Which is better, care provided in a facility or in-home care?

One more aspects about in home caregivers for me is that I am ultimately responsible for my parents.. even with a caregiver there. I cannot go out of town or completely take a day off. The responsibility is always there. I am always checking... checking what they do. ..fearing for the next downward spiral.

I know some of this responsibility will remain when they are in a facility but it shouldn't be as limiting in my life. I have been 4 years without taking any time off. I worry about the next sick spell that will require hospitalization for one of them.. while I am still left to care for the other.

Any infection.. like UTI's, bronchitis, pneumonia... are a constant worry for me. The last bout my dad had with pneumonia he was hospitalized while I was left careing for my mom who also had bronchitis.. both took a scary downward mental spiral while they had an infection. It was a couple of weeks of sheer h*ll and I still to this day (months later) don't think I have gotten over it yet.. the exhaustion is still there.

I am also going back and forth in my mind about facility vs at home. The biggest issue right now is that I don't think I can physically make it much longer in the current arrangement..it is too much for someone with no family support. I hate that the deciding factor may be me.....

I have d excellent privately hired caregivers. Never had a good experience with licenced agencies. The success in finding the kind of caregiver I need has been time-consuming on the front end, and easy and peace of mind through the rest of the time. I went to every church in the area and asked the secretary for references of people who had used caregivers. From one afternoon of investigation, I got 20 names of people to interview over the phone, and from that list, had in person interviews with 6. I got references from each one, and can pay them more what they are worth, but still pay much less than an agency. I've had the same 3 private caregivers for my dad for almost 1 full year. The agency caregiver experience has been completely different. Don't show up, ask for loads of a days off. Seem disconnected and not invested in my dad. Remember, the same type of employee that an agency provides is the same type of employee that a facility will provide, and you're paying a premium for less than adequate care in many cases.

If you can find a good AL, they can be awesome places to use, if you can afford them. They have lots of activities going on and are legally responsible for providing the best care of your loved ones while they are there. There is never a better place for them than home, assuming that there is round the clock care there by family or friends, or even someone that comes routinely over the long haul that they can learn to like and trust. But, this is not always possible, and if one person is responsible for their care, they definitely need time away routinely. Just keep in mind that, if you do decide to use an AL, whether part time or full time, this can be very upsetting to someone who has any dementia going on. Any change in their daily routine can upset their world. However, if everyone gives them plenty of time to adjust until the new place becomes their 'routine' and they get familiar with everyone there, it can work well.

I've had 3+ years experience with 3 different agencies and one AssistedLiving. I agree with all of the above. When you find good caregivers they are worth their weight in gold. 24/7 home care was costing about $16K a month and I was still there at least 60 hours a week between dealing with doctors, pharmacies, insurance companies, home maintenance problems, Caregiver's canceling, etc. As my Moms Parkinson's and dementia progressed I had to place her in a care facility. They have provided an environment for her for the past 5 months that I could never have created at home. It is interesting to watch the connection between dementia residents as they relate to each other. Now it requires 2-3 caregivers to transfer my less than 100# Mom. She's where she needs to be and I'm so grateful. Prayers for you in this decision.

I have cared for my mother in the home we built on our acreage for 10 yrs. She has Parkinson's and Dementia. I had luck with two helpers, but still trapped and not able to go anywhere with my very caring husband for more than a trip to the store or a lunch out. Of course the short time I am gone the cellphone is by my side and yes it rings constantly with either mom or the helper calling for one reason or another. January she had to go to Rehab after a hospital stay 4 bad falls in 2 hours. I can't lift her and my husband is disabled so he is just moral support. Since she can't stand safely let along walk it turned into a nursing home setting. I am so relieved that she is in a super safe environment, and I don't feel guilty anymore. She goes around the entire facility shuffling in a wheelchair. She has developed friendships, and is very social. She is safe 24/7 with a fantastic staff that I now consider family. I still let mom think she is going to go back to the way it was, but it's not going to happen. For the first time in 10 years my husband and I are going to have an actual vacation:-) I can't express how excited I am knowing mom is totally safe and happy so I can have some much needed time with my wonderful hubby. I have to admit I was so focused on her staying home that I fought what was needed, but now I have seen how wonderful it can be for her. Now I walk in with a new item for her closet, treats or flowers and get to be her daughter again. Yes I am still responsible as POA but much less stress.

