By Gary Fenstermacher

Elders experiencing frailty, whether mental, physical, or both, often face a choice between remaining at home or entering a long term care facility. This month’s column examines some of the pros and cons of the two options.

Remaining at home can bring many pleasures as well as challenges. Finding competent aides for in-home care is clearly among the challenges. Aides may be supplied by an agency or independently hired by the elder or family member. In the former case, the aides who visit the home may change occasionally or frequently, depending on how much care is needed and the quality of the agency providing that care. If the elder hires his or her own aides, close and nurturing personal relationships often ensue. Unfortunately, when these aides leave the elder’s employment there is often great emotional let-down along with the trauma of finding replacements.

Staying at home may also increase the risk of falls, depending on the physical layout of the home. Falls typically impact the well-being of the elderly far more than it does younger adults. Loneliness is another possible risk of remaining at home. Some elders handle living alone with little difficulty; for others, the degree of debilitation can range from mild to severe.

Choosing a long term care facility also has risks, though of a different kind. Moving to a much smaller space means relinquishing memories and possessions that bring joy and contentment. It means being in the company of strangers during the weeks after move-in. And it means abiding by procedures common to congregate settings, such as activity schedules and close supervision of medications. There is always a period of adjustment when changing venues, but it is made far easier with careful selection of the facility.

Though often viewed with suspicion, most modern independent, assisted living, and memory care facilities offer highly appealing surroundings, a host of engaging amenities, and a safe, nurturing environment. A well-run facility offers careful monitoring and administration of medicines, a well-balanced diet, professional support for everyday activities, close oversight of the resident’s health, and daily social interactions. On the subject of social interactions, residents and staff members often become quite close. In smaller, more residential facilities, residents and staff members sometimes know more about one another than their own families know.

Good genes and good fortune may allow the elder to remain at home until the end. However, when assistance and support are needed, there is a choice to be made. Neither option should be excluded without careful assessment of the elder’s needs and a thoughtful review of the different facilities available.

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