Watching a parent or spouse need more help each day is hard. You want the best care possible, but what does that look like? Should they stay in their familiar home with caregivers coming to them? Or would they be safer and happier in a facility designed for seniors who need support?
This decision affects not just your loved one’s health but also their happiness, your family’s finances, and everyone’s peace of mind. There’s no one-size-fits-all answer, but understanding the options can help you make the right choice for your unique situation.
What Is Home Care?
Home care means bringing help to your loved one in their own house or apartment. This help can range from a few hours of assistance each week to around-the-clock care.
Types of Home Care
Home care typically includes:
- Personal Care Services: A home health aide helps with daily tasks like bathing, dressing, toileting, and meal preparation. These aides aren’t nurses, but they provide hands-on care that helps people stay independent.
- Skilled Nursing Care: Registered nurses or licensed practical nurses provide medical care at home, like giving injections, caring for wounds, or managing medications. This type of care needs a doctor’s order.
- Homemaker Services: Helpers take care of household tasks like cleaning, laundry, shopping, and cooking. These services don’t include hands-on care but make it possible for someone to stay at home safely.
- Therapy Services: Physical, occupational, or speech therapists visit the home to help people recover skills after illness or injury, or learn to adapt to new limitations.
The National Institute on Aging offers a comprehensive overview of different home care services that can help seniors age in place.
What Is Facility Care?
Facility care means moving to a place designed for people who need help. There are several types of care facilities:
Types of Residential Care Facilities
- Assisted Living Facilities: These provide housing, meals, and help with daily activities. Residents typically have their own apartment or room and get help with things like bathing, dressing, medication management, and transportation. Staff is available 24/7, but there isn’t constant one-on-one care.
- Nursing Homes: Also called skilled nursing facilities, these provide 24-hour care for people with serious health needs. They offer medical care from nurses, therapy services, and help with all daily activities. Residents typically share rooms and follow a structured schedule. This is called ICP Medicaid to distinguish between other types of Medicaid coverage.
- Memory Care Facilities: These specialized facilities are designed for people with Alzheimer’s disease or other forms of dementia. They have extra security to prevent wandering and staff trained to handle dementia-related behaviors. Activities and environments are designed specifically for people with memory problems.
- Board and Care Homes: These small facilities (usually 20 or fewer residents) provide rooms, meals, and basic personal care in a home-like setting. They’re less institutional than larger facilities but offer fewer amenities and services.
Finding quality nursing homes in Jacksonville starts with early planning and careful research.
How to Choose Between Home Care and Facility Care
When deciding between home and facility care, consider these factors:
1. Care Needs Assessment
Start by getting a clear picture of your loved one’s needs:
- How much help do they need with daily activities like bathing, dressing, and toileting?
- Do they need around-the-clock supervision for safety reasons?
- Do they have medical needs that require skilled nursing care?
- Can they call for help in an emergency?
- Are they at risk for falls or wandering?
The Florida Department of Elder Affairs offers assessments through its CARES program that can help determine the appropriate level of care needed.
2. Home Evaluation
If home care seems possible, look at the home environment:
- Is the home accessible with no stairs, or can modifications be made?
- Are bathrooms safe for someone with mobility issues?
- Is the home in good repair?
- Is there room for equipment like a hospital bed if needed?
- Is the location convenient for caregivers to reach?
At Berg Bryant Elder Law Group,we can guide you through early planning, help protect your assets, and create a strategy to ensure your loved one qualifies for the Medicaid program that best meets their needs.
3. Family Resources
Be honest about what family members can provide:
- How much hands-on care can family members realistically offer?
- Who can manage scheduling and supervising paid caregivers?
- Who lives close enough to respond to emergencies?
- How will caregiving responsibilities be shared?
- Will family members burn out from the demands of caregiving?
Even with paid help, home care often requires significant family involvement to be successful.
4. Social Needs
Consider your loved one’s personality and social needs:
- Do they enjoy being around other people?
- Will they feel isolated at home, even with caregivers?
- Would they enjoy planned activities and outings?
