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Should We Use At Home Care or A Nursing Home?

Question: My mother, a 79 year-old widow, is being discharged from the hospital to a nursing home for rehabilitation after a series of strokes that left her partially paralyzed on the left side and unable to do most of the activities of daily life. But her mind is in tact, and she is very independent. She wants to be assured that after the rehabilitation, she can go back home. The cost of care in the facility will approximate $5,000 per month including her medications and adult diapers. We believe that we can come out better financially at home by lining up 24-hour care. Mom has good income and assets and can pay her own way. Do you have any advice about being home as opposed to being in a nursing home?

Answer: If possible and prudent, care at home certainly will provide a less restrictive environment for your mother; however, before you take that step, you should consider the practical problems. First, lining up and maintaining 24-7 care can be a real chore. If you try to do it yourself (which we donít suggest), you must contact each references and get criminal background checks on each caregiver. And if a caregiver does not show up for the 7 AM shift while you are getting ready for work, unexpectedly quits, or is not doing the job, you will be responsible for the care and oversight. And donít forget taking care of wage withholding and tax matters.

To avoid undue stress on family members and to attempt to assure quality care, we recommend that before you begin home care, you engage an experienced geriatric care manager to assess your mother and her residence as, in many instances, modifications of the home are essential to insure proper care. If home care is the option you choose, we suggest you retain an established agency to provide the caregivers. The geriatric care manager should continue in an advisory capacity to oversee, manage, and coordinate the caregivers and home health nurses.

From a cost standpoint, we believe you will find it will be much more expensive to provide care at home than in a facility. In addition to the on-going expenses of the residence, food for your mother and caregivers, and the cost of her medications and adult diapers, you will be paying caregivers at least in the $12.00 per hour range. When you compare the cost of care for 720 hours per month, we believe that you will see that a $5,000 per month nursing facility bill is a bargain with an average of $7.00 per hour for round-the-clock nursing care, food, medications, laundry, etc

Bottom Line: While home care is certainly more desirable in some instances, where total care is needed, a good nursing facility is generally the better choice. That does not mean, however, that you should not be proactive in making sure your mother receives the care she needs. We suggest that a geriatric care manager be engaged to periodically review your motherís charts and to make sure her plan of care plan is being followed by the facility.

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