Surprising Ways to Avoid Nursing Home Care

By Joseph L. Matthews, Caring.com Author

Most older adults, needless to say, would choose their own homes. But for any number of reasons, from physical or mental health issues to dwindling finances, staying at home doesn't always seem possible. If someone close to you appears to be headed for a nursing home, there are alternatives that can -- sometimes indefinitely -- forestall the need for such a move.

Here are some ideas for keeping your loved one at home: 

1. Share care
As an older adult's need for in-home care begins to mushroom, even the combination of paid and family caregiving may quickly become too expensive, too time-consuming and exhausting, or both. Many people discover they're able to share caregiving (and its costs) by pooling their resources. Examples include:

Moving in with a relative, friend, or neighbor. Living alone significantly increases the need for caregiving. Many older adults address this problem by sharing their living space with someone else who's in similar circumstances. This might mean sharing one or the other's existing home, or getting a new place together. The roommates can then help support each other while sharing some family and paid caregiving, reducing both the burden and the cost.

Simultaneous family-and-paid caregiving shared with a neighbor. There may be someone who lives in the same building or on the same block as the person you're caring for who also needs regular in-home care. If so, and assuming that the two of them get along and accept the idea, it may be possible for them to share some in-home caregiving. One of them could be taken to the other's home -- and, if both physical setups allow, this could alternate between the two places -- and be cared for there for a day or a few hours, either by a paid or family caregiver. A comfortable chair or bed could be added to one or both places to make this more workable.

2. Move to a less expensive area
If in-home care gets too expensive, consider moving your loved one to a different, less costly, location. The cost of living -- including both the regular expenses of daily life (housing, food, utilities) and the cost of an in-home caregiver -- varies substantially in different areas of the country. For example:

Urban areas tend to be more expensive than rural ones.

By reducing costs, it may be possible to afford considerably more in-home care in a new, less expensive location. When making such a move, consider:

Moving your loved one near a family caregiver. Making a major move may be most sensible if it's to a place near one or more family members who will be involved with caregiving. Even if most in-home caregiving continues to be paid, having a nearby family member who's responsible for overseeing that care and for providing extra care and other assistance when needed will further reduce costs.

3. Use adult daycare

One way to make in-home care work -- both in terms of cost and preventing family caregiver burnout -- is to supplement it with adult daycare. Your loved one can spend from a few hours to a full day at an adult daycare center while the primary in-home caregiver sees to other matters or simply gets a break from caregiving.

The benefits of adult daycare aren't just for the caregivers. Adult daycare centers typically offer meals, activities, exercise, and transportation, providing the person in your care a change from the isolation of home, socialization with others, and activities he or she might not otherwise participate in. Many adult daycare centers accept, and have special services for, people with mild to moderate Alzheimer's or other forms of dementia.

Adult daycare centers charge considerably less per hour than in-home caregivers -- $25 to $75 for a full day, depending on location and services provided. Also, many centers offer sliding-scale fees.

4. Hire free or low-cost companion care

Skilled in-home care can cost $20 to $30 an hour -- and even more. If the number of hours needed for care begins to mount, consider what type of help is actually necessary. Can your loved one get by with skilled in-home assistance for only a small part of the day (first thing in the morning, for example, or at bedtime), and for most of the day have a nonprofessional caregiver who simply provides companionship, helps with small household chores, and provides a presence for safety and security?

If lower-cost (or free) "companion care" is workable for your family member, here are some sources of such help:

Senior-to-senior programs. In some areas, local government or nonprofit organizations operate an agency or referral service that connects local senior volunteers with other seniors in need of companion care.

Churches. Some churches have programs in which congregation members volunteer to provide free in-home care for older adults. These programs usually provide only a few hours of help a week, but even that can make a big difference to a family caregiver and to overall costs. If you or your loved one belongs to a local church, find out if it has such a program, or if it knows of congregation members who provide this kind of unofficial help on their own.

