Home vs. Facility Long-Term Care: Your Essential Checklist

Updated August 7, 2025 | Lisbeth Cano

When your aging parent needs more help, choosing between care at home and a facility is a big decision. It feels overwhelming. You want what's best for them, but also need to be realistic about cost, safety, and available support.

This checklist helps you compare home care with facility care. It covers key areas to consider. Use it to organize your thoughts and make an informed choice.

Understanding Your Parent's Needs

Start here. What kind of help does your parent truly need?

Health and Medical Needs

Daily Medical Management: Does your parent need shots, wound care, or specific medication timing that you cannot provide?
Chronic Conditions: Do they have conditions like advanced dementia, Parkinson's, or severe heart disease requiring frequent monitoring?
Mobility: Can they move around safely on their own, or do they need help walking, transferring from bed to chair, or using the bathroom?
Continence: Do they manage personal hygiene independently or need help with toileting or incontinence?
Emergency Response: Are they at high risk for falls or other medical emergencies? How quickly would help arrive at home versus a facility?

Activities of Daily Living (ADLs)

These are basic self-care tasks. How much help does your parent need?

Bathing and Grooming: Can they wash, dress, and brush their teeth alone?
Eating: Can they prepare and eat meals independently, or do they need assistance?
Toileting: Can they use the toilet by themselves?
Transferring: Can they get in and out of bed or a chair without help?
Mobility: Can they walk safely, or do they need walkers, wheelchairs, or physical assistance?

Instrumental Activities of Daily Living (IADLs)

These are more complex tasks necessary for independent living.

Managing Medications: Can they remember to take pills correctly and on time?
Managing Finances: Can they pay bills, handle banking, and manage money?
Meal Preparation: Can they plan, shop for, and cook nutritious meals?
Housekeeping: Can they keep their living space clean and safe?
Transportation: Can they drive or arrange transportation for appointments and errands?
Communication: Can they use the phone or other devices to communicate?

Cognitive Function

This is crucial, especially for safety.

Memory: Do they forget important things regularly, like turning off the stove or taking medications?
Decision-Making: Can they make sound decisions about their own well-being?
Judgment: Do they understand risks or potential dangers?
Wandering: Is there a risk of them wandering away from home?
Behavioral Changes: Are there any behavioral issues that require professional management?

Home Care Considerations

Keeping your parent at home requires careful planning and resources.

Safety and Accessibility at Home

Fall Hazards: Is the home free of rugs, clutter, and uneven surfaces? Are there grab bars in bathrooms, and is lighting adequate? ¹ See our Fall Proofing Home and Grab Bars and Ramps guides for details.
Accessibility: Are doorways wide enough for walkers or wheelchairs? Are there stairs that pose a challenge? Learn more about Home Modifications.
Emergency Systems: Is there a medical alert system in place? Can emergency services easily access the home? Check out Medical Alert Systems for options.
Home Modifications: What changes are needed to make the home safe and functional? Can they be done affordably? Visit our Home Modifications page for ideas.

Cost of Home Care

Home care can range from part-time help to 24/7 skilled nursing.

Hours of Care: How many hours per day or week are needed?
Type of Caregiver: Is it a family member, a non-medical aide, or a skilled nurse?
Professional Services: What is the cost of home health aides, skilled nursing, physical therapy, or occupational therapy?
Medical Equipment: What equipment is needed (e.g., hospital bed, oxygen)?
Medications and Supplies: What are the ongoing costs for prescriptions, bandages, and other medical supplies?
Insurance Coverage: What does Medicare, Medicaid, or long-term care insurance cover for home care? ²³
Out-of-Pocket: What can your family afford?

Caregiver Support

Family Availability: How much time can family members commit to caregiving?
Caregiver Burnout: Are family caregivers at risk of becoming overwhelmed or exhausted? Learn about Avoiding Caregiver Burnout.
Respite Care: Are there options for temporary relief for family caregivers?
Professional Agencies: Will you hire a home care agency? What are their credentials and costs?

