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As people reach their golden years, many choose to age in place, or stay in their home until the end of life. The goal of aging in place is to avoid moving to assisted living or nursing homes, even as health needs increase. A recent AARP study found that 77 percent of adults 50 and older want to remain in their homes for the long term.
Deciding whether to age in place, or move to a care-community setting, depends on a person’s individual needs, preferences, and resources. Aging in place is often a comfortable choice for those who age, since change can often be traumatic to someone who has cognitive deficits or simply wants to stay at home. But sometimes moving to a care community may be a better individual choice.
There are important issues to consider and understand in advance of making this decision.
1. What does Medicare cover? Medicare will pay for certain services to be provided in the home. Physicians, Nurse Practitioners and Physician Assistants around the country do provide medical care in the home – even housecalls. If someone has challenges getting to a brick and mortar office, they may meet “homebound” criteria, and can have primary care services, some specialist services, x-rays, lab draws and even physical therapy come to them. Candidates can find resources about whether there are house calls available in their area by going to the website for the American Academy of Home Care Medicine.
2. What Other Costs Must be Considered? Understanding the costs of care for aging in place versus assisted living or other care communities is a critical decision step. Aging in place can be more expensive than moving to assisted living if someone needs a lot of assistance with daily activities. In the aging in place model, private duty home health aides, sometimes called nursing assistants, are often needed to assist with companionship or activities of daily living. While aging in place can initially seem less expensive if there is less need for assistance with daily living activities, costs can skyrocket over time. In general, Medicare will not pay for these services.
Homecare can be very expensive in the long term, even with long-term care insurance, so interested parties should be prepared for some sticker shock. Assisted living communities often provide an “all-in-one" package, and there is always staff around to assist. The national median cost for assisted living per month is $4,500, which breaks down to around $148 per day. However, the cost can vary greatly depending on geographic location.
3. Will Changes to the Home Need to Be Made? Changes to one’s home are often needed to successfully age in place. As people age, there are often structural challenges that are in a home setting that need to be addressed. Stairs, narrow hallways, out of reach switches, bathroom design, doorways, and even cabinet designs can be challenging if someone chooses to age in place. Many building companies do provide residential redesign options, often called “universal design”.
4. Are Nursing Homes and Assisted Living Facilities Covered by Insurance? These types of communities are not the same thing and are also not considered “aging in place.” Typically, an assisted living facility is funded privately. Insurance will not usually pay for assisted living in most locations, not even Medicare. Nursing homes are often just a building that provides rehabilitative services for those coming out of a hospital, but they can also have “long-term care” beds. Long-term care beds are often two to three times as expensive as assisted living and may not provide any additional services.
Oftentimes, if someone qualifies for Medicaid, they can live in a nursing home for free or at a reduced cost, funded by the state in which they live. It is important to understand that assisted living facilities and nursing homes can both be paid for privately, but understanding what level of care is required should be carefully considered before choosing one or the other.
5. How Can Professionals Help? It is recommended that people interested in weighing their options should seek professional guidance to understand the choices that need to be made. There are many professionals who are trained to understand the choices of aging in place versus moving to another type of living arrangement. These types of professionals are often called “care managers,” and have titles such as “Aging in Place Specialist,” Life Care Manager,” or Geriatric Care Manager.” They are typically private pay.
There are also regional and local resources available, which may also be provided for free through the Department of Aging.
There is a lot to consider for those looking to age in place and live out their lives at home. That is why it is important to educate these communities about their options, and encourage them to seek out professionals who can help guide them toward the right decision.