Long-term care refers to a range of services designed to help people who have lost function due to chronic illness, disability or advanced age. The type, frequency and intensity of services vary depending on the person’s needs but they usually involve housing, assistance with day-to-day activities and/or medical care. Most long-term care patients are 65 years or older (1).
Traditionally, long-term care has been associated with institutions such as nursing homes that provide 24-hour room and board, supervision and nursing/medical care. But long-term care is also provided in other settings: at home (either the individual’s home or that of a family member) or at one of several other types of residential/assisted living facilities.
The majority of older adults receive long-term care informally at home, from unpaid non-professionals – usually family members or friends (2). As needs change, the family may arrange for additional support, for example, a weekly or biweekly visit from a home care professional. Initially, the main advantage of home/community-based care was that it was much less expensive than going into a nursing home. Today, that’s still a factor for some, but it’s usually not the most important one. As more and more older adults strive to stay active, maintain their independence and enjoy a good quality of life, many prefer home/community-based long-term care (3).
It sounds great but it begs the question, is it a safe and effective long-term care option?
What the research tells us
To answer this question, the Agency for Healthcare Research and Quality (based in the US) compiled, reviewed and summarized the results of 32 studies conducted from 1995 to 2012 comparing home/community-based care and assisted living to nursing home care for older adults (4). What they found was that changes in physical and thinking abilities and emotional well-being did not differ greatly between nursing home and assisted living residents. There was also no significant difference in the mortality rate between residents in these two environments.
The comparisons between nursing home care and home/community-based care were not as clear, however the researchers found that different living environments pose different risks. For example, nursing home residents were less likely to experience pain or use anti-anxiety medication but were more likely to get pneumonia or have a pressure sore than older adults who were receiving home/community-based care.
What does that mean for older adults and their families weighing the pros and cons of long-term care options? While the evidence is considered “low-strength” and further research is recommended, these studies suggest that the risks and benefits may not be significantly different between home/community-based care, assisted living or nursing home care. Ultimately the best setting suits the needs and unique circumstances of each individual and the people caring for them.