Home Care vs. Assisted Living: A Brief Guide to Long-Term Care Decisions

Home Care vs. Assisted Living

Most American families eventually face tough decisions about how to care for their parents, spouses, and themselves as they grow older. Vivian is the caregiver for her husband, who is currently in a rehabilitation center for daily physical therapy to get stronger after a recent hospitalization. She has been kind enough to share her caregiving journey in our Aging in America campaign, which is an effort from our group to recognize the struggles many family caregivers face, like: Should she continue caring for her husband at home or move him into a facility after rehab?

In her interview with us, Vivian shared, “At the end of this month, we’re going to have to make a decision whether he should come back home with full-time [home] care, hiring healthcare people, or to put him in an assisted living place where he would get the medical care he needs, but where he would be away from me. Of course, I would go and visit him, but it will be heart-wrenching not to have him live at home where he belongs, really—with me.”

Vivian’s words highlight the emotional heart of a tough decision millions of family caregivers grapple with daily. Using her story as our guide, here’s what family caregivers can consider about the decision of arranging in-home care versus placement at an assisted living facility or nursing home, updated with information for caregiving in 2025.

Assessing Care Needs: ADLs, IADLs, and Medical Needs

When deciding on in-home care or facility-based care, it is important to first understand your loved one’s current care needs and anticipate what support needs they might require in the future. This way, you can prepare emotionally and financially. Care needs are typically categorized as:

• Activities of Daily Living (ADLs): Essential tasks like bathing, dressing, toileting, feeding, and transferring.
• Instrumental Activities of Daily Living (IADLs): Complex tasks like medication reminders and management, cooking, transportation, and finances.

Medical or Rehabilitation Needs: Require licensed (“skilled”) healthcare professionals to handle treatments such as wound care, injections, catheter management, physical therapy, medication administration, and chronic condition management.

Decision-Making Framework: Home Care vs. Assisted Living vs. Nursing Home

These considerations can be a lot to take in. To help orient a family caregiver like Vivian to the options of home- versus facility-based assistance, we can review each factor in the table below carefully and consider care needs and care options together. A family caregiver in Vivan’s situation can check the column that best aligns with their experience. If most factors align clearly with one column, this indicates the type of care setting that might best suit an individual’s care needs.

Applying this framework to Vivian’s story

Vivian’s husband now needs extensive daily support, medical supervision due to ongoing health issues, and supervision to prevent falls and injuries. Vivian herself has reached significant stress and fatigue, indicating potential for caregiver burnout. Their financial resources could dwindle quickly due to mounting home care costs if this route is chosen. Using this framework, Vivian’s scenario aligns strongly with assisted living or possibly skilled nursing home care, indicating that it may be wise to explore both options to find a situation that is most sustainable for both her husband and herself.