Trust me, you can not count on anything or anyone to take care of your loved ones. My mom is in assisted living, and my god with the brochures that were sooo beautiful and nutritious meals and the BS that this is your home and we work "for you" is all hog wash. That's why I only wk p/t because you have to WATCH everything!!! My motto is anybody hurts my mom I will hurt you. God bless and good luck.

If you can care for him at home that is the best, however if it gets to be too much you should have him in a Memory Care Facility. My husband has had dementia for five years. I work full time and I'm exhausted but it would break my heart to have to put him in one of those facilities. I went through eight caregivers before I got the two that I have now. They are not great cleaners but they show up on time and have never asked for time off. That is most important to me as I work and cannot have someone not show up. I have them through an agency and I know they only make $10.00 an hour so at holiday time I give them something extra out of my pocket. My husband goes to adult day care three days a week and he loves it and they love him. If he did not go I am sure he would have passed away already.
Can't tell you which is better but I believe that as long as you can keep him home in his familiar surroundings it is better for him.

The caregiver we found for my MIL was a middle-aged lady who had been cleaning house for a neighbor for some years. She was a very competent, sweet lady that my MIL grew to love. When MIL became too much for us to deal with, we tried a convalescent hospital for her, which she totally hated. They put their patients in wheelchairs and left them there all day, but most of them were too disabled to do activities. That lasted a week. Fortunately, a SIL was able to take grandma, with a hospice nurse who came by a couple of days a week and taught my SIL how to take care of her. There were several daughters in the area that could do some respite, and I was there for her last night. I know several women who do housecleaning (not for an agency) and some of their customers are housebound seniors. (This might be a good pool for finding carers.) My nephew found a young woman through a church in their small town who loved older folks and adopted my brother and was extremely good with him. Last I heard she is now caring for another senior. I suspect that the personality of the elder makes a difference in how well they do at home or a facility; some people prefer being alone most of the time and some don't.

Jazzy,

I think it all depends on the person. AL is one thing. A nursing home is another. My mom was in a nursing home's longterm care unti for two weeks after being on their rehab floor for 4 mos after a stroke. The longterm unit was an absolute nightmare and intolerable. She had a horrible roommate, they would just park all the residents in the world's most depressing "TV room," and let them sit there all day. My mom is not demented, so she was fully aware of her surroundings and begged me all day to get her out.

We were extremely lucky because her apartment (in which she lived alone) is fully wheelchair accessible. She needs 24/7 care and in NYC that is now being covered 100 percent by Medicaid (after shelling out a lot privately before that went through).

She has 2 caregivers. One does 4 days, one does 3. One of them we have had since the beginning and she is just wonderful, one of those rare ones you feel you can't live without. The other ones have been a mixed bag. A few were let go by the agency, but I have now fired 2 of them - one who was sweet, but very young and not up to the level of care, and one who was a total prison guard, with not an ounce of warmth or humor. Her replacement just started yesterday and I am nervous. She's very kind, but older (60 ish) and does not seem comfortable moving my mom from bed to wheelchair which is nerve-wracking. All the other aides were able to do this with no problem. We have a hoyer but no one else has needed it and I am hesitant to use it because it just makes simple transfers complicated and makes my mom feel more like an invalid.

Again, it all depends. I'll keep finding new aides if I have to rather than ever put my mom in any of the nursing home options in our area.

It is so frustrating to know what to do with one's LO.
Your choices are:
#1 Live in place with home health aides coming in.
#2 AL
#3 SNF
#4 Making sure to choose the one that will be best for all involved.

