Alternatives to Nursing Home Care

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Family members sometimes feel that nursing homes are the only alternative for a relative who needs more care than the family can provide. A parent’s health condition might make it difficult for families to assure that their mom or dad receives the health care they need while living at home.

Seniors who might benefit from continuous medical care often resist the suggestion that they enter a nursing home. A December 2021 poll by the John A. Hartford Foundation found that 71% of older adults say they are unwilling to live in nursing homes. About 90% of older adults said that changes need to be made before nursing homes will appeal to them.

Nursing Home Challenges

Negative publicity during the pandemic contributed to the unwillingness of seniors to enter nursing homes. Residents of long-term care facilities accounted for nearly a quarter of all COVID-19 fatalities. The virus was readily transmitted in facilities where the mobility of residents was limited. A disproportionate share of deaths occurred in nursing homes because residents often had the kind of serious health conditions that made them more vulnerable to COVID-19 infections.

Other difficulties in the nursing home industry have also discouraged families from seeking nursing home care for disabled parents. The pandemic contributed to an epidemic of staff shortages. Some nursing homes have been accused of neglecting patients because they lack adequate staff to meet their needs. A majority of nursing homes are losing money and at risk of closing. Every closure creates demand for nursing home that the industry is struggling to meet.

The nursing home industry has attempted to improve its image by substituting the phrase “long-term care community” for “nursing home.” More substantive changes will include a greater reliance on registered nurses to oversee certified nursing assistants, stricter regulatory control, and redesigning nursing homes to make them seem more like homes than hospitals. Those changes will require greater investment, including higher wages for professionally trained staff. The lack of financial resources to meet those challenges is the biggest roadblock to nursing home improvements.

Alternatives to Nursing Homes

Healthcare writer Joanne Kaldy recommends that families consult with a geriatrician before making decisions about care options for an aging parent. A comprehensive geriatric assessment will pinpoint the senior’s health care needs. Adult children will be better positioned to begin a search for residential health care solutions when they understand a parent’s care requirements. 

Home Care

Most seniors hope to age in place. An older parent who needs help with the activities of daily living but does not need to live in an institutional setting may prefer to hire outside care workers. Like other options, paying for home care can be expensive (Kaldy cites an average cost of $5,000 per month), but that cost may be reduced when family members help with caregiving.


The Program of All-Inclusive Care for the Elderly (PACE) provides a package of medical and social services to older adults who are still living in the community. The program is designed to help seniors with serious medical conditions avoid entry into nursing homes.

The program provides medical care, prescription drugs, home care, physical therapy, social services, transportation, and other services. Most PACE services, including a meal, are provided at adult day care centers. The program also covers some in-home services, doctor visits, and hospital stays.

Most people who receive PACE services are eligible for both Medicare and Medicaid, although they do not need to be enrolled in those programs. A PACE participant must meet state criteria for a nursing home level of care and must live in an area that is served by a PACE organization. 

Board and Care Homes

Board and care homes share features in common with group homes for minors and boarding homes that were popular before and during World War II. In some states, they might be known as senior group homes or residential care homes. 

Residents have their own rooms but share common areas for dining and interacting with other residents. Their monthly rental fee typically covers meals and cleaning of common areas. In some homes, the fee may cover cleaning of the resident’s private room and laundry services.

Residents of board and care homes receive help with their activities of daily living. Some homes provide dementia care. Board and care homes are thus similar to assisted-living facilities, although board and care homes generally serve only six to twenty residents and do not offer all the amenities that are typically available at assisted-living facilities.

Assisted-Living Facilities

While assisted-living facilities vary in size, most have 50 to 200 residents. Like board and care homes, assisted-living facilities offer residents help with their activities of daily living. 

Many assisted-living facilities offer a range of activities that encourage residents to socialize. Most have a dining hall where meals are served, although units may have a kitchenette if residents want to prepare their own meals. Fee schedules vary, but residents will typically pay an extra fee if they want meal delivery, cleaning, or laundry services.

Staff members who assist residents are usually certified nursing assistants. A registered nurse supervises their work or is available on-call. However, assisted-living facilities do not provide medical care.

Continuing Care Retirement Communities

A retirement community is limited to residents who have reached a specified age (commonly 55). Most retirement communities are meant for seniors who can live independently. They do not offer caregiving services, although some communities allow residents to receive assistance from family or hired caregivers.

A continuing care retirement community (also known as a life plan community) blends several kinds of senior housing on the same campus. Residents generally start living independently in a traditional retirement community. When they develop sufficient need for care, they move to an assisted-living facility. When they need around-the-clock care, they move to a nursing home. 

A continuing care retirement community generally charges a large initial fee. That investment may pay off if the retiree eventually needs substantial care. Until that time, the retiree can enjoy all the amenities offered by the community, which may include a golf course and swimming pool. Since continuing care retirement communities offer different kinds of contracts, purchasers may want to obtain legal advice to make sure they understand their legal obligations before making a commitment.

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