Comparing Home Health Care, Independent Living and Assisted Living Facilities
Posted in Senior Health Care Tips
Choosing the right supportive living arrangement as an older adult requires quite a bit of planning and research. Unfortunately, many families wait until a significant emergency or hazard becomes known before they begin this learning process, leading to a feeling of being rushed and settling for solutions that are only “good enough.” 
This blog sets out to discuss three of the most common supportive living solutions for older adults who may need some degree of assistance in their day-to-day lives, Independent Living Facilities, Assisted Living Facilities, and Home Health Care.
The Basics
Assisted Living (AL) and Independent Living (IL) solutions involve an individual moving into a group housing arrangement similar to a traditional rental unit. Independent Living arrangements are generally light on services and restrictions, but incorporate shared spaces where residents can spend time together. Assisted Living facilities, on the other hand, tend to provide more direct services to residents, including assistance with daily living tasks like dressing and bathing.
Many individuals who choose to live in a group facility will begin in an Independent Living arrangement, but may move to an assisted living facility should their needs increase. To facilitate this transition, many facilities offer both levels of service in the same facility.
Home Health Care differs from AL and IL facilities in that the individual is able to remain in their existing home, and assistance comes in the form of either visiting or live-in caregivers. Unlike a group facility, the transition to home health care does not require a major move, downsizing of belongings, or entering a new social community beyond the visiting caregivers.
Living Space
Independent Living residential units take the form of standalone houses or apartments, and often look similar to any other private residence inside, with a full kitchen and other household amenities available for free use by the resident. Like other planned communities, there are often community amenities available like gyms, game rooms, and other spaces for socialization.
Assisted Living residential units are almost always apartment units to facilitate easier delivery of services, and kitchens may be significantly pared down, or may be omitted entirely to avoid potential accidents. Assisted living units are typically segregated with special wings for those who may need additional help, either due to cognitive impairment, memory issues, or other special cases.
Both IL and AL facilities tend to provide both single-occupant or shared residential units at different monthly price points.
Home Health Care allows the patient to remain in their existing home. As a result, they have access to the same facilities and amenities as they did prior to service beginning. While this tends to be the least disruptive method of receiving assistance, it is important to remember that a home health care recipient will continue to experience all the benefits and drawbacks of their existing home. For example, a patient’s long-time home may be just steps away from a familiar grocery store, but that home may only be accessible via a challenging staircase or other built-in challenge.
Amenities and Services
Independent Living facilities offer services to make day-to-day life more convenient for residents, like laundry service, property upkeep, restaurant-style dining, and housekeeping, but stops short of hands-on assistance with tasks like medication management, grooming, and dressing.
Assisted Living Facilities combine the amenities of an IL facility with more hands-on assistance with daily living activities like bathing, dressing, and managing medication. These facilities will also typically have at least one medical professional (usually a nurse practitioner) on call around the clock in the event of an emergency. Most AL facilities do not include intensive hands-on care or skilled nursing services, but allow for private caregivers to provide additional care.
Beginning home health care services does not result in any change to the amenities available to the client, however facilities in the client’s community become significantly easier to reach thanks to door-to-door travel assistance from their home caregiver.
Hands-on services also tend to be more readily available for a home caregiver client, as the caregiver is not dividing their time between multiple patients in different locations. Home caregiver teams also tend to be significantly smaller than those working in an AL facility, resulting in more personalized care and a closer relationship between patient and caregiver. Similar to an AL facility, home health care agencies usually have a Registered Nurse or Nurse Practitioner on-call to provide guidance to on-site caregivers in the event of a medical emergency.
Cost
The cost of all three of these options vary significantly throughout the country, however fee structures and methods of payment remain consistent.
Monthly costs in an IL facility are typically restricted to rent, utilities, and upkeep fees. Because IL facilities do not provide any medical care, Medicaid, Medicare, or long term care insurance cannot be used to pay monthly fees. Instead, residents will typically pay using social security benefits, pension income, annuities and other personal funds.
Monthly costs in an AL facility include the same fees as an IL facility, as well as additional fees for personal care assistance, meal plans, and laundry services. If a resident hires additional private caregivers, those costs are managed separately by the resident.
Unlike IL facilities, AL facilities offer medical care and thus can be paid for with a broader range of funds, including long term care insurance or Aid and Attendance benefits from the US Department of Veterans Affairs. Medicare will not pay for IL facility fees, however, Medicaid funds can be used in some circumstances to cover costs.
Home health care is typically billed by the hour or service day, independent of any fixed costs the patient may spend on their living space (rent, utilities, mortgage, etc.) This means the client has significant control over their monthly care expenses depending on the number of hours they schedule.
Depending on the client’s various forms of healthcare coverage, home health care can be paid for entirely through, or subsidized by long term care insurance, short term disability insurance, Medicaid, Medicare, veterans benefits, or out-of-pocket payment.
We hope this guide is helpful in guiding you through the first steps of planning your or a loved one’s long-term aging plan. New York City families have called on SelectCare to provide supportive services at home and in Independent and Assisted Living facilities for nearly 40 years.
To learn more about SelectCare, call us today, read our free in-home care guide or visit our client testimonial page.