We recently learned that a 101-year-old client at home with around-the-clock care is moving to a nursing home.  She has the financial means to cover at-home care for at least 3-4 years – simply based on the value of her home and statements made by her daughter – but she complained constantly about spending “so much money” on something she felt she didn’t need.  Her daughter facilitated the move “to make mom happy.”   That is akin to deciding that instead of well-prepared, home-cooked meals you are going to start buying frozen dinners because they are cheaper and easier to prepare.  The food is not as flavorful and the nutritional value is far less but the price is right and food is food.

Home care and nursing home care sound similar and the list of services you get are indeed similar but there are differences that are as distinct as the differences between apples and oranges.  Let’s quickly review the fallacy of this daughter’s reasoning:

  1. Mom didn’t want to spend so much money:  Mom complained about the cost of home care because she didn’t WANT the care not because she didn’t need it or couldn’t afford it!  Mom’s goal was to “get these strangers out of my house.”  Everyone, including her daughter and doctor, knew she needed the support.  Since the daughter felt compassion but couldn’t address the underlying issue she took action to address the superficial one, the cost.
  2. Mom wanted to be left alone to enjoy her home as she had for decades: She enjoyed her lake views as she sat beside her wood burning stove in the winter or on her private deck in the summer.  No matter how well-designed and well-intentioned the staff, a nursing home is never going to match someone’s own home, especially a suburban, lakefront home with a cozy den and a shady back deck.
  3. Mom complained about the meals: Mom pointed out how caregivers didn’t cook her favorite things the right way and how sometimes they served lunch or dinner when she wasn’t hungry.   Now she has institutional food.  Worse, it is prepared to meet the dietary needs of a large group of people (think salt, sugar, or other restrictions, limited spices, etc.) and meals are served at set times every day.  Mom was complaining as a means of returning to her former life but the effort to address the problem made it that much worse.
  4. Mom wanted privacy: Now, instead of one person there all day (someone whom she knows and who knows her) she has staffers that don’t know her nearly as well and who have to split their time between a group of residents.  Thus, they aren’t always available promptly when most needed.  Likewise, the caregivers in her home could sit in the next room and simply come in as needed.  However, because a nursing home is rated on falls and other incidents and leaving patients alone is a big no-no, patients are rarely, if ever, left alone.  Now mom spends most of her time in a group, with a staffer and several other residents.

I could go on, but you get the point.  Note that I am not talking about the quality of nursing home care.  Frankly, nursing homes get a bad rap since stories of neglect or terrible care make the papers and newscasts while better service flies under the radar.  But for the most part nursing homes – especially small chains or independent ones –  provide adequate care that is not headline-worthy.  No matter how you look at it, institutional care is never going to be as good as one-on-one care in your own home and food prepared for one person’s particular needs or tastes is going to please that person better than having an institutionally-prepared meal.  And the lack of privacy with at-home care is rarely as onerous as the lack of privacy in an institutional setting.

Many people cannot afford home care, I get that.  But to have enough money to afford home care and choose the nursing home because you believe that the difference in cost is disproportionately greater than the difference in quality of life, that is the mistake I have focused on today.