Alzheimers home care versus facility care - Weighing your options

Joy Johnston January 5, 2018

Brain & Memory > Alzheimer's

Alzheimer's home care vs. facility care: Weighing your options

Choosing between home care or a facility for your loved one with Alzheimer's is one of the most difficult choices a family must make. My father, who had Alzheimer's, was cared for at home before being placed in a facility. I'm sharing my insight to add to the conversation on this important topic.

Home care for people with Alzheimer's

Many families care for loved ones with Alzheimer's at home during the early stages of the disease. Because the initial decline is often slow, family members may not consider themselves caregivers. Over time, the person with Alzheimer's becomes more dependent upon others to help with the daily tasks of life.

This is what happened in my family. Over the course of a few years, my mother began to compensate more and more for my father's failing mental faculties. She took over the finances, helped him get dressed, and eventually assisted with bathing and toileting. My mother became a full-time babysitter to prevent my dad's wandering. My father became violent, socking my mother in the jaw as she was helping him get ready for bed. He said he was shadow-boxing and my mother got in the way.

Shortly after that incident, my father fell ill and required emergency surgery. The hospital stay triggered a series of events that prevented his safe return home. My father never stepped foot inside his home again. He spent the last year of his life in a memory care center, an hour-and-a-half drive from my mother.

That proved to be a blessing and a curse. I was relieved that my mother would not have to contend with my father's violent outbursts and that my father would be in a secure facility to prevent him from wandering. There was a huge burden lifted from my mother's shoulders now that she wasn't a full-time caregiver. But my mother experienced a profound sense of loss, loneliness and isolation. She missed her husband of 40 years, even though the last few years had been difficult. I lived 1,300 miles away and couldn't visit often.

Home care pros:

  • More affordable (at least in early stages)
  • Companionship between caregiver, care recipient
  • Ability to control level, quality of care

Home care cons:
  • Expenses mount in latter stages of disease
  • Burden falls on family members to provide 24/7 care
  • Increased risk for stress and depression, which can impair caregiver's health
  • Social isolation: Friends and relatives may be reluctant to visit

Facility care for people with Alzheimer's

My father was placed in a secure memory care unit of a nursing home upon his hospital discharge. The place wasn't terrible, but it was understaffed. My father had repeated falls while wandering. After falling out of bed on multiple occasions, the staff placed his mattress on the floor.

We paid $4,000 a month for his shared room. Even though my father had a pension and Social Security, it was not enough to cover the monthly payment. There were additional fees for things like medications, adult diapers, Ensure drinks, haircuts and nail trims.

My mother didn't drive, so she took a bus to and from the memory care center. She was so exhausted after one such grueling trip that she fell in the middle of the night after falling asleep on the toilet. She broke her shoulder and the injury nagged her the rest of her life.

Dad began showing signs of illness that weren't addressed until they became severe. He was hospitalized, then transferred to a rehab center a three-hour drive from my mother. My father died surrounded by strangers in the rehab center. Because the hospital DNR order had not carried over to the rehab center, an EMT broke my father's ribs trying to revive him. This was not the dignified death I would have preferred for my father.

Facility care pros:

  • May offer more secure environment
  • Caregiving burden lifted from family
  • Some people thrive in a community environment with activities

Facility care cons:
  • Expensive, hidden costs
  • Separation from family
  • Potential for elder abuse

What I found is that when families are faced with the choice of home care versus facility care, resources can be limited and time short. Discuss this topic with family soon after the Alzheimer's diagnosis, so you have time to carefully consider all options. Talk to others who have been through similar situations to learn about the positives and challenges of each form of Alzheimer's care. This will help you and your family make a difficult choice a bit easier to manage.