What is aging in place?

If you’re a Baby Boomer approaching the retirement years or a family member concerned about making that transition as safe and seamless as possible for your loved ones, you may have heard the term "aging in place."

Eighty percent of Americans age 50 and older say they want to remain in their own homes.

You may be surprised to learn this is not simply a casual turn of phrase. The definition of aging in place is, according to the U.S. Centers for Disease Control and Prevention, “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income or ability level.” Unsurprisingly, nearly eighty percent of Americans age 50 and older say they want to remain in their own homes and communities as they age, according to a 2018 survey by AARP.

Widely perceived as the “opposite” of assisted living, aging in place is, in fact, a viable option for many people today specifically because many kinds of services and assistance are available in people’s own homes as they age. Help is available with a wide range of routine and specialized tasks and responsibilities that make aging in place a realistic option for many, including aid with routine household chores, personal and medical assistance, financial management, access to transportation services and nutritious meals, social and entertainment activity support, and more.

Considerations and benefits of aging in place

The decision whether to remain in a private, personal home or to make the transition to a professionally managed assisted living or retirement community residence is personal and complex. It will ultimately take into consideration many factors, including each individual’s intellectual, physical, and emotional capacity to safely and autonomously remain in the home of his or her choice.

But for those who are able, aging at home in a familiar and beloved place, (or downsizing to a house with features that are optimized for older adults) may offer significant benefits.

Cost savings. Assisted living is all-inclusive, and therefore expensive. In 2017, the average national monthly cost was $3,750, or $45,000 per year. (Nursing home care is significantly more expensive, at $6,844 per month, or $82,000 per year). And with very few exceptions, none of these expenses are covered by Medicare. Aging in place at home (even with part-time housekeeping and home health aide help) is typically substantially less expensive; some older adults who meet the Medicare definition of “homebound” may even qualify for Medicare reimbursement of in-home medical aides, provided their physician has ordered the help.

Comfort and familiarity. The psychological and emotional benefits of aging in a home of one’s choice—often one with a long, cherished, personal and family history—can not be overstated. And these are the strongest motivators for aging in place. Staying close to existing friends, family, community ties, and routines like routine get-togethers at favorite restaurants can even help to maintain the social connections that stave off cognitive decline later in life.

Making a plan for aging in place

Aging at home successfully doesn’t simply happen; it requires a great deal of forethought, planning, and preparation.

Planning for aging in place should begin years before the retirement transition, with carefully considered financial planning for the years when home maintenance and services will be required for safe, comfortable, independent living.

Readying the home itself also becomes a part of planning for retirement; renovations and modifications may be required on older homes, or a new home purchase may be the more practical if an original home is too large, or if original home features (such as narrow staircases and bedrooms on higher floors) cannot be remediated practically within available financial means.

A comprehensive plan for includes carefully thought-out provisions, budgets, and future projections that take into account:

• Medical and physical needs

• Financial needs

• Personal connections, social, entertainment, and community involvement

• Transportation needs

• Logistical assistance with home care and maintenance

• Backup strategies in case of unanticipated situations, such as unanticipated illness, injury, or major changes in financial or housing conditions (i.e., flood, fire, natural disaster)

• The proximity and availability of friends and family as caretakers or caretaker adjuncts

What does aging in place mean for families?

Perhaps the most contentious issues surrounding aging in place for children and loved ones of older adults who want to remain in their homes as long as possible are, “I want to support this decision, but I also want my loved one to be safe and to be sure the people coming in and out of the home are reliable and trustworthy.”

Family members who live near their older loved ones may be able to participate actively in the planning, decision-making, and transition, selecting care assistants whom they trust. Those who are helping to coordinate aging in place from a greater distance may want to consider additional services to help increase peace of mind and ease the burden. Personal emergency alert systems (PERS) and cell phones with features that streamline communication with the family’s caregivers can help to bridge the geographic distance while maintaining independence.

Families may also consider a professional geriatric care manager (GCM), who starts by completing a specialized elder care needs assessment. Based on the findings, the GCM can then step into an intermediary role, helping the family by providing local “eyes and ears,” navigating the sometimes-labyrinthine health care system, supervising and coordinating home-based help.

