Dementia Care Insights: Home vs. Facility Choices

Navigating dementia care decisions can be incredibly personal. In October 2024, we polled 1,000 dementia caregivers to understand more about their needs, their loved ones' needs, and how they've supported their families with memory care.

Based on that survey, dementia caregivers appear to be incredibly confident in the memory care options available — nearly 80% of respondents feel somewhat or very solid in understanding the difference between home care and memory care facilities. Our respondents largely base their care decisions on what their loved ones need, balanced with the support caregivers feel they can provide.

Of the 1,000 dementia caregivers who filled out the Caring poll, the minority (10%) were spouses of someone with dementia or Alzheimer’s. Many more were children, step-children, cousins, siblings, in-laws, or nieces and nephews of a loved one with dementia.

Respondents were fairly evenly split between two genders: 45% of the caregivers were male, and 55% were female. The majority of respondents (66%) were white, and 18% of respondents were Black. American Indians and Asian Americans accounted for 2% or less of respondents per subgroup.

Nearly 60% of respondents said their loved one is early in their diagnosis and living with dementia for one to three years. Since the early stages of Alzheimer's and dementia often require less specialized care, 73% of caretakers say their loved one is receiving care at home rather than a memory care facility.

There are two main types of home care: home health care and in-home care. Home health care is when someone with a medical certification — often a nurse, therapist, or aide  — visits the home to administer medication and skilled nursing services. In-home care involves nonmedical personnel coming to the home to provide services like companionship, meal prep, and transportation. Of the home care respondents, 43.5% said their loved one receives a combination of medical and non-medical care.

In-home care providers also offer medication management; while in-home care companions can’t administer the medication, they can remind your loved one to take it. Medication reminders are a huge benefit of in-home care for dementia caregivers because it relieves them of needing to monitor the clock. 

When asked why caregivers opted for home care, the majority of respondents (692 caregivers) reported that their loved one preferred staying in a familiar environment. “We are here to help families navigate the aging journey while helping their loved one age gracefully wherever they call home, ”says Margaret Haynes, president and CEO of Right at Home, an in-home care provider whose client base is 9% dementia care. “When we think about our mission, it’s not just the seniors or adults with disabilities receiving care, it is really the entire family.” 

Right at Home’s in-home caregiving process involves working with both the loved one and their caregivers to craft a care plan based on routines and lifestyle, which aligns with the most popular reason dementia caregivers chose to keep their loved ones in the home.

Respondents could select multiple reasons behind their choice of home care. Other popular reasons for receiving memory care at home and not in a facility included the home's proximity to friends and family and the ability to more easily personalize home care to their loved one's needs.

Of the caregivers who chose home care, 28% have concerns about memory care facilities. Namely, these concerns relate to quality of care (30% of respondents) and worries over fall risks and abuse by staff (17% of respondents).

Since 17% of our dementia caregiver respondents worry about abuse in memory care facilities, it can be empowering to know what steps to take if elder abuse is suspected. Here are a few elder abuse resources:

• The National Adult Protective Services Association has online resources that can help you file an abuse complaint.
• Reachable via 1-800-677-1116, the Eldercare Locator helps you find local organizations that will assist you. 
• State Long-Term Care Ombudsman programs advocate for residents of nursing homes and assisted living.

Often, after filing an online or phone-based abuse complaint, the complaint will be evaluated to see if it meets your state’s requirements to be labeled as abuse. If the complaint meets that label, an Adult Protective Services representative will meet with the complainant in person to assess the situation. 

For many dementia caregivers who put their loved one in a memory care facility, concerns of abuse are often replaced with concerns that they couldn’t provide their loved one enough support if they remained in the home. 

For 16% of survey respondents, a memory care facility was the best option for their loved one. Potential hazards in the home were the most popular reason caregivers chose a memory care facility — nearly 75% of respondents who opted for a memory care facility cited home safety concerns. 