Isolation: Will your parent be isolated at home, especially if they have limited mobility?
Social Activities: How will they stay engaged and connected with others?
Personal Preferences: Does your parent strongly prefer to stay in their own home?

Facility Care Considerations

Facilities offer different levels of care, structured environments, and professional staff.

Types of Facilities

Assisted Living (ALF): For those needing help with ADLs but not 24/7 skilled nursing. Offers meals, activities, and some medical oversight. Learn more about Assisted Living.
Memory Care: Specialized units within ALFs or nursing homes for individuals with dementia. Focuses on safety, structured routines, and cognitive support. See our Memory Care resource.
Skilled Nursing Facility (SNF) / Nursing Home: For those needing 24/7 medical care, rehabilitation, or extensive help with ADLs.

Safety and Environment in a Facility

Staffing Levels: How many staff members are available per resident, especially during off-peak hours?
Security: How secure is the facility from unauthorized entries or exits, especially for residents with wandering tendencies?
Emergency Protocols: What are the procedures for medical emergencies, fires, or other incidents?
Cleanliness: Is the facility clean, well-maintained, and free of odors?
Accessibility: Is the facility designed for easy access for all mobility levels?

Cost of Facility Care

Facility costs vary widely by type, location, and services.

Monthly Fees: What is the base monthly cost?
Tiered Services: Are there extra charges for higher levels of care (e.g., incontinence care, feeding assistance)?
Hidden Fees: Are there admission fees, move-out fees, or charges for non-included services?
Insurance Coverage: What does Medicare, Medicaid, or long-term care insurance cover for facility care? ²³
Out-of-Pocket: What can your family afford? For more on financing, visit Financial Planning for Elder Care.

Care and Medical Support in a Facility

Medical Staff: Are nurses and doctors available on-site or on call?
Rehabilitation Services: Are physical, occupational, and speech therapy available?
Medication Management: How are medications dispensed and monitored?
Specialized Care: Can the facility meet specific medical needs, like oxygen therapy or tube feeding?
Dementia Care: If needed, does the facility have a secure, specialized unit with trained staff for memory care? Learn about Memory Care Safety.

Activities Program: What activities are offered? Are they engaging and varied?
Social Interaction: Are there opportunities for residents to socialize with peers?
Personalized Care: Does the staff seem to know residents personally and respect their preferences?
Environment: Does the facility feel home-like, or is it institutional?
Visitation: What are the rules for family visits?

Making the Decision

Use this checklist to have open conversations. Involve your parent if they are able. Talk to other family members. Consult doctors, elder care attorneys, and financial advisors.

Prioritize Needs: Which of your parent's needs are most urgent?
Financial Reality: What care options are truly affordable long-term?
Preferences: What does your parent prefer, if they can express it?
Trade-offs: What are you willing to compromise on?
Trial Periods: Are there facilities that offer short-term stays to test it out? Can you try home care with a professional agency first?

Moving forward, remember this is a process. Your choice today might change as your parent's needs evolve. Review this checklist often.

National Institute on Aging. (2024, May 2). Prevent Falls and Fractures. Retrieved from https://www.nia.nih.gov/health/fall-prevention/prevent-falls-and-fractures ↩
Medicare. (2024). Long-Term Care. Retrieved from https://www.medicare.gov/basics/glossary/long-term-care ↩ ↩
Administration for Community Living. (2024). Paying for Long-Term Care. Retrieved from https://longtermcare.acl.gov/paying-for-care/index.html ↩ ↩

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Lisbeth Cano Clinical Researcher and Elder Advocate

Meet the author: Lisbeth Cano earned her medical degree from Universidad de Iberoamérica in Costa Rica and worked as a doctor before becoming a clinical researcher. She now focuses on senior care, writing evidence-based guides for SeniorCanvas.com to help families make safer, smarter decisions for aging parents.