeing you and your family to focus on enjoying the time you spend with your loved one. However, it’s important to note that the quality of care can vary widely from one facility to another. At some ALFs, a small number of on-site staff members work with a large number of residents — which means your loved one may not get as much personal attention as they deserve. Staff turnover can also be confusing for residents with Alzheimer’s, who may be upset to find “strangers” replacing the caregivers they’ve gotten to know.
When choosing an ALF for your loved one, you’ll want to investigate the facility’s reputation, read the reviews, and spend some time there yourself. Talk to the caregivers, chat with a few residents, and get a feel for the culture. If anything seems amiss, trust your instincts. And before making a commitment, make sure you know exactly what’s included in each price package — for example, private one-on-one care usually costs extra, and some facilities also tack on additional charges for housekeeping and laundry services.
Family caregiving lets your loved one stay home, but it’s a big commitment.
If you live with a loved one who’s been diagnosed with Alzheimer’s, or visit their home on a daily basis, you may decide to care for them yourself. Your loved one will almost certainly prefer this approach — and there’s no doubt it offers certain advantages. Family caregiving can minimize disruption to the lifestyle of the person in your care, by enabling them to keep living in a familiar environment, surrounded by people they know and love.
The more independent your loved one feels — and the more they’re able to continue practicing their hobbies, visiting familiar stores, and socializing with friends — the more optimistic their outlook is likely to be. In fact, the combination of positive mental health, nutritious diet, regular exercise, and mentally stimulating activities can delay the onset of serious Alzheimer’s symptoms for months, or sometimes even years after the initial diagnosis.
At the same time, it’s important to be aware that family care is a major commitment. You’ll need to make sure the home is safe and accessible for your loved one, by installing grab bars, anti-slip mats, nightlights, and wheelchair access ramps. You’ll also need to be increasingly vigilant about sharp objects, tripping hazards, toxic chemicals and other hazards. You may need to place locks on the doors and windows — and you’ll want to keep an extra set of keys, in case your loved one accidentally locks you out.
And as Alzheimer’s progresses into its later stages, it’s important to recognize that family care will become a 24/7 job. You’ll be cleaning up clutter, taking out trash, and helping your loved one bathe, get dressed, and go to the restroom. At that point, many families choose to hire an in-home caregiver, who specializes in caring for people with Alzheimer’s around the clock.
In-home care can be expensive, but it can combine the best of both worlds.
Although hiring an in-home caregiver may feel like “giving up,” the truth is that professional one-on-one attention can significantly improve your loved one’s quality of life; especially if you continue to spend time with them on a daily basis. In many ways, in-home care combines the best aspects of family care and assisted living — enabling your loved one to keep living at home, while receiving expert attention from a caregiver who knows them personally.
When it comes to choosing an in-home care plan, you’ve got a wide variety of options — and some are much more affordable than you might expect. For example, you can start by trying out a caregiver on a part-time basis, giving them time to get to know your loved one and demonstrate their abilities before you agree to a full-time hire. Depending on your situation, you may be able to reduce costs by combining in-home care with adult day programs and other out-of-home arrangements. A number of tax credits and deductions are also available to offset in-home care expenses.
As you consider the pros and cons of assisted living, family care and professional in-home care, it may help to remember that these aren’t “all-or-nothing” choices. You can hire a one-on-one caregiver at a residential facility, share your responsibilities with a part-time caregiver at home, or combine several options in ways that balance affordability with quality of care. Ultimately, it’s about what works best for you and your loved one — and that’s a decision only you can make.