Living Options for a Person with Dementia: In-home Care

One of the many important factors to consider when dealing with cognitive decline is deciding upon the right living environment. The question of how to approach living arrangements for seniors with dementia can be confusing, given the various living options available. In this series, Conversations to Remember walks through some of the benefits and challenges associated with various living options. For our first installment, we discuss remaining in the senior’s home. 

What is in-home care?

As the name implies, in-home care refers to assistance received at home, rather than through alternative options such as a designated facility. Building trust between the caregiver and the person struggling with dementia is extremely important in all cases. However, it is especially important to build trust with in-home caregivers as they operate inside the older adult’s (or a loved one’s) home. While cognitive decline may make facial and memory recognition a challenge, it is key to establish a positive bond between everyone involved to ensure smooth care. 

There are various types of in-home care providers to fit the diverse needs of someone struggling with dementia or other forms of cognitive decline. If necessary, a licensed medical professional, such as a nursing assistant, may help with physician-prescribed, routine medical procedures such as giving injections, administering medication or supervising physical therapy. However, it should be noted that in-home care does not equate to on-site medical personnel who can assist in the case of emergencies.

If the older adult does not require medical assistance, non-medical caregivers are available to assist with more general needs. For example, if daily chores such as housekeeping or cooking prove challenging, a non-medical caregiver may provide basic help with household maintenance. Additionally, you may consider utilizing grocery or meal delivery services to facilitate grocery shopping. A non-medical caregiver may also assist with bathing or basic hygiene if cognitive decline has made these activities difficult for the older adult who requires assistance. 

Benefits of in-home care

With in-home care, older adults are able to remain at home, providing them with a comfortable environment. For the most part, everything from the home decor to the structural layout is familiar. Familiarity with their living space may help avoid the emotional strain of not only adjusting to a new environment, but also finding a suitable alternative living arrangement in the first place. In-home also allows the senior to retain a sense of control over their life: if they do not want to move, they are not required to do so. 

Another advantage of in-home living is reduced restraints on decision-making. That is, residents of community-style living facilities may not have the opportunity to select what foods or when to eat, what television channel to watch or what activities to participate in. Living in a private setting also reduces the risk of infection inherent in institutional living arrangements. 

It may also be beneficial for family members to be involved in the senior’s life. In-home care facilitates visitation — that is, family members either share the senior’s living space or can comfortably visit their family members. 

Disadvantages of in-home care

In-home care may also pose various disadvantages that must be accounted for. First, hiring in-home caregivers can be expensive, especially for 24-hour care. There may also be instances in which the caregiver is unexpectedly unavailable and no one can immediately cover their responsibilities. In some cases, this could be life-threatening for the person who requires care. 

Safety around the home may also be an issue. As the senior’s dementia progresses, new issues may arise: falling, wandering and medication misusage may become more frequent. With in-home care, all responsibilities for adequately protecting the home and senior fall on the family members. Family members may also need to assist seniors who remain at home on a regular basis — being constantly emotionally and physically attentive to a senior’s every need may strain familial relations. In the worst cases, this could lead to social isolation if family members subconsciously or voluntarily step away from the senior.

There will likely come a time when in-home care is simply insufficient for the senior’s level of dementia. Unfortunately, moving to a new environment may be more difficult at that point, as they will have less ability to adapt to a new environment. On the other hand, they may not realize that the environment is unfamiliar.

Every person is different. For many people, remaining at home may be the best living option, but this is not an exhaustive list of all the benefits and disadvantages of in-home care. It is always important that each senior and their family consider what it most appropriate for them.