We find that many families think that assisted living vs. home care is similar services and that we are competitors trying to sell to the same people.
Even people within the geriatric services community are mistaken that home care and assisted living facilities are competitors. That someone that needs home care can go to an assisted living and revive the same type of service.
The problem is it is 100% wrong.
What this article is going to explain is what the differences are between home care vs. assisted living facilities and you will have a full understanding of what assisted living and home care services can offer and what the three biggest differences between them are.
Information To Explore Related to Assisted Living vs. Home Care
Though this guide will be an excellent reference for anyone in the United States looking for care for a loved one, I can only accurately speak to what Massachusetts does, as that is where Minute Women is. If you are interested in learning more about private home care, we wrote a very detailed guide to understanding everything about those services.
Finally, I am going to be referring to some sites that I listed in a previous post called the 56 Best Caregiving Tools Online. It is a great resource to browse. It has and enormous amount information and links to sites for families looking for any senior care services.
Let’s get into our topic on Assisted Living vs. Home Care!
Definitions of Assisted Living vs. Home Care
We will start out with the basic definitions of assisted living vs. home care, so you know what each service provides, so you have an idea of what we are comparing.
What Is An Assisted Living?
An assisted living facility (ALF) is a community of older adults that need little or no assistance or help to enjoy day-to-day activities. Most rooms are smaller studio or 1 bedroom apartments that encourage residents to mingle, partake in activities, and enjoy the amenities that are offered in the community.
What is Home Care?
Home care is having a trained home health aide come into a senior’s home (whether it be a nursing home, assisted living, or private residence) to help them with activities of daily living for a few hours a day all the way up to 24/7 care. It is one on one care so that at any point if a senior needs assistance they have someone to provide them help with their activities of daily living so they can live longer and as independent as possibly in their home.
There are three categories that most families are interested in learning about.
- Cost/Running out of Money
- Services Offered
- Medical Services/Hospice
There are plenty of other questions to ask when you sit down and start understanding everything about senior services, but these three are significant differences between the two services.
The Cost of Assisted Living vs. Home Care
Everyone’s top question, so there is no point in hiding it at the bottom to make you read all the way down. When comparing assisted living vs. home care, both are out of pocket expenses, but the costs are different.
Neither accepts Medicare insurance or private insurances for payment. There may be cases that private insurance will reimburse a family, there is also long-term care insurance and Veterans aid and assistance that you should investigate, as will help cover the costs. Even with those programs, the majority of people who use these services are paying out of pocket.
Costs at assisted living facilities in Massachusetts range significantly. Many assisted living facilities have tiered programs, meaning there are different levels of services, and each tier of service costs more than the one below it. As a resident needs more services, the cost goes up.
According to the Genworth Long Term Care Study, which offers national data on assisted living, home care, and nursing home costs, the average cost of an assisted living room in Massachusetts is $5,300 per month.
Depending on where you live in your state, how new or recently renovated the building is, and what services you are receiving, all these components can drastically change this price. The cost of a high end assisted living in Brookline is going to be much more expensive than a lower end community in Lynn.
Private Home Care
The cost of private home care ranges in price as well. Instead of paying for room and board in an ALF, you are having an aide assist a senior for however many hours you choose to receive.
The three factors that determine cost are the services performed, the number of hours per day, and the difficulty of the case.
- Services – Someone providing companionship is a less skilled service than someone helping transfer, bathe and clean a client. Because the services can differ so can the cost of the services.
- Hours – The more hours per day a caregiver is needing is going to lower the hourly cost. It’s hard to get a caregiver to accept a case for less than five hours per day. Many home care companies charge more if lower hours are needed because they need to pay their caregivers more to get them to accept the job. Some home care companies will offer a discount to families requiring a high amount of attention, like 24/7.
- Difficulty – As a case gets more complicated (a dementia patient that is combative, or the person receiving care is rude and mean) is going to increase the cost of the hourly rate, purely because the caregiver deserves to get paid more to work in a difficult home.
The Metlife Long-Term Care Costs study has Massachusetts home health aides costing families on average $26/hour. P can range from $20 – $35 per hour, with most right around the average listed.
You can get more detailed information by reading our complete guide on private home care.
Food for Thought
If you are comparing between two companies and one is on the low end and another on the high. I can promise you it’s not all profit that is the difference. If someone is charging you $20/hour, it means they are paying their caregiver’s between $10-12/hour, while someone on the higher end is getting paid $15-18/hour. It might not seem like a big gap in pay to you, but the difference in the quality of care and experience can be huge.
Running Out Of Money
There are only two ways of paying for senior care regardless if you are comparing assisted living vs. home care services. Paying entirely out of pocket until the senior passes away or spending down until the senior is eligible for Medicare/Medicaid. Yes, there are things like long-term care insurance, bridge loans, or reverse mortgages, but in the end, these services will be coming out of person’s assets. Veterans Aid and Attendance can assist in payment, but usually, there is still a balance left over each month which needs to be covered by the family.
It can be an uncomfortable conversation with adult children who are running out of money for the services they require. With both assisted livings and private home care, it means moving away from the services the senior has been receiving and moving into a skilled nursing facility.
