Navigating Senior Care: What Adult Caregivers need to know before choosing senior living or in-home care

Experts at Easterseals Delaware estimate that 30% or more of adults ages 45 and up are serving as caregivers, a share that is rising as people live longer with complex needs.

The Role of the Adult Caregiver and the Challenging Decisions about what is “best”

WILMINGTON, Del. — An adult caregivers and caregiver, in the broadest sense, is anyone who invests time, money and energy to assist an older adult who needs help. In many families, it takes a village—relatives and friends, neighbors, nurses and aides, the person who handles the bills, the one who fixes the leaky sink, the cook who keeps meals coming. All of them are caregivers in their own unique ways. But the primary caregiver is different. The buck stops with that person. They make the hard decisions, explain changes to the family, and too often become the lightning rod for suspicion, grief and frustration when reality doesn’t match expectations. It is one of the most demanding roles a person can hold.

A growing share of us are caregivers. Experts at Easterseals Delaware estimate that 30% or more of adults ages 45 and up are serving as caregivers, a share that is rising as people live longer with complex needs. For many, this season arrives suddenly and without a playbook, piling stress onto already full lives of work, children, and finances. The result is a simple, anxious question that starts the process: What do we do now?

“Where do I start?”
“When families call us, the first thing they say is, ‘Where do I start?’” said Lynn Paxson, a leading consultant to caregivers in Delaware and president of Oasis Care Advisors. “Overwhelm, guilt, and fear are common. The good news is that once options are clear, most people feel relief and empowerment.”

A journey, not a single decision
The path to care rarely begins with a moving truck or a signed home-care agreement. It starts with unease as small lapses turn into patterns. A doctor’s visit brings new instructions; a hospital discharge adds urgency. By then, the conversation has shifted from if help is needed to what kind of help will keep a loved one safest and most supported.

Five stages families face

• Early concerns: Subtle signs—missed medications, skipped meals, isolation—raise the question: Is Mom safe at home?

• Health decline: Falls, ER visits or memory lapses push the discussion forward as safety becomes the priority.

  

• Care and housing decisions: Families compare staying at home with a caregiver versus moving to a senior living community, weighing the cost, care level, and lifestyle.

• Legal and financial planning: Power of attorney, advance directives, and budgets move to the front burner; families may explore VA Aid & Attendance or long-term care insurance.

• Transition and adjustment: Whether moving or starting home care, emotions run high; ongoing support helps the new routine stick.

The turning point: choosing a care setting
Senior living communities offer structure: staff on site around the clock, medication management, a built-in social life, and a predictable monthly bill that bundles housing with care. For older adults who are lonely, missing meals or struggling with routines, the daily rhythm—and the presence of peers—can be stabilizing.

Why do many stay home?
In-home care preserves the familiarity of the house and neighborhood. Care is scheduled by the hour or day and tailored to what the person needs, whether that’s help with bathing, transportation or specialized dementia support. The tradeoff is coverage: safety at home depends on how many hours a caregiver is present and how well those hours match the risks.

What it costs—and what fits?
Communities invoice monthly and adjust fees as care needs rise. Home care can begin modestly—just a few hours a week—but expenses climb quickly if nights, weekends or specialized skills are required. “Families often discover there is no single ‘cheap’ option,” Paxson said. “There’s the option that best matches risk, personality, and budget.”

Paperwork with a purpose
Even as families compare models, a second track of tasks arrives with its own clock. Power of attorney, advance directives and a workable budget are no longer paperwork for “someday”; they become essential tools to avoid crises. Some households qualify for help through long-term care insurance or VA benefits; others stitch together resources with savings and family support. Social workers and case managers can coordinate therapies, equipment and home-health orders that complement either path.

The first weeks are emotional
Once a decision is made, a new set of emotions takes center stage. Moves are rarely purely logistical; they are identity-shifting. Families who choose home care worry about finding the right fit; those who choose a community worry about how their loved one will adjust to a new routine. “That’s where coaching matters,” Paxson said. “We walk with families through the first weeks—touring, matching caregivers and checking in after move-in—so small problems don’t become big ones.”

Vetting in-home care agencies
For households opting to remain at home, ask whether the agency has caregivers available now in the right ZIP code and with the needed skills—mobility support, memory-care experience or chronic-disease know-how. Screening, training and a reliable backup plan for call-outs are nonnegotiable, as are transparent pricing and proper licensing.

Touring communities the right way
Visit at mealtimes, observe an activity, and talk with residents and families, not just the marketing team. Note staffing visibility, response times and how teams interact with residents who need extra prompts or redirection.

Avoid the pitfalls
A few warning signs can help primary caregivers steer clear of costly detours and unsafe arrangements.

1. Unverified call centers and vague online ads — They often sell your contact information instead of solving problems.

2. “Too good to be true” offers — Beware of hidden fees, unlicensed operators or services that won’t meet your loved one’s needs.

3. Pressure tactics without a full care assessment — Anyone rushing you to decide, especially without transparency, is a red flag.
   “Your loved one’s safety and dignity should always come first,” Paxson said. “Work with credentialed advisors, ask blunt questions and see the care up close—whether that’s in the living room or the dining room.”

How to get started today
Write down the specific worries—falls, medication mix-ups, loneliness—along with current diagnoses, medications and doctors. Identify a decision-maker who can speak for the family. Then schedule a no-cost consult with an advisor or social worker to map options and timelines. Bring insurance cards and any legal documents. That preparation, Paxson said, shortens the search and lowers stress: “Clarity is the antidote to panic.”

Editor’s note: This is the fourth article in a continuing series on the unique needs of caregivers in our community, focusing on practical steps families can take when tough decisions must be made for a loved one.

Staff Writer

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