When I asked for topics you'd like me to spend a bit more time writing about, home health care versus living in a nursing home was near the top of the list. Most of the folks I talk with would like to stay in their home as long as possible before the move to a full time care facility. There is comfort and peace of mind in being in a familiar place, with your belongings around you.
Of course, there are obvious complications and problems that can arise. As health deteriorates the risk of falls or accidents increases. Becoming forgetful about taking pills and eating properly can have serious consequences. Your spouse, partner, or grown children must take on a more active role in your care. If you wait too long, nursing care facilities may not welcome you. In an odd irony, you may find you are too ill to be admitted to the nursing home of your choice.
If you are able (and willing) to move into a continuing care community at some point, this situation is already taken care of; a nursing home environment is part of what you contracted for. In the meantime, you can remain independent or have some assistance on a daily basis. But, for many the costs are too great to make this a viable choice. For others, the thought of living among people who are all the same age and social status is not attractive.
Luckily, new technology and options are making it much more viable to remain in your home for a longer period of time. If you would prefer to stay in your present home as long as possible, there are choices you can consider. Something as basic as an emergency button that summons help can provide a much needed level of security and safety. Other new products provide monitors and computer links to family members or care professionals. Pills not taken or daily activities not performed as required trigger an alert to allow for quick follow up.
New options for in-person caregiving are also more readily available. Professional help or volunteer visitations are just two of the possibilities.
Because this is an area I have no direct experience in handling, I really can't offer specific suggestions. My dad (and mom before her death) lives in a three level community with constant supervision and care so I am not faced with the toughest choices. At the moment he is in the assisted living section, but is guaranteed a place in the nursing facility when the time comes.
What I can offer is the following list of links to sites that discuss this topic in greater detail or offer options that may make your decision easier.
Of course, the decision to stay in one's home affects both the individual or couple in the home, as well as other family members who find themselves in a position to take on extra visits, care, or responsibilities. Any decision with this level of seriousness should be discussed with all those who are involved, and that includes doctors and other caregivers.