Aging in Place: A Guide to Growing Older at Home

Aging in place occurs when someone makes a conscious decision to grow older in their current residence instead of moving to an assisted living or long-term care facility. It works best for people who create a plan, modify their home and establish a supportive network of family and home care services. Affordable, accessible and suitable housing options also make it easier for older adults to age in place and remain in their community for years to come.

The choice to either age in place or transition to assisted care is a complex and personal decision influenced by emotional, physical and financial factors. But the choice of aging in place has become a leading senior housing option for a wide majority of people nearing retirement.

Staying in a familiar setting is a priority for many seniors. But aging in place isn’t always as easy as it sounds. Maintaining independence can become increasingly difficult as age increases and health declines.

Everyone’s situation is unique. It’s important to evaluate and be realistic about your own circumstances, and to weigh the benefits of aging in place with the realities of the loneliness and depression experienced by many seniors who live alone.

While staying in the family home is ideal, it isn’t always a realistic retirement lifestyle.

“It’s not for everyone. It’s important to explore your options,” Louis Tenenbaum, a former home modifications contractor who now runs the aging-in-place policy and advocacy organization HomesRenewed, told RetireGuide. “Every house isn’t a good candidate, and everyone’s situation is different.”

A 2020 Census report reveals that only 10% of U.S. homes are fully ready to accommodate residents aging in place. While Tenenbaum said most homes can be adapted for aging residents, he admitted that certain situations make remodeling difficult and expensive.

A widowed 70-year-old woman who lives in a ranch-style, accessible home within 15 minutes of her two adult children will likely have an easier time aging in place.

An 85-year-old man who lives in a large, three-story home in a rural area with no nearby family or friends will have a difficult time aging in place.

“A multistory home without a bathroom on the first floor, for example,” said Tenenbaum, who founded one of the country’s first design-build remodeling companies focused on aging-in-place services back in 1993. “Or if access is difficult from the outside, like a really long driveway. There’s also a lot of homes that are just suffering from major maintenance neglect.”

Cognitive impairments, such as Alzheimer’s disease and dementia, also make aging in place precarious because round-the-clock care is required as the disease progresses.

Advances in home care and expanding home health services make aging in place possible for more Americans. There are several benefits you should consider when deciding if it is the best choice for you.

Aging in place also comes with disadvantages for many older Americans. You should carefully determine whether these cons outweigh the pros based on your personal health conditions and situations.

Aging in place isn’t simply a decision to do nothing and stay put. Things will need to change, and preparations will need to be made. Creating a roadmap and checklist can help prioritize what needs to be done. Examining available home care and community resources makes it easier to decide what’s right for you and your family.

“If you start planning and addressing where the holes are in your aging-in-place plan, it’s going to make things more comfortable in the long run,” Tara Ballman, program director at the National Aging in Place Council, told RetireGuide.

Proper planning can go a long way. It’s better to have a support system established before a health crisis forces you to make uncomfortable decisions. “If you wait until you’re already infirmed or in bad health, that’s a poor time to hire a remodeling contractor to modify your home,” Tenenbaum said. “We really want people to take these steps in advance.”

Staying social is also key for seniors aging in place, Ballman said. “The social aspect is something people don’t plan for — but they should.” Bellman also works as an aging services expert at HomeWorks Physical Therapy in Costa Mesa, California.

Senior centers, clubs and community activities are a good way to stay involved. Zoom or FaceTime calls with loved ones can help, too.

Often seniors choose to age in place simply because it is the most economical option. Nursing homes can be more than three times as expensive as noninstitutional long-term care services, according to an analysis by the U.S. Department of Housing and Urban Development.

Many seniors dread the idea of expensive institutionalized care, especially those who own their own homes outright. But aging in place isn’t cheap. Yes, the dwelling itself might be paid for, but other costs exist. At-home homemaker services are often available but the median cost is about $61,776 annually.

That’s why it’s essential to create a budget — even if it’s a tough subject to discuss with your family. “The roles are starting to reverse as the adult children see a need or desire to help their parents, and that is uncomfortable for everyone,” Susan Greenhalgh, accredited financial counselor and president of Mind Your Money LLC, told RetireGuide.

Evaluate your sources of income as well, such as Social Security benefits, disability benefits, retirement account distributions and pensions.

Keep in mind that the cost of aging in place will likely increase over time. It may be more affordable to stay in your home now, but that might change in five or 10 years.

Speaking with a financial advisor or money coach is a wise way to map out future expenses. Another option is talking to a geriatric care manager. This professional is usually a licensed nurse or social worker.

You can use the Eldercare Locator to find geriatric care manager recommendations.

Modifications can make it easier for you to navigate and live in your home as you age. According to a 2021 survey by AARP, 34% of respondents recognized the need to make physical changes to their homes to age in place. Some of those changes are relatively quick and easy, such as removing throw rugs or rearranging furniture. Other renovations are more costly and time-consuming.

Nearly 80% of respondents plan to make bathroom modifications to age in place; 70% want to renovate for access, either at the entranceway or inside the home; and 60% want to add an emergency response system. These types of modifications are key to improving your mobility and home safety as you age in place.

The cost of home modifications can range from a couple of hundred dollars for basic projects to several thousand dollars for extensive modifications.

If you decide to move forward with modifications, it’s wise to consult with an expert. The National Association of Home Builders certifies aging-in-place specialists who are trained to design and build barrier-free living environments specifically for older adults.

“Everyone’s home is different, and everyone’s physical limitations are unique,” Adam Fine, president of Accessible Construction and two other California-based companies, told RetireGuide. “A professional can come in and assess your needs room by room.”

Fine is a certified aging-in-place specialist who entered the industry more than 20 years ago when his father was dying from Parkinson’s disease. “Many people will start out with just a few basic modifications. Over time, people’s needs change. They may call us a few years later and decide they want that stair lift installed after all.”

If you want to remain in your home, you’ll likely require some type of in-home care. Home health care is typically less expensive, more convenient, and as effective as services you receive in a hospital or nursing facility. But it comes at a cost. Genworth estimates home health care services median cost is $61,776 annually, depending on the type and amount of