When Your Loved One Has Dementia: The Home Versus Move Debate

When your loved one has a diagnosis of dementia, the desire to keep them home as long as possible is usually one’s first instinct. However, in some cases, one or both of you moving to a senior living community may make more sense in the long run. Both choices come with their own set of advantages and challenges, and the decision is often shaped by personal preferences, financial situation, caregiving support, and general health needs.

The Importance of Proactive Planning

Planning is key when it comes to long-term care. Traditionally, planning follows a timeline of saving, spending, and sharing. However, this approach is often reactive, addressing issues only as they arise. With a dementia diagnosis, it’s important to plan for both present and future healthcare, housing, legal, and financial needs.

Rather than sticking to the traditional planning timeline—saving for retirement, managing expenses during retirement, and leaving a legacy—an updated approach emphasizes continuous financial planning that adapts to changing cognitive and health circumstances. Being proactive rather than reactive can make all the difference.

The Challenges of Decision-Making

One of the biggest hurdles in making these decisions is the uncertainty about future needs. Statistics show that 70% of people over 65 will require long-term care at some point, with an average duration of three years. These numbers are often higher when someone has a dementia diagnosis, highlighting the importance of making informed decisions about care options well in advance. According to the Alzheimer’s Association, “People age 65 and older survive an average of four to eight years after a diagnosis of Alzheimer's, yet some live as long as 20 years with Alzheimer's. This reflects the slow, uncertain progression of the disease.”

Understanding Medicare and Medicaid

A clear understanding of Medicare and Medicaid is crucial when planning for long-term care. It’s important to note that Medicare does not generally cover long-term care. Yet, the Alzheimer’s Association reports, “Medicare beneficiaries with Alzheimer's or other dementias are more likely than those without dementia to have other chronic conditions, such as heart disease, diabetes, and kidney disease.” On the other hand, Medicaid can help, but only after meeting strict eligibility criteria, including a significant asset reduction. This can dramatically reduce a family’s savings, so it's essential to be fully aware of these factors when planning for long-term care.

Exploring the Spectrum of Long-Term Care Options

Long-term care comes in many forms, and it’s essential to understand the range of options. According to the Alzheimer’s Association, “People living with Alzheimer's or other dementias make up a large proportion of all elderly people who receive adult day services and nursing home care.” Senior housing options vary from independent living to memory care and nursing homes, each providing different levels of care and supervision. Selecting the right option involves first considering if you are both moving or if you are at the point where the person with the diagnosis may have to move to memory care. Making this decision involves understanding your current and future healthcare needs while addressing the financial, emotional, and logistical implications. Here are some key options:

• Aging in place with home care: Staying in your home while receiving necessary home care or healthcare services.
• Downsizing to a life plan community: Moving to a community that offers various levels of care as needed, where ideally, you can both start out together in Independent Living.
• Moving to Memory Care: The person with the diagnosis living in a community that provides assistance with activities of daily living (ADLs).
• Transitioning to a nursing home: Receiving 24-hour medical care and supervision.

Weighing the Pros and Cons: Staying Home vs. Moving to a Community

The Desire to Age in Place

Many older adults wish to stay in their own homes as they age. According to Georgetown University's Global Social Enterprise Initiative, 91% of seniors want to remain in their homes, and 96% believe it’s important to maintain as much independence as possible.

The Costs of Aging in Place

While aging in place is a popular choice, it can be expensive. Home care costs can exceed $250,000 per year, depending on the level of care needed. According to the Alzheimer’s Association, “family caregivers bear 70% of these costs in unpaid caregiving and out-of-pocket expenses”. Additionally, there are other costs to consider, such as home accessibility and safety renovations, ongoing maintenance services, and care management.

The Decision to Move

Deciding when to move to a senior living community is challenging. Whether to move shortly after a dementia diagnosis or later when the disease has progressed further depends on several factors, including health, financial situation, and personal preferences. Moving early allows for better planning and a smoother transition, while moving later may be necessary due to immediate health needs, a recent crisis, or safety issues like wandering.

Comparing Scenarios: Aging in Place vs. Moving to a Community

If you wish to age in place, it's essential to consider several important factors to ensure your home remains a safe and supportive environment for your loved one with dementia. Key aspects include home accessibility renovations, such as installing ramps or chair lifts, widening doorways, adding locks, and installing grab bars.

While you may initially require just a few hours of home care per day, planning for the potential need for more extensive assistance with activities of daily living (ADLs) as you age is vital. Adult day programs for loved ones with dementia are another option. Over time, the costs of staying at home with increased care needs can exceed those of moving to a memory care assisted living community. For example, while assisted living could cost over $100,000 annually, the expense of 24/7 in-home care can surpass $250,000 per year.

Additionally, consider the emotional and social aspects of aging in place, such as potential isolation, and whether your home can meet advanced healthcare needs as they arise. It's also wise to consider the availability of family or community support, access to emergency medical services, and whether your home environment will allow you to maintain your quality of life and independence over time.

Several factors should be carefully evaluated when considering a move to a life plan community. Key decisions include the timing of your move, the logistics of selling your home to cover the entrance fee, and ensuring that your income can sustain the ongoing monthly fees both now and, in the future, as you transition to higher levels of care.

Additionally, when selecting an independent living or assisted living community, it's important to consider the availability and variety of activities, any religious affiliations that may be significant to you, the community’s proximity to your family, and the costs associated with additional levels of care for memory care. It's also worth exploring the community's approach to social integration and the availability of wellness programs, which can help maintain your overall well-being and quality of life as you age.

For those considering a nursing home, you should assess whether the community accepts Medicaid, its location relative to family, and the staff turnover rate, which can impact the quality of care. Other important considerations might include the community’s reputation, resident satisfaction, quality of on-site healthcare services, and the availability of specialized care for conditions like dementia or Alzheimer’s.

Building a Supportive Team

Since so many decisions across many disciplines (healthcare, legal, finances, housing, well-being, etc.) go into long-term care planning when your loved one has dementia, it can be overwhelming, confusing, and anxiety-inducing. However, having a well-thought-out plan can instill confidence and peace of mind. Surrounding yourself with a team of professionals—such as financial advisors, healthcare professionals, and elder law attorneys—can provide the comprehensive support and guidance you need.

Proactive planning is essential whether you decide to age in place or move to a senior living community. It ensures financial stability, access to necessary care, and peace of mind for both you and your family. After your dementia diagnosis, don’t wait for a crisis—start planning today to secure your future and maintain your quality of life as you age.

Want to Learn More?

Check out the webinar: How Will We Pay for Care: Financial Considerations of Caregiving

Author
Arvette M. Reid, Client Services Director, Signature Estate & Investment Advisors (SEIA)

Arvette brings a unique perspective to the healthcare-driven financial discussion. Born and raised in Alexandria, VA, Arvette spent 15 years in the senior housing and healthcare industry before joining SEIA six years ago. Her personal experience of dealing with her mother’s unexpected decline after surgery and her father-in-law’s move to a retirement community adds depth to her professional insights. She brings the perspectives of a professional and an adult child.

At SEIA, our philosophy is "Planning First." A healthcare-driven financial plan drives the investment strategy, focusing on cash flow rather than just assets. Understanding your income needs and how to cover housing and dementia care costs is vital to your financial well-being.