Next Steps: Nursing home vs. home care: Cost-benefit analysis

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Q: My father, an 82 year-old widower, has been discharged from a local hospital to a nursing home where he will receive rehabilitation to help with the strokes that left him partially paralyzed on his left side, unable to talk and unable to take care of personal hygiene. But Dad has a sharp mind and is very independent. He keeps wanting my brother and me to promise him that after he finishes his rehabilitation, he can go back home. While we want to assure him, we also don't want to lie to him, either. The cost of care in the nursing home will run about $6,500 a month, including his medications and other needs. My brother and I think we can come out better financially at home by lining up 24-hour care. Dad has income of nearly $4,000 monthly and enough assets to pay his own way. What is the best way to handle his requests, and would we be making a mistake to take him home, assuming he gets better?

A: When possible and prudent, there is no question that care at home is certainly less restrictive for your Dad; however, consider the practical issues before you take that step. First, lining up and maintaining 24-7 care is a challenge. If you try to do it yourself (which we don't suggest), you must check out the references and get criminal background checks on each caregiver. And if a caregiver doesn't show up for the 7 a.m. shift, unexpectedly quits or is not doing the job, you will be responsible for the care and oversight until you find another. And don't forget about wage withholding and tax matters that need to be attended to.

To avoid this undue stress on the family and to ensure quality care, have an experienced geriatric-care manager assess your father, his plan of care and his residence, because in most instances, modifications of the home are essential to proper care. If home care is the option you choose, then retain an established agency to provide the caregivers. The geriatric-care manager should continue in an advisory capacity to be another set of eyes 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. There are the ongoing expenses of the residence, food for your father, his medications and adult diapers. You will be paying caregivers between $12 and $15 per hour, even though some overnight deals may be available.

When you compare the cost of care for 720 hours per month, we believe that you will see that a $6,500-per-month nursing-facility bill is a bargain with a lower per-hour cost 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 dad receives the care he needs in the least restrictive environment possible.

Again, we suggest that a geriatric-care manager be engaged to periodically review Dad's charts and to make sure the plan of care is being followed by the facility and, if feasible, then at home.

Jan Warner is a member of the National Academy of Elder Law Attorneys and has been practicing law for more than 30 years. Jan Collins is editor of the Business and Economic Review published by the University of South Carolina and a special correspondent for The Economist. You can learn more information about elder care law and write to the authors on .


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