Aging is an inevitable part of life. The most important thing is to age in the best conditions. For many people, their house is the ideal place to grow old, but many aspects should be considered to have the best experience.
Main Points
- Aging in place refers to the decision to age in your own home rather than a senior care facility.
- Aging in place can help seniors feel more comfortable as they are in their own surroundings and offers more privacy than a communal setting.
- If significant in-home care is required, aging in place can be much more expensive than moving to an assisted living facility or other senior care setting.
- To safely age in place; a family member or other caregiver should be around in order to help with activities of daily living.
- Planning ahead for home modifications and ensuring financial resources will be available is essential to successfully age in place.
What is Aging in Place?
Aging in place refers to the option for seniors to live safely, freely, and comfortably in their own home and community as they age and need increasing levels of care and support. According to the AARP, 77% of adults 50 and older wish to age in place rather than move into an assisted living facility, board and care home, or other senior care facility.
Benefits of Aging in Place
Aging in place provides many benefits to seniors including maintaining a sense of independence, living in a familiar and comfortable living environment, maintaining social connections in their community, and can be less expensive than aging in an assisted living facility (depending on the type of care required).
Maintaining a sense of independence is critical for many seniors. While some ADLs become more challenging for many as they age, with the help of a home health aide (HHA), they can remain in place and retain a high quality of life. Even with help from a HHA, aging in place often gives seniors more self confidence and a positive attitude – both of which are helpful in dealing with health issues that may encounter as seniors continue to age.
Aging in place provides seniors with familiarity which is helpful particularly for seniors who may have memory challenges – being in their own home helps these seniors to have more stability and sense of normality.
Another advantage of aging in place is that it is easier for seniors to maintain social connections and relationships when they remain in the community they have been a part of for years. Independent living can help maintain positive interactions with friends, family, and community members which can help prevent depression and may help with dementia.
Finally, aging in place may be a less expensive option than living in a senior care facility as room and board is generally not covered by medicare unless it is associated with short term skilled medical care. Aging in place tends to be particularly cost effective when the senior primarily needs light housekeeping help, companion care, or minimal help with activities of daily living. If 24/7 custodial care or skilled medical care is needed, receiving this care in a senior care facility may be more cost effective.
Challenges of Aging at Home
Despite its numerous advantages, aging at home has its drawbacks. Accessibility within their homes is one disadvantage of aging at home. In order to successfully age in place, many homes require significant modification to help aging seniors improve their ability to accomplish activities of daily living (ADLs). This often includes modification of stairs (installing lift seats or ramps), removing slippery floors, updating door handles and faucets to be easier to use, modifying bathrooms and showers to improve accessibility and safety, among other updates to keep seniors safe.
Additionally, as older residents begin to have difficulty walking, getting around outside of the home may become challenging as many seniors are unable to safely drive themselves. This can prohibit them from seeing friends, attending social functions, or making doctors appointments – all of which affect their long-term health. To compensate for this, planning for transportation is essential.
As aging in place requires additional attention and care, it is important to decide how that care will be provided. Many families opt to have a spouse or family member provide care, but this can lead to caregiver burnout. If this route is chosen, it is important to plan for respite care.
Planning Ahead to Age in Place
If you decide that aging in place is the best choice for you or your loved one, it is critical to start planning well ahead of time. Planning ahead helps prevent things like accidents from failing to properly modify a home, and will ensure that proper help is provided for everyday tasks (household chores, grocery shopping, etc) and personal care (companion care, help with ADLs, skilled medical care, specialist care / therapy, etc). Failing to plan can result in un-needed injuries, exacerbation of health conditions, and undue stress. When planning ahead, it is recommended to:
- Meet with a financial adviser to help you create a long-term budget plan factoring in the care required alongside your finances and the benefits afforded by health insurance, long-term care insurance, medicare, and any VA benefits that may be applicable.
- Talk with family members about the care plan – see if they are willing and able to help with care or if you will need to hire care.
- Start by making a list of all the house modifications required to make the home safe and comfortable.
- Consider transportation options to ensure you are able to get to appointments, the grocery store, social functions, etc. Many local communities offer senior transportation.
What Support is Needed to Age in Place?
It is important to recognize that new support systems will need to be put in place to make sure older adults are safe and well cared for in their own homes. This assistance can take many forms, including family support, social services, and in-home care services. As a result, you should start thinking about your support system and what it should comprise.
Home Health Aide
Professionals that provide home health aide care typically assist the elderly with ADLS to help them with their daily life. These needs might include anything from getting out of bed, walking, bathing, and dressing.
