Savvy Senior: How to know when home care isn’t enough

Dear Savvy Senior: My mother has several chronic health conditions and needs a home caregiver to help with daily activities. I know she wants to stay at home as long as possible, but how do I know when it’s time to consider an assisted living facility or nursing home? — Exhausted Daughter

Dear Exhausted Daughter: Most older adults hope to remain in their own home as long as possible, and with the right support many can. But there might come a point when home care is no longer enough to meet a person’s needs. While moving to an assisted living facility or nursing home is never easy, recognizing the warning signs early can help you avoid a crisis and make the transition less stressful.

If you answer “yes” to several of the following questions, it might be time to explore other care options:

Is home care becoming too expensive?

Eight to 10 hours of care a day, seven days a week, can easily cost $100,000 a year or more. That’s well above the median annual cost of a one-bedroom assisted living apartment (about $70,000), though still less than a private room in a nursing home (about $128,000), according to Genworth’s Cost of Care Survey.

Does she need more medical care?

If your mother needs ongoing nursing care or frequent medical monitoring, a nursing home might be the better choice. If she mainly needs help with daily activities, assisted living might be enough.

Is she falling, forgetting medications or going to the hospital more often?

Frequent falls, medication mistakes and repeated hospitalizations are often signs that living at home is becoming unsafe.

Does she have dementia?

Wandering, confusion or unsafe behaviors can make home care increasingly difficult. Memory care communities provide a secure environment and specially trained staff.

Does it take two people to help her?

If she needs two people to assist with transfers, bathing or toileting, both the cost and safety risks of home care rise significantly.

Has her home become unsafe?

Stairs, narrow bathrooms and the lack of features like grab bars or a walk-in shower can increase the risk of falls. Home modifications might help, but they aren’t always enough.

Is she isolated or neglecting personal care?

Loneliness, poor nutrition, weight loss or neglecting bathing and grooming can all signal that she needs more support than can realistically be provided at home.

Is caregiving overwhelming?

If you’re constantly worried, sleep-deprived or neglecting your own health, it might be time to consider a higher level of care. Planning ahead gives your family more choices and helps avoid making an important decision during a medical emergency.

Keep in mind that Medicare generally doesn’t pay for long-term stays in assisted living or nursing homes. It only covers limited skilled nursing care after a qualifying hospital stay.

If you’re unsure what level of care your mother needs, an Aging Life Care professional (aginglifecare.org) can assess her situation and recommend appropriate options. An initial assessment can cost $300 to $800 or more. You can also use a senior care advising service like A Place for Mom (aplaceformom.com), which provides free guidance because it is compensated by participating care communities.

To research facilities, visit Caring.com. For Medicare-certified nursing homes, use Medicare’s Care Compare tool at Medicare.gov/care-compare. You can also contact your local long-term care ombudsman (ltcombudsman.org) to learn about complaints or quality concerns involving facilities you’re considering.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org.