A Guide to Aging in Place
Last Updated: August 12, 2021
As people age, they tend to feel a stronger desire to keep the familiar close. Many seniors feel connected to the homes where they raised their children and entertained their grandchildren, and they often don’t want to leave that home. When a senior chooses to live at home rather than move into an assisted living or skilled nursing facility, it’s known as “aging in place.” Yet living independently can present both health and safety risks for older adults, like falls. If you have an elderly loved one who wants to live at home, you might find yourself wondering how to manage these risks while listening to their desires.
In spite of the potential risks, the majority of seniors want to age in place. According to a survey published by AARP, 76% of adults aged 50 and older want to remain in their current homes as they age, and 77% indicate they want to live in their communities, even if their own homes won’t meet their needs. If you have a senior in your life, chances are you’ve had some discussions about their desire to age in place.
Thankfully, today’s seniors have a number of resources available to help them age at home safely. In this guide, we discuss how to determine if aging in place is best for your loved one, and what programs, services and supports are available to help them continue living at home.
When Is Aging in Place a Good Solution?
Before you decide that aging in place is the right solution for your loved one, you must consider three main elements: the person, the home, and the support network available. Aging in place makes sense only when all three of these factors support the decision.
First, you must consider the person. Most people will indicate a desire to stay in their homes as they age, but sometimes seniors simply can’t do so safely.
Next, consider the home itself. The home needs to meet the needs of an elderly person, be accessible if they require assistance walking and be a size that they can take care of with the right support.
Finally, the senior needs a strong support network to provide aid and care when needed.
Here’s what having all three factors in place might look like:
- A senior lives in a one-story house and knows their neighbors well.
- An adult child moves into the home next to their parent, so they’re able to provide support on a regular basis.
- A two-story home is modified so the senior can live on the main floor, without the need to go up and down the stairs, and a caregiver comes in regularly to help with housekeeping and personal care.
When Aging in Place Doesn’t Make Sense
For many older adults, the desire to remain independent and at home and their physical, emotional, or cognitive state don’t line up. While health issues alone may not prevent an adult from aging in place, they can make it far more difficult. Here are some situations when aging in place may not be the right choice.
- You and other potential family caregivers live far away or work full-time.
- Your loved one has few friends in the community who can help.
- You can’t build a network of caregivers who live close to your loved one.
- An overnight caregiver is needed, but the home can’t accommodate one.
- The senior needs medical equipment or supplies, but the home isn’t large enough for them.
- Your loved one is wheelchair-bound and the home has narrow doorways or hallways.
- The senior isn’t comfortable having paid caregivers in their home who they don’t know.
- Your family can’t afford to hire a caregiver but doesn’t have time to provide caregiving services within the family.
- You believe your loved one feels isolated or lonely at home.
- Your loved one can’t drive, and public or senior-friendly transportation options aren’t accessible.
Ultimately, if you’re the one in the role of the caregiver, and you feel that one of the three factors makes aging in place a bad idea for your loved one, consider alternatives.
Senior Care and Services to Support Aging in Place
A network of support services can make aging in place possible. These supports can range from socialization and care in the home to transportation and home-delivered meals. You need to learn what resources are available in your area that can meet your loved one’s specific needs.
There are several organizations in the United States that help seniors age in place. These include:
- Area Agencies on Aging. Local AAAs coordinate a number of services for older adults, and many specifically help seniors who are aging at home.
- National Aging in Place Council. The NAIPC has chapters in many major cities throughout the United States, and this organization helps connect seniors and their families to service providers that can assist with aging safely at home.
- The Center for Aging in Place. The Center for Aging in Place assists communities with putting local resources in place that can help seniors continue living safely in their own homes.
In addition to these resource suggestions, there are other factors you may need to consider when helping a loved one age in place, including:
Many families provide care for their senior loved ones on their own, but it’s not always possible for a family member to quit their job and become a full-time caregiver. Without a network of other family members and friends who can step in, you may need outside help. There are three types of in-home care you might draw on in this situation. These are:
|Care Type||Services Provided|
|Care (or elder) companions||Provide company for older adults who live alone, especially those who are shut-ins because of frailty or mild to moderate dementia. Companions might spend time chatting or playing cards with the older adult in their care or reading aloud to them.|
|In-home caregivers||Help seniors with the activities of daily living, such as shopping, meal prep, and grooming, and some provide help with personal care like toileting and bathing. These caregivers cannot provide medical care, though. While they may provide medication reminders, they are not allowed to administer medication. They are also not housecleaners, although they often do some light housekeeping.|
|Home health care||Unlike in-home care, home health care can only be arranged under a physician’s order. This short-term skilled medical care is delivered or supervised by nurses and therapists (physical, occupational, and speech). It’s typically provided while someone is recovering from a serious illness, accident, or surgery.|
To determine which level of care your loved one requires, take some time to evaluate their abilities and needs. Keep in mind that the care level may change with time. At first, you may just need a care companion, but as your loved one ages, they may need more help with personal care or require health care services.
