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It's honestly entirely a personal decision driven by (among other things):

1. How available you or other family members are to manage care by aids and to check on your elder
2. Age, condition, needs of the elder and ability of agency or aids to address them safely
3. Most of all, assets. In home care is very expensive dependent on how many hours daily are required.

It's ALWAYS good to consider it when you see the need for it rearing its head. So, gather costs, availability, reliability, assets together, explore in facility care places, and get a good idea what you are looking at.
This is something for family to do TOGETHER if you all get along, first in DISCUSSING it, and the assigning, taking action, exploring, forming lists of questions and plans, and meeting to reassess thoughts on the subject.

We, as a Forum of strangers who don't know any of you or the needs, assets and availability of care in your area probably won't be a great help just now, but when you are ready to go we can help you form lists of questions for ALFs and MC facilities as well as of agencies.

Good luck. Starting the new year off with a bit on your plates, I think? We are here to help you attempt to think it through.
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Reply to AlvaDeer
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For me, an AL. No worries about aides quitting or not showing up. Payroll for these aides. With an AL there is a Nurse and aides around the clock.
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Reply to JoAnn29
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In our situation with momma - I live out of state being the primary caregiver with no help from siblings that live local. Also once I started adding up her expenses that if we left her in her house with aides she would have burned through her money quickly. She couldn't drive anymore, was not taking her medication correct, wasn't doing anything for herself in her house, couldn't handle a checkbook any more, being taken advantage of my siblings wanting money out of her, the housekeeper was taken advantage of her (wanted more money) and her medical needs were increasing especially after she fell a couple of times and suffered double hemotomas. Dad had purchased her a LTC policy and when she did go into assisted living she got approved. The value of that policy was over $500 thousand and we have been using it for the past six or seven years. She still has some left on it. Of course her and my siblings don't like me very much because I squished the money train and momma didn't want to go into assisted living but she is somewhat better off there then living at home. She will be 91 in May.
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Reply to akababy7
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when is the right time to start thinking about it ? As soon as you can. Since you raised the question , start looking into it. As to making the decision, first you need to think about the current needs, think about the future needs (they usually increase progressively), and determine whether staying home or AL will be better. It depends on a lot of factors but start looking into it, talking to other pertinent members of the family and support structure about it now!
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Reply to strugglinson
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The decision may be made for you when the person being cared for can't manage without an aide present. We're going through this right now with my 92yr old mother, in our 9th year of home healthcare. She adamantly refuses to go to assisted living, though the social workers and I try to convince her every time she's in the ER-hospital-rehab (regularly).

My mother had worked up to having a CNA from 8am-1 or 2pm daily; since her last return from rehab (2 days before Christmas!) an additional daily CNA has been added from 5-8pm (the rest of the time she's in bed with an emergency call button). The very good agency is struggling to schedule these additional hours, and it's been really rough with the holidays, bad weather, and illness.

The aides are excellent & very caring, and I feel really bad about what they're being expected to do: split shifts with all of the additional driving back in the evening. And they also have to work at the facility. But this has become a big problem, because my mother cannot take care of herself at all. (She now lets the aides in for their shift by pressing her garage door opener while in bed.)

I'm not willing to step in and help with her care - I have a fulltime job and don't have/am not willing to get the training to give my mother the care she requires. I believe (as do her doctors) that she is long past the need for a facility. I'd stop doing her shopping if I thought it would force her into care, but I know if I did, she would simply demand more aide hours to do her shopping for her, and I would feel guilty about having that added to their burden. Fortunately/unfortunately, she has the means to pay for whatever she wants. And in-home care at this level does cost much more than an excellent assisted living facility.

It's important to be aware that health crises usually occur suddenly (e.g. broken hip) and it can be very difficult to pivot to get the additional in-home help that will be needed.
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Reply to Oldestchildof4
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We found using an aide in the home to be a good option for the time period when help was needed on a limited basis. My dad hired a great helper for daily help from 8am-2pm, during which he showered so she’d be nearby if there was a fall, she made breakfast and lunch, prepped a dinner, did laundry as needed, took him on errands and appointments as needed, and whatever else they came up with. We also found that dad’s needs were quickly increasing and the arrangement wasn’t going to remain as an option for long. He couldn’t afford to pay for more helpers to cover the remaining hours, the falls were happening at a faster rate, and his overall health was quickly declining. Had he lived much longer, we’d have had to change to some form of managed care. The right time for assisted living is when the needs of the person overwhelm the help reasonably available, and it’s never fun to reach that point. Caregivers must protect not only those they love, but their own wellbeing in order to continue to advocate and support the person in need
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Reply to Daughterof1930
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More information is needed. Does this person live alone ? How much help does LO need? Are they safe home alone overnight ? Does this person have dementia ? Is LO cooperative ?

In general 24/7 paid care at home is much more expensive than AL .
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Reply to waytomisery
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Ledwards83 Jan 1, 2025
She does live alone. She is now needing help with medication as she hasn’t been as diligent taking it as she should. She did have two falls recently but is ok - no rehab needed. Does like to have someone there for bathing (in case she feels a bit uneasy). She is approved for an aid but they have been inconsistent and not reliable. She can prepare her own meals.
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