Considerations for Aging in Place
Most people, when asked, want to continue living in their current home as they age. This is often called “aging in place.” But as people get older, there comes a time to evaluate whether it makes sense to continue to live independently in their home. It may be possible to do so by making changes to the home or hiring help with some day-to-day activities, but other factors such as community and friends are also important.
Whether you are facing these decisions yourself or have friends or family members who are, there is a range of considerations for aging in place and a number of alternatives that may be a more appropriate choice for some situations.
Starting the conversation about whether to age in place early is important. We have found that clients who make decisions in advance experience the most successful transition. Planning ahead gives you the time to understand the options available to you so that you are prepared when your circumstances require you to leave your home, reducing stress for you and your family.
Staying at Home
Aging in place in your current home can be possible by making changes to make your home safer and more comfortable. Lighting and color can be changed so that it is easier to see in the home. Railings in the hallway and grab bars in the bathroom can reduce the occurrence of falls. Closets, shelves and kitchen cupboards can be rearranged to make essential items easier to reach. If the home has stairs that are difficult to climb, it may be possible to install an elevator or chairlift. You can also hire help for tasks such as shopping, home maintenance and paying bills, and you can hire caregivers to help with daily tasks like personal care. With the expanded availability of online services for transportation and meal and grocery delivery, they could also be a key component of an age-in-place plan.
If the decision is made to stay at home, it’s important to consider whether the community and neighborhood have the services that may be needed. One way to find referrals to service providers is through a Village Model organization. The Village Model is a network of community-based nonprofit membership organizations that serve seniors. A Village Model organization charges an annual membership fee that includes some free services and offers screened referrals to fee-based services, such as transportation and home care. Examples of Village Model organizations include San Francisco Village and Beacon Hill Village in Boston. People living in the same multi-unit building may choose to share services to help them age in place, thus creating their own naturally occurring retirement community.
One of the benefits of aging in place is being near long-time friends and neighbors, religious and social organizations and familiar shopping and entertainment venues. However, as people age, they may have difficulty going out due to limitations in physical mobility and challenges driving, potentially leading to feelings of isolation and loneliness. People who age in place should make sure that there are appropriate transportation options available if their needs change. Rather than aging in place at home, some people may be able to move to another home in the same neighborhood or community that better suits their needs without uprooting themselves from their familiar surroundings. If and when it truly no longer makes sense to stay at home, there are many alternatives.
Other Options to Consider:
- Active Adult Communities
- Cohousing Communities
- Continuing Care Retirement Communities (CCRCs)
- Assisted Living Facilities
- Residential (Care and Board) Homes
- Skilled Nursing Facilities
- Resources to help you find additional information are included at the end of this article.
Active Adult Communities
Active adult communities have age restrictions of 55 or 62 under federal law. An age 55 community requires that 80% of residents are age 55 or older. This allows for couples where one spouse may be under the age requirement or people who care for grandchildren. An age 62 community requires that everyone is age 62 or older. Homes in age-restricted communities can be for rent or purchase, and they are often less expensive than a similar home that is not in an age-restricted community. Age-restricted communities are typically quiet and secure and may offer amenities, social activities and services, but they do not provide health care.
Cohousing is an intentional community of private homes clustered around shared space. Cohousing offers a way for a senior to live independently while being part of a small community. Private homes in the cohousing community contain all the features of conventional homes, but residents also have access to extensive common facilities. Shared spaces typically feature a common house, which may include a large kitchen and dining area, laundry and recreational spaces. Shared outdoor space may include parking, walkways, open space and gardens.
Continuing Care Retirement Communities (CCRCs)
CCRCs provide three or more levels of care, including independent living, assisted living and skilled nursing care. Residents can move from one level of care to another as their needs change, but most CCRCs require you to be in good health when you move in and some CCRCs have an age limit for entrants. CCRCs come in several models, ranging from facilities with large entrance fees that do not raise fees due to a move to the next level of care to facilities that charge no entrance fee but increase fees when residents need higher levels of care.
The monthly fees for a CCRC range from several hundred dollars to as much as ten thousand dollars per month, depending on the facility and the type of plan purchased. The entrance fee can range from $0 for a rental agreement to as much as a million dollars for an equity model in which residents buy in to the facility. Some contracts provide a refund of all or part of the entrance fee after the unit is resold or re-contracted for, and there is sometimes an option to share in the profit if the unit is resold for more than the original purchase price. It’s important to understand if and when the entrance fee you pay is refundable and how refunds or rebates are structured. A CCRC normally requires a resident to qualify financially.
Some expenses of a CCRC may be considered a medical expense and qualify for an income tax deduction. If you have long-term care insurance, you should coordinate the insurance policy with the CCRC contract so that you do not pay twice for the same service due to purchasing prepaid medical service through the assisted living contract.
Before signing a contract, carefully evaluate the CCRC, paying attention to the following factors: entrance fees, monthly fees, insurance requirements, facilities, medical care and financial condition of the CCRC. Entering a CCRC is a significant financial commitment and it entails risk, so make sure you carefully read any contract you are asked to sign and review it with your attorney.
Assisted Living Facilities
An assisted living facility is designed for individuals who require assistance with everyday activities, such as meals, medication management, bathing, dressing and transportation. They offer social activities and other services and amenities. A base monthly fee is charged, and you can usually pay for additional services, but there is typically no entrance fee. Long-term care insurance policies may cover some of the cost of assisted living. Some people in assisted living choose to hire their own caregivers rather than pay for the assisted living facility’s additional care services.
Residential Care (Board and Care) Homes
A residential care (board and care) home is a residential home licensed by the state to provide care for seniors. The number of residents in a board and care home is usually six or fewer. Residential care homes provide meals and assistance with everyday activities, but they do not provide the amenities available at larger assisted living facilities. Long-term care insurance policies may cover some of the costs. Because they provide less extensive services, the monthly cost of a residential care home is usually less than the cost of an assisted living facility.
Skilled Nursing Facilities
A skilled nursing facility provides 24-hour care and is available for short-term or long-term stays. Long-term care insurance may cover some of the costs. Medicare may pay for a Medicare-certified skilled nursing facility after a qualifying hospital stay (minimum three days). Medicaid will pay for qualified individuals at a Medicaid-certified skilled nursing facility.
Resources for Additional Information
Village to Village Network can help you find or establish a virtual village through which you can find resources to help you age in place
USAging – National Association of Area Agencies on Aging
Eldercare Locator is a public service of the U.S. Administration on Aging connecting you to services for older adults and their families
The Private Care Association is a national professional organization for private duty home care providers
Aging Life Care Association, also known as geriatric care management, is a holistic, client-centered approach to caring for older adults
Commission on Accreditation of Rehabilitation Facilities (CARF) is the accreditation organization for Continuing Care Retirement Communities
California Advocates for Nursing Home Reform provides information on CCRCs