When Should an Alzheimer’s Patient Go to a Nursing Home? Making the Case for Home Care

When Should an Alzheimer's Patient Go to a Nursing Home Where do we go when our mind betrays us and when the person that we have been our whole lives gets lost in the recesses of our brain? It’s a question with deep and often terrible philosophical, moral, and emotional implications, and the lack of an answer is one of the crueler parts of dementia and Alzheimer’s for a sufferer’s loved ones. But there is also a more tangible, though no-less-difficult, question: Where should they go?

The question of home care vs. nursing home for an Alzheimer’s patient is a difficult and challenging one. It ties in questions of cost, quality of care, and quality of life. It is about what a family can sacrifice, personally and financially. It is a question of what is best for the patient, but also what is best for the family, especially when the patient might be unaware of what is happening.

There are no easy answers. But if a loved one of yours is suffering from dementia and Alzheimer’s, you need to ask yourself, your family, and professionals what the best course of action is. Very few people consider home care, but increasingly, it is a viable and popular option. It is a life-changing decision and should be met with the same gravity.

Here are a few things to consider when thinking about when an Alzheimer’s patient should go to a nursing home or if there is a case for home care.

The Costs of Care

It’s easy to say, “Cost won’t be a consideration! We’re talking about Mom here!” Most people mean it when they say it because everyone wants the very best for their loved ones. The idea that personal finances can make a difference in whether or not someone in their last years suffering from a dreadful disease gets good care or not is criminal, but that’s the unfortunate truth. It does no good to bankrupt yourself.

Alz.org broke down some basic costs around the United States for home and nursing care. The numbers are somewhat staggering:

  • $225 per day for a nursing home semi-private room ($82,125 per year).
  • $253 per day for a nursing home private room ($92,378 per year). 
  • $3,268 per month for the basic services in an assisted-living facility ($43,539 per year).

Obviously, the least-expensive option is attractive, financially, especially considering that, according to a NYTimes study, Medicare patients with dementia pay 80% more out of pocket than those with heart disease or cancer. Still, most people want more than basic care. It’s a question of what they can afford, which is why it is tempting to look at home care.

Initially, home care costs can seem overwhelming. As alz.org showed, you can pay $20 per hour for a home health aide. That comes up to $480 a day if you have 24-hour care, or $175,200 a year. That’s considerably more than the private room.

But the difference is that the nursing home costs are fixed. You have to pay what you have to pay. With home care, there is more flexibility and that depends on you. If you hire an aide for an eight or even 10-hour shift, and the rest of the family pitches in, that’s a lower expense.

That’s not the only reason why home care is a viable offer.

Maintaining Continuity

One of the cruel ironies of Alzheimer’s is that the steps many have to take to get better care, such as taking someone to a nursing home, can worsen the symptoms. A woman we know named Sue had lived in her apartment for nearly 50 years, but as Alzheimer’s robbed her sharp mind, her family moved her into a smaller and safer place, where she didn’t have to go out as much.

This threw her for a terrible loop. She knew where everything in her old apartment was, and even as faces and names and short-term memory left, she had a grasp on her home. It was comfortable. She was terribly confused in the new place and became more ill-tempered, frustrated, and sad. When they moved her into a nursing home, it became worse again (especially because she kept having to switch rooms).

But they were doing what they felt (not incorrectly given their finances) was their best option, which makes it even more tragic. Being able to maintain continuity is a way to help ameliorate the ravaging symptoms of the disease for a longer time.

Crowded Nursing Homes in the Bay Area

There’s another factor, as well, that correlates with cost. California and the Bay Area are on the verge of what could fairly be described as an Alzheimer’s epidemic.

By 2030:

  • The population of the state with Alzheimer’s will double to nearly 1.1 million.
  • 1 in 8 Californians over the age of 65 will be afflicted.
  • There will be a 100% increase for African-Americans and a 200% increase for Asians and Latinos.

In San Francisco alone by 2050, there will be nearly 55,000 Alzheimer’s patients, 56,000 in Almeda County, 59,000 in Santa Clara, 42,000 in Contra Costa, 38,500 in San Mateo, and on and on. There will need to be massive investment in facilities in the Bay Area, but even with that, costs will increase and the laws of supply and demand take a hideous toll.

Can You Handle Home Care?

There is no question that home care is challenging. Caregivers, both professional and family, must deal with mood swings, frustrations, and the dripping sadness of seeing the slowly-receding tide of a loved one ebb away. But there are resources to help. In the Bay Area, you can look into:

There is continuity in home care. There are financial considerations. And though it may be difficult at times, there is still the daily joy of seeing your loved one and knowing they are still there with you. Your loved one may not always be there in full. But with home care, you can be.

At Institute on Aging, our programs and services help older adults, their families, and caregivers explore aging together, through good times and bad, as an adventure and a journey. Connect with us today to learn more.

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Institute on Aging

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