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Over the years, I've heard many people state such things as, "I will never put my loved one in a nursing home," and "I promised them that I would care for them at home until the end." The reality is that most of those receiving long-term care, and most caregivers, prefer a home environment but unfortunately end up transferring out of the home before they pass.

Today, there are approximately 10 million older Americans receiving care, of which 70% are in their own home or the home of a family member or friend. According to the National Association for Home Care & Hospice, over 12 million individuals currently receive care from more than 33,000 providers. Causes include acute illness, long-term health conditions, permanent disability and terminal illness, to name a few.

Staying at Home is Affordable

Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving demands might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.

Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $3,000 to $6,000 a month for care in a facility. Likewise, it's much less costly and more loving for a daughter to have her widowed mother move into the daughter's home than to liquidate mom's assets and put her in a nursing home. Besides, personally taking care of our parents or spouses is an obligation most of us feel very strongly about.

For many long term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives, engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and may include occasional help with housecleaning and shopping, as well as help with getting out of bed, dressing and bathing.

Most of the time these people don't need the supervision of a full-time caregiver. There are, however, some care situations that make it difficult to provide long term care in the home.

The ongoing and escalating need for help with activities of daily living, or the need for extended supervision often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one.

On the other hand, if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting. By planning for eldercare in advance and providing the funding necessary to remain in the home, no one need go to a facility to receive long term care. In most cases, with enough money, anyone who desires, can remain at home to receive the necessary care.

Can't Afford to Stay Elsewhere

Now, on to another concern. Why pay an in-home care company when you can hire a private individual at a lower rate? This is a very common question and the answer lies in the individual's needs and level of comfort, in addition to the financial considerations. Some don't feel comfortable allowing others into their home. Some have heard stories that bring up negative thoughts.

The other side of the coin though is that by hiring a firm to provide skilled caregivers, you also have less risk of providing the wrong level of care, and their employees are certified by the state, as well as bonded and insured. Too many people have been undermedicated, or the opposite, and end up hospitalized as a result.

Furthermore, when someone is not cared for properly, they will certainly pay the price healthwise, with some unable to recover. This is all too common and is completely avoidable. Most in-home care companies provide significant training to their caregivers, where most private caregivers, although generally very well-meaning, receive very little if any skilled training.

One Day Can Change Everything

The reality of what is best for you is truly determined by your own personal standards, and how well you have planned. Most folks desire to plan ahead but end up in a crisis due to their good intentions not being acted upon. Also, in my own experience with clients, a medical episode ends up causing the change in where the care is provided. A stroke, fall, heart attack or similar issue sends them to a hospital, where a physician must inform the patient that what was working at home will not work going forward, due to an increase in care needs.

Planning to stay at home and knowing the options available to assist in that endeavor will allow many to achieve this goal, but understanding the reality of it actually happening, and remaining flexible when it doesn't, will serve you well during it all. Staying at home is a great goal, but don't allow yourself to pursue the goal to the detriment of you and/or your loved one's health.

Gregory A. Steen is the CEO of Steen & Company, a full-service estate planning firm. Steen is also the host of the popular Truth4Seniors TV program, and founder of Truth4Seniors. He is certified in Life Resource Planning, and a member of the National Ethics Association and the National Association of Senior Advocates. He can be reached at greg@truth4seniors.com.