The Cost of In-Home-Care
by Eric Corum
Aging in Place and the Cost of Home Care in the Long Term
The goal for the vast majority of seniors in the United States is to live in their home for as long as they can. The aging process, however, presents many hurdles that get in the way of achieving this. Luckily, many of these hurdles can be overcome with the right resources. This article outlines some of the biggest reasons why people are unable to successfully age in place and discusses options and costs associated with aging in place.
Aging In Place Barriers
Looking at what causes seniors to move into assisted living facilities (ALFs) is one of the most straight forward ways of evaluating the barriers for successful aging in place. Below is a list of common reasons why a person moves into an ALF:
- Medication compliance
- Difficulty with personal care / bathing
- Loneliness / geriatric depression
- Nutrition & Hydration
- Cognitive Decline
- Dwelling Cleanliness
For each of these items, there are concrete things that can be done in the home to enable aging-in-place. It is only when the total cost of all of these solutions becomes more expensive that moving into a facility make sense. The nation-wide average monthly rate for an ALF was $3,600 in 2015 according to the 2015 Cost of Care Survey by Genworth. Using this number as a benchmark, it is possible to successfully age in place if you can solve all of the aging-in-place related issues for under $3,600/mo.
Aging In Place Solutions
Not taking your medications or mixing up your medications is a recipe for disaster. Just talk to any ER nurse and they will be able to tell you ample stories of seniors who get admitted to the hospital because of medication mishaps that lead to an accident or exacerbation of an existing condition. The best and easiest place to start with for ensuring compliance to a medication regimen is with a medication dispensing device like the Phillips Medication Dispensing Service. This device, which is loaded with a person’s medications, gives reminders and automatically dispenses the correct pills at the correct times to the senior. If the pills are not taken, the machine knows about it and retracts the pills so an accidental overdose does not occur. The device can also alert family members and/or caregivers if medications have been missed. Phillips currently charges $60/mo for this service, which is a fantastic bargain compared to the cost of an ALF or hiring a person to ensure medications are administered correctly at home.
Difficulty with personal care / bathing
Difficulty with personal care / bathing is often tied to either the morning routine and/or the bedtime routine when a senior is transitioning in and out of bed, changing clothes, doing dental hygiene, etc. If a person only needs help at one time during the day, then the easiest thing to do is hire someone who can come to the home and help the senior with the routine. The average hourly cost of senior in-home care is about $20/hr depending upon where you live and what types of services are needed. There are usually a minimum number of required hours for help to come out as well. Let’s assume that someone is hired for 4 hours. This person would not only be able to help with the personal care & bathing, but also with other items on the list of aging-in-place barriers. The cost of having someone come out every day for 4 hours would be $2,433/mo. Although this is no small amount, it is still $1000/mo cheaper than moving into an ALF. Typically, seniors receiving in home help do not start out with needing help 7 days a week, but rather only need just a couple of days a week until gradually growing depending upon the need of the senior.
If the senior needs help with both the morning and night time routine, it is still possible to age-in-place for less than the cost of an ALF if you can find the right helpers at a good rate. There are a lot of great people out there to help with situations like this, finding them, though, is the trick.
Loneliness / geriatric depression
Geriatric depression is one of the most under-addressed issues when it comes to aging in place. There are significant negative health outcomes tied to being socially isolated, depressed, or just plain lonely. Human beings are social creatures. We live in communities and are much healthier when there is positive social engagement. Solving this is actually very easy to do, although, it isn’t addressed nearly enough. Here are some very simple ways to address this topic:
Hire a helper to be a grocery shopping buddy. Getting the senior out and having them engage with the community while shopping is great social engagement.
Hire a helper to take the senior to a social event / meeting. Unless you live in a very small town, it is usually not hard to find a club or social group that regularly meets.
Hire a helper to exercise with the senior at the local recreation center. Not only does this have the benefit of getting the senior out of the house, but it also helps them stay moving and healthy.
Video Calls! Give your senior your old smartphone (you know, the one you didn’t want to throw away but didn’t know what to do with) and teach them how to answer Facetime or Skype video calls. Then have a schedule for each (great) grandchild to call and talk.
The cost of addressing loneliness is fairly low. Hiring someone to come out 2-3 times a week to do any of these activities would be sufficient and could be bundled with other services noted in this list.
Incontinence, especially bowel incontinence, is a common reason why seniors transition into an ALF. If the incontinence is just to the point where it causes some extra laundry and planning to ensure there are enough briefs in the home, a caregiver who is regularly in the home is typically enough to help. If the incontinence is to the point where the senior must be regularly checked to ensure they are not sitting in a wet/dirty brief, then an ALF is typically the best solution because this can happen at any time during the day or night.
Nutrition & Hydration
Proper nutrition and hydration is often tied to mobility issues, difficulty cooking, and/or cognitive decline. One of the most successful ways of addressing this is to couple it with the social event of having a helper accompany the senior to the grocery store and helping with the meal preparations. The helper can then closely monitor not only what is bought but also how much is consumed. Depending upon other needs of the senior, this could be easily achieved with two visits per week by a helper.
Mild cognitive decline usually manifests itself in a decline in some of the areas mentioned in this article such as difficulties with bathing, cooking, medication, etc. All of these issues can be addressed fairly readily by hiring a caregiver. If the cognitive decline results in safety issues such as the senior wandering and getting lost or leaving the stove on, then constant oversight is needed and this is where an ALF may be appropriate.
Aging In Place Summary
Aging-in-place can be done successfully when effective resources are utilized. Most of the hurdles for living at home as you age can be overcome by hiring a helper that specifically addresses the senior’s need. Careful review of the senior’s state and being matched with the best caregivers can go a long way to avoiding the need to move into an assisted living facility.