Finding a Caregiver
If you decide to hire someone to help with senior care, you’ll want to make the decision carefully. You need confidence that the caregiver you choose is going to deliver a high level of care, and screening them isn’t always easy.
One option to help you in your search is to use an in-home care agency. These agencies take care of hiring, training and performing background checks on individual caregivers. They’ll handle things like payroll taxes and scheduling, as well, so you’re free to focus on other aspects of your loved one’s care.
Another option is to use your personal network to locate an independent caregiver. If you know someone who’s used a senior caregiver in the past and had a good experience, you can ask for a reference. Putting a post on social media may also give you some leads. If you choose this route, be prepared to do background checks on your own. You may also want to provide the caregiver with insurance coverage in the event of a workplace accident or injury.
The cost of in-home care services vary and is based on the type and amount of care provided. The 2020 Genworth Cost of Care Survey indicates the average cost for home care in the United States is $4,481 per month. For home health care services, plan to pay about $90 more per month. This breaks down to about $23-$24 an hour.
Visit our In-Home Care Directory to learn more about in-home senior care options near you.
According to the 2020 Genworth Cost of Care Survey averages, in-home care can cost more than assisted living. Thankfully, seniors who want to age in place have options to cover the cost of these services.
If your loved one needs in-home care, costs can add up quickly. This is where planning ahead is helpful. Long-term care insurance policies, according to the American Association for Long-Term Care Insurance, can cover in-home care in addition to care in a retirement community or nursing home.
In addition, seniors can often use government programs to pay for this care, especially if they need home health care. “When a low-income senior qualifies for a skilled nursing facility (i.e., a nursing home) but wants services provided at home, they can be eligible for several programs that can help,” says Alicia Sheerin of Amada Senior Care in Philadelphia.
“These programs go by different titles in each state, but they are all part of what’s known as 1915(c) Home and Community-Based Services Waivers,” Sheerin says.
Seniors who qualify for Medicare, Medicaid, or veterans’ benefits may also have coverage for in-home care through these programs. Using Medicare to pay for in-home care can be complicated, but Medicaid automatically covers home care services through its home and community-based services waivers. In some states, Medicaid funds can pay family members to serve as in-home caregivers, according to AARP. Eligibility for HCBS waivers is based on income and asset limits. The Veteran Directed Care program administered through the Department of Veterans Affairs can also provide coverage to pay family members, chosen by the senior, to provide in-home care.
Adult Day Care Programs
If you find you can’t afford an in-home caregiver arrangement, adult day care may be a more affordable choice that offers the support your loved one needs. These programs provide supervision, activities, and socialization during the day while family and friends are at work, then allow the senior to return home at night when you are free to help with caregiving. The staff at adult daycare centers are trained to supervise seniors who are physically frail or have dementia, providing a safe, supportive environment for your loved one. These programs may operate in connection with local hospitals, residential care facilities, churches, or senior centers, or as stand-alone centers.
In an adult day care program, your loved one will usually receive at least one meal. Planned programming is offered, such as games, fitness, and art classes, to help improve cognition and keep seniors socially engaged. Adult daycare centers often offer door-to-door transportation options to help your loved one get to the facility. AARP indicates there are around 4,600 adult day care centers in the United States serving over 286,000 seniors, which shows this is a popular choice for many older adults and their families.
According to the 2020 Genworth Cost of Care Survey, the average nationwide cost for adult day care services is $1,603 per month, which is almost $3,000 less than the cost of in-home care. However, this amount can vary significantly. Some adult daycare centers charge just a few dollars per day, while others charge up to $100.
Your geographic location and the specific services provided by an adult daycare can affect the cost. Keep in mind that you need to look for a center that offers the level of care your loved one requires based on their physical and cognitive needs. Again, if your loved one qualifies, this is a cost that state and local services, private insurance plans, Medicaid or the Veterans Administration may pay for.
To find a program near you, search by zip code in the Caring.com Adult Day Directory.
Food and Meal Preparation Services
Proper nutrition is a critical concern for seniors living at home. You may find your loved one may not be able to shop for groceries or prepare and cook healthy meals as easily as they used to. When cognitive issues set in, your loved one may overlook nutritional balance when preparing meals.
“Providing nutritional meals for seniors is a huge issue on many different levels,” says Lynette Whiteman, executive director of Caregiver Volunteers of Central Jersey, a nonprofit that helps older adults remain independent.
