Assisted living vs. private live-in companion. Any advice?

My guess is people who say don't do it, probably haven't done it. I have done all three. The apartment approach has worked wonders. Best financial decision. Best caregiving decision. Lived on her own own for 21 years, had medical issues and decided to move to a nursing home, then assisted living. The nursing home was a nightmare, understaffed, horrible, bad food, messed up meds, etc. Cost was $5600/month. Because you can't pick your caregivers, she had men bathing her. The staff would call me constantly. I had to go there weekly, if not daily. She begged me to get her out. Think you're getting trained staff? Half of them didn't know how to take BP. Found a new assisted living. Gorgeous. Lots of bells & whistles. $6700. First four days, they forgot to give her meds. BP shot way up. Showers weren't given on days paid for. Doors weren't locked. Residents wandered off. Understaffed. Food horrible. Found a second AL. Same price. First night they tried to give her someone else's meds. Later I found someone else's meds in her nightstand. The shower leaked. She fell, broke her hip. Laid there for hours pressing the button, pulling the red call button. No one came. Receptionist finally found her. Food was mainly white bread and deserts. Four COVID deaths. Had outbreaks never told anyone about. After she broke her hip, said I'd have to hire more care. Hired round the clock care which meant the AL staff stopped helping. Later found roaches and saw evidence of rats. And this is a swanky nice place, but it allowed pet. Each time BP went up, insisted on sending her to hospital. I was constantly being called and had to drive a long way to see her.

I live in a nice apartment complex. Decided to move her there. Bigger place. With a garage $1700/month. all maintenance, pest control, trash collection, utils, included. All on auto-pay. Best maintenance staff ever. Has social events she actually goes to because it's uplifting, not a bunch of old people staring at each other. Sits out by the pool almost every day. Payment is setup automatically. I bought / installed accessible things. Use Care.com and found qualified caregivers. NEVER have a live in. It may be slightly less expensive, but you get far better care with hiring more than one. Unlike an agency, I get to pre-screen/qualify caregivers. I've got four great caregivers who provide 24 hour care. I use Care.com's Homepay to pay taxes. So easy. Texas doesn't require workers comp, but policy wasn't expensive. I am now in charge of what she eats, and she gets great low carb, high protein, food that's easy to fix or pre-prepare.

Mom was declining in the AL/Nursing home environment. Anyone would. VERY depressing. People constantly being carted off in ambulances. Staff is nice to your face, but will treat your loved one poorly. We've reduced cost by about $5,000/mo. with Apt. So much less stress for me. I don't have to deal with myriad of staff. I can fire the caregivers if they don't work. You can't fire staff at a NH or AL! She's not that social, but she sees people daily. In AL/NH she rarely left the room. Goes out for walks with caregiver in her wheelchair daily & sees people. We go to weekly things like PT/church. So much less stress on me. I don't have to worry she'll be kicked out or that she will be neglected or pay for care she's not getting. Don't have staff calling every 15 minutes about her. And she's now doing things for herself and is much better off physically. She gets meds on time, eats right, exercises and I can spend time with her without stressing. Place is easy to clean. It takes planning, but it's FAR better than any 'place'. Not for everyone but best decision I've made. Would NEVER place her in NH or AL. Those places really don't 'supervise'. She can age in place here. Gets better care. Eats better, etc. You cannot pick the caregivers at any of these places. That's really the key. And there's lots of great private caregivers out there. They just don't work for agencies

I agree with everyone who said no-go regarding private caregivers in an apartment. I considered this for my mother and discarded the idea.

You'll need more than a companion. A companion generally will not handle bathroom duties. You'll need at least two caregivers, one live-in and another one or two for reliefs. They should at least be CNAs. Add to that managing the things that make a home - paying rent, handling water bills, electric bills, pest control and so on. Then insurance and withholding taxes for all employees, and all of the foregoing will take a lot of your time and energy.

Your caregivers will want and need some time off. Living in an apartment with a seriously ill old woman is not going to appeal to most. They may want weekends off so they can go home and tend to things.

Leave her where she is. I don't know why she needs 24/7 in an AL facility with a private caregiver. She may be ready for a nursing home.

I'm sorry you're going through this.

If mom needs 24/7 personal care, it sounds like Skilled Nursing is in order. Relying on a "companion" in a private apt does not address the medical requirements at all! And what about when this helper calls in sick? What about 24/7 medical supplies, equipment, food shopping and prep, laundry, someone else to cover the night shift, etc? Appointments and how does that get managed? Med administration which companions don't do. Experienced people to safely bathe her, etc etc.

