In home vs residential care

04th Jun 2018 | CARERS | ENRICH LIVING

In home care vs residential care: the pros and cons of both

This article originally appeared in the Sydney Morning Herald on the 14th of February 2017.

The post-war baby boom babies are now heading in to their later years and are living much longer. With age comes the invaluable knowledge and history that has helped inform and shape the society that we live in today, but in turn, this is accompanied by greater aged related health complications, and further pressures on our healthcare system. A significant proportion of this ageing population (and their children), are wondering ‘where to from here’.

Most older people want to spend their retirement in their own homes. Research shows that ‘ageing in place’ is the preference for the greater majority. A recent Government report showed that of those surveyed, just over 75 percent of elderly people wanted to remain at home.  And indeed, the report also showed that this was the most cost-effective option for both the Government and individuals.

There are several different options available for providing appropriate care to ageing family members and the choice often depends on specific circumstances. Generally speaking, the two main options are around residential care (care in a nursing home) or care at home (home care). They are distinctly different and it is important to understand the difference from the outset.

Residential care is moving from a private home into a care facility, such as a nursing home, where 24 hour clinical care is available. Home care is when an older person is provided with care and support so that they can stay in their own home. Some circumstances dictate specific solutions. For example, residential care is better suited to high-dependency individuals whose health has deteriorated in a significant way and they require around the clock care. Home care is better suited to people who are still able to perform some home duties and self-care at home (either alone or with some assistance).

There are pros and cons to both models of care and here we consider some of the advantages and disadvantages to both.

Access to Care

Access to Care in a Residential Facility

Residential care by its very nature provides around the clock care. It is staffed by qualified clinical staff (mostly nurses), and other visiting medical professionals such as doctors. However, it does not provide emergency care for acute conditions. This type of care is provided in a hospital setting. Residential care is more suited to high-dependency individuals that are unable to perform most self-care.

Access to Care at Home

Around the clock care at home can easily be achieved, based on the individual requirements. The advantage of in-home care is that it is fully flexible and can be tailored to the individual’s unique needs. Home care provides different levels of care, where the individual selects services under a home care package that best suits them. This ensures they are getting the exact type of care they require. They may be able to prepare basic meals for themselves but may need assistance with preparing a hot main meal, help with a shower or a bath, a regular visit from a physiotherapist or some social support. The advantage to home-based care is that it is not a blanket approach, and tailoring the type of care to the needs required enables dignity to remain intact and supports an individual to retain their independence and live life on their own terms.

Social Networks

Social Networks in a Residential Facility

Most nursing homes offer some form of social program, which often includes outings and excursions, as well as on-site activities to keep residents socially engaged and active. There are limitations to the types of activities due to the fact that these organised activities need to cater to many individuals, who all have unique needs. They are also held during select times so do not offer a lot of flexibility.

The process of moving away from home and familiar networks can be disruptive and upsetting. Combined with the management of chronic health conditions, losing long-term connections and limited social interactions can be detrimental. However, it is also worth considering that the nursing home setting provides a whole new group of people to build and maintain friendships with, if the person going into care is so inclined.

Three generations sitting on couch with family dog

Social Networks at Home

One of the advantages to home-based care is the ability to maintain a familiar environment and keep in touch with old friends, neighbours and family. By introducing support at home, little needs to change around social networks and it may also provide an opportunity to re-establish old connections with the help of a carer to support outings. A regular carer can also provide companionship and friendship, fostered through spending time together in an informal environment.

There are quite a few home care programs that support social connection and living a social and active life. People can choose exactly what they would like to do, whether that is fostering a hobby, going shopping or to the movies or enjoying an organised day out. The flexibility of formal home care allows the individual to choose what they would like to do within their home care package budget and requirements. (Have added this last thing as there are some stipulations on what the money can be spent on as well as the budget depending on the level of care assessed).

Emotional Well-being

Emotional Well-being in a Residential Facility

Some seniors can find moving from home into residential care a particularly upsetting experience, especially those who are in the early stages of dementia. It can be quite frightening and confusing. Loss of independence can be a very emotionally challenging experience. Loneliness is also a major health risk and being in residential care does not mitigate it simply because they are surrounded by people. Often residents are not able to take a lot of the personal items from home with them (because of space limitations or occupational health and safety). Being surrounded by unfamiliar things can cause distress and may make settling in more difficult. Being forced to be in contact with people they might not have much in common with communal spaces may also be an issue for some.

Emotional Well-being at Home

The advantage of at home care is that there is no major life change (such as moving to a new environment) to overcome. While having a carer visit the home may require a period of adjustment, there is unlikely to be any trauma attached to it, and introducing a carer gradually may mitigate this. Introducing in-home care may actually increase emotional wellbeing if the senior person strongly wishes to remain at home. Usual social and family interactions can continue and having extra support may enable the elderly person to do some things they wouldn’t be able to without the home-care support. Being in a familiar place, with their own things can not be underestimated.


Cost in a Nursing Home

Aged care costs can be complicated. Each person is required to pay a Basic Daily Fee, which is currently set to $48.44 per day, which is 85% of the basic Single Age Pension ($678.16 per fortnight, per person). The second component is a means-tested care fee. If personal circumstances permit, the senior person will be asked to contribute further to the cost of their care. The Department of Human Services determine what level of fees a resident is required to pay, based on their personal circumstances.

The third component is fees for optional extras, which include services such as hair dressing, or Foxtel. More often than not, residential aged care homes require a bond/accommodation payment or holding deposit to secure a place, which can rule out many individuals. This bond can range between $200,000 up to one million dollars, which often requires the family home to be sold to secure a place. This bond is returned to the family once their loved one passes on.

Cost for Home Care

Like residential care, home care provided through the Home Care Package program, requires a Basic Daily Fee. The Basic Daily Fee is 17.5% of the Single Age Pension ($139.58 per person, per fortnight). The second component is a means-tested care fee, which is based on an assessment of your income and assets. You can only be asked to pay a means-tested care fee if you have an individual annual income of $25,792; or a combined income (as part of a couple living together) of $40,050.40. There are annual and lifetime caps added to the income-tested care fee.

It is difficult to compare the costs of nursing home care with in-home care simply because the models of care differ significantly. In both cases the government invests and subsidises some of the care, but the major difference between the costs of the two models of care is that there is no bond to pay for care in the home. That alone makes home-based care a more financially viable option.

Choosing care for your loved one can be a stressful and emotionally fraught time. Understanding that most people want to remain at home so they can maintain some independence, and age with the dignity and respect that they deserve is a major consideration. In some instances, residential care is the only option due to the deterioration of health, but in many cases working in partnership with a home care provider, seniors can remain in their homes keeping their assets, their independence and their dignity intact.

Enrich Living Services, we are rethinking aged care.  

We understand that entering the complex world of aged care can be daunting at first. There are many options to choose from and any questions to be asked. it can be a little confusing figuring out what is available and how to get the right support and right provider. Our aim is to make it as simple as possible for you to understand your choice right from the word go, and then implement the right plan of action. In this way we can support and empower you right from the beginning.



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