Choosing Long-Term Care: Alternatives to Nursing Homes

Although many older adults are able to live independently and without any assistance, it is very common as people age to find that they need some level of help with day-to-day self-care and activities. In fact, half of all older adults- numbering 18 million- are reported to need this kind of assistance. 1

In this scenario, a common option is nursing home care. But most older adults would like to stay in their own homes- as many as 90% of adults 65 or older prefer this arrangement, known as “aging in place.” 2 And if staying at home is not an option, what are the other choices available?

To better understand the options, we’ll define each one, and explain the differences between them. Each person’s situation will be unique– and for each person, there are options that are a good fit for meeting care needs due to aging.

Nursing homes

“Nursing homes” are sometimes a catchphrase for living in a group facility that is not your own home, but what are they, exactly?

Also called skilled nursing facilities, nursing homes are facilities that provide medical care for older adults that have chronic health conditions requiring ongoing care. Services offered include:

Short-term care (often a bridge between a hospital stay and returning home)
Long term care
Rehabilitation services like occupational therapy (OT) and physical therapy (PT)
Nursing care including medication administration
24/7 supervision
Assistance with daily activities

Some of the conditions regularly treated at a skilled nursing facility are:

Complex wounds, including surgical wounds
Rehab after joint replacement surgery
Stroke
Renal disease (including patients new to hemodialysis)
Medicines that can’t be given at home, especially intravenous (IV) medications
Poorly controlled medical problems, or problems that have required long hospital stays

There are qualifying conditions that must be met for Medicare reimbursement of this kind of care. 3 You’ll need to check with your insurance provider to be sure you are eligible before choosing a nursing home.

Assisted living

An assisted living facility offers a group living option for people who do not need the level of medical care a nursing home provides. In these facilities, residents have their own private living quarters but have access to common areas. Services offered include:

Laundry and housekeeping
Prepared meals
Assistance with activities like shopping, meal prep, and self-care
Social and recreational activities
24-hour on-call assistance when needed
Transportation to activities outside of the facility

It is a lower-cost alternative to nursing home care, coming in at less than half the expense. 4

However, for older adults with complex medical conditions, assisted living facilities do not provide the level of care needed to address these problems. Instead, each state and facility defines levels of care based on needs, and residents who need a high level of medical care would need to consider nursing home placement.

Continuing care retirement communities (CCRCs)

These organizations provide an option for transitioning between types of care provided as needs change. In CCRCs, the above options are all in the same location, with some shared resources like community activities and services. Living in a CCRC can offer multiple living options and services:

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

An older adult can start in an independent living situation, and easily move to a higher level of care if needed, without losing familiar community surroundings.

This type of arrangement usually requires an entry fee- with the average cost at $402,000. 5

Some other alternatives

The previous examples are the most common options chosen when an older adult is seeking a living arrangement in a facility outside of their home. There are some other options as well:

Board and care homes, also called group homes- a small private facility, often in a large home, where multiple people live together under the same roof. They may share bedrooms. The staff provides personal care and meals but does not provide medical care.

Adult day care centers- facilities where older adults who need additional help and social interaction can stay during the day while their primary caregivers/families are at work. Staff provides personal care, entertainment, activities, and meals.

Home care

To meet the desire of most older adults to remain in their own homes for as long as possible, home care offers an option that avoids relocating to a facility.

With home care, a person can age in place and receive non-medical care in their home. Caregivers may be family members, or paid professional caregivers, and they may stay with an older adult part-time, occasionally such as for respite care, or 24/7. Care provided includes:

Bathing & dressing
Light housekeeping
Bathroom assistance
Transportation
Meal prep
Companionship
Help with safe ambulation (walking)

In-home care, like assisted living facility care, is a much lower-cost option than nursing home care, with a median monthly cost that is 43% lower than some nursing homes. 6 It also allows a person to keep the most familiarity and independence possible, often with consistent caregivers.

Unless activities and companionship are provided by caregivers, friends, or involvement in regular activities outside the home, home care can sometimes be more isolating than an assisted living facility that offers group activities.

Along with paying out of pocket for home care services, two programs that are available to help with the cost are PACE and HCBS. These programs can assist with payment for daily care needs and medical needs as well.

PACE

The Program of All-Inclusive Care for the Elderly, or PACE, is offered in some states under Medicaid. You must receive either Medicare, Medicaid, or both to apply for this program. PACE pays for community-based services and healthcare so its members can avoid going to a nursing care facility. To qualify, you must: 7

Be 55 or older
Live in an area serviced by a PACE organization
Need a nursing home-level of care (as certified by your state)
Be able to live safely in the community with PACE assistance

HCBS

HCBS, or Home and Community-Based Services, are Medicaid programs that offer waivers to help cover the cost of care at home. Eligibility depends on local and state regulations related to Medicaid and HCBS programs.

Making a big decision

As you can see, there are many options to consider as an alternative to a nursing home, depending on a person’s situation and needs. The ultimate goal of whatever care you choose should be to maintain maximum quality of life and health despite any challenges faced.

Regardless of your decision, circumstances can change and a different type of care may be needed in the future. Understanding these options allows you to be flexible in choosing care options.

If you feel that aging in place and home care would be the best option to maintain independence and quality of life, Caresify offers professional caregiving services to meet any personal care and companionship needs you may have at home. You can read more here, or call 888-799-5007.

Providing personalized in-home care to seniors