Choosing Long-Term Care: Alternatives to Personal Care Homes

Questions and decisions about long-term care options are common later in life. As we age, activities of daily living (ADLs) can begin to become too challenging to manage alone. Older adults experiencing changes in mobility, vision, and even cognition have several long-term care choices to pick from. But which one is best?

A personal care home may be one of the choices you are considering as a long-term care option. Understanding what they offer, and what alternatives there are to personal care homes, can help you make the best decision for yourself or your loved one.

What is a personal care home?

Personal care homes, in general, are facilities where an older adult can live long-term and receive help with ADLs. Often, they are smaller in size and situated in a residential home rather than a facility. They may serve a small number of older adults, with care provided by the facility owners who live on-site.

Each state has different rules about what kind of facility can call itself a personal care home, but in most cases, you can expect that a personal care home does not offer medical care or skilled nursing-level services.

Personal care homes are similar to assisted living facilities, and in some states, they are essentially considered to be small assisted living facilities. In other states, such as Pennsylvania, assisted living facilities are licensed differently and offer a higher level of services. 1 An older adult living in a personal care home can expect assistance with care needs such as:

Personal hygiene, like bathing
Dressing
Toileting
Eating
Laundry/light housekeeping
Help with ambulating (walking) safely
Transportation to and from activities, such as doctor’s appointments

If your care needs involve ADLs and regular caregiver supervision, a personal care home may be a good fit. Let’s take a look at the other options available as well.

Nursing homes as an alternative to personal care homes

Also known as skilled nursing facilities, nursing homes offer a higher level of care for their residents. Older adults who have medical care needs can receive help with both ADLs and healthcare while living in a nursing home. This can include skilled nursing care, physical therapy (PT), and occupational therapy (OT), for example.

Nursing home care is generally one of the more expensive options for care, with the national median monthly cost of nursing home care at $7,908 for a semi-private room and $9,034 for a private room. 2

People who are eligible for a nursing home level of care may be able to cover a portion of their care costs with Medicaid, Medicare, or both. Some rules and restrictions define who is eligible for this type of care, and what part of the costs are covered. These vary from state to state.

To determine who qualifies, these four areas of need are often part of the process:

Physical functional ability- what level of help a person needs with ADLs

Cognitive impairment- the impact of Alzheimer’s, other dementias, or conditions like Parkinson’s on a person’s ability to live independently

Behavioral problems- the presence of dementia-related behaviors like aggression and wandering

Health issues/medical needs- whether help is needed with medical services like injections or catheter care

A person who is admitted to a nursing home for care can receive care for conditions such as:

Medicines that can’t be given at home, especially intravenous (IV) medications
Medical problems that are difficult to control
Medical problems that have required long hospital stays in the past
Complex wounds, including surgical wounds
Rehab after joint replacement surgery
Stroke
Renal (kidney) disease (including patients new to hemodialysis)

Continuing care retirement communities (CCRCs)

Maybe right now you don’t need nursing home care, and a personal care home offers the right kind of support for your needs. But what if those needs change in the future? A continuing care retirement community (CCRC) might be the solution you’re looking for.

CCRCs offer multiple long-term care options all housed in one community. They are designed to allow older adults to start at one level of care, and easily transition to a higher level of care without losing the familiarity and resources of their community.

In a CCRC, you can find choices from independent living to 24/7 supervised care. Services provided to residents may include:

Private apartments or homes
Assisted living
Nursing home/skilled nursing care
Home care services for those living independently
Healthcare services

This combination of choices means as your needs change, so can your care. It comes with a price, though- an average entry fee of $402,000 to buy into the community, in addition to the average standard monthly charges of $3,555. 3

Home care as an alternative to personal care homes

There is another option available to you if you don’t need nursing home care for ongoing medical needs. In-home care brings caregivers to you in the comfort of your own home. A home care aide can assist you with the same ADLs as a personal care home.

They do not, however, offer skilled nursing care. Depending on your needs, these services can sometimes be brought to you through a home healthcare agency, with your daily personal care needs met by your in-home caregivers.

In-home care can be part-time, 24/7, or even just for occasional respite help. Some older adults even choose to have a live-in caregiver help with ADLs so they can stay in their homes longer. Most older adults– as many as 90%– prefer to stay in their homes as long as possible, called aging in place. 4

The national median monthly cost for in-home care is $5,148. 5 Medicare does not cover this type of care, but there are some options that can help with the cost:

HCBS- Medicaid’s Home and Community-Based Services waivers cover part of the cost of home-based care. Eligibility rules differ between states.
PACE- the Program of All-Inclusive Care for the Elderly, or PACE, is offered by Medicaid and Medicare in some states to offset some in-home care expenses if you are eligible for a nursing-home level of care.

Other options as an alternative to personal care homes

Along with the long-term care choices discussed above, there are some other options to consider:

Adult day care centers- these programs are available to supplement family caregiving tasks. They provide a safe and supervised environment for an older adult to stay in during the day while a family caregiver works or tends to other responsibilities.

Large assisted living facilities- depending on your state regulations, these facilities may be able to offer a larger spectrum of care services, including access to some skilled healthcare services as needs change. They can also provide activities and amenities that may not be available at a smaller personal care home. Your state’s Aging Services Division can help direct you to specifics in your area.

Some final thoughts on alternatives to personal care homes

No matter which long-term care option you choose, care needs can change. It’s important to be flexible and keep the resources discussed here in mind. Each one has its own pros and cons. You may find later that changing long-term care plans from whatever option you pick now to a different one offers better resources for you or your loved one.

If you’ve considered these choices and would like to use home care as a long-term care option, Caresify offers professional caregiving services to meet any personal care and companionship needs you or your loved one may have at home. You can read more here, or call 888-799-5007.

Providing personalized in-home care to seniors