Caregiving: Nursing home or care at home? The emotional question There was a time when Grandma always lived at home and maybe we like to think it was like life with The Waltons where mom and dad and their many kids all honored and cared for crusty old grandma. Sadly, the days of The Waltons are gone, along with big families and the farm life that, in any case, offered few alternatives to care. What most families have now is one daughter or son who keeps mom or dad at home, trying to attend to daily needs and medical care, mainly alone. It can be rewarding, isolating, and exhausting for both caregiver and patient. According to Caring Steps and Stages, these are the issues that families face when a loved one gets dementia or suffers physical ailments that can no longer be treated independently. These days, when a person is hospitalized for treatment under Medicare, they often go to a nursing home for rehabilitation, which can last up to 100 days, depending on the patient's progress. During this time, family can make the decision to take the patient home or start a longer term stay in the facility. Here are some primary triggers to consider a nursing home: Caregiver's health declines -- The caregiver must be physically and emotionally able to make meals, maintain housekeeping, cope with emergencies, and provide companionship. Senior's health declines -- When skilled medical care becomes a daily necessity, a nursing home becomes a prime consideration. Nursing home medical care often improves a patient's health. Cost of home care becomes excessive -- A home aide costs at least $20 per hour ($160 per day). Staffing can become an issue if the senior requires 16- to 24-hour skilled care. A skilled care nursing home costs $220 per day but it also offers 24-hour care. Here are some issues the patient will face: Confusion -- Seniors with dementia often do not know where they are initially. They might think they have been arrested, or are in a new home (Where's the kitchen?). They might constantly be worried about paying for dinner (Where's my purse? Waitress!). Dissatisfaction -- They might complain about staff, facilities, food, or routine. But they could also accept this and find the bustle of the nursing home engaging. Loneliness -- All nursing homes have activities, including church services, shopping trips, and games. Family and staff can help to engage patients. The staff social worker might help to link up those with similar cognitive abilities.