24/7 care at home vs. nursing home and possible 24/7 care there. Which is cheaper?

Home care brings with it various problems, such as relief care in addition to the live-in, and who shops and cooks and cleans.

I hired home care for my parents, one after the other for a total of 5+ years. I wouldn’t do it again. We had a live-in and several relief helpers. All CNAs. It was well managed but issues came up, such as they try to get prescriptions at the pharmacy for dad but pharmacy won’t give them to a hired caregiver. Or they will but the credit card fails and I had to straighten it out. Or someone has to go buy catheters but the CG can’t leave dad so I have to drive all over town to find the right size, and I know nothing about catheters. We had a housekeeper once a week, it was totally necessary because the rest of us didn’t have time to clean. And we had to take them to their medical appointments ad infinitum. And so on.

A facility would have been so much easier and cheaper too.

Using a 20 Buck per hour wage scale, 24/7 at home will cost 14560 a month. A nursing home in my area is about 11,000 per month.

I"m going to just comment primarily on the costs side of things, as I have researched that out extensively and recently.
As for the other considerations and pros/cons, and unexpected things, others are discussing those in their posts, (and I'm still a novice in elements of side issues and problems, and am newly discovering them! )

One important distinction - would the facility be an actual nursing home / SNF, or are you saying assisted living?

In my state, to be admitted to a nursing home/SNF the person has to meet the medical justification for this level of care. If going that route, then depending on insurance, you may well have temporary and/or permanent coverage for the costs depending on whether its private insurance with SNF coverage, Medicare, Medicaid. In my state, if one is on medicaid, its basically fully covered. So if one needs a SNF, usually thats going to be lowest cost.

If one is not going to SNF, then it would be Assisted living. In my state, except for medicaid where you can get some coverage for AL, for non medicaid people, you pay yourself for the costs of assisted living. With that said, in my dads assisted living, the total cost is $8000 a month for everything. He will likely require more help over time, and maybe move to "memory care" level of care in time, so maybe with time that may raise up to as high as, $12,000 a month in current 2023 dollars.

If I were to have him at his house with 24/7 coverage (which I have now decided to NOT do, see my other posts), but if it were to be done, I would get an agency to provide caregivers in the house (there are other posts about agency versus getting people independently in the house so I wont go into that aspect). An agency would send people on three 8 hour shifts per day. The cost is roughly $36 an hour in my area (high cost of living area), so thats about $28,000 a month just for the staffing with 1 person 24/7. From a couple agencies I called, their rules are that the caregivers can "assist with walking and stability", but if the client falls, they are not permitted to try to lift them. My dad is pretty big and when he falls its at least a 2 person job to get him up, sometimes needs three. And, I have a bad back, so I cant help much. So I figured that, if he had 24/7 help at home and fell (which eventually would happen), then what is going to happen is 911 would have to be called, he would end up going to ER for evaluation etc etc each time.
The other option to prevent such ER visits, could be hiring on TWO people, 24/7. They probably would give some discount, but at the full rate of $36 per person, that would be $56,000 a month without discount!!! who can afford that, let along the $28,000 for one person a month?!!? If someone is truly terminal on palliative care, I suppose it could be done for their final month of life or so. ...

If someone has LTC insurance or something that will help cover at home costs, that could make things different. Or, if someone does not need that much help at home. For example my in laws just need 4 hours of help per day. Then at home could be feasible, But, you mention that your mom needs 24/7 care......financially, as I have recently learned with the above figures, at home care 24/7 is non feasible unless one has super high level of money available.

The other route that sometimes happens - paying out of your own funds for care, but then when funds dry up, then applying for medicaid coverage and then using that coverage which may then change the type of set up for care depending. I am not well versed on how that all happens when one qualifies for medicaid, there are numerous posts about that topic.

If Mom has LTC Medicaid, the nursing home will be the way to go. Nursing homes are responsible for her health and safety and if under Medicaid, you do not have to pay for private assistance. If you are self pay, it may be cheaper to keep mom at home. Nursing homes in my area cost about $14,000 a month. Unless you need to hire 2 caregivers and have 24 hour care on site, it likely will be cheaper for home care as long as family is helping to fill in the gaps.

Again, I understood from all of your previous posts that you are not POA for your parent and are not in charge of these decisions.
Can you tell us, Djanaras, if this has changed.

All seniors are fall risks. There's nothing unusual about that. Seniors WILL fall. It's a brain balance issue. Generally in nursing home there are many falls. No one is transported unless head or facial injury or apparent injury to mobility and bones.

Costs are a matter of math. You shouldn't need us for that. Just work out monthly costs of in home 24/7 care. I think you will quickly get the idea of the cost of it.

I've never heard of a SNF "requiring private assistance" from hired caregivers, never. In AL or MC, sometimes. My mother fell 95x in AL and MC and they didn't require me to hire private caregivers which is ludicrous anyway, as an elder WILL fall, period.

If you look for "potential challenges " you'll find them in spades. Get all your facts lined up before you do the math on comparative costs between SNFs and home care. Obviously it would cost a lot more in a SNF WITH 24/7 caregivers than it would at home with just 24/7 caregivers. Read Peggysues post and add those 2 figures together to get the SNF cost with 24/7 caregivers.

In my experience, a full time caregiver at home for my father was more expensive than Long term care at a facility.