When Is Facility-Based Care More Appropriate than In-Home Care for a Parent with Dementia?

Lisa Fields
Added: 06.24.2022
5 minutes read
Many older adults prefer to live at home for the remainder of their days, but a dementia diagnosis may complicate things. Although you may want to honor your parent’s wishes to age in place, it may not be feasible to keep them at home after a certain point, for safety reasons or financial reasons.

“As the disease progresses and the patient needs more services, they usually need it 24 hours a day,” says geriatrician David Hackethorn, MD, assistant professor of internal medicine at Texas A&M Health Science Center in College Station. “It might make more sense to have somebody in a facility, like assisted living or a dementia unit, than to have them at home.”

There are many reasons why your parent with dementia may eventually need 24-hour care, such as:
  • They may wander away from home and be unable to find their way back.
  • They may forget to eat or drink, which may lead to weight loss, dehydration or malnutrition.
  • They may neglect to turn off the stove or oven after preparing meals, increasing the risk of fire or carbon monoxide poisoning.
  • They may unknowingly eat expired or spoiled food, which could make them ill.
  • They may forget to bathe, if nobody is there to remind them to do it.
  • They may forget to go to the bathroom and have “accidents.”
  • They  may confuse night and day, staying awake all night and sleeping during daylight hours. Some people become agitated if they’re awake when it’s dark out.
  • They may fall and need help getting up, or they may injure themselves during falls.

When your parent needs 24-hour care, you may consider two options: In-home care and facility-based care. While you may want to find a way to keep your parent at home, it may not be an affordable option.

“Finances drive a lot of decision-making when it comes to ‘I can no longer take care of my loved one at home,’” Hackethorn says.

In-home care
When your parent needs 24-hour care, they typically need home healthcare, not skilled nursing. Most people have to pay for home healthcare out-of-pocket.

“Caregiving in itself is not covered by anybody unless you have long-term-care insurance, and you have to have impairment of at least two of your basic ADLs, activities of daily living... bathing, dressing, eating, those sort of things,” Hackethorn says.

How much can it cost to have 24-hour home healthcare for your parent? Costs vary by location, but it may be as much as $15,000 to $17,000 per month for 24/7 in-home care for your parent. This sum may be out of the question, even if your parent has savings.

Even if your parent can afford 24-hour in-home care, they may not feel comfortable with a caregiver they don’t recognize.

“Do they want somebody coming into their home? Will the patient even accept somebody coming into the home?” Hackethorn says.

Facility-based care
If costs prevent you from keeping your parent at home, a long-term-care facility is a more affordable option. Costs vary by location, but you may pay $5,000 to $8,000 per month or more. It’s pricey but considerably less expensive than in-home care.

“When you go into a facility, you’re going to have complete care, 24 hours a day,” Hackethorn says. “Assisted living is a little bit more independent in its presentation to the patient, because they’ll have their own room and maybe go down and have meals with everybody, as opposed to some dementia units, which are structurally somewhat more like a nursing home.”

If your parent is unable to afford a long-term-care facility, they may qualify for Medicaid, which may cover some or all of the cost.