Choosing Between Assisted Living and In-Home Care

One of the toughest decisions families face is determining the best care option for an aging loved one. The decisions usually come down to whether they should stay at home with support or move to an assisted living community. Both choices have significant emotional and practical implications, from cost and safety to independence and social connection.

In this article, we break down the key factors to consider, including health needs, budget, and personal preferences, so that you can make an informed decision with confidence. Whether you're planning or navigating an urgent situation, understanding these options will help you find the right balance of care, comfort, and peace of mind for both you and your loved one.

In-Home Care vs Assisted Living

When your parent or spouse needs assistance in their daily life, many families face a tough choice – assisted living vs in-home care.

Choosing between assisted living and home care involves many factors, both personal and financial.

It’s a complex decision, and the answer depends on your older adult’s specific situation.

We share what you need to know about the three essential factors to consider: how much help they need, key differences between assisted living vs home care, and their financial situation.

Knowing the facts helps you make the best choice for an older adult.

70% of seniors will eventually need long-term care, yet most families aren’t prepared to choose between in-home and facility care (AARP)

1. How Much Help Does Your Loved One Need?

Before making any decisions, it’s essential to determine how much help your older adult needs and compare that with the help that is already available.

Previously, we’ve talked about understanding their needs in 8 key areas of life and being realistic about how much help family will provide.

First, make a list of everything your older adult needs help with on a daily, weekly, and monthly basis. Being able to see the whole picture helps you choose the correct level of care.

Next, be realistic about how much help you, your family, your friends, and your neighbors will provide. It’s essential to think about this in terms of long-term, ongoing help – a few weeks or months won’t be enough.

After comparing those two lists, you’ll have a better sense of the tasks your older adult will need additional help with – anything that isn’t already covered.

In some cases, looking at this list makes it evident that in-home care will work best. In other instances, assisted living might be the clear choice.

2. Understand the Differences Between In-Home Care and Assisted Living

Before you can choose between in-home care and assisted living, it’s essential to understand how they work.

Here are the basics and key pros and cons for each.

In-home care: pros and cons

In-home care is when a caregiver is hired to come into the home to help seniors with activities of daily living. This enables your older adult to continue living safely at home.

The specific help provided depends on the older adult’s needs and could include meal preparation, navigating the house, transportation, bathing, dressing, using the toilet, and more.

Pros

• Seniors get one-on-one care tailored to their needs and preferences.
• Seniors can stay in their home or a relative’s home as they age.
• Costs can be lower depending on the hours of care needed and the caregiver's skill level.
• The family gets to choose the caregiver.
• Seniors get to know one caregiver, rather than being cared for by many different people.
• Flexibility in care arrangements: different types of care could be combined to lower costs, increase social interaction, or provide medical-type care – family help, adult day programs, privately-hired caregivers, agency caregivers, and home health care

Cons

• High costs if 24/7 care is needed
• Ongoing family involvement is needed for hiring and managing caregivers, as well as planning backup care options.
• Potential for social isolation, which can contribute to depression, cognitive decline, or health problems
• The home may need modifications for safety or wheelchair accessibility
• Housekeeping and home maintenance need to be done, and groceries, personal care, and household supplies need to be bought

Assisted living: pros and cons

An assisted living community is a place where many seniors live, in rooms or small apartments.

Most communities offer a wide range of care options, from seniors who are mostly independent to those who need a high level of care.

Services like meals, transportation, group activities, and housekeeping are typically included in the monthly fee.

Pros

• A more affordable way to get 24/7 supervision and care
• Family can focus more on the relationship rather than on care needs
• Your loved one has plenty of opportunities for social interaction with other residents
• Family doesn’t need to worry about hiring, scheduling, or managing caregivers
• The level of care can be ramped up as needed because the staff is already in place

Cons

• One-on-one care won’t be as personal or consistent as it is at home, and frequent staff changes are common.
• Quality of care can vary depending on the staff.
• If significant one-on-one care is needed, hiring and paying a private aide out of pocket may become necessary.
• Seniors could get kicked out of the community for a variety of reasons with little advanced notice.
• Seniors may not enjoy being in a group living environment

Now that you know more about assisted living and in-home care, the choice between them is probably becoming clearer. The next item to consider is the cost of care.

3. Understand the Financial Situation

Before you can choose assisted living or in-home care, you need to know how each option would work with your older adult’s budget.

Figuring out assisted living and in-home care costs isn’t easy and varies depending on each person’s needs, location, and the amount of family help available.

This takes some work, but it’s worth the effort because it helps you plan for the future and avoid unpleasant scenarios, such as your older adult suddenly running out of money.

The best thing to do is to call around to get actual pricing information from assisted living communities you’d consider and in-home care providers you might use.

That way, you’ll know how much it would cost to get the level of care your older adult needs in the city they live in.

A faster, but less accurate approach is to use averages from an online long term care cost estimating tool.

According to Genworth, the 2020 national average monthly cost for in-home care was $4,481 for 44 hours of care per week. The 2020 national average monthly cost for assisted living was $4,300.

There will be a lot of factors to consider because you’re essentially making financial estimates for the next 5 to 10 years of your older adult’s life.

If analyzing and comparing costs becomes overwhelming, ask a trusted relative or friend for help. Or, consult a reputable financial adviser or accountant.

Here’s an overview of the key costs you’ll need to take into account.

Monthly in-home care costs

• Hours of care needed x caregiver hourly rate
• Groceries and meal preparation
• Personal care supplies
• Household supplies
• Housekeeping and laundry
• Transportation
• Rent or mortgage, and property taxes
• Home and yard maintenance
• Utilities, water, and garbage

Assisted living costs
Assisted living fees vary by community, so don’t assume that the base monthly rate covers all services.

That’s why it’s essential to ask for a list of all potential fees in addition to the monthly rate. Your older adult may need these additional services now or in the future.

Common fees include:

• Monthly base rate
• Additional fees for the necessary level of care
• Housekeeping and laundry
• Personal care supplies
• Meals, in-room dining, or snacks
• Overnight visitors

After adding up the costs, you’ll have a good idea of which option fits better in your older adult’s budget, assisted living or in-home care.

Recommended for you:

• Moving to Assisted Living: 5 Ways to Know When It’s Needed
• When to Move to Assisted Living? Advice From a Social Worker
• How to Choose an Assisted Living Facility: Helpful Checklist and Tips

A version of this article was originally published on Sixty and Me

About the Author

Connie Chow

Connie was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also knows how important support is — especially in the form of practical solutions, valuable resources, and self-care tips.