The Essential Guide to Aging at Home

Long-term care no longer must mean moving to an assisted living residence, nursing home or continuing care retirement community (CCRC).

Most people want to live the rest of their lives in their current homes, according to an AARP survey. But AARP estimates only about 10% of homes are fully prepared for aging in place.

Fortunately, aging at home over an extended period with dignity and safety is becoming more and more viable. New resources and other developments make this goal more achievable every year.

But accomplishing this goal requires planning and taking actions well ahead of time.

To successfully age at home, you should aspire to more than living in the same home. You should want to stay there safely and independently and only if you can maintain a good quality of life at a reasonable cost.

But it’s important not to be among those who defer important decisions about aging because of thinking it’s too early. People who wait to take action on these matters often find that when the time comes, they no longer are able to do what needs to be done or can’t have it done in time.

A significant aid to aging at home that many people still aren’t aware of is that most long-term care insurance (LTCI) covers care received at home.

LTCI isn’t nursing home insurance. Most policies issued in force now cover LTC wherever it is received, whether in an assisted living residence, memory care facility, nursing home, or your residence.

The choice of where to receive care is up to the policyholder and any other decision makers, such as family members, not the insurer.

Some policies will pay only for care provided by caregivers who have appropriate licenses. But other policies don’t restrict who is paid to provide care at home, even family members.

Also, today’s technology makes it easier and safer for someone to remain in their home in circumstances that wouldn’t have been advisable in the past, and more technology is on the way.

Some tools can report a person’s vital signs to medical providers, allow video visits with providers, and submit other information and data to medical providers so fewer trips from the home are required.

Loved ones and others can stay in regular contact and be reassured thanks to technology. Simple daily emails, texts and video or phone calls are sufficient for many people. Motion sensors and noninvasive monitors also are available.

Tools are available to ensure medications are taken properly and on time. Some technology helps prevent falls or report falls.

Technology also can perform or assist with some daily tasks.

Another step to successful aging at home is to evaluate the home and determine how the residence should be altered to maximize the time that can be spent there in one’s later years.

Some people will find modifications to the residence are needed while others will decide it’s better to move to a nearby residence that’s better suited for aging in place or can be more affordably modified.

The biggest issue is that mobility and dexterity are likely to decline as one ages.

Common modifications to deal with these issues include ramps to one or more external doors, elevators or chair lifts to supplement stairs, and walk-in tubs or showers. Another common modification is to change doorknobs and cabinet handles to levers that are easier for those with arthritis or other joint problems to use.

An alternative to an elevator or chair lift is to convert a multi-level home to one-level living by moving the owner’s bedroom to the main floor.

Rugs and other items often should be removed to reduce the risk of tripping. Stronger handrails can be put on stairs. Interior lights can be brightened and equipped with motion detectors.

Some people ensure there is a room or apartment available for one or more live-in caregivers if it should be needed. That’s a good idea even when you’re only hoping one or more relatives will be available to help at times.

Not everything required for a home to accommodate aging in place is obvious. Good sources of ideas for modifying a home include the National Association of Home Builders (which can refer you to Certified Aging in Place Specialists) and AARP.

Successful aging in place also requires consideration of some activities we take for granted.

Transportation is one issue. You need to go to medical appointments, buy groceries and other essentials, run errands and simply get out of the house. There might be public services or non-profit groups to help meet these needs. Know the services that are available before you need to rely on them.

Some communities have various networks in place to help their older residents. Innovative concepts implemented in different localities include the “village” concept and naturally occurring retirement communities (NORCs). The idea is you have the benefits of a retirement community without moving to one.

Details vary around the country, but in general one or more non-profit groups in the area serve as a clearing house to match providers to those with needs. Often there are fees for the services.

Of course, learn about the local providers of services that help people stay in their homes if they need help with chores such as cleaning, preparing meals, dealing with mail, paying bills, reading or safely going for a walk. In many areas, there are services, known generally as homemaking or companion services, that help with these tasks for a fee.

The next challenge to aging at home occurs when more assistance with the activities of daily living is needed. Some services might have to be provided by licensed or certified nursing assistants or other people with medical training and certification.

You should decide before you need care at what point aging at home no longer is desirable or practical.

For some people, the tipping point is when they need in-person help more than a few days a week or a few hours each day. For others, aging at home no longer makes sense when they need round-the-clock assistance.

Finances are likely to be a major part of that decision. Know how you’ll finance different levels of assistance and services when they’re needed.

In some areas, home care aides cost about as much as residing in an assisted living residence (ALR). When you have home care aides, you’ll also pay for all the costs of owning and maintaining the home, as well as your food and other needs. In an ALR, all or most of those costs, plus a good deal of assistance, are bundled in the monthly fee. So, there could be a point when aging at home is much more expensive than moving to an ALR.

Keep in mind that the home and your physical needs are only part of the picture. Successful aging also requires social connections. Research shows that social isolation accelerates cognitive and health declines. Contact with caregivers isn’t sufficient. A person needs some close personal relationships.

If you want to age in place, will you be able to establish and maintain social contacts? Do you have close friends and relatives nearby? If so, will they remain there, and will you be able to see them regularly? Will you be able to establish new relationships as people you know move or pass away?

Social connections are one reason people give for wanting to age in place. They cite nearby family, longtime friends, their faith community, clubs, and similar contacts. But keep in mind that you often can stay in the same general community and maintain those contacts without staying in the same home.

An advantage of apartment-style independent living or assisted living communities is social connections can be more frequent and easier to make. You don’t have to leave the building to meet people, and there are a lot of people to meet. A range of activities is on the calendar. You only have to choose those that interest you.

What’s probably most important is that you have one or more people you trust who can monitor your quality of life. There should be people you’ll listen to who will tell you when living on your own has reduced your quality of life and it’s time to consider another arrangement.