As social gerontologists, we frequently encounter this dilemma. Before offering suggestions, we conduct a comprehensive study of the client’s situation, considering factors such as disease progression, current ‘disability,’ prognosis, rehabilitation possibilities, available support systems, and financial implications. This article compiles instances where clients grappled with the decision of ‘staying at home’ versus moving to a care facility. Let’s delve into these concerns.

  • Roshan J Mundapallil, Sowmya Lakshmi

With a growing population of older adults in India, the demand for Long Term Care Services (LTCS) is rising significantly. LTCS encompass a wide range of medical and social services aimed at assisting older adults and individuals with infirmities in performing activities of daily living (ADLs) such as bathing, eating, medications, toileting, as well as instrumental activities of daily living (IADLs) like grocery shopping, cooking, purchases, and transportation. While approximately 60-70 percent of Indians may require LTCS in their lifetime, predicting the duration remains challenging. The necessity for LTCS increases with age, as individuals over 80 often require five times more assistance with personal care than those under 80. These services can be delivered in various care settings, broadly categorized as institutional care facilities or at home. The question arises: Is it preferable to stay at home with community-based support or move to institutional care?

The majority of Indians express a strong inclination to “age in place,” reflecting a global trend of preferring to stay in their homes for as long as possible. This desire is particularly pronounced among older Indians, who harbour a dislike for institutionalisation. But, at some point, you or a loved one may face the decision of whether to stay at home or move to an assisted living facility to meet long-term care needs. The response hinges on various factors, including the level of infirmity and independence. There’s no straightforward answer, and staying at home may not be the right choice for everyone. To make the most informed decision, factors such as health condition, ability level, financial considerations, and available support networks should be carefully considered.

“I faced considerable challenges persuading my elderly parents to consider moving to advantAGE Care Home instead of living alone. Despite my efforts, they wanted to stay back, supported by various aides, often leading to emergencies where I had to intervene. It was a tough time for me, always worried about their safety. However, after my mother’s passing three years ago, my father approached me on his own, expressing readiness to go to advantAGE home. It seems that the loss of my mother left him feeling lonely. Initially, he voiced complaints, particularly about the food and noise, but I anticipated a positive change. True to that expectation, he is now much healthier, happier, and enjoys his newfound company. This is how Renuka described her father’s transition to institutional care.”

“My grandmother had been dependent on my elderly parents for care since she lost the ability to walk last year. During a short visit to my hometown in Hassan, my parents planned to place her in a care home in Bangalore. I resisted, knowing it went against her wishes and fearing it would make her unhappy. However, my parents convinced me with compelling reasons. Seeking guidance, I turned to you, and you conducted a thorough analysis of the physical, social, and financial aspects, recommending institutional care.

Despite my initial belief in the benefits of in-home care surrounded by friends and family, witnessing advantAGE seniors assisted living facility changed my perspective. The ‘culture change’ concept and the ‘privacy policy’ of advantAGE seniors impressed me. Given the practical constraints of my living in the US and being unable to provide physical assistance, I moved my grandmother to advatAGE seniors assisted living. Through weekly video calls I am in regular touch with her, she hasn’t voiced any complaints and appears to have adjusted well. Sunanda Ram, residing in Connecticut, shares how the initial predicament transformed into a win-win situation.”

At the age of 78, Govind Pai relocated to Bangalore, where he lived independently in a retirement home for four years. Having retired from Canara Bank in Bangalore and appreciating the city’s climate, he believed it to be an ideal place to spend his remaining days, especially after the loss of his wife to cancer. Desiring independence and preferring not to live with his daughters, he moved to a retirement community in Bangalore on his own. However, except few bank colleagues and few distant relatives none of the immediate family resides nearby – they all live in different cities, closest is at least 600 kms away. Following a fall and subsequent hip surgery, the retirement facility where he was residing lacked the expertise to care for the bedridden. A friend recommended advatAGE skilled nursing home and the family shifted Pai uncle to our skilled nursing facility.

Occasionally, he expresses missing his family, attempting to figure out a way to “come back to Hubballi. “At this condition, we lack the capability to provide comprehensive support, requiring round-the-clock caregivers for his extended bedridden state. Despite personal pleas to stay in Hubballi, he left, disrupting the care arrangements. Now, we believe it’s best for him to stay at your care facility, where he receives good nursing care. At this point care is most important for recovery. We are aware of the complexities of looking after the bedridden, returning to Hubballi would likely result in loneliness and isolation. Family members can visit Bangalore periodically and see him”, Ranjit, youngest son-in-law, is forthright in admitting his family’s inability to look after his father-in-law at this stage and convinced about the care he is receiving now. Ranjit wants us to counsel his father in law to stay back.

I As mentioned earlier, the majority of elderly Indians express a preference to age in their own homes, and this inclination is easily understandable. This choice holds several significant advantages that make it appealing to many:

Comfort and familiarity: Remaining in a cherished, familiar environment helps alleviate uncertainties and fears associated with aging.
Established routines: Retaining control over daily patterns, from waking up to meal choices, provides a sense of independence.
Convenience: (Opting to stay in one’s own home eliminates the challenges of packing, downsizing, and dealing with movers.

Now let’s see the disadvantages of staying back in your home. Unfortunately , aging in place at home presents its own set of challenges, often overshadowing the advantages:

Managing a home can be difficult and dangerous: Routine home maintenance, and household chores can become increasingly challenging as our bodies age and energy level dips. Living alone, seniors may overexert themselves in keeping up with home demands, risking injury.
Frequent entry of strangers: Food delivery persons, cleaners, repairmen, and health professionals may need regular access to your home, which can be unsettling, particularly for those with cognitive issues. Unnoticed health issues: Seniors are susceptible to various health problems, some of which are challenging to self-observe. This will in turn develop into grave problems.
Isolation as a serious threat: Unfortunately, one in three older individuals experiences loneliness, contributing to severe mental and physical health issues. As mobility diminishes and leaving home becomes harder, the risk of isolation intensifies.

Working extensively with the senior population for many years can be emotionally challenging, as we sometimes find ourselves needing to counter the priorities of our clients, potentially causing emotional distress. However, we provide recommendations after carefully considering the advantages and disadvantages of both home care and institutional care, even if it goes against the client’s wishes. While many seniors express a desire to remain in their familiar environments for as long as possible, practical considerations come into play, and when support systems weaken, the necessity for institutional care may arise. As practitioners in social gerontology, our preference is for seniors to stay in their own homes as long as they can manage independently. Once signs of infirmity emerge, it becomes crucial to reassess and make informed decisions.

When the time comes to decide how to help an elderly loved one through those difficult days when they aren’t physically able to care for themselves, the decision can be a difficult one. How do you know what’s right for the senior in your life? This article doesn’t outright advocate for institutional care but underscores the importance of evaluating specific factors as indicators for the appropriate path. A thorough assessment of the client’s needs forms the foundation for determining the most suitable approach. By weighing the advantages and disadvantages of both home care and nursing homes, a more informed decision can be made.