Sheilasllison, your situation is what I'm trying to duplicate. I fully intend to keep him at home as long as I can, but have started taking him to day care 3 days a week. I think it does him a lot of good, and so do his hospice nurses, but he would prefer to stay home in bed and sleep all day. That's where I'm torn between doing what I think is best for him or what he wants. I have the same issue with ice cream. Not good for his blood sugar but he doesn't have a lot of time yet. Why not just make him happy.

But, again, maybe one reason he's made it 11 months is because I limit his ice cream and make him socialize 3 days a week!

Depending on the abilities/disabilities of the elder, home-based or small family-based residential facilities may be a possibilty.

Give him the ice cream! My mom, who was always prone to excess as far as eating and drinking, now has hardly any appetite or interest in alcohol. She was very overweight before her stroke and now she is bordering on skinny. She herself said, "I finally lost weight and got sober!" Boy, do I wish she'd gotten sober 35 years ago - but never mind that. It's so weird to have to urge her to eat and drink (enough water, that is). She has always had super high blood pressure, barely controlled with meds, and now her blood pressure tends to be too low so she has gone off them. Crazy!

Anyway, my feeling is that when our loved ones are nearing the end of their lives, we should allow them to indulge in any pleasures they want. Why not? That's what I hope for when I'm at that age. (If you haven't read Roz Chast's brilliant graphic memoir about her parents' decline, get it asap!)

I disagree with the "let them indulge" stuff - it doesn't produce a happiness that lasts more than the few minutes of eating. It adds health complications which make care worse. Doing a few other things, is much more healing - like read to her, sit for half an hour every few days, without any chores or TV, just be silent and chat a bit.

I had my 80 yr old mom, with vascular dementia, living in my home for one year. We had caregivers daily, from 8am to 8pm. The caregivers were awesome. Very attentive and kept mom busy with singing puzzles, walking and PT exercises. Cost $7800/mo.
A beautiful new Memory Care facility opened up. I was getting tired from interrupted sleep every night and from having caregivers in my house everyday. We had just down-sized our home and we were trying to get used to the smaller place, when we had to take over mom's care. We moved her into the memory care unit. $4500/mo I supply briefs, pads & wipes, as well as her clothing, linens & hygiene supplies. I was amazed by the relief I felt and how my mother adapted so soon. I did have some issues with the caregivers, mostly because of her incontinence and anal redness. I had her PCP order Calmoseptine twice daily, instead of as needed. I found out that PRN/as needed meds are rarely given. I'm told that the CNA cannot make medical decisions, but the med techs don't assess (look at her butt). So a twice a day order has worked. They toilet her every 2 hrs, while awake. This is a $500/mo incontinence fee, included in the $4500 that I mentioned earlier. The caregivers are trained to allow the residents to do and say what they want. They go along with their crazy stories and redirect them if the are stressing over something. My mom asks where her husband is very often (he is deceased) and they say he is playing poker or at Walmart. She is fine with that. My sisters and I had a hard time in not correcting/arguing with her. We have learned a lot, since mom has been in the facility. Hope this helps. Your health and wellbeing is important. You can visit as often as you want & you can be free to enjoy your life. God Bless you all!

I am in a different position. My mother has dementia and other health issues. THe quality of life and care that she gets in an assisted living faciity is far superior to the care she would have been receiving at home with an aide. We recently moved Mom from AL to the memory care unti in the same facilty, and Mom is having a good time. They help her with daily hygiene, clean the room, she has meals in the dining room, and is taken on outings.