While it may seem counterintuitive, investing in a GCM who is intimately familiar with eldercare law, Medicare, Medicaid, and the unique financial planning issues faced every day by older people aging at home, can be a money-saving decision. Beyond the financial savings, however, it can also be a relationship-saver, allowing children to be children and parents to be parents while outsourcing the more difficult, confrontative aspects of care coordination and management.

Challenges older adults face when aging in place

No matter how well we eat, how much we exercise, how many weights we lift, or how diligent we are about our annual preventive health screenings, aging changes us. Physical and cognitive changes associated with aging affect everything from how we move through the world to how we perceive it, and these, in turn, affect how the environment in which we age needs to change to accommodate older adults safely and comfortably.

• Vision deficits become more common, especially in low light

• Unassisted hearing becomes less acute

• Unaided balance may become less stable due to inner ear problems or other sensory deficits

• Muscle mass and density decrease, leading to reduced strength while rising, sitting, and transferring from one position to another

• The risk of falls increases due to the combination of balance issues, reduced strength, lack of flexibility, delayed reaction time when stumbles do occur

• Mental processing, problem-solving, and learning take longer

• Memory may begin to decline

Each of these changes can impact older people’s ability to care for themselves independently in their own home. For many, health challenges may create significant struggles with everyday self-care tasks (a subset of which are known formally in healthcare as activities of daily living, or ADLs).

Basic ADLs: Bathing and/or showering, personal hygiene and grooming, dressing, toileting, functional mobility (moving from one place to another) and transferring positions (lying to sitting, sitting to standing, etc.)

Instrumental ADLs: Cleaning, laundry, cooking, home/lawn care, trash, and food waste management, shopping, medication management, money management, driving, etc.

Aging in place home modifications

While overwhelming consensus is that aging in place is the goal, the Wall St. Journal reported in 2018 that Harvard University recently found fewer than one-fourth of homeowners who want to remain in their current residence have a full bath and bedroom on the first floor of their homes.

If aging in place safely, comfortably, and independently is a goal for you or a loved one, the following modifications will help to minimize the risks of avoidable home-based injuries:

Sensory aids: Install additional task lighting and brighter overhead lights. Replace batteries in smoke and CO2 alarms regularly and make sure they are loud enough for the older person to hear. If there are hearing deficits, consider alarm systems that also include visual cues.

Stability: Install safety railings and grab bars throughout the home, especially in bathrooms, hallways, and staircases. Declutter to remove potential trip hazards. Remove throw rugs. Replace slippery floor surfaces in kitchens and baths with non-skid flooring or install thick, industrial foam non-skid mats.

Mobility: Add outdoor ramps to help with access. Consider installing chair lifts or elevators indoors before the need arises.

Get a grip: Help hands with reduced grip strength by replacing doorknobs with lever-style handles, and replace traditional, handled faucets with touchless versions.

Add peace of mind with smart home technology. From smart lights, thermostats, security systems, voice-controlled assistants and robotic cleaning devices to smart pill cases that remind you if you’ve skipped a dose the era of the internet of things is poised to open a vast new horizon of tech-assisted ways to help older Americans retain their comfort and independence as long as possible. For extra peace of mind, a Personal Emergency Response Systems (PERS) with fall detection provide an additional layer of reassurance and the option to call trained responders should anything out-of-the-ordinary arise. Some voice-activated smart home assistants even allow seniors to simply call out for help with no need to carry around a mobile device. As remote monitoring and response technology continues to evolve and expend, expect more features, options, and levels of assistance to be offered in this rapidly expanding space.

In aging, as in all things, nothing is assured. The possibility that at some point, those who have made plans to age in place may find themselves in need of a different form of temporary or permanent residence is always a real one. Rehabilitative housing, assisted living, or another residential arrangement (such as moving in with extended family or a larger community of older adults). There is no single “right way” to age, and every significant change in circumstances is an opportunity for a re-evaluation of each option, including potential advantages and drawbacks.