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How to Decide Between Home Care or Long-Term Care During COVID-19

Key questions to help families weigh the options

By Rick Lauber

Remembering my father's advancing Alzheimer's disease and my 10 years as his co-caregiver, each day brought unexpected challenges, new responsibilities and conflicting emotions (from grief to joy). I helped move him and my mother repeatedly, paid his bills and managed his investments, shuttled him to doctor's appointments and in due course, served as his joint guardian and alternate trustee, making key life and financial decisions for him.

home care, Next Avenue
Credit: Adobe

And now there's yet another issue – the coronavirus pandemic, which hasn't just hit long-term care facilities, it's also hitting family caregivers.

Should a loved one stay in a care facility, move elsewhere, come to a family caregiver's home and rely on care provided by one or more family members or receive professional home care?

If I were still caring for my dad today, this wouldn't have been an easy decision.

"Family caregiver burnout is very real."

More family caregivers seem to favor home care during the pandemic, says Veronica Tissera, vice president of customer experience for Nurse Next Door Home Care Services in Vancouver, Canada.

Some people are contacting home care companies earlier than in the past due to concerns about COVID-19 in long-term care facilities.

Pros and Cons of Home Care

"Giving seniors the choice to age happily, and independently, in the comfort of their own home is a major benefit of in-home care," explains Tissera.

Veronica Tissera, Vice President of Customer Experience, Nurse Next Door, Vancouver, Canada, Next Avenue, home care
Veronica Tissera, Nurse Next Door

Abraham Kuriakose, director of operations for Comfort Keepers Home Care in Edmonton, Alberta, adds that maintaining independence not only benefits elders living at home, it can also allow for respite care for the family caregiver. Handling the extra work required can become too much for family caregivers and trying to manage everything can often lead to higher levels of stress.

"Family caregiver burnout is very real," Kuriakose notes. Additionally, home care offers a more routine schedule, building relationships with regular caregivers, and escorting those in need on outings. 

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Kuriakose notes that it's important to choose the right home care provider if that's the route you decide to go. He recommends asking if they're accredited, have liability coverage and workers' compensation coverage.

Abraham Kuriakose, Director of Operations, Comfort Keepers Home Care, Edmonton, Alberta, Canada, Next Avenue, home care
Abraham Kuriakose, Comfort Keepers Home Care

He also points out that it's important to match "the right caregiver with the client," and to make sure in-home assessments are part of the initial conversation.

The average cost of an in-home health aide in the United States is $4,385 a month, according to Genworth Financial's Cost of Care Survey.  

"Generally, the rates should not change for days, evenings or nights. But on holidays, expect to see it go to about one and a half to two times the rate. If a home care worker needs to travel further distances [more than a half hour] to reach an older client, mileage costs can be charged," says Kuriakose. 

An additional cost may involve personal protective equipment — face masks, gloves and gowns. This equipment may be supplied by the agency or the family caregiver may be expected to pay for it. 

The price of home care can add up, although as Tissera points out, "A lot of families think that their parent will need full-time care, but that's rarely the case." Home care services can be provided on a part-time, flexible basis.

The Pros and Cons of Long-Term Care

According to the National Institute on Aging's website, "People often need long-term care when they have a serious, ongoing health condition or disability. The need for long-term care can arise suddenly, such as after a heart attack or stroke. Most often, however, it develops gradually, as people get older and frailer or as an illness or disability gets worse."

A compromise, of sorts, exists for family caregivers still torn – home care staff can be hired to supplement long-term care and provide extra companionship.

U.S. nursing home costs average about $7,500/month for a semi-private room and $8,500 for a private room.

My father's long-term care facility provided housekeeping (including laundry), congregate living and staff such as a social worker, recreation director and therapist. My dad's home was also owned and operated by a nonprofit, making the monthly rent a bit lower than a privately-run operation.

In general, long-term care facility rent can fluctuate depending on other services provided (additional meals, laundry, haircare, outings, etc.); my dad's rent was a fixed amount.

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It may have been cheaper to keep my dad in his nursing home, rather than hire a home care worker to be available all the time. While my dad's facility was older, many newer buildings offer continuing care under the same roof, making it easier for residents to move when their health fails.

On the other hand, I witnessed staffing turnover and more limited meal options. The care facility's staff/resident ratio was quite high. One staffer was responsible for many residents (and even more so overnight when fewer people are working). My dad never complained about this arrangement nor living in a larger group setting.

Your loved one may not be as agreeable and could become more withdrawn or irritable with noisy neighbors.

While it was not an issue for me and my family at the time, COVID-19 has swept across the country and hit our older population hard. Larger care facilities may become hotspots for the virus, with more residents and staff and less social distancing. 

Can't decide? A compromise, of sorts, exists for family caregivers still torn – home care staff can be hired to supplement long-term care and provide extra companionship in facilities. Private caregivers visiting long-term care homes must abide by the facility's rules during COVID-19, though. 

When deciding between home care and a long-term care location, there is no "one-size-fits-all" answer.

One family caregiver's care choice may greatly differ from another's. It may depend on a loved one's health condition, living needs and the family's beliefs regarding who can provide the highest quality and safest care.

Choosing care can be a difficult and potentially life-changing decision, so family caregivers need to research and weigh their options carefully. 

Rick Lauber
Rick Lauber is a former co-caregiver, author and writer based in Edmonton, Alberta. Lauber has written two books, “The Successful Caregiver’s Guide” and “Caregiver’s Guide for Canadians," both published by Self-Counsel Press, as valuable resources for prospective, new and current caregivers. Read More
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