When an elderly person's health condition changes, family members often find themselves in a dilemma: should they arrange for a Residential Care Homes for Elderly Persons or continue with Home Care?

In reality, every family's situation is unique. There is no absolute right or wrong choice, only the most appropriate decision for the current moment. The most reliable approach is to calmly follow a framework of "Audit- Trial- Evaluate- Adjust." This article compares the two modes from a practical Hong Kong perspective and provides an actionable decision-making framework.

Why Home Care is Often the Better Choice

If the environment and budget permit, home care offers significant advantages in four key areas:

1. Higher Quality of Life: Staying in a familiar environment allows daily routines and hobbies to continue. Visits from relatives and friends are more relaxed, reducing the anxiety caused by adapting to a new environment.

2. Controllable Medical Risks: With fewer people in the household and a simpler environment, the risk of cross-infection is much lower than in collective living. Medications, wounds, and catheters can be managed according to an individual pace.

3. Delaying Functional Decline: Continuing to use original daily routes (such as walking to the bathroom or grooming) helps maintain muscle strength, balance, and cognition. This avoids the "institutionalization" effect where over-reliance leads to faster physical decline.

4. High Flexibility: Care hours and content can be adjusted based on periodic goals (e.g. 24-hour intensive care immediately after hospital discharge, transitioning to daytime rehabilitation during a stable phase).

5. Family Participation and Faster Decisions: Observation is immediate and communication is direct. Unexpected situations can be triaged by an on-site nurse, reducing unnecessary hospital visits.

Note: Not all situations are suitable for staying at home; see the section below to identify a better decision for your family’s current situation.

When is Residential Care Home More Suitable?

1. Home and Property Constraints: No elevator, narrow corridors, difficulty in installing medical gas or suction equipment, or restrictions on medical waste/logistics by building regulations.

2. Requirement for a Protective Environment: For cases involving severe wandering, continuous pacing, or aggressive/self-harming behavior that requires specialized units with security gates and sensors.

3.  Treatment Focus on Intensive Daytime Activities and Socializing: Cases such as moderate dementia or emotional disorders that clearly rely on group training and structured daily schedules.

In most of these cases, short-term transitional arrangements can be used to stabilize the condition before evaluating whether a move to a suitable residential facility is necessary. The focus remains on safety, compliance, and sustainability.

Five Key Decision Points

Before deciding, please review these five dimensions with your family:

1. Person (Elderly's wishes and physical functions): Does the elder prefer staying at home? What is their status regarding walking, transferring, swallowing, cognition, and mood?

2. Disease (Medical complexity): Does it involve tracheostomy, long-term catheters, intravenous therapy, or pressure sore dressing? What is the expected rate of deterioration?

3. Home (Care environment): Can the physical environment be improved (e.g., lighting, fall prevention, bathing equipment)? Is there available caregiving manpower for shifts?

4. Money (Cost): List the specific hours and skills truly needed to avoid paying for unnecessary time. Should the budget be adjusted monthly?

5. Risk (Short, medium, and long-term): Clearly define the risk levels for falls, medication errors, or aspiration pneumonia, as well as "who, when, and how" to intervene.

How to Measure "Effectiveness" in Home Care?

Even when choosing home care, many families wonder how to ensure the plan is effective. Home care should not just be about "buying time"; it must be about results. We recommend a monthly review using "Three Layers and Eight Indicators":

1. Medical support: Emergency visits, re-admission frequency/days, infection/fever events, and wound or catheter complication records.

2. Function: Average daily activity time or steps, bed-to-chair transfer ability, swallowing/nutritional intake, and pain scores.

3. Life: Sleep quality, emotional fluctuations, family caregiving hours, and overall family caregiver stress/satisfaction.

If more than two indicators are not met, the care hours or content should be adjusted the following month (e.g., strengthening rehabilitation or changing the care configuration).

In-depth Comparison: Risk and Nursing Quality

Safety is usually the biggest concern. It is often assumed that nursing homes are safer due to 24-hour staffing. However, safety depends on risk management systems rather than location. Nursing homes rely on "institutionalized and standardized" collective management, while home care can achieve "personalized and high-intensity" precision prevention.

1.  Infection Control: Nursing homes are crowded, leading to higher risks of cross-infection for flu or pneumonia. Home care allows control over visitor arrangements and sterile procedures.

2. Fall and Pressure Sore Prevention: Nursing homes have institutionalized rounds. Home care allows for environmental modifications (lighting, non-slip surfaces, bed rails) and customized turning schedules.

3.  Medication Safety: Nursing homes manage this through systems. Home care requires a nurse to establish medication lists and schedules with double-checking and regular reviews of drug interactions.

4. Continuity of Care: Nursing homes rely on shift handovers. Home care is provided by the same nursing team, maintaining a consistent routine with immediate feedback on plan changes.

Practical Strategy: The "Seven-Step" Approach

To reduce the cost of decision errors, follow this process:

1.    Comprehensive Assessment: Evaluate functions, risks, home environment, available hours, and budget.

2.    List Two Options: Clearly outline "Home Plan A" and "Residential Plan B," comparing hours, skills, costs, and risk controls.

3.    Short-term Trial (2-4 weeks): Start with home care and daytime support. If unstable, evaluate moving to a nursing home or increasing hours.

4.    Define Goals and Milestones: For example, "Zero falls within 4 weeks" or "Pressure sore area reduction."

5.    Weekly Fine-tuning and Monthly Review: Summarize indicators and change content as needed.

6.    Medical-Social Integration: Consolidate resources from family doctors, therapists, and community support into a single handover sheet.

7.    Prepare Contingency Plans: Prepare emergency procedures, contact lists, and Advance Care Planning.

Common Decision Traps

1.     Only looking at monthly fees or hourly rates while ignoring nighttime or emergency costs.

2.     Thinking that one can "tough it out" without arranging for relief staff or caregiver self-care.

3.     Failing to review the plan for six months, causing it to become disconnected from reality.

4.     Viewing a single fall or infection as a "must-admit" situation without reviewing if the environment can be improved.

How YDCare Can Assist You

The pressure of decision-making should not be borne by family members alone. Our professional nursing team provides:

1.  One-time Comprehensive Home Assessment: Quantifying the "Person-Disease-Home-Money-Risk" factors to provide two clear options and budgets.

2.  Case Management and Specialist Nursing: Managed by a Nurse Manager to coordinate Registered Nurses, caregivers, and therapists based on periodic goals.

3.  Result-Oriented Monthly Reviews: Providing a one-page report based on the "Three Layers and Eight Indicators" to adjust the care plan immediately if targets are missed.

4. Flexible Transition: If home conditions change, we assist with respite care, nursing home transitions, or strengthened nighttime support to maintain safety.

If basic home conditions are met, home care often outperforms nursing homes in quality of life and risk control. Manage expectations with data and milestones.

Unsure how to choose? Contact YDCare today to learn more about our home care solutions.