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The information in this guide should not be considered legal advice. While we strive to provide as detailed, reliable and understandable legal information as possible in our Elder Law Guides, they cannot substitute for an attorney applying the law and years of experience to a particular client situation. We urge readers to use the Guides as background material and to consult with one of our members before taking action.

Alternatives to Nursing Home Care

Devise creative solutions to care puzzles

Staying home
One of the greatest fears of older Americans is that they may end up in a nursing home. This not only means a significant loss of personal autonomy, but also a tremendous financial price. Depending on location and level of care, nursing homes cost between $60,000 and $300,000 a year. In 2016, the median cost of a private room in a nursing home was $92,378 a year, according to Genworth.

Studies show that older Americans prefer to stay in their own homes if they possibly can – not a surprise. As a result, most care is provided at home, whether by family or by hired help. Read More

This has many consequences, some of which may be quite unexpected. To begin with, family members shoulder most of the burden of caring for the elderly at home. Being the primary caretaker for someone who requires assistance with activities of daily living, such as walking, eating and toileting, can be a consuming and exhausting task. One important consideration when one family member has the sole responsibility of caring for a parent or other older relative is the question of equity with other family members. For example, is the child being fairly compensated for her work? If the older person is living with a child, does the elder help pay for the house? If the care is taking place in the elder’s home, should the child have an ownership interest in the house?

For parents with only one child, such arrangements may not be so complicated, but if the parent has more than one child, it can be difficult to know what’s fair.

An arrangement that seems equitable today may not seem that way after a child has devoted, say, five years to the care of the parent.

An important consideration when one family member has the sole responsibility of caring for a parent is the question of equity.

And if a plan is set up that is fair for five years of care, what happens if the parent suddenly moves into a nursing home during the first year? With no planning for such eventualities, the care of an older person can foster resentment and guilt among family members. Fortunately, most elder law attorneys are skilled in helping families devise creative solutions to such problems. Read More

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Getting outside help

State and federal government officials are slowly recognizing that home care is more cost-effective than institutional care. This means that, depending on the state, financial or other assistance may be available for those who choose to remain in their homes despite declining capabilities.

Public and private agencies offer a variety of home care services that may be available:

  • Home health care, either part-time or 24-hour care
  • Personal care and homemaking services, such as shopping, cooking and cleaning
  • Services delivered to the home, such as meals programs, transportation and home repair
  • Adult day care centers that offer more intensive services than senior centers. There are more than 5,600 such centers around the nation, according to the National Adult Day Services Association (, and they are often affiliated with churches or non-profit community agencies
  • Money management
  • Respite services. These programs provide caretakers a periodic break. A home care professional or aide substitutes for the caretaker for a specified period of time

Medicare and Medicaid provide some coverage of the medical portion of home health care. Although the coverage is often inadequate, when combined with other resources available to the client and his family, it may be enough to keep a fragile older person at home for a longer period of time. Read More

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Medicaid Rules, etc

View All Elder Law Topics Questions & Answers State Medicaid Information