Memory care facilities know caregivers look to them for safety and trained support. “Our commitment is to provide the highest standard of care,” says Dawn Melanson, vice president of sales and marketing for ProMedica. For ProMedica’s Arden Courts memory care community, that standard involves rigorous safety protocols and comprehensive staff training. Melanson continues, “Our experienced caregivers are dedicated to nurturing a supportive and safe environment where residents are treated with the utmost respect and dignity. We invite families to discuss any concerns directly with our team, as we are here to provide reassurance and transparency."

According to our survey, the second-highest motivating factor behind choosing a memory care facility was the presence of professional staff members who could provide specialized medical care. In the poll, specialized care tied with caregivers feeling unable to manage care at home. This overlap indicates that many of the dementia caregivers reached the limit of what they could do for their loved ones in a home setting.

For our respondents, proximity to other loved ones played a small part in caregivers opting for a memory care facility, with nearly a quarter of caregivers choosing a facility close to friends and family. However, when respondents were allowed to rank proximity against factors like cost and service specialization, proximity was the least important factor in choosing the facility instead of home care. Factors like quality of care and safety far outweigh proximity to friends and family.

When deciding between home care and a memory care facility, quality of care was the most important factor for all dementia caregivers in our survey. Their loved ones' safety and emotional well-being ranked the next highest. 

Our survey revealed that caregivers primarily focus on the quality of care. Of those with a loved one in a memory care facility, 36% of respondents worry about the quality of the care their loved one with dementia receives, while 32% are also concerned about the quality of care they'd receive if they were home instead.

Meanwhile, 28% of surveyed caregivers chose home health care because they worried about a facility's quality of care. But even with their loved one at home, 38% of dementia caregivers worry about the quality of home care.

When asked if caregivers would reconsider their choice of care, 61% said they wouldn't. Only 8% of caregivers would switch to home health care, while 10% would opt for a memory care facility if they had to reconsider.

Price was not a major factor in respondents' decisions when caregivers could rank cost alongside their loved one's safety and emotional health. However, 75% of caregivers reported that financial concerns somewhat or significantly affected their care decisions. When respondents were limited to a single selection, 26% of respondents chose the cost of memory facilities as their top issue, and 17% were concerned about the cost of home health care.

When it comes to covering the cost of dementia care, our respondents said the most popular methods of payment were Medicaid or Medicare, followed closely by Social Security and the loved one's retirement funds. It is very common to use multiple sources of income to cover the cost of memory care.

While this payment data indicates that seniors are often well prepared, 270 surveyed caregivers said they're dipping into their personal savings to cover their loved one's dementia care.

Our survey showed that an astonishing 91% of dementia caregivers feel somewhat or totally supported in decision-making about their loved one's care, but that doesn't prevent 52% of respondents from feeling caregiver burnout. Common signs of caregiver burnout include:

• Trouble sleeping
• Weight fluctuation
• Shorter temper
• Increased illness or ailments

Nearly the whole respondent pool —  98% of caregivers —  say their loved one's Alzheimer's or dementia diagnosis has affected their own well-being. It may seem counterintuitive, but looking after yourself is the first step in ensuring your loved one is well cared for. If you're a dementia caregiver who is feeling a little overstretched, visit our guide to coping with stress and burnout.

When asked about the support or resources they were missing, dementia caregiver respondents said they'd love more educational resources and support groups. Others asked for more advice from medical personnel or a caseworker to help them navigate their loved one's dementia journey. More government financial aid would be a plus, as well. Many respondents said they'd love more familial support or assistance from their loved one's spouse.

When we asked caregivers what advice they could share, one sentiment rose above the rest: patience. One of the best things caregivers can do for their loved one with dementia is to take each day as it comes and fill those days with love and understanding. 

Caregiving takes a village. Use these resources to build yours.

• The Alzheimer's Association has a full resource library dedicated to population-specific dementia care, helplines, and online tools. 
• The Alzheimer's Foundation of America has support groups, caregiver webinars, and guides on how to make your home safe for a loved one with dementia.
• The National Alliance for Caregiving offers educational resources like peer support, videos, and pamphlets.
• Well Spouse is a national network of support groups for the spouses and partners that are in the role of caregiver.