How to Choose Between Home Health Care, Assisted Living, and a Nursing Home

Caring for someone can be time-consuming and exhausting—for you and your bank account. Family and friends can step in to assist, of course, but there may come a point when your loved one needs professional care. Here are some basic options to consider.

Home sweet home

In-home health aides average $19 an hour, and hired companions who don't provide health care are slightly less expensive. Do the math and you'll see that for round-the-clock assistance, the tab can run as high as $170,000 a year, making home care a very costly option.

"It's so expensive because people are basically trying to recreate the nursing facility at home," says Chris Cooper, a certified financial planner and social gerontologist in Toledo. Medicare and private insurance generally do not cover long-term in-home care. So unless you have a long-term-care insurance policy, the cost must be paid out-of-pocket, which may mean liquidating assets or applying for a reverse mortgage.

Despite the expense, "most people try to do what they can to stay at home before placement in a facility," says Nancy Wexler, a Los Angeles–based geriatric care manager and author of Mama Can't Remember Anymore: Care Management of Aging Parents and Loved Ones. The good news is that many people don't need 24-hour care, at least not right away. Someone with a chronic condition like heart disease, for instance, might only need help with specific tasks, like meal preparation or bathing.

To find an in-home aide, ask others who have used one or consult a geriatric care manager. It might cost more to employ an aide through an agency, but if any sort of problem arises, the agency will furnish a replacement quickly. That beats spending stressful days trying to find aides and conducting background checks.

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