Providing care at home vs. seeking it outside

By Anna M. Rappaport, Society of Actuaries and WISER Board Member

Would you rather age at home or in a specialized aging community?

Most individuals say they would rather be at home. This raises some interesting questions:

  • What does it mean to be “at home”?
  • What are the options for getting help at home and what are the pitfalls and risks?
  • What happens when things go wrong?
  • Are there advantages to getting care in a community?

I have personal experience with both options. [KEEP READING] My husband chose to stay at home and receive care at home. My mother chose to move to a community when she felt she was having problems managing at home. I feel that my mother’s experience worked out very well.

My husband was housebound for several years before he died. Now that I have personal experience in a community, I can see how our lives would have been very different if we had chosen to live in a community.

When I think of being at home, I think of being with my own things, being able to choose my own activities and go out as I choose, being able to control the TV set, make phone calls, and eat when I want to, etc. Essentially, “at home” is being in a familiar environment with the freedom to function.

To me, being in a community means having a home that is still mine but is within the confines of a community. In it, I have choices of activities and friends inside or outside the community. The community provides support through the aging process, but it does not control it.

When one has mobility limitations, they constrain what one can do within and outside of a community.  But the activities inside of the community may add a lot to what is available.  My husband was housebound, and had he been in a community with activities and a dining room, he probably would have been able to have access to a lot more options and people than he had while at home.

Getting help at home can be challenging and expensive. Agencies often have a four-hour minimum for help. Caregivers may not be a good fit – focusing on getting tasks done rather than making the individual happy. For individuals that need continuous care, having a caregiver call in sick can create a major issue. If there is not a strong support system for the individual in need of care, it can still be very lonesome to be with a caregiver.

On the other hand, if there are friends and family who are available regularly, and the individual in need of care is not home-bound, in-home care may work out very well. It depends on the situation.

Whether being in a community is comfortable also depends on the situation. For couples who are in retirement communities, when one needs a lot of care and the other is independent, it is relatively easy for the healthier family member to see the family member who needs help daily, to talk to the caregivers, but also to have a life.

I have seen several situations where one partner is getting care and the other is independent. I have also seen similar situations between parents and children in the same community. In these situations, the person getting care was able to remain social for longer. My view is that this would have been a better situation for us than my husband being housebound at home.

Living in a community also protects against unexpected life-changes. I know of two situations where the caregiving partner died, and their spouse was left with a mess. The people around the survivor had to scramble to find a stable situation for them. Similarly, home caregivers may reach a point where they are no longer able to manage the situation. This can be disaster, and the health and well-being of both caregiver and the person being cared for is threatened. We experienced a point at which home caregiving – even with multiple outside paid caregivers – fell apart. We were extremely fortunate that the hospice we were working with found us a good alternative.

So, which is the better choice – at home care or a community?

My answer is: it depends. I think it requires careful thought. I also believe that it is very important to focus on the welfare of the caregiver as well as the welfare of the person being cared for.








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