- How important is privacy to them?
- How do they feel about following a schedule versus setting their own?
Some people thrive in the social environment of a facility, while others strongly prefer the privacy of home.
How Medicaid Can Help Pay for Long-Term Care in Florida
For many families, the cost of either home care or facility care becomes overwhelming. This is where Medicaid can help.
Florida Medicaid has two main programs that cover long-term care:
1. Nursing Home Medicaid (Institutional Care Program or ICP)
This program pays for care in nursing homes for people who qualify. The good news is there’s no wait list – once you qualify financially and medically, Medicaid will start paying.
To qualify in 2025, you must:
- Need nursing home level care (based on a medical assessment)
- Have less than $2,000 in countable assets as an individual
- Have monthly income below $2,901
This program is comprehensive, covering:
- Room and board in the nursing home
- All nursing care
- Medication management
- Therapy services
- Personal care services
Our guide to Florida nursing home Medicaid planning provides more detailed information about qualifying for this program.
2. Home and Community-Based Services (HCBS) Medicaid
This program can pay for care at home or in assisted living. The challenge is the wait list – it can take months or even years to get approved, and there’s no guarantee when your name will reach the top of the list.
To qualify, you need to meet the same financial limits as nursing home Medicaid. The coverage is more limited:
For home care, HCBS typically provides:
- Home health aide visits (usually a few hours per day)
- Adult day care
- Meal delivery
- Medical equipment
- Some home modifications
Asset Protection Strategies for Medicaid Qualification
Both Medicaid programs have strict financial rules:
- $2,000 asset limit for singles (in 2025)
- $3,000 asset limit for married couples (both applying)
- Up to $157,920 asset allowance for a spouse at home (in 2025)
- 5-year lookback period for gifts and transfers
The Florida Medicaid program has complex rules that change frequently, so working with an attorney who focuses on elder law ensures you have current information.
FAQs About Home Care vs. Facility Care
Is home care always better than facility care?
No. While many people prefer home care, it’s not always the best option, especially for those who need 24/7 supervision or have complex medical needs that require skilled nursing care.
When is facility care the better choice?
Facility care is often better when someone needs around-the-clock supervision, has advanced dementia with wandering behaviors, has very complex medical needs, or lives alone without nearby family support.
Does Medicare pay for long-term care?
Medicare pays very little for long-term care. It covers short-term skilled nursing (up to 100 days) after a hospital stay, and limited home health services when ordered by a doctor, but not ongoing personal care.
How can I pay for long-term care if I can’t afford it?
Options include Medicaid (if you qualify), veterans benefits (if eligible), long-term care insurance (if you have a policy), reverse mortgages, and family cost-sharing.
Can I get Medicaid to pay for care immediately?
For nursing home care, yes – if you meet the financial and medical requirements. For home care, there’s usually a wait list unless you use the nursing home transfer strategy mentioned above.
How do I start planning for long-term care?
Begin by talking with your loved one about their preferences, getting a professional assessment of their needs, researching options in your area, and consulting with an elder law attorney about payment options.
Getting Help With Your Long-Term Care Decisions
Choosing between home care and facility care involves many factors beyond just cost. The right decision depends on your loved one’s specific needs, your family situation, and your financial resources.
At Berg Bryant Elder Law Group, we help families in Northeast Florida make these difficult decisions and create plans to pay for long-term care. Our attorneys can help you evaluate care options and develop legal strategies to protect assets while qualifying for benefits like Medicaid.
If you’re trying to decide between home care and facility care for a loved one, or looking for ways to pay for either option, contact our office for guidance tailored to your family’s situation.
Author Bio
Kellen Bryant, Esq.
Founder
Florida Bar Board Certified Elder Law Attorney, Kellen Bryant focuses his law practice on advising and helping caregivers with a particular focus on asset protection and preservation from long-term care costs, creditors, and predators. Kellen Bryant is AV Preeminent® Rated, meaning his attorney peers rated him at the highest level of professional excellence. Kellen Bryant was nominated and selected as a Super Lawyer, Rising Star: 2022.