I've had experiences both good and bad, for my cognitively-intact stroke-survivor spouse who is a fall risk due to hemiparesis. We've just come off a multi-year great experience with an agency caregiver who was observant, industrious and good company during her once a week five-hour shift. We miss her greatly. On the bad side, from another agency, when I still had a job with a long commute and needed a 12 hour shift, the aide -- who was really good at some things -- asked me one day if he could work for us privately. It was clear to me that during my lengthy absences he'd been going through stuff on my desk and found an invoice from the agency, which indicated the hourly agency rate. After I said no, he started not showing up (so I couldn't get to work) and after about the third time of that, the agency told me he wouldn't be coming back. No reason given. I still owed them for a shift for him and told them via certified mail that I'd pay it if they gave me a reason. If not, no dough. Never heard from them again.

I am going back to at home care for my wife after trying Memory Care. I just found out that many memory care facilities hae a policy of taking all your money then kicking the patient our when you are broke. The ones having continuous care are filled up. Another one has a policy of calling 911 for every little problem and having taken to emergency where they are admitted for observation which means Medicare will not pay 80% of the hospital bill. Others have a policy of accepting levels one & two but, kicking them out if they become worse. Others promise physical therapy and speech therapy but do not do it. The last one I tried required everyone to sit around and watch whatever TV program the staff wanted and a head nurse wo told me, "This is MY facility and I will do whatever I want to your wife and you have no say"
Another problem is that Medicare no longer allows rails on the beds and now there is an effort to ban bed and chair alarms. It seems the new thinking is that it is the patients right to fall. With all the interest in health care why is there no interest in healthcare for the elderly?

You may have had an unfavorable experience with home care, but there home care programs that are superior to an facility care because of better intensity of care, more pleasing meals, more positive environment and a fraction of facility care cost. Before you commit your parent to the unfamiliar facility care program, contact us for the best experience for mom or dad.

Even the best facilities make mistakes in medication/ residents fall. When a resident presses a button, often they have to wait. My Mother 991/2 yrs old was made ill by bad decisions/ negligence/ intentional acts at a rogue facility. We moved her to a great facility. Myself or other family are with her all the time. She is improving every day from the state her rogue facility had left her. She paid insurance for round the clock Nurses Aids. The rogue facility did not provide the same for her yet kept on charging her $1,000 per month after they took over the former facility that had gone bankrupt. I say it can take round the clock attentive family members giving their LO round the clock care whether the LO is at home or at a facility. For my Mother, being able to get herself out of bed to go to the bathroom herself is a danger to her. We don't leave her alone day or night. Her cat is here too in Independent Living with me and other family members 24 x 7. We found a very caring facility. It is no more expensive than Assisted Living for herself alone. She is thriving and happy. We are Blessed.

Wish I could find a memory care facility like Canyon 727

Mom's is $330 a day plus I have personal caregivers with her 12 hours a day but she is correct that they let the residents do and say what they want which means they largely ignore them

Fights break out, folks fall and UTIs are rampant as no one is changed or taken to the bathroom every 2 hours despite the $450 a month incontinence fee

Whether at home or in a facility, dementia is a long tiring journey for everyone

Can't agree more with all of you loving caregivers! Have had little success with agency people who claim their aides are, "experienced & knowledgeable with ALZ." It's been no break for me, still up to let them in at 7:30, then hearing & most always having to intervene when the aide is clueless on how to handle my brother. In the 6 years of this journey, I know of 6 who were capable, 2 of those from an agency, leaving to move on to better opportunities. The 4 private as well. It almost seems less stressful to take care of him on my own, even though I keep trying & hoping for the "perfit fit." The day programs, on the other hand, a lifesaver. He wants to go, lucky for me, so he does. Yes, he probably sleeps there more these days I know, but still, the support & stimulation they provide is more than I can do at home. For example bathroom reminders work there, "no" is what I hear at home, so changing is never ending. Stay the course with an excellent day program, use fibs to aid in encouraging him to go if need be, try gradually increasing the days, better for him & you. Respite care is excellent as well, find a good facility which offers short stays, even a 3 night, a tease yes, but helps to recharge you. Not everything will work forever, changing course will happen, I am "getting it," thinking that a good facility versus home may be a better choice, yet still tough to do, not in denial just saddened. The care needed & behavior changes, all part of the progression, are winning. An experienced & knowledgeable team do make a difference. Stay strong & focused & take care of you, absence of any guilt. Blessings 🌸

Care facility or home care ? Home care hands down. Home care provides professional one-on-one care, parents enjoy their home, better protection and it is a fraction of the cost of a care facility. In fact, home care may have no cost.

