When an older person requires help with daily living, options range from residential facilities to in-home care. Typically, less expensive than care facilities, professional in-home care can benefit older adults by allowing them to remain in a home setting. Although some view staying in one's home as favorable to nursing home care, recently released findings have shed light on the serious issues facing those who rely on in-home care.

A staggering 50 percent of all older adults using professional home care are not getting the help they need, according to an analysis of the National Health and Aging Trends Study. Half of all adults who rely on home care do not have adequate help with showering, dressing, laundry, or cooking. Compared to those residing in facilities, older adults in in-home care are more likely to miss meals and medication and remain in soiled clothing for extended periods.

Older adults with in-home care were also nearly five times more likely than adults in living facilities to have persistent unmet needs. Fulfilling these needs may require care for longer durations or more complete care that addresses the full range of an adult's needs, from laundry to food preparation.

The Effect of Stepfamily Relationships

While challenges can affect all older adults aging in place at home, the negative consequences can be more pronounced for those with stepfamilies. Societal changes have made stepfamilies more common, and one in eight older adults with mobility limitations now has a stepchild. Yet in comparison to older adults with only biological offspring, those with stepchildren are half as likely to receive help from their children, research shows.

Stepfamilies might see children's attention divided between a greater number of parents. Adult stepchildren who never received care from their stepparents because, for instance, the marriage occurred later in life, might not feel obligated to help. Children might also feel closer bonds and a sense of responsibility to their biological parents.

Although biological children are more likely to help, even adults who lived with partners and had biological children still had unfulfilled needs when they remained at home. 

Challenges Facing People With Dementia Who Receive Home Care

Like those with stepchildren, low-income individuals with dementia are also more susceptible to the inadequate in-home care. Many older adults with dementia are dual enrollees in Medicaid and Medicare and, consequently, have fewer assets to cover in-home services. They also have less family support.

Individuals with dementia are twice as likely to have unmet needs compared to older adults without dementia who utilized in-home care. Many older adults with dementia could not afford sufficient in-home care and had less family support to fill in the gaps in care.

Older adults evaluating the benefits and drawbacks of different care options should speak with an attorney who can help them assess their unique needs and plan for their care.