This a an increasingly common dilemma and there is no formula that fits different individuals situations. Neither is there are "right answer". Indeed in my experience it is rather a case of finding the best "bad answer", best for the individual and family/carers, from a range of "bad answers". In my experience the choice between the option of staying home rather than the alternative option of moving into residential care needs to be considered against a range of issues and wants, medical diagnosis, resources ... and a range of issues too extensive to outline briefly here. It's for this reason that in my view the advice of health professionals, trained, credentialed and experienced in aged care should be sought. Access to expertise in aged care is variable however increasingly specialist physicians in aged care, geriatricians, are more readily available. Valuable expertise and advice is also provided by aged care nurses, allied health professionals working in aged care, aged care assessment teams and other providers. In my view an essential part in making informed choices is complete and expert information based on sound and accurate diagnosis. A range of medical illnesses can affect olde rpeople and medical assessment and diagnosis is essential as the basis on which proper care and longer term planning should be made.
It should also be said that care at home or in a residential care setting should be undertaken with ongoing advice and care planning which itself is sometimes difficult to access. GP's do a good job in udnertaking ongoing medical care and plannning but, in the setting of general practice the day to day monitoring of an older person which of necessity includes regular medical review, ongoing assessment of physical, mental and psychologicla functioning and a range of other considerations is challenging. Regular review by a care team, in touch with and reviewing day to day management is ideal. Unfortunately this type of case management and monitoring is difficult to come by. I have bene involved in the development of suystems of care that adderss these issues in the home setting. Previously with NSW Health in the Healthy At Home Program, and more recently with a community based service organisation - HomeHealthHQ - that I have been involved in setting up - community/home based care, coordination, oversight and care planning can be achieved in conjunction with the patient, family, carers, GP and Geriatrician.
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