How to Choose Between Assisted Living vs. In-Home Care for an Aging Adult: 3 Important Considerations

As parents and other family members age, we often get to a point where it's time to make that big decision: where will they live when they can't meet all their needs on their own anymore? For seniors who don't need the high-level, full-time medical care of a nursing home, in-home care or assisted living are the two best options. But how do you choose which is best for your loved one?

The decision may feel complicated; after all, every person has different needs and every family has different situations and limitations when it comes to caregiving. When you break it down, deciding between in-home care or assisted living comes down to three main factors:

1. Understanding the main differences between in-home care and assisted living

2. Evaluating the level of care your aging loved one needs

3. Understanding the costs associated with in-home care and assisted living and your loved one’s financial situation

This article serves as a simple guide to help you work through these three considerations so you can feel more confident in your decision.

1. Understanding the differences between assisted living vs. home care

The main difference between these two care options is the location of caregiving, followed by the cost. Sometimes it helps to look at assisted living as a caregiving package with already-built-in features and services and in-home care as a menu of services created by you and your loved one. While both options provide services that match individual needs, in-home care tends to be more personally customized but more time-consuming for the main family caregiver. In contrast, assisted living offers more generalized services but is more hands-off for the family members.

Assisted Living: Pros & Cons

Pros

• More affordable for seniors who need a higher level of care or 24/7 supervision

• The level of care can be adjusted as needed

• Offers more social interaction with other seniors and opportunities for activities and outings

• Family does not need to worry about making often expensive modifications to their loved one’s house or their own home to accommodate their needs

• Built-in reliable care with no need to vet, hire, schedule, and manage individual home caregivers

• Removes the challenges of family caregiving so the family can focus on spending quality time with their loved one

Cons

• The quality of care can vary depending on the facility, and the family does not get to be involved with staffing decisions

• Care is often less consistent due to staff changes, which are common in assisted living environments

• An assisted living facility can evict a resident with very little notice (common reasons include missing payments, increased level of care that can't be provided at the facility, breaking resident rules, or endangering the safety of others)

• Residents may have fewer choices about things like meals, visitation times, and how much private time they get.

• 3 out of 4 adults over age 50 say they would like to age at home, which means moving to an assisted living facility may be a difficult adjustment 

In-home Care: Pros & Cons

Pros

• The aging adult gets to remain in their own home or in a family member's home.

• Care is highly customizable based on the specific needs of the aging adult.

• There are a wider variety of options, like adult daycare, private or agency caregiver, family and friend help, home nurse, or share care, where resources are pooled with other families with aging adults.

• Costs may be lower than assisted living if a lower level of care is needed or family and friends are contributing to caregiving.

• The family gets the peace of mind that comes with selecting their aging adult's caregiver.

• The aging adult gets a chance to build a deeper, more personal relationship with a single caregiver.

Cons

• Family caregiver(s) may experience burnout that often comes with caregiving.

• Costs can get high as more advanced levels of care are needed, especially if 24/7 supervision is required.

• Modifications may need to be made to the home as safety and mobility needs change.

• Aging adults may begin to feel socially isolated if they are not able to spend time with friends regularly or participate in activities outside the home.

• The family caregiver or aging adult will need to navigate the complexities of Medicare and insurance as there are nuances to what is covered in an assisted living facility versus an in-home care service.

2. Understanding the level of caregiving your loved one needs

Before choosing a living arrangement for your loved one, you must really consider their current needs and think about their future needs.

First, consider the main activities of daily living: eating, bathing, and personal hygiene, dressing, toileting, and mobility. Can your loved one make their own meals? Safely bathe? Do they have control of their bladder and bowel functions? Thinking about the simple daily living activities will help paint a larger picture of what kinds of care they will need day-to-day.

Second, consider the emotional, social, and cognitive needs of your loved one and the caregiving family member(s). Do you have friend and family support or does the bulk of caregiving rely on you? Does your loved one receive the social, emotional, and cognitive stimulation they need? It's important to be realistic about the kind of support you can expect from your network of family and friends.

Lastly, consider your loved one’s medical needs - now and in the future. Do they have medications that need to be managed and reminded to take? Do they have any disabilities or chronic illnesses that will progress? Of course, it's not possible to predict the future, but if your loved one has a condition that you know will cause a higher level of care to be needed down the road, that's important to take into consideration.

3. Understanding costs and your loved one’s financial situation

Estimating caregiving costs is not easy, so it's important to take some time to fully review your loved one’s financial situation before choosing in-home care or assisted living. Having a clear budget for caregiving can help prevent future challenges associated with costs.

Remember that senior care costs can vary quite a bit. There are many different levels of care and services available for seniors in both an in-home care situation and at an assisted living facility. The best way to begin estimating costs for your aging adult will be to research services in your area. Call or visit different assisted living facilities to get an overview of services and pricing. Call in-home care agencies and several private in-home caregivers to learn about their services and pricing. Don’t forget to look into additional services you may need, like adult day care, meal delivery, or transportation. 

If you want a broader overview as a starting point, try this online cost-of-care estimation tool, which will help you with a foundation of knowledge regarding hourly, daily, monthly, and yearly median care costs in your area. You can even estimate future costs based on how current data is trending.

As of 2021, the monthly median cost for assisted living is $4,500, and the median cost for in-home care is $5,148. 

There is no right or wrong decision

As you take steps to decide whether in-home care or assisted living is right for your loved one, remember that there is no "correct" choice. Every individual and family has unique needs when it comes to caregiving, and it's okay for the situation to change over time. Seniors can thrive in both an in-home care or assisted living environment. Keep channels of communication open with your loved one and members of your support system. It may even help to talk to others that have experience with in-home care or living in an assisted living facility to get their perspectives.