Your plan is undoable imo. Plus, you can wind up spending MORE this way and getting LESS.

Look and see if Morningstar Assisted Living exists in your area. Although AL, they accommodate more needy residents who require a LOT more care than traditionally offered in regular AL. It's like a cross between AL and Skilled Nursing. Yes, it's more expensive but probably no more so than in home 24/7 proper care. Plus doctors come in house and meds are done on each patient.

Good luck to you

Trustee, welcome to the forum. Sounds like the facility was recommending that your Mom now needs the around the clock care that one would received in a Skilled Nursing Home.

As others here have mentioned, a live-in companion would be doing the work of 3-shifts a caregivers per day. One person doing all that work will burn out very quickly. Then you are back to square one looking for a new companion. Plus a "companion" cannot handle your Mom's medication, you would need to do that.

Renting an apartment you have the monthly rent, furnish the apartment like that of a nursing home [hospital bed, etc], purchase renter's insurance, plus the companion is now an "employee", either you or your Mom will need to get "workman's comp" in case the employee gets hurt on the job. And all the accounting involved with payroll.

I would recommend looking for a Skilled Nursing Home. I hope you aren't paying for all of this, as it can take a huge bite out of one's savings.

Aside from whether or not this makes financial sense something else to consider is that in this kind of scenario her whole world will shrink down to her apartment and the two or three people who care for her, there will be no opportunities for any social interaction. Plus you will no longer have many eyes on them and her, no staff RN or facility doctor, no dentists, podiatrists, hair dressers and whatever other amenities your facility provided.

I think a SNF is the way to go in this situation. It’s not perfect but your mother will receive all the support she will need. We placed my dad recently. It’s not perfect but his needs are met. He had bronchitis a few weeks ago. He had a chest X-ray in his bed to diagnose it. I would not have been able to get him out of his house to get a chest ray so it was good he was there. I can sit with him and visit as a daughter, not be a nurse. They do have activities during the day so there is more stimulation than laying in the recliner and sleeping all day which is what he did at home.

If the 24/7 is due to primarily dementia, I recommend either a small dementia place or a board and care. Forget about the “hotel amenities” like waterfalls and massive foyers with grand pianos. That all takes away from the care part.

If there is a medical need, I’d go with a nh.

You shouldn’t need to pay another person to come in.

Just want to tell you about what I observed yesterday at the hospital. I was there all day with my husband who had surgery.

I went to grab a quick bite in the hospital cafeteria. I picked out a sandwich and my bottle of water and sat at a table to eat.

There was an elderly woman with her private sitter getting ready to be seated to eat as well. I would hire this person in a heartbeat. She treated this older woman in a wheelchair with so much warmth, kindness and respect.

I could instantly tell that the older woman was completely comfortable with her sitter. She was the kind of person that all of us would dream about sitting with our mothers.

When our children are young we guard them with our lives. When our parents grow old we want to be strong advocates for them so they will receive the very best care.

We want caregivers who will allow our parents to retain their dignity. I saw that in the sitter at the hospital yesterday.

When my children were young and I was concerned about finding a good sitter so my husband and I to go out by ourselves occasionally, a friend of mine gave me excellent advice. She said that if I were ever to take turns with another mom watching each other’s children to watch carefully how she treated her own children. I never forgot her advice. She said that if the other mom was rotten to her children that she would be rotten to mine too.

I think this advice applies in any kind of caregiving. If an individual cares for their own parents well, either themselves or by being an excellent advocate for them, they are going to be responsible with your parents.

In your particular situation, I still vote for facility care, but if you do decide on a private caregivers, be very selective about the people that will be staying with your mom day in and day out. Also, install cameras. A picture is worth a thousand words.

If you think it is expensive now, just wait 24/7 care plus apartment rental fee and other expenses will be at least double what she will pay for a facility.

Staying in Al with the care you are told she needs doesn't make sense to me. Sounds like a nursing home is more in line or if it is dementia related MC.

A home that has a step up program is where we placed both my mother & step-mother. Step-mother was in AL now in MC, my mother at 98 is still in AL, doing fine, very healthy over all for 98, and her mind is sharp.

We had private caregiving firm for my mom. Yes it was very expensive. One reason is my moms home was a shambles and not in condition for a live in.

Something to consider with a live-in is who relieves the live-in when they are fatigued? Who watches patient when live-in needs to go on errands? When does the live-in get a day off?

My concern with live-ins is their burnout and how patient care is affected. I think at a certain point the care needs to be implemented by a team of persons. I speak from my experiences and what we went through with my moms care.

Good luck. This is a difficult journey.