Comparing the cost of long-term care alternatives can be challenging. All “costs” aren’t readily apparent. Some costs are more qualitative. There are many factors to consider, including:
How much care do you need?
If you are living in your own home and finding yourself needing some additional assistance beyond what family and friends can provide, you have a number of options. In-Home Care is the least disruptive option affording the fewest lifestyle changes and the most flexibility. Assisted Living requires a move into a (generally) smaller and communal living environment. Assisted living facilities provide living accommodations, housekeeping and some transportation and meals for those requiring minimal extra support. If your needs are more advanced and include one-on-one or more specialized care, these are often provided at extra cost. Nursing Homes (Skilled Nursing Facilities) often provide 24-hour supervision, medical care, full meal preparation, rehabilitation services and assistance with most activities of daily living (ADLs). It is usually not a “choice” to move into a Nursing Home, but a medical necessity.
Monetary Cost
According to recent studies, costs of care in the St Louis area approximate:
On the surface, the lowest cost alternative appears to be In-Home Care up to a point. For example, if you are considering an Assisted Living facility that costs $4,000 per month, the breakeven point with $25/hour home care would be 40 hours per week. If your home care needs exceed 40 hours per week, then Assisted Living would appear to be the cheaper alternative. However, if your needs require memory care and/or one-on-one care for extensive hours each month, this would increase your out-of-pocket costs and your cheaper alternative might very well be to remain in your home.
Quality of Life
Although cost is always a factor, it can often be eclipsed by qualitative factors. You have heard it said that a person’s home is their castle. The routines, memories, local friendships, pets and possessions of a lifetime are valuable and giving them up to move into a facility can be highly disruptive. The activities a facility offers can be very attractive, keeping residents active, engaged and involved. On the flip side, the independence that a person is accustomed to can also be challenging to give up when a resident must adhere to facility schedules, meals, restrictions and social norms. Communal living is not for everyone. A socially-minded resident can thrive in close proximity to others, but a more private individual can be overwhelmed when moving from the privacy of their own home into the relative hubbub of a facility. How important is it to you to have dedicated one-on-one care to address your needs on demand? In your home, you can have one caregiver paying attention only to you. In a facility, the staff may be attending to the needs of 10-20 residents or more. As important as your needs may be, you will have to wait your turn. For the right person, residency in an Assisted Living Facility can be a Godsend. For the wrong person, it can be tragic. It is important to seriously consider these intangibles when evaluating care alternatives.
Who is paying?
If you are fortunate enough to have options (other than Medicaid) such as long-term care insurance and/or personal assets (home equity, investments, family financial support, etc.), you may want to consider your actual out-of-pocket costs of care. In the example above, 40 hours per week was the breakeven point between In-Home Care and Assisted Living. If you can afford to pay for 40 hours of In-Home Care and would prefer to remain in your home, and you have a long-term care policy that will pay (say) $200 per day toward the cost of care, this would justify paying up to 80 hours per week. In other words, you could afford nearly 12 hours per day of In-Home Care before it would equal the cost of moving into an assisted living facility. Of course, if your long-term-care policy would pay toward care at home or in facility, this difference wouldn’t exist. But if your preference is to remain in your home, long-term care insurance can help you justify your choice.
Flexibility
A final consideration when evaluating long-term care options is flexibility. How likely is your situation to change, and what alternatives do you have if it does? Moving into a facility can simplify your life. On the other hand, as your needs increase, you can expect your costs to increase as well. And if you find facility life is not for you, how easy would it be to reverse the process and move back into your home? Have you sold your home and disbursed your possessions? Will your health allow another move? Remaining in your home and utilizing In-Home Care, even if it proves more expensive than Assisted Living can give you enormous flexibility, prolong your independence and enable care based on your specific needs and wishes.
- How much care do you need?
- What is the monetary cost?
- How will this impact your quality of life?
- Who is paying (what’s your out of pocket costs)?
- What if you change your mind?
How much care do you need?
If you are living in your own home and finding yourself needing some additional assistance beyond what family and friends can provide, you have a number of options. In-Home Care is the least disruptive option affording the fewest lifestyle changes and the most flexibility. Assisted Living requires a move into a (generally) smaller and communal living environment. Assisted living facilities provide living accommodations, housekeeping and some transportation and meals for those requiring minimal extra support. If your needs are more advanced and include one-on-one or more specialized care, these are often provided at extra cost. Nursing Homes (Skilled Nursing Facilities) often provide 24-hour supervision, medical care, full meal preparation, rehabilitation services and assistance with most activities of daily living (ADLs). It is usually not a “choice” to move into a Nursing Home, but a medical necessity.
