Type of Care

Home vs. Family vs. Facility Care.

I’m kicking this post off with a loaded question – if you become incapacitated to the point where you can no longer care for yourself, what type of care do you want and who do you want to provide it? The primary choices are:

  • Home with Assistance
  • Family Assistance
  • Facility Care

Of course, there are several different flavors of each of the above options but these are the basics.

Most folks don’t want to think about it until it happens – and can you blame them? No one wants to think about reaching the point where they can no longer provide for their own basic needs. Planning, however, is the only way to give ourselves the best chance of receiving the type of care we desire.

Despite the fact that we just don’t want to think about it – we need to do so anyway. If you are one of the adult kids reading this, it would be great to take the time to have this conversation with your parents. This is not something that you can just bring up cold and expect an immediate answer. It’s likely that your parents haven’t thought much about this either. Even though they may be aging and in poor health, they may still think that they will be able to care for themselves at home for the rest of their lives. And some are able to do exactly that.

Having said all of that, we see these issues every day and either the adult kids or the “well” spouse find themselves in a position of having to find the “right” answer at the last minute. Last minute planning is stressful – and sometimes better results could have been achieved by planning ahead.

Each of these are big topics, so today we’ll start with some of the variations of receiving care while staying at home. Each level brings a different type of care.

The Home Ladder of Care

Think of staying home while you are aging as a step-ladder. Yes, you are at home, but which step are you on? What type of care do you need right now?

  1. At Home with Spouse
  2. Home alone
  3. Stay home with kids checking in
  4. Home with one of the kids living with you
  5. Home with non-medical caregivers + family assistance
  6. In home with non-medical caregivers + family + medical home care
  7. Hospice

Let’s look at each of these in a little more detail

At Home with Spouse

Mom and Dad may have been married for 50 plus years and want to stay at home for the remainder of their lives. One of the spouses may be declining in health yet are providing assistance. As an adult child it is wise to keep careful watch on the situation to make sure that the one who is declining the fastest is receiving the care that they need while the one providing the care is not doing so to the detriment of their own health. The key here is to determine when the well spouse needs help. They might be reluctant to accept the needed assistance and it may take several conversations to make that happen.

Home Alone

After one of the spouses dies the remaining spouse may want to continue to remain at home and may be reluctant to accept needed care. Again the goal is to monitor the situation and to provide assistance when needed. Several patient conversations may need to occur before assistance will be allowed.

Stay Home with Kids Checking In

This is usually how it starts. The kids start checking in an hour or so a day. (Journey Stop #1). Slowly but surely the time required for assistance may swell to several hours per day (Journey Stop #2 or #3). Can the kids continue to provide the type of care that’s needed? Yes, for a while. But then what?

Home with one of the kids living with you

This can be a tremendous blessing OR it may be a disaster. Sometimes one of the kids will move in with Mom and Dad to provide assistance only to find themselves quickly overwhelmed with the amount of work required. Since they’re living with Mom and Dad full-time, their siblings may believe that the live-in sibling is “taking care of everything” and that they (the other siblings) no longer “need to worry about it”. There are many other issues associated with this option and with the flip-side option of moving Mom in with you – so if you are considering either of these options, contact an elder law attorney for assistance.

Home with non-medical caregivers + family assistance

As more care is required this is usually the next step. Families often quickly determine that they can’t provide all of the care themselves so they bring in non-medical caregivers to supplement the care required.

In Home with non-medical caregivers + family + medical home care

Usually after the first hospital stay the doctor will prescribe medical Home Health which may consist of a nurse checking in periodically, along with various therapists and home health aides to help with personal care needs a few times a week. This is in addition to the non-medical Home Care and Family Assistance.


At some point it is clear that the parent is not going to recover. The focus may shift from improving health to just keeping the aging parent comfortable. Hospice services can be provided in the home, in an Assisted Living Facility or Nursing Home, or in an in-patient hospice facility.

Stay Encouraged & Be Proactive

If you are an aging adult, I would encourage you to consider the options discussed in this article and decide what type of care you would want should you decline substantially before your death. You may want to go online to get information or tour some of the local facilities in your area to help with your decision. You may also want to have this conversation with your family at a Mom Centered Meeting to get their input before you decide.

If you are one of the adult kids, please review the options so that you will be equipped to have a series of patient and loving discussions with your parent.

Best wishes to you and your family as you make these difficult decisions.

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About the Author

Doug & his wife Cindy have not only helped hundreds of families with their estate planning and elder law needs over the years, but have personal experience as caregivers and advocates for their Loved Ones as well.

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