The typical cost of home health aid is $5,148; While Medicare parts A and Plan B will cover skilled medical care and therapy at home, Medicare does not cover custodial care or household help that a home health aide may provide. As such, typically Medicare will not cover a home health aide unless they are providing skilled medical care – this is typically provided by specialists though such as nurses, physical therapists, etc.
Companion Care
Companion care is an example of an in-home care service. Such services might require the caregiver to run errands for a senior, such as food shopping or picking up medications. Caregivers will plan and prepare regular meals, handle housekeeping chores, and give constant reminders for medications. Additionally, caregivers accompany clients to appointments and social events.
The cost of such care is approximately $4,957 and is typically not covered by Medicare unless it is required alongside skilled medical care.
Household / Homemaker Services
Household or homemaker services assist with household chores – these often include chores around the house like laundry, cleaning, and food prep. Depending on who is providing the care, these services might be provided by the same person who provides custodial care. The typical cost of these services is $4,957. Medicare will not cover household services.
Food Delivery
As many seniors cannot go grocery shopping and may have difficulty preparing healthy meals, it can be helpful to have groceries or prepared meals delivered to their home – this provides peace of mind to family members that older adults will have access to healthy and nutritious meals. Often there are community organizations with programs to assist these groups of people meet this demand. Meals on Wheels is a volunteer-run program that distributes meals to elderly seniors to help them meet their nutritional needs for $6.00 – $7.00 per meal. Additionally, there are several meal delivery services now such as Doordash and Uber Eats as well as grocery delivery services like Instacart. Note that Medicare does not cover such services.
Transportation Services
The inability to drive is one of the most significant obstacles older people experience while aging in their current home. As a result, it is important to find other ways to get to daily activities like shopping or medical appointments. The first to come to mind might be family relatives or neighbors, but that may not be a long-term solution since they can sometimes be unavailable.
To help solve that problem, The National Volunteer Transportation Center can help you find alternate transportation options. Some of the transportations available can be free of charge; however, some cost up to 12$. While less affordable, transportation is also available from ride share services like Lyft and Uber. Unfortunately, transportation costs are not covered by Medicare.
Adult Day Care
Adult daycare is typically utilized to free the caregiver of their day-to-day responsibilities while ensuring that the senior adult receives proper care in a safe and welcoming atmosphere. This can be helpful to either give the primary caregiver a break on an occasional basis or to provide routine care when there is a recurring conflict with a primary caregiver’s schedule. These adult daycare centers typically cost $1,690 (possible for coverage with Medicare part C coverage).
Skilled Nursing Care
Skilled nursing provides medical care beyond the ability of a home health aide – This care is frequently needed after surgery, an accident, or when severely ill. Some of the services that skilled-nursing care includes are nursing, physical therapy, occupational therapy, speech therapy, wound care. The price for skilled nursing care can vary from $271 – $399 per day and part-time or intermittent skilled nursing care at a patient’s home is covered by Medicare.
Telehealth
As the word suggests, Telehealth offers health services through telecommunication. This is done through live video conferences using smartphones, tablets, or computers. It is a subset of the broader area of telemedicine, which encompasses a wide range of virtual health and medical services.
Telehealth services can be especially helpful for older people who are aging in place without convenient access to transportation. In the face of difficulty getting to appointments, a telehealth service may be a helpful substitute in some circumstances. A telehealth visit is approximately $79, and part B of Medicare may cover these services.
Medical Supplies / Durable Medical Equipment
Durable medical equipment is medical equipment that aids you in living a normal life. It includes walkers, wheelchairs, and oxygen tanks, along with other supplies that often make it easier to age in place. If your doctor prescribes durable medical equipment for your home, medicare will cover the cost of medically necessary equipment.
Helpful Home Modifications to Age in Place
Ensuring that a senior’s current home is safe for them as they continue to age in place is a critical part of planning for their long-term care plan. There are some common modifications which are helpful in creating a safe environment:
- Changing the flooring to a slip-resistant one, especially in the bathroom. Depending on where you live in the country, the cost for this modification might range around $6,400 to $11,000.
- Increasing the width of doorways and hallways to accommodate wheelchairs and scooters. Such modifications can vary anywhere from $200 to $7,000, depending on your house structure.
- Adding a walk-in tub or shower to your bathroom. Walk-in tubs or showers range from $3,000 to $15,000. They have a low entry step of only a few inches, making it easy to get in and out of the tub.