Monetary Cost
According to recent studies, costs of care in the St Louis area approximate:
- In-Home Care can range from approximately $20-$30 per hour for CNAs. Care can include companionship, housekeeping, personal care, skilled nursing, errands and transportation services. Minimum visits can range from three to four hours up to 24 hours per day. Live-in care can also be obtained, usually at a lower hourly cost. These services are generally private-pay and can be reimbursed by long-term-care insurance.
- Assisted Living Facility costs, according to the Genworth 2019 report, can range from $3,300 to $7,000 per month with some facilities costing in excess of $10,000 per month for base-level services. The facility’s staff members are caring for multiple residents. Memory Care and additional services can be provided at additional cost. If a resident’s needs require one-on-one care or exceed the facility’s capabilities, they will often allow the resident to hire independent, In-Home Care at their own additional expense. In extreme cases, if a resident becomes disruptive to other residents or greatly exceeds the facility’s ability to cope, they may ask the resident to leave the facility. Other than Medicaid, these services are generally private-pay and can be reimbursed by long-term-care insurance.
- Nursing Home Care is generally reserved for patients discharging from hospitals or requiring rehabilitative services or with extreme medical needs. Costs approximate $5,000 to $6,000 per month and are often paid by medical insurance.
On the surface, the lowest cost alternative appears to be In-Home Care up to a point. For example, if you are considering an Assisted Living facility that costs $4,000 per month, the breakeven point with $25/hour home care would be 40 hours per week. If your home care needs exceed 40 hours per week, then Assisted Living would appear to be the cheaper alternative. However, if your needs require memory care and/or one-on-one care for extensive hours each month, this would increase your out-of-pocket costs and your cheaper alternative might very well be to remain in your home.
Quality of Life
Although cost is always a factor, it can often be eclipsed by qualitative factors. You have heard it said that a person’s home is their castle. The routines, memories, local friendships, pets and possessions of a lifetime are valuable and giving them up to move into a facility can be highly disruptive. The activities a facility offers can be very attractive, keeping residents active, engaged and involved. On the flip side, the independence that a person is accustomed to can also be challenging to give up when a resident must adhere to facility schedules, meals, restrictions and social norms. Communal living is not for everyone. A socially-minded resident can thrive in close proximity to others, but a more private individual can be overwhelmed when moving from the privacy of their own home into the relative hubbub of a facility. How important is it to you to have dedicated one-on-one care to address your needs on demand? In your home, you can have one caregiver paying attention only to you. In a facility, the staff may be attending to the needs of 10-20 residents or more. As important as your needs may be, you will have to wait your turn. For the right person, residency in an Assisted Living Facility can be a Godsend. For the wrong person, it can be tragic. It is important to seriously consider these intangibles when evaluating care alternatives.
Who is paying?
If you are fortunate enough to have options (other than Medicaid) such as long-term care insurance and/or personal assets (home equity, investments, family financial support, etc.), you may want to consider your actual out-of-pocket costs of care. In the example above, 40 hours per week was the breakeven point between In-Home Care and Assisted Living. If you can afford to pay for 40 hours of In-Home Care and would prefer to remain in your home, and you have a long-term care policy that will pay (say) $200 per day toward the cost of care, this would justify paying up to 80 hours per week. In other words, you could afford nearly 12 hours per day of In-Home Care before it would equal the cost of moving into an assisted living facility. Of course, if your long-term-care policy would pay toward care at home or in facility, this difference wouldn’t exist. But if your preference is to remain in your home, long-term care insurance can help you justify your choice.
Flexibility
A final consideration when evaluating long-term care options is flexibility. How likely is your situation to change, and what alternatives do you have if it does? Moving into a facility can simplify your life. On the other hand, as your needs increase, you can expect your costs to increase as well. And if you find facility life is not for you, how easy would it be to reverse the process and move back into your home? Have you sold your home and disbursed your possessions? Will your health allow another move? Remaining in your home and utilizing In-Home Care, even if it proves more expensive than Assisted Living can give you enormous flexibility, prolong your independence and enable care based on your specific needs and wishes.