Home and Community Care for the Elderly

As the United Nations reported in 2009, the world’s population is aging. And today, across the globe, policies and attitudes are shifting to accomodate an increasing demand for high quality care for the elderly. In an effort to improve service quality and reach, national health care coverage programs that directly assist the elderly, such as Medicaid, are facing reconsideration and reform. In the United States, over 42 million families consistently provide caregiving to the elderly, while more than 60 million families have or will provide temporary care to aging loved ones.  Unfortunately, according to the AARP, many families are unprepared for the emotional and financial demands of elder care.

In the United States, elderly care can include assisted living, adult day care, nursing homes, hospice care and in-home care. Although ninety percent of elderly parents prefer staying at home than moving into an adult care facility, their gradual disabilities may make it unsafe for them to stay at home alone. The care for senior citizens in adult care facilities frequently includes specific designs in housing that cater to the elderly (such as elevators and limited staircases), as well as recreational activities and therapy.

The following is a broad overview of the most common types of elderly caretaking facilities, and will be helpful to readers who are unfamiliar with elderly care in the U.S. Importantly, like any type of caretaking, elderly care should be approached with respect: although the elderly might need assistance with daily activities, they also desire to live with dignity.

Assisted Living

Assisted living consists of housing facilities for the elderly and the disabled. These housing facilities provide assistance with daily activities, coordinate services with other health care providers and monitor all residential activities in order to support residents’ well being. Assisted living facilities can be expensive. Currently the annual national median of costs is almost $40,000, as Medicaid does not cover assisted living.

Assisted living facilities can be thought of as a bridge linking home care and nursing homes; although they offer a great deal of help, they also do not typically provide the high levels of continuous nursing care found in hospices, hospitals and nursing homes.

Adult Day Care

Adult day care consists of non-residential day services for the elderly and disabled. Most day care centers operate ten to twelve hours a day, offering meals, social and recreational activities and constant general supervision. As adult day care is meant to temporarily relieve home caretakers, this service can be useful in situations where the elderly are still well enough to stay at home. Currently more than 4,600 adult day centers operate in the U.S., which provides care for about 150,000 elderly Americans.

 Nursing Homes

A nursing home, also referred to as a skilled nursing facility (SNF), is a type of residential care facility provided for the elderly. They are geared towards individuals who need constant care and assistance with daily activities, as their services frequently include speech and occupational therapy, recreational assistance and transportation. In nursing homes, skilled licensed practical nurses (LPNs) and/or nursing aids should be on site twenty-four hours a day. Unlike assisted living, nursing homes can be reimbursed by Medicaid.


Hospice care is palliative, residential care provided for the terminally ill. Its underlying philosophy is to approach care with self-respect and tranquility, as hospices do not approach care from a “medical” perspective. Rather, their facilities emphasize holistic treatment, approaching death as a human experience that benefits from medical care, rather than the other way around. Anyone who enters into hospice care is usually within the last year of their lives, as they are choosing to live the final year with controlled pain and respect. Hospices are usually more affordable than assisted living and hospital costs, ranging from $70 to $100 a day for care. Currently Medicaid only partially covers costs for hospices.

 In-Home Care

In-home care, also referred to as social care, is a caretaking service provided at a patient’s home.  Services can include aiding the elderly with daily tasks such as bathing, preparing meals, recreational activities and eating. In-home care is best for families who need some assistance taking care of elderly parents or relatives living at home. In-home caretakers frequently include licensed practical and registered nurses, as well as social workers. In-home care costs can vary per state, from $15 to $30 an hour.

Elderly care always depends on the needs of the senior citizens, as well as the needs of those who take care of them at home. For example, if someone is terminally ill, home care or hospital-based hospice care would make more sense than nursing homes or assisted living. Additionally, there are several other related issues that need to be carefully researched and considered before decisions on elderly care are much such as Medicaid, costs and elderly independence.