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Services Choosing The Right Care Setting

  • Facing Fear of Change
  • Identifying Care Needs
  • Things to Consider
  • Cost
  • Cost Comparisons

Facing Fear of Change

The truth is moving anywhere new is difficult for most of us, young or old. The idea of change is scary and often causes anxiety. It’s hard to change what you’ve known for so many years. We all know and understand how difficult it is for us to assist our parent or loved one to find the appropriate care setting. How do you know what they really need? What is best for them? This decision affects not only the individual who needs the direct care but also affects the spouse, adult children and often the extended family. No matter what care setting you choose there are several elements that you need to consider when hiring a team of caregivers in any care setting; in-home care, home health care, assisted living, respite care, adult day care, residential care homes or hospice care.

The elements to consider go way beyond the physical appearance of a care setting. More important to consider is the care team. Who are the caregivers? Can you meet them and talk to them? How involved is the management and the ownership? Are they directly involved with the residents and the caregivers and their doctors or health care team? Do they work at building relationships within the care team and family or do they follow a more administrative and hands off approach? Be sure to meet the entire team; owners, administrators, managers, doctors, nurses and caregivers you will be working with to get an idea of their motivation and commitment to you and your loved one in which ever care setting you choose during this last chapter of life.

Identifying Care Needs

The key to finding the right place is to do your homework, as hard and as time consuming as it is. You only want to make this difficult and expensive change once. We need to be honest with ourselves about the real picture of what is going on with our loved ones and what to expect in the future. We often minimize the amount of care our loved one needs and don’t want to think about the increased care they will need as time goes on. It is important for us to know our parents and our loved ones like we know our own children. We need to be honest with ourselves about their needs. Say to ourselves what would I do if this were my child? This is much more difficult for us as adult children. We want to value and respect our parents’ wishes. We wish that we could take them ourselves and care for them as they did for us, but we know that is often not practical and in many cases impossible to do for a variety of reasons.

The reality is that if they are getting to the stage where they need assistance they have probably lost or are losing their own insight and judgment and will likely continue to decline. It’s like our 6 yr. old child that says … please get me the dog mom, I promise I will walk him and feed him. The child of course believes they will do it, but we as the parent knows the child lacks the insight and judgment to know all that’s involved. So when our parents try to convince us that they can do it and we should let them have what they want, we need open our own eyes and anticipate what it is they are going to need and help them to make the right decision based on what we know is best for them. If they have been isolated in their own home and have difficulty getting motivated to participate in things now that probably won’t change in the Assisted Living type environment.

Just because they offer activities in the community room or offer unaccompanied shopping trips doesn’t mean the senior, who needs some assistance will be able and motivated to participate. Most seniors do want some companionship. They do want some assistance and they know things are getting more difficult to do on their own. They just don’t want to ask for help or be a burden to anyone including family or paid caregivers. They have been independent their whole lives; managed their jobs, finances and families. They worry about the cost and they are also afraid of the unknown, especially of the thought of losing more control as they allow increased amounts of assistance. Many seniors have been or known someone who has been to a nursing home or the hospital and those are not happy places to imagine going to. It is hard to sell the idea of having to move to our loved ones.

Things to Consider

For some of us it might seem easier to convince our loved one to move to a Hotel- like Assisted Living where they can still have their own apartment. The appeal of the “idea” of hotel- style living, socialization and fun helps convince the senior to move in, but the danger is the false assumption that the hotel-like Assisted Living will be able to provide the appropriate amount assistance now and as the residents function continues to decline and he or she needs more and more assistance. Many people think they are looking for a hotel–like environment with the active vacation lifestyle, but that is often a misdirected hope.

If you are independent and do not need any assistance then you are free to choose any living setting and independent senior living makes sense, but if you need any level of assistance it is wise to reevaluate the idea of a hotel style lobby, dining room and isolating private apartment and be honest about what the current care needs are and what they will likely be in the future. The photo of a senior sitting in his private room, alone, is just one example of how a big facility can be isolating compared to a family style Residential Care Home. The Assisted Living Facility may say they provide additional assistance, but you will have to pay privately for additional care services or you may be forced to move because they cannot provide enough assistance no matter the cost. Even if you or your loved one needs a minimal amount of care now, be sure to ask before you move in to see current examples of “heavy care” cases and what the cost is for the most or maximum level of care. Consider that it might not be easy for the resident when their needs increase and they are forced to move and have to get to know a new care setting and new care team.

The best solution to caring for an aging parent, spouse or loved one who has increasing care needs is to find the most effective care team where all members of the team: caregivers, family, patient, doctors and other health care providers work together and have frequent communication with each other. A good team can be developed in a care facility or within your own family system depending on what resources are available to each individual and their families. Only when you know and interact directly with all members of the team will you feel the caring we all seek.


While most senior care is expensive, Residential Care Homes are a considerable value compared to the large Assisted Living Facilities, In-Home Care, and Adult Day Care. Residential Care Homes usually simplify the billing and offer an inclusive or fixed monthly rate that includes the room and care services. One analogy would be that Residential Care is like an all you can eat buffet for one fixed price. You get as much care and service as you want and or need. The caregivers providing the care and service are always around to help when needed which is clearly a better value to the resident compared to the A La Cart billing system of Assisted Livings. Assisted Living Facilities are often managed more like a big business than small Residential Care Homes. They utilize A La Cart billing to maximize their ability to charge for items or service provided.

The name “Assisted Living” implies you receive assistance in the base rate. In fact, in most cases, you get independent living with 3 meals and once weekly laundry and housekeeping service. No assistance or medication management in the base rate. Those are additional A La Cart add on items or services.

Residential Care, Assisted Living and other Cost Comparisons

Residential Care Homes Offer inclusive pricing which includes, private and shared rooms, personal care assistance, 24hr care when needed, medication management and transportation to appointments and accompanied outings. The monthly rates do not tend fluctuate when care needs increase compared to other care options. Prices range from $1,500/mo to $5,000/mo including all care and services. Residential Care Homes are the best value.

Assisted Livings - have studio or 1 bedroom units and range from $2,000- $3,500 for base price of room and meals only. All other care and or services are add on costs and often push the rates up to a range of $4,000 to $6,000 per month. Assisted livings are generally expensive for the amount of care provided and work best for people who are more independent.

Adult Day Care – can supplement care for 4- 8hrs a day at a cost of $75- $100 per day or $2,000 per month. This can be costly and only covers a portion of the day. Usually family is responsible for providing the additional care after day care is over. Adult Day Care provides little to no assistance with personal care or medication management and is generally a short term fix. In-Home Care- is very expensive at $25/hr with a minimum of 4 hrs a day. That is $3,000 per month for only 4 hrs a day of service. If 8hrs or more is needed the cost easily skyrockets to $6,000 or more. In addition, it is often hard for an agency to provide consistency and there is frequent turnover of staff. Generally there is little coordination of care and Medication management is not included.

Unfortunately, there are limited choices for senior care and fewer cost effective choices available. No one care option works for everyone, each has pros and cons. The choices include- In Home Care, Assisted Living Facility, Residential Care Home and Nursing Homes. Of those choices the best, most cost effective long term care option is a family style Residential Care Home. Remember, in all settings, senior care is a service and the caring and feelings surrounding any care setting are based in human contact and emotions that depend on continuity of care, relationships among and between the administration, their own staff, the residents and families they serve.

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