Senior Care and Aging
Home or Facility? What Seniors and Families Are Really Choosing
HEALTH & WELLNESS FEATURE
SENIOR CARE & AGING
Home or a Facility? What Seniors and Families Are Really Choosing
By Melissa D. Jackson, CNA
Most older adults say they want to stay home. But cost, safety, and health needs often complicate that choice—and the research on both options tells a more nuanced story than either side of the debate usually admits.
When the time comes for help with daily activities, the decision about where a senior receives that care rarely belongs to the senior alone. In practice, it is usually adult children and other loved ones who end up steering the choice between a facility and remaining at home.
A recent industry report captured the tension well: Families overwhelmingly say they prefer home care for a loved one, yet many struggle to determine what type of care is actually needed or where to find a provider they trust. According to the survey, more than half of family caregivers expressed a strong preference for in-home care over senior living. At the same time, one-third admitted they were unsure what level of care was appropriate, and cost remained a top concern throughout the decision-making process (Gonzales, 2025).
WHAT SENIORS SAY THEY WANT
The preference for home is well documented. According to AARP's 2024 Home and Community Preferences Survey, 75 percent of adults age 50 and older want to remain in their current homes as they age (AARP, 2024).
Pew Research Center's 2026 survey of adults age 65 and older found an even more lopsided pattern when respondents were asked what they would prefer if they could no longer fully care for themselves. Sixty percent said they would prefer to remain in their own home with a caregiver, compared with just 18 percent who chose assisted living and only 1 percent who chose a nursing home.
Income also influenced those preferences. Upper-income older adults were considerably more likely than lower-income adults to say they would choose assisted living if the need arose—28 percent compared with 13 percent (Pew Research Center, 2026).
As seniors weigh where to receive care, their choice can also intersect with their overall health outlook, since life expectancy can differ meaningfully between care settings.
WHAT THE RESEARCH SHOWS ABOUT LIFE EXPECTANCY
A widely cited longitudinal study that followed 690 nursing home residents over three years found a median survival time of just 2.2 years after admission, with roughly one-third of residents dying each year during the study (Vossius et al., 2018). That finding aligns with similar research from other cohorts and is often used as a benchmark for what families can expect after nursing home placement.
Comparable research on home-based and community care is less consistent because outcomes vary widely depending on a person's frailty, diagnosis, and the intensity of support they receive. However, several studies point in the same direction. Moving frail older adults into supportive, non-institutional settings has, in multiple cohorts, been associated with a lower mortality risk rather than a higher one.
One large French analysis that followed community-dwelling seniors for nearly two decades found that those who moved into senior housing—short of a nursing home—had a significantly lower risk of death than those who did not, even though they were more likely to eventually require nursing home care.
None of this means home care guarantees a longer life for every senior. Health status at the time the decision is made remains one of the most important factors. However, the evidence suggests that the common assumption that a facility is always the safer option does not consistently hold up under scrutiny.
Nursing home placement is associated with a median survival of just over two years—a statistic that should inform, not dictate, how families weigh their options.
—Based on findings published in PLOS ONE (Vossius et al., 2018)
THE CASE FOR FACILITY-BASED CARE
Facilities offer something home care cannot easily replicate: around-the-clock, on-site medical support.
According to the National Institute on Aging, the primary benefits of facility-based long-term care include 24-hour supervision by nurses and aides, prepared meals, opportunities for safe social interaction, transportation to medical appointments, and structured support for behavioral conditions such as Alzheimer's disease and other forms of dementia (National Institute on Aging, 2026).
Nursing homes are only one option within a broader continuum of care. Assisted living communities, retirement communities, and behavioral health treatment centers each offer a different balance of independence and support.
Assisted living, in particular, is designed to serve as a middle ground. As the Federal Long Term Care Insurance Program explains, "Assisted living helps people live as independently as possible while getting a helping hand when they need it" (LTCFEDS, 2024).
For seniors who need more oversight than can safely be arranged at home but do not require skilled nursing care, this level of support may be the right fit.
THE CASE FOR STAYING HOME
In-home care offers several well-documented advantages, chief among them affordability and reduced hospital utilization.
Research examining hospital readmissions has found that home-based recovery is generally associated with lower costs and may shorten the amount of time patients spend in the hospital compared with institutional care.
For many seniors, however, the appeal extends well beyond finances. As one longtime home care client put it when asked about her own future care, "I want to stay in my home" (Personal communication with Renegar, 2026).
That simple statement reflects what most seniors report wanting: independence, familiar surroundings, and a sense of control over their daily lives.
Still, in-home care is not without challenges. One of the most common concerns is a breakdown in communication between hospital discharge teams and the family members, caregivers, or home health aides who assume responsibility after a patient returns home.
When discharge instructions are not fully understood or properly followed, seniors face an increased risk of medication errors, complications, and avoidable hospital readmissions. In many cases, it is this coordination gap—not the home setting itself—that contributes to adverse outcomes.
COMPARING THE COST
Cost remains one of the most significant factors for families, and the difference between care settings can be substantial.
According to A Place for Mom's 2026 Cost of Long-Term Care and Senior Living Report, the national median cost of a semi-private nursing home room is $9,581 per month, or approximately $114,975 per year (A Place for Mom, 2026; CareScout, 2025).
Assisted living is considerably less expensive, with a national median monthly cost of approximately $5,419.
The cost of in-home care depends largely on the number of hours of assistance a senior requires. At the national median hourly rate of approximately $34, a senior receiving about 44 hours of care each week would pay roughly $6,478 per month—meaningfully less than a nursing home.
However, that financial advantage narrows considerably as care needs increase. Families requiring around-the-clock in-home support can expect costs approaching $24,700 per month, making home care more expensive than a nursing home once continuous supervision becomes necessary (A Place for Mom, 2026).
In other words, the affordability advantage of home care generally applies to seniors who need moderate, part-time assistance—not those requiring constant, around-the-clock care.
Regardless of the setting, long-term care represents a significant financial commitment. Most families rely on a combination of personal savings, Medicare (which covers only limited, short-term skilled care rather than long-term custodial care), Medicaid for those who qualify financially, and, in some cases, long-term care insurance.
THE TAKEAWAY
There is no universally correct answer to where a senior should receive care—only the answer that best fits that individual's health, financial situation, and personal priorities.
Facilities provide important safeguards that are difficult to duplicate at home, including continuous supervision, on-site medical professionals, and structured care for individuals with complex medical or cognitive conditions.
Home care offers something equally valuable: independence, familiar surroundings, and, for many seniors requiring only moderate assistance, meaningful cost savings.
Families are best served by carefully evaluating a loved one's medical needs, functional abilities, financial resources, and available support system rather than defaulting to either option based on habit, convenience, or assumption.
