Elder care shifting away from nursing homes

— -- Michelle Booth of Foster City, Calif., has never been much of a morning person. But seven days a week, she gets up at 7 a.m. to make breakfast for her parents.

On weekdays, a bus takes them to senior day care, which gives Booth, 54, a few hours to run her home-based business. At 4 p.m., she picks up her parents. She has dinner ready at 4:30. Once they're in bed, she does chores and unwinds by watching TV. She rarely goes to bed before 3 or 4 a.m. "If I can get five hours of sleep, it's wonderful," she says.

Booth's mother, Bess, 87, has early-stage Alzheimer's disease. Her father, Hyman, 88, has been disabled by strokes. They require round-the-clock care, making it hard for Booth and her 14-year-old daughter, Alystar, to leave for a weekend, or even a day.

Booth's parents took her in a decade ago, after her marriage ended, and helped care for her daughter. Now, she says, "The roles are reversed." Yet, she has no plans to put them in a nursing home:

"I can't even imagine seeing them in a home. If their physical needs become such that I couldn't handle it, I'll have to sort that out."

As the parents of America's baby boomers move further into old age, Booth's life could increasingly represent the face of elder care in the USA. Adult children, worried about costs and the loss of their parents' independence, have long viewed nursing homes as a last resort.

But a shift away from institutionalized care is growing. The percentage of people over 75 in nursing homes fell from 9.6% in 1985 to 6.4% in 2004, according to the AARP Public Policy Institute.

Elder care experts say the decline reflects the growth of less-restrictive types of care, ranging from assisted living to supervised adult day care. These alternatives are usually less expensive than nursing homes and often provide a superior quality of life.

Still, nursing homes, for all their drawbacks, provide 24/7 care in a federally regulated site. By contrast, most alternatives impose heavier responsibilities on family caregivers, notes Caroline Harada, a geriatrician at the University of Chicago Department of Medicine. As a result, baby boomers are likely to become increasingly entwined with their parents' care.

"When people are in these less-supported living environments, the family has a much greater role to play in ensuring the patient gets all the care they need," Harada says.

This expanded role comes as unpaid family caregivers are already providing an average of 21 hours of care a week, according to an AARP study set for release today. In 2006, the economic value of unpaid caregiving equaled $350 billion, the study found — more than the nation's Medicare spending in 2005. Among the challenges for adult children as caregiving evolves:

Costs.

The average annual cost for a semiprivate room in a nursing home is nearly $67,000, reports the MetLife Mature Market Institute reports. In parts of the country, it's much higher. Still, if a senior citizen exhausts all her assets, Medicaid will cover her nursing-home care.

Not so with other types of long-term care. Except in isolated instances, Medicaid doesn't cover assisted living or home-based health care. That means families often have to pay those costs. The average cost for an assisted-living facility was $35,616 a year in 2006, according to the MetLife Mature Market Institute. The average cost for a home health aide is $19 an hour.