In-Home Care vs. Residential Care: How to choose the right care option
This article is designed to help simplify the decision making process for selecting the most appropriate care option when it comes to selecting between In-home care and residential aged care. It incorporates insights from the aged care industry on what to look for, and what you need to be aware of when selecting an appropriate aged care support.
The decision for care can be a tough
The decision to turn to residential care or in-home is never simple. It’s important to understand that the process can take several weeks not only to select the right care provider that matches your requirements, but also to find a bed within the right facility.
When you start your research you’ll potentially hear several stories of families making the aged care decision following everything from serious accidents that result in permanent impairment, to individuals recognising that appropriate care will allow them to achieve an improved quality of life and provide more independence. There is definitely some fear and trepidation within this process for all involved. Expert advice can make navigating care selection easier.
So let’s first start with understanding the difference between an aged residential care and in-home care.
What’s the difference between aged residential care and in-home care?
When compared to residential care, in-home care is generally agreed to be the best choice when it comes to the two options. But before selecting one of the two options you need to consider the level of care that is needed.
With in-home care, you stay at home and your care plan is built around this, to match your lifestyle requirements. This is what makes in-home care so good. You retain your independence, while gaining a support plan that ensures you also retain quality of life. Services are tailored to suit your individual requirements - covering everything from; personal care, domestic support and social assistance.
Residential care is more suited to those who require more direct and intensive support that is ongoing. It comes in two forms, permanent live in care and temporary or short term care. Understand that when selecting this form of care there is less one to one attention, when compared to in-home care, as residential care facilities will always be made up of a set staff number who are providing assistance to several residents within a schedule of daily events. The care delivered is still good, but is done within the framework of a daily schedule that the broader residential group will also generally follow based on facility type.
How to make the aged care decision
Step 1: Get an ACAT / ACAS assessment
What version of care is best for your situation - residential care vs home care. The best place to start in answering this is with your preferred doctor, who can provide a realistic review of your care requirements.
Your doctor can also assist with getting you in contact with the Aged Care Assessment Team also known as ACAT (or ACAS based on your home state) for care requirements and eligibility - but you can also call them directly if preferred. This assessment will be an in person appointment completed in your home and will be used to determine the suitability of residential aged care or in-home support.
Step 2: Do your research and gather knowledge
At this stage there is no regulated rating system or true measure of quality for aged care facilities. Facility accreditation today is focused on safety, but does not account for quality of service. This lack of a quality standard puts consumers at a slight disadvantage as it means families don't really have a full picture of what they are paying for. So what are some considerations you should account for?
Residential care - - ask yourself and the care facility the following:
- What are your first impressions?
- Does the facility feel clean and inviting?
- Is there a resident-centered care approach in place?
- Is the environment spacious e.g. bedrooms, bathrooms, and common spaces like living rooms?
- What are the staff like and how many residents do staff tend to look after based on the nature/size of the facility?
- How qualified are the staff?
- What is the staff turnover of the facility like?
- Are there culturally appropriate care options?
- What is their restraint use policy?
- How do they foster the involvement of family and friends in the care process?
- Are residents happy and actually really cared for?
- Are there scheduled activities that allow residents to interact and go outside?
- What common facilities are made available to residents?
- What does end of life care look like within the facility?
- Was the facility open to you asking questions and did they actually answer them well?
Avoid the bling! Facilities will advertise; pools, gyms, ensuites etc so you buy into the resort style living dream. But the reality is that the majority of individuals in aged care classify as high-care - meaning that the majority never really utilise the resort style living on offer. The focus should be on quality and number of staff to patient ratio, design of the lived environment and general quality of therapeutic care provided to residents.
In-house care - - ask yourself and the care provider the following:
- Who are your caregivers certified under?
- Are caregivers insured through the lead agency?
- How does the agency hire and review/ assess caregivers?
- How often is caregiver performance reviewed/evaluated throughout the year?
- Is there any ongoing training provided to caregivers and if so, what is it?
- If there are any compliance issues how are these reported and managed?
- What is the plan for backup resourcing?
Step 3) When evaluating providers consider the following 4 key points
- Compare service providers - Evaluation is important. Do you research and compare service providers in order to find the best fit for your situation and requirements. The wider the research the better for identifying what a good standard of service provision is. You should feel free to interview both the staff that will be working with you, and in terms of residential care definitely speak to residents and their families where possible. Visit the facility and assess things such as rooms and the food.
Feeling lost in regards to what questions you need to ask? Don't worry, there is some excellent government resources out there to assist;
- Ask about staffing ratios when it comes to residential care - Currently there is no regulation on staff to residents or skill when it comes to aged care, so ensure you ask about this. When it comes to staff ratio the focus needs to be on how many staff are providing direct care to the residents in the facility. Ask about nurse numbers as well as personal care numbers for the facility, along with allied healthcare support i.e. osteopaths that may visit the facility regularly. It’s also a good idea to ensure a site visit so that you can see such teams in action to determine the level of care they work with when it comes to residents.
- If looking for specialist care support check on staff knowledge and accredited skills
- If requiring specialist support for a disease such as Alzheimer’s or even for care needed for someone who is hearing impared then definitely do check staff qualifications and capability across the related area. Furthermore also request a breakdown of how such specialist care would be provided over a regular day. This includes asking about things such as restraint policy and rates for facilities that may be looking after people with dementia.
- Look into daily routines - This critically includes looking into regularity of access to doctors, nursing and general allied specialist. While also taking into account what a schedule looks like for a regular resident, in comparison to someone who may have more complex needs e.g. dementia vs. someone who may be more independent and want to regularly go out over a day with family. How a facility sets up its routine based on resident need will tell you a lot about the quality of care. Indeed feel free to also test this through a temporary care arrangement.
The above are a few simple tips to help you start understanding how to navigate making a decision about in-home care or residential.
A key part of this process is to understand your rights and protections.
In-home care rights and responsibilities of all sit under the Australian Government's new Aged Care Quality Standards, via the Charter of Care Recipients' Rights and Responsibilities - Home Care. Aged care rights are made available via the government's Rights and Responsibility charter.
This list isn’t all inclusive, but we think it’s a great start. Ensure you get your questions answered in order to feel comfortable with the final care option you select.