“Not only are many homebound seniors unable to get themselves to the grocery store, but some of them also have dietary restrictions or even problems chewing and swallowing,” she says. “When we’re younger we take it for granted that we just go to the store and get food, but for older people, it can be a real struggle and something they worry about all the time.”
Poor nutrition can lead to a number of health problems, according to Mayo Clinic. These include:
- Weakened immunity
- Muscular weakness
- Decreased bone mass
- Increased fall risk
- Increased hospitalization risk
- Increased risk of premature death
Inadequate nutrition is an issue for today’s seniors. The National Council on Aging found that 7.3 million older Americans faced the threat of hunger in 2018.
Several organizations have programs to help address this need. Many communities have senior centers that offer congregate or home-delivered meal programs for local seniors. Meals on Wheels is a nationwide, volunteer-run organization that delivers meals to homebound seniors to help cover their daily nutritional needs. Local food banks may offer home grocery delivery services, and senior service organizations often offer nutritional counseling to seniors and their families as well. The best way to find these services in your area is to contact your local Area Agency on Aging.
One of the biggest challenges your loved one may face while aging at home is the inability to drive. When it becomes clear that your loved one is no longer safe behind the wheel, you will need to find alternate transportation options to get them to medical appointments and necessary shopping trips.
For many families, relatives and neighbors are good resources to help with transportation, but you may find this assistance isn’t sufficient or these individuals aren’t always available. The Area Agency on Aging serving your region can help you find alternate transportation options.
Many municipalities offer reduced rates for seniors on their public transit programs. Some even have door-to-door service for seniors who can’t access public bus stops. Look for a program with accessible vehicles if your senior loved one uses a mobility device.
Some communities have social service organizations with volunteer drivers and escorts who serve the elderly and disabled in the area. The National Volunteer Transportation Center is one of these, and it operates hundreds of volunteer transportation systems across the country.
Another option is to use ride-sharing services, such as Uber and Lyft, for occasional trips. Both of these companies have specialized services that help older adults, including services you can book without using a smartphone. Uber’s UberAssist vehicles are accessible for seniors and people with disabilities. Seniors can use third-party programs, such as Go Go Grandparent or Common Courtesy Rides’ Joy Ride program, to connect with these ride-sharing options more easily.
Other resources are more location-specific. Carpooling and senior transportation services through local charities are possible options. To find these types of services, contact your local AAA or senior center.
Helpful Home Modifications for Aging in Place
As people age, they often struggle with mobility impairments. Many homes aren’t designed to help older adults who use mobility aids or are at a high risk of falling. Hallways that are less than 36 inches wide, slippery flooring in a kitchen or bathroom and even transitions between carpet and hard flooring can all pose safety risks. If your senior loved one wishes to age in place, you can complete some helpful modifications to make their home safer.
Both long-term care insurance and some government programs help seniors pay for home modifications. Each has its own eligibility requirements, so seniors can start by contacting their private insurance agent and by learning more about HUD Home Improvement Loans and the VA Aid and Attendance benefits.
Stairs are hard for older adults to navigate. Sore joints and balance issues can make them a safety risk as well. Yet moving to a one-story home negates some of the benefits of aging in place.
Stairlifts make it safer for seniors to navigate staircases. A stairlift has a seat or platform that attaches to the banister or wall of the staircase, with a lifting mechanism that carries a seated senior up the stairs. Many have joysticks that allow an individual to control the speed at which they ascend.
Walk-in tubs allow seniors to bathe without having to step over a high tub edge. They have a swinging door that opens to let the senior to walk inside, and they also have a seat to allow for a seated bath or shower. This limits the risk of a bathroom fall if a senior trips over the edge of the tub.
When a senior is wheelchair-bound or has trouble walking well, a walk-in tub is necessary for bathing at home. Even with home care help, having to step over the tub edge is an unnecessary hazard.
Simple Home Modifications
Your senior loved one may not need major home modifications such as a stairlift or a walk-in tub. However, there are some smaller changes you can tackle to make their home safer, with less of a commitment of time and money. Here are some areas to consider:
- Declutter: Look around the home for potential trip hazards, such as trailing extension cords or gathered clutter, and address them. Consider placing a container in each room where your loved one can put items that don’t have a place, rather than leaving them on the floor.
- Anti-slip mats: Slippery floors can be a hazard, especially in the bathroom where water increases the fall risk. Add anti-slip mats on the bathroom floor, as a backing on throw rugs and in the shower or tub.
- Handrails: Adding handrails and grab bars in the bathroom and in hallways can protect against falls. They also make it easier for your loved one to navigate their home independently.