What are the specific services you are going to get with assisted living vs. home care? How are they different from one another and how are they similar? Though we care for the same segment of the population, one person might be a great fit for one service, but not the other. Here are the differences in services between the two options.
Assisted Living Facilities
What an assisted living facility can provide pooled care for many people who need little to no assistance from an aide. When you pay for assisted living, you are paying for room and board, meals, and about one hour of one on one care per day.
You will not receive nursing care (that can include medicated eye drops, diabetes injections, medicated creams, managing pills – more here) and you will get limited amounts of one-on-one care.
What you are paying for in an assisted living is a community of like-minded and aged people that live together. They have activities in and out of the facility, meals, shuttle buses, and charming outdoor areas to spend their time. Also, there always is someone at the front desk or the nurse’s station to provide assistance in an emergency.
Problems that can Occur
Any salesperson in any industry can be accused of making promises that they cannot keep. The senior care side can be just as notorious for shady operations as anyone else. Both ALF and private home care industries are not highly regulated in Massachusetts but assisted living facilities recently have been under more scrutiny.
The reason we bring this up is part of the problems that occur likely misinformation. At some point in time, a communication lapse occurs, and an elder is placed into an assisted living facility when they should be in a nursing home.
3 Reasons A Senior Can Be Mistakenly Accepted into and ALF
- The families make assumptions that the facility is going to provide them with services that are not available.
- The family does not realize or is in denial about the amount of care a family member needs and says “mom doesn’t need assistance walking” when, in fact, she does.
- The assisted living is a business that needs to occupy beds to make a profit. Admissions and marketing accept seniors that should not qualify for assisted living, but exceptions are made to hit sales quotas.
- Some ALFs seem more like nursing homes. Residents are allowed to stay in in the community when they should have been transferred to a nursing home long ago. Some facilities keep their residents too long, while others accept new residents that should not be allowed at all. They need far more care than what the community (and even home care) can provide.
Worst Case Scenario
Multiple times we have met with families who end up choosing assisted living facilities over home care when it is evident to us that their loved one is not suitable for ALF. Eventually, the family ends up calling us to provide their loved one 24/7 care to allow them to stay in a facility they expected to relieve them of this very issue.
In the above situation, a family is paying an assisted living facility $5,300/month for the room and board and on top of that paying home care $18,000/month to provide their loved on with one on one care. They could have kept mom home, and saved themselves $5,300/month, or done it all themselves. That realization can be devastating to a family.
Private Home Care
Private home care services center around ADLs (activities of daily living). These are dressing, bathing, toileting, feeding, and mobility. Additionally, IADLs (instrumental activities of dialing living) are provided as well and include, housework, medication reminders, shopping, communication help, and transportation.
An aide is paid to be at an individual’s home for a specific amount of time to accomplish as many tasks as needed. They are scheduled for specific blocks of time, usually at a minimum of three-hour blocks (minimums vary) and increasing to 24/7 and anything in-between.
Like ALFs, home care aides cannot perform medical tasks like diabetes shots, administering medications, or caring for open wounds. Some private home care companies offer nursing services, but for an additional charge.
Costs of Private Home Care
The drawbacks to home care are the costs can add up quickly. At an average of $26/hour in Massachusetts, one month of 24/7 care can cost close to $19,000.
Veteran’s aid and attendance and long-term care insurance can assist in reimbursing families for the cost of home care, but like assisted living facilities, private home care is an out of pocket expense.
Another drawback is that caregivers are coming into your parents’ home, which can be stressful, scary and invasive. The more hours required, the more caregivers are needed to cover all the shifts (you don’t want caregivers going into overtime). With having up to ten caregivers on one job this means people can be late, there can be personality conflicts, and you may go through a few caregivers before you find the ones that work best for each case.
What happens when a senior needs medical services?
Medical tasks like wound care and diabetes management are not services covered under private home care. Medicare nurses can come out on doctors orders but only until they have brought the senior to “baseline,” which is terminology for “we have done all we can do.”
Medicare nurses do not come out forever. Since ALFs are not allowed to provide medical care, this leaves a gap in coverage that the facility can not provide.
Home care companies can offer medical services through an LPN or RN, but this comes at an additional cost. Nurses can handle skin tears, medication management, diabetes, apply medicated ointment or eye drops and other medical tasks.
Just know that when looking at an assisted facility in Massachusetts, they will not be able to help you loved one with specific medical tasks.
When someone has an illness and needs hospice services, it changes the type of care the individual receives. Assisted living facilities allow hospice companies into a senior’s apartment to provided hospice services. Nurses, aides, and medications are provided by the hospice company even while in the assisted living facility.
When it comes to home care, there is a big difference. Home care can not provide hospice services. Families can pay for home care to help make someone comfortable as hospice aides are not available around the clock.
If a family discontinues home care services, this can cause separation anxiety for the senior. This is because the senior has relied on aides for months if not years. This decision does provide financial relief so that the family is not spending as much money on care.
Finishing Up Assisted Living vs. Home Care
Making the decision for a family member who needs assistance can be tough. Deciding on what kind of services you need can be tough to families. But now know what the differences are between assisted living vs. home care.
We are not competitors. We are services that complement each other to provide the perfect amount of help for an older person needing assistance.
What are your thoughts experiences with assisted living vs. home care? Join the conversation below!