Home or Facility? The Pros and Cons of In-Home Medical Care

A hospital stay is usually just that: a stay, followed by discharge to a skilled nursing or rehab facility, or recuperation at home. It all depends on the nature of the illness or the surgery performed. In some cases, especially for older individuals, the lines between hospital and home have begun to blur in terms of the care patients receive.

That’s because many people needing rehabilitation care are opting for in-home care vs. going into a facility. While many of those offer on-site care at varying levels, from fully independent living to various “a la carte” assisted living programs, and even full nursing home and hospice care, the vast majority of patients (more than 95 percent, according to the AARP) very much want to remain at home.

There is no one “right” answer when it comes to who will thrive with in-home services rather than some form of facility care, so it’s worth taking a look at some of the pros and cons of each.

Advantages of in-home care

• Aging in place. People are most comfortable in an environment they know, with the possessions and memories of a lifetime around them. The idea of losing control is a very strong negative, and the idea of an “institution” is not a comforting one to most seniors, even temporarily.
• An affordable option. Facility care is going to cost money — around $554 a day at a skilled nursing facility if it isn’t covered by insurance, Medicare, or Medicaid, according to the National Association of Home Care. Independent living facilities also are often expensive, and as more care is required, those costs go up. Many people are now purchasing long-term care insurance, but that remains a small percentage of the overall population.
• Skilled care as needed. Remaining in home doesn't mean that professional care cannot be provided. Many medical conditions, such as COPD, can be treated in a home setting with oxygen delivery and other methods.

Disadvantages of in-home care

• 24/7 monitoring is costly. Sometimes much more medical intervention is needed for someone’s safety and continued good health than can be provided in a remote setting. In a facility, that comes with the services; in the home, it means adding on more services, staff, or other interventions.
• Cost of highly skilled workers. A home care services agency will have staff who are capable and competent for the services they provide, but most are not highly trained medical caregivers. Those, such as licensed practical nurse, therapists or home health aides, can be hired, but doing so can be costly and begin to negate the fiscal advantages of staying home vs. moving to a care facility.
• Navigating Medicare and insurance. Choosing to receive care at home can also run afoul of Medicare and other insurance requirements. What might be fully covered in an assisted living or rehab facility may not be covered, or only partially so, as an in-home care service.

This is not to say that home vs. facility is an all-or-nothing proposition. These are big decisions, and don’t have to be made overnight. If someone wants to stay home, and is beginning to lose the ability to care for themselves properly, it’s important to note that there are “guard rails” that can be put into place to address safety concerns, including:

• Having friends or family stop by on a regular schedule just to visit, and check on activities of daily living such as cooking, bathing and laundry.
• Hire a caregiving agency to help with some of those services, as well as additional offerings such as staying overnight, meal preparation and transportation to and from doctor’s visits and other errands.
• Remote monitoring, such as cameras, which with the approval of the individual can allow children or other family members to see and hear what’s going on inside the home if there are concerns.

And finally, let’s return to the cost of care, regardless of location. It’s going to fluctuate between states, and the type of health care professionals needed. Some services will be out of pocket, while others may be partially or fully covered by public and private sources such as Medicare, Medicaid, the Older Americans Act, the Veterans Administration, and private insurance.

Nursing homes and skilled care facilities that continue to excel are those that treat residents as people worthy of respect, regardless of medical condition or funding source—and regardless of the pressures felt by staff. HealthStream works with skilled nursing and LTC facilities, as well as across the care continuum, to address these challenges, from keeping pace with regulatory requirements to engaging and developing competent staff who can satisfy the demands of increased patient complexity. Learn about HealthStream’s Workforce Development Solutions for the Continuum of Care.