- Reconstructing the entryway. Installing a permanent ramp that allows you to access your home with a walker or wheelchair can improve your everyday life for around $874 to $1,751 when done by a professional.
- Installing grab bars and grips. They are strategically installed on shower or bath walls to help prevent slipping and falling. They can also be installed near the toilet and other living areas to help with sitting and standing; also, they can provide additional stability when installed close to the sink or vanity. The average cost for such installations is $248.
- Making a bedroom on the first floor is also a good option to avoid getting up and down the stairs every day. If there is a room available on the first floor, turning that into a bedroom can save you a lot of money.
Costs of Aging in Place
In-home care in the United States costs around $4,600 per month. This price highly depends on your location. States with higher living costs tend to be more expensive. Additionally, you should take into account the cost of home modifications. Depending on the changes you find necessary, the cost can be anywhere between $200 to $15,000. You might choose to age in place simply because it can be half as expensive than a nursing home.
How to Pay for Aging at Home
Finances play a large role in developing your aging-in-place strategy. You must budget for all expenses and determine how you will pay for them. These expenses include home modification, in-home services, and food and transportation services.
Medicare
Medicare is a government-run healthcare program in the United States. Persons aged 65 and over are typically covered by the program, while some plans are offered to younger people with specified medical conditions.
Medicare is broken down into numerous sections covering various medical services, supplies, and treatments. There are two main divisions called Original Medicare and Medicare Advantage Plan.
Original Medicare includes Medicare Hospital Insurance (Part A) and Medical Insurance (Part B). These will often cover services provided at home. That said custodial care, help with household chores, and other non-medical care is not covered by Medicare.
Part A covers the following:
- Inpatient hospitalization
- Care in a skilled nursing facility
- Nursing home care (non-custodial or long-term inpatient care at a skilled nursing facility)
- Hospice treatment
- Healthcare at home
Part B deals with two different sorts of services:
- Medically required services include services or supplies required to diagnose or treat your medical condition and comply with accepted medical practice standards.
- Prevention services: Preventing disease (such as the flu) or detecting it early, when treatment is most likely adequate.
It covers the following:
- Clinical trials
- Emergency medical services
- Durable medical equipment (DME)
- Mental health
- Limited outpatient medications prescription
Medicaid
Medicaid is the federal government’s healthcare program for individuals with low income – it is federally funded but each state has it’s own qualification and benefit rules. The great majority of Medicaid recipients are very low income and do not have other options for affordable health care – most people do not qualify for Medicaid coverage. Medicaid covers a range of health treatments and keeps out-of-pocket expenses to a minimum for enrollees.
Mandatory coverage includes:
- Inpatient and outpatient hospital services
- Physician services
- Laboratory and x-ray services
- Home health care
The optional benefits offered by Medicaid are:
- Prescription medications
- Care management
- Physical therapy
- Occupational therapy
Medigap
Medigap insurance is also known as Medicare supplemental insurance. A Medigap policy can assist pay for some of the healthcare costs that Original Medicare doesn’t cover. Depending on the services you need at home and your plan’s details, a Medigap plan may help you get services you need for a better price. Those include :
- Medicare deductibles
- Coinsurance
- Care while traveling outside of the country
Other things to remember about Medigap insurance include:
- Original Medicare Parts A and B are both required.
- In addition to your Medicare costs, you must pay a monthly premium for your Medigap policy.
- A single person is covered by Medigap coverage; spouses must get separate policies.
- You might not be able to obtain your Medigap policy back if you cancel it.
Medicare Advantage
Medicare Advantage is a Medicare-approved private company plan that provides health and medication coverage in addition to Original Medicare. Part A, Part B, and, in most cases, Part D is included in these “bundled” plans. Similar to Medigap; whether Medicare Advantage will be useful for you will be determined by your needs and your Medicare plan coverage.
Out-of-pocket costs of Medicare Advantage may be lower than with Original Medicare. Also, programs may include supplemental benefits not covered by Original Medicare, such as vision, hearing, and dental care.
Long-term Care Insurance
When you have a chronic medical disease, a disability, or an illness like Alzheimer’s, long-term care insurance coverage can help pay the costs of that care. While Medicare focuses on healthcare; long-term care insurance helps with senior care – specifically coverage for things including housing, help with ADLs, and memory care which are not covered by Medicare or traditional health insurance.
Long-term care insurance coverage varies by plan but typically it will cover things like:
- Home health care
- Adult day care
- Personal care
- Homemaker services
- Hospice services
- Respite care
- etc