Local high schools and colleges. Many high schools and colleges offer community service programs in which students volunteer to provide free local services, such as in-home care for older adults. Student volunteers aren't usually capable of providing extensive care (such as managing medicines or bathing), but often they can run errands, perform household chores, and provide companionship for an older adult for several hours a week. Also, many colleges have student employment centers where students list their availability to provide care for pay, usually at rates considerably lower than those of professional caregivers.In-home care agencies. Most in-home care agencies offer different levels of care, including lower-cost companion care.

5. Check out your own backyard
For some people, having a loved one move in with them would make providing care much easier -- in fact, it could eliminate the need to move to a nursing home. But lack of space and the intrusion on the privacy of both the family and the person being cared for often make such a move impractical.

One solution is the addition of a small, separate living unit in the backyard or other open space at a family home. The space, sometimes called an ECHO -- Elder Housing Cottage Opportunity -- unit or accessory dwelling unit (ADU), may be temporary or permanent and can be fitted with special features (safety rails or an easy-access shower, for example) designed for older adults.

The addition of a separate living unit is neither simple nor cheap. There may be zoning issues, and the cost can run between $25,000 and $75,000 to purchase the unit, or between $1,000 and $3,000 per month to lease it. Still, these costs are considerably less than even one year in most nursing homes. Also, once the unit is no longer needed, it can either be removed or kept and used for other purposes.

6. Get creative with financial tools
If lack of cash is the reason your loved one can't remain at home, and you think you've exhausted all possibilities for raising funds, consider two often-overlooked sources:

Reverse mortgage. If your loved one owns the home he or she lives in, a reverse mortgage might raise enough money to pay for a considerable amount of in-home care. Unlike a conventional mortgage, none of the reverse mortgage loan amount has to be repaid until the homeowner dies or permanently leaves the home. This means that all the money from a reverse mortgage is available to pay for in-home care, or for any other expenses, as long as the homeowner continues to live in the home.

Cash for life insurance. Certain life insurance policies can be cashed in with the insurance company itself for 50 to 75 percent of the policy's face value. Some policies permit these "accelerated benefits" or "living benefits," as they're called, only if the policyholder is terminally ill. A "life settlement" (also called a "senior settlement") may also be possible, which involves selling the policy to a life settlement company for a lump sum. The amount of the settlement -- 50 to 75 percent of the policy's face value -- depends on the policy benefit amounts, the policy's monthly premiums, and the policy holder's age and health. The settlement company pays the policy's premiums until the person dies, and then it collects the life insurance benefits.  

7. Consider assisted living Even though assisted-living facilities are sprouting up everywhere, many older adults and their caregivers don't realize that an assisted-living facility -- usually far less costly and less institutional than a long-term care facility-- may be right around the corner. Or there may be assisted-living facilities near a family member who can provide regular companionship and extra support beyond what the facility offers.

If your loved one needs regular monitoring but not round-the-clock supervision, and assistance with some but not all aspects of daily living (such as bathing, eating, walking, getting in and out of bed, using the toilet), then it may pay to look into an assisted-living facility. Some things to know:

Assisted-living facilities offer a separate, private living space -- from a single room to a one- or two-bedroom apartment, usually with kitchen facilities -- in a building of 20 to 150 units that house other older adults.

Assisted-living facilities offer basic supervision and services -- meals in a common dining area, housekeeping, help with activities of daily living, monitoring of medication, transportation, and social and wellness activities.

Many assisted-living facilities provide specialized care and services for people with Alzheimer's or other forms of dementia.

What are the advantages of assisted living facilities over long-term care facilities?

More privacy. Because each assisted-living facility resident has an individual living unit, there's much more privacy than in a long-term care facility.

Greater independence. Assisted-living facility residents come and go as they please, can choose to join others for a common meal and social activity, or instead have their meals and socialize privately in their own units. They may also have outside visitors in their private residences.

Less institutional. Many long-term care facilities tend to look and feel like hospitals. Assisted-living facilities are much more homelike, both in the common areas and in the private units, where residents can have some or all of their own furnishings.

Cost. Assisted-living facilities tend to cost a third to a half less than long-term care facilities in the same geographic area.

Find out about and compare assisted-living facilities in your area.    

Ed. note: the information on Assisted-living facilities referenced above is US based, as is Caring.com.