ChrisA1, where are you getting your no cost home care? I'm finding the day care to be less expensive in that home caregiver is $20 an hour and day care is $120 a day for up to 12 hours AND he gets 3 nutritious meals. Plus, I think it's really been good for him. He actually carried on a conversation with me on the way home today, commenting on things he observed in the environment. Yea! Progress for now until the next decline.

I chose to hire friends that I though I could trust. The first was an old roommate, he actually lived in my home for 3 years free so I could help him get straightened out. At first he was wonderful after a few months all he did was sleep on my couch!!!
Then comes one that was recommended from a friend of a friend, she seemed great also, very talkative, friendly, and recommended from someone who actually retired for the Police force as a dispatcher. Well I guess I should have checked her record!!! Bad mistake there, called in sick all the time or just did not show.
The third one I though well this is perfect!!! long term friend, also lived in my home twice trying to help him out. I trusted him so much we had a 12 year friendship and to me I considered him part of the family. Well again, After Mom was rushed to the hospital and we were advised by the doctor to place her in a home for her safety, she had started to fall and needed round the clock care. At that time I started to get my senses back, after 4-5 years of dealing with this your kind of brain dead. This time I realized that my dear friend had purchased his Gas, Beer and Food Even tools off of Mom's credit card.
She is now in a very nice home. I hate that she is not with me but I know its best for her. We are so fortunate to have found the place that we did. I can't speak highly enough about the facility and the staff members, all of them are wonderful. I do worry sometimes because I see Mom fading fast and I don't know if its the disease or if she sees others that are way worse than her and she is becoming like them. It really bothers me. I hate this disease!!!! I don't want my Mom to live this way but I don't want her to die.

I just selected an AL facility for my mother. Prior to this placement she lived with her husband, and together they had in home care staff. When he passed, I continued to have the in home care. It was so expensive, and I had to also be in the home with mother for her care.

After a few months, being tired, from working, being away from my family. I had to make the decision for mother-her condition was not improving. There was never-ending situations with the home care staff. My mother and I was stressed. The AL facility is great, my mother is adjusting. I am trying to get my life back.

I think we as caregivers for our parents, want to do all that we can to keep them home and care for them. I am learning to have no guilt about the decision I made for my mother. I found that the time, and energy needed to care for my mother was greatly affecting me physically, and mentally. I love my mother with all my heart but I am physically and mentally tired.

AL is different from a nursing home, though. With AL, you live in your own apartment, but have the option to eat meals in a dining room and help if you need it. A nursing home is a whole different animal. Even though in-home caregivers are not always the best, living among old and dying people in a nursing home seems like the most depressing thing ever. AL seems great if it's a nice place. But to each his or her own!

okhoneybee,, doesn't sound selfish ,, you've done a lot,, we all know when we have hit the breaking point. I really do relate this journey to giving birth. some people were "stay at home" moms and some nursed and stayed with them for 3 - 4 months then went back to work. Our Parents are our little babies now. It broke my heart when I dropped my child off at day care ,, I cried all the way to work. He would hold up his arms and cry for me ,, I felt like the worst mother in the world,, but after some time ,, he didn't even want to come home when it was time to leave. I feel that our loved ones do the same thing ,, cry and are sad ,, adjust and make friends and find interests in what's around them.

Try care.com. You can read references of Caregivers as well as their background check. If you had caregivers like that, they definitely wouldn't have good references. Also check their ages. CNAs under mid-thirties just don't have that compassion an older CNA has. I had to hire CNAs and found that out the hard way.