- Lighting: As seniors age, their eyesight diminishes. Make sure there’s ample lighting in the home, particularly in normally dark places like hallways, and install light switches in convenient areas or use motion sensors that turn the lights on automatically when someone enters the room.
- Furniture: Sharp furniture edges increase the risk of injury when a senior falls, so place clear bumpers over the edges. Make sure all chairs are steady.
- Special knobs and window pulls: Arthritis or muscle weakness can make it difficult for seniors to turn doorknobs or operate window pulls. Replace these with lever handles or chains that are easier to use.
- Accessible shelving: Add shelving in pantries and closets so your senior loved one doesn’t have to bend or reach to access stored items.
- Ramps: Consider adding a ramp so your loved one doesn’t have to navigate steps to enter or exit their home.
- Bathroom: A bathroom has numerous potential hazards. To enhance safety, add anti-slip mats, grab bars, and anti-scalding devices on the faucets.
How Technology Can Help a Loved One Age in Place
There’s no doubt about it, caregiving is a high-stress job. Fortunately, there’s an ever-increasing slew of gadgets and tools that can make it easier to help older adults age in place. Here’s a look at some helpful tech solutions.
Investing in a smart home, which contains seamlessly embedded sensors, could go a long way towards helping your loved one age in place. Smart home technology includes appliances like smart stoves that automatically shut off to sensors that control climate, detect fire and flooding and check carbon dioxide or carbon monoxide levels.
Many smart homes contain motion sensors that automatically turn on lights. They can also alert caregivers if the resident has stopped moving for long periods.
One of the benefits of smart sensors is that they can unobtrusively collect and process data as residents move around the home. In fact, some smart sensors can identify the progression of dementia by tracking a senior’s behavior and will alert caregivers about any unusual behavior.
A system for comprehensively using this type of technology to help supplement physical caregiving is referred to as “remote activity monitoring.” Incorporating many of the technologies mentioned below, these systems are able to remotely send alerts to a caregiver if certain conditions are met. For example, if wandering is a concern for someone with dementia who is living alone, the system could automatically alert a family member or caregiver if an exterior door opens during certain hours.
With the need for elder caregivers expected to rise precipitously in the coming years, this type of technology will be in high demand. Smart home technology can be more reliable than a PERS because it operates in the background and requires no input from the user, who may be reluctant to ask for help
Emergency Response Systems
For many older adults living alone, a personal emergency response system (PERS) can be a lifeline, ensuring they get help in the event of a fall, slip or other medical emergency.
PERS, which have been around for decades, come in the form of lightweight pendants or wristbands that your loved one can wear while going about their normal daily routine. With some units, seniors must press a button to contact emergency services, while other systems automatically activate when a fall is detected.
This AARP report also notes that technology has advanced so much that some systems include fitness trackers, movement sensors and more.
In either case, an operator at an emergency response center will respond, diagnosing the seriousness of the situation and deciding whether to call an ambulance or a designated caregiver to check on the senior.
If you buy a PERS, you’ll have to pay an installation fee and a monthly monitoring charge. (Medicare, Medicaid, and most insurance companies typically don’t pay for the equipment, though you may be able to get a subsidy if your income is low.)
For more information about PERS, visit our guide to the Best Medical Alert Systems for Seniors.
Meanwhile, wearable devices like watches, smart activity trackers and smart clothes can record vitals like heart rate and blood pressure, automatically alerting patients, family members or doctors if measurements get dangerously low or high.
Sensors that emit ultrasound waves to detect objects can be clipped to clothing or woven into vests to help people with poor vision move around safely.
Another benefit of wearables is that they can allow you to remotely monitor your loved one without being intrusive, for instance, by inserting Smart Soles, an orthotic with a GPS tracker, into their shoes.
Keeping as healthy as possible is vital for anyone aging in place. With telemedicine, patients can communicate with healthcare providers from home using two-way video calling equipment.
This eliminates traveling to clinics or medical offices, making it easier for seniors and their caregivers to take care of their health.
Like many older adults, your loved one may have an extensive pharmacopoeia of prescription medicines. Taking a plethora of different pills all at different times of the day can be confusing for anyone, let alone if they have dementia.
Medication reminders can make this process simpler by notifying them and/or you when it’s time to take medication and keeping track of missed doses. Options include a dedicated set-up, such as a pillbox that vibrates when it’s time to take meds, or one of the many smartphone apps that send out digital reminders when the next med is due.
Aging in place is challenging, but not impossible. If you can build the right network of support around your senior loved one, and make some home modifications to improve the safety of the home, you can help them age at home with independence and good health. By utilizing the resources in this guide, you can lessen the risks of aging in place while maximizing the benefits.
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