There are many reasons to consider moving a patient who has previously been receiving in-home care to a different facility. Any care provided not at home is often called an alternative to in-home care or “care outside of the home.” Alternatives to in-home care are regularly discussed when elder care is involved but they can be an option for a patient of any age.
Reasons to find alternatives to in-home care could include a patient requiring physical care that is not possible in their home, the demands of caregiving exceeding the capacity of their caregivers, or the need for more professional care. Many reasons, all valid, all unique to the situation and people involved. CaringInfo is here to provide information on what you should consider when moving care from home to another facility.
Decisions about whether to continue in-home care or choose alternative care outside of the home is not simply a question of where care will be delivered. These are decisions about where a person lives, what their physical environment is, what food they eat, who they live with, what rules will govern their lives, and what level of care or services will be available. With serious or life-limiting illnesses, the driving forces determining whether care is provided at home or outside the home are often the intensity of care required and the resources available at home, whether from the inner circle or by paid professionals.
Discussing Moving Care Outside of the Home
No one wants to bring up the subject of moving a person out of their long-time home—it seems almost as difficult as talking about death, but it is important to do so, as early as possible.
Some people will choose to move to a “senior or supported living” environment themselves, anticipating needing or wanting more support later; others will want to stay where they have lived for as long as possible.
But there’s just no way to avoid this transition when it becomes necessary. The only way out is through. Moving from a person’s own home to a care facility of any kind is emotional.
As a person looking to help or advise, acknowledge how difficult the change is, both for the person(s) moving as well as for their inner circle. If the struggle is too much, get third-party help. Often a close friend, a religious leader or a paid counselor can offer support and fresh ideas to assist you both in looking to the future.
It may be best to bring up the subject when things aren’t going so smoothly at home. Aim for a day when there are plumbing problems or when the bill is due for lawn maintenance. It’ll give you an opportunity to casually move into the conversation rather than bringing it up out of the blue. Express your understanding of their desire to age in place but point out the importance of planning for the future and the benefits that come with moving.
Don’t seek commitment right away, as it may appear you have already made the decision for them. Help them — whether it’s your mom, dad, other family member or a patient — feel that this matter is entirely in their control, and you’re just there for support. AgingCare has an informative article that focuses on discussing moving with seniors, but it can be used when talking with patients of any age.
The following articles provide additional insights and resources on discussing moving care out of home:
- NIH’s National Agency on Aging has additional information about what to consider when trying to decide whether it’s time to move out of the home.
- CNN Money discusses how to talk to parents about leaving their home.
- SeniorNavigator provides 10 Factors to Consider Before Moving Your Elderly Parents In with Related Caregivers.
- Senior Safety Advice provides tips and strategies for when those living at home refuse to leave when they need more care.
What to Consider When Moving Care Outside of the Home
When moving care to a place outside of the home, there are some considerations to keep in mind, no matter which type of facility is chosen.
Will the new care facility option be convenient for visiting and handling issues that arise?
Convenience is not just a matter of distance—it may also be traffic or difficult roads—anything that affects the ability of people to visit. Is the new place near to public transportation if that is important? Will the new place be close to just one of the caregivers/inner circle? Is that person ready for the increased responsibility?
What are the non-negotiable services and needs that the care option must address?
Make a list. If kosher food or two bedrooms are absolutely required, know that going in. Whatever your non-negotiables are, note them—this will simplify narrowing your choices.
What are you signing up for when you use “free” referral services that help you find alternatives to in-home care?
Making referrals to senior and other living facilities has become big business. These services are paid by the facilities to which they refer and therefore have an interest in your choosing the facilities they recommend. The best known of these services is A Place for Mom, a private, for-profit company, which owns additional websites such as assistedliving.com, agingcare.com, and alzheimers.net. To use their services, you must give your name, ZIP code, email, and phone number. When you accept their terms of service, you also give consent to receiving calls and texts which may be auto-dialed (also known as robocalls); they’re collecting information about you from social media and they’re sharing your information with various business entities. Which is not to say that you may not find their service useful, just go in with eyes wide open.
What are the specific services this care option provides?
Keep in mind that with all care environments, even within the same state and town, services offered may be different from one to the next. There may be a variety of sources of pay that are accepted, outside health care providers that are allowed to visit you and other differences. Always ask questions – when you know one facility, you only know one facility! We have provided questions that are specific to various living/care situations but for all places it makes sense to ask for referrals. Ask to speak to people who are currently residing in the facility and their inner circles as well as people who have lived there in the past. Ask the people you speak with for additional contacts.
What is in a care option contract’s fine print?
Read all the documents you are given before you sign. More and more facilities are inserting arbitration clauses into their contracts. Arbitration clauses stipulate that in the event of disputes, residents must submit to binding arbitration. A lawyer, not a judge or jury, would rule on the claims, with the parties required to split the proceeding’s costs. Since 2019, Medicare regulations have prevented nursing homes from requiring arbitration for admission or residence. Yet they’re still being included in admissions packets, and family members or residents are still being told to sign the papers. Both the National Consumer Voice and Justice in Aging urge residents and their representatives to simply strike out arbitration clauses when signing the initial paperwork. In nursing homes, arbitration clauses are not required.
Assisted living companies may require them but may not be willing to push the matter especially if there are multiple competitors nearby. If they do sign, potential nursing home residents have 30 days to rescind their agreement to arbitration. But assisted living, including memory care, is not federally regulated, so those rules don’t apply.
Finding Welcoming Housing and Care Options for the LGBTQ+ Community
Finding the right match for housing and care is difficult to begin with and can be even more difficult for LGBTQ+ persons. In senior living communities, LGBT people may live side by side with heterosexuals who came of age when homosexuality was considered a mental illness or even a criminal offense. Bullying and discrimination can be a problem.
SAGE is a national advocacy and services organization that “has been looking out for LGBTQ+ elders since 1978” per their website. SAGE sponsors the National Resource Center on LGBTQ+ Aging which contains both a national and a statebystate list of nonprofit resources focused on the LGBTQ+ community and their caregivers.
Learn about Care Facility Alternatives and Options That Are Available to You
There are a number of types of care facilities available to help support you and patients when caregiving at home can no longer be supported. Some may have better services for independent seniors, others may have better services for more intensive care. We’ve gathered together information for you on each major alternative to in-home care so that you can become informed when making your decision.
Continuing Care Retirement Communities (CCRCs) are communities that are designed to care for seniors from retirement through the end of life. They offer a number of services on one campus, and care can increase over time without the resident needing to move to another facility. Learn more about CCRCs and what to consider when selecting one.
Assisted living facilities (ALFs) can offer apartment-style living alongside care services that can help residents take care of day-to-day tasks like providing medications, laundry, food preparation, and more. It is possible that as care needs increase a resident will need to move to another facility. Learn what assisted living facilities offer and how they are paid for.
Nursing homes are usually permanent residences for people in need of 24/7 care that includes some medical assistance. Residents often have multiple medical conditions and can require assistance with daily activities such as bathing and dressing. Learn more about how nursing homes serve their residents.
Skilled nursing facilities are a temporary residences for patients undergoing medically necessary rehabilitation treatment. When the treatment at a skilled nursing facility is complete, the patient may return to their more permanent place of residence, like a nursing home. Learn more about the care skilled nursing facilities provide.
Take the time to learn about these options and then think about how best to communicate which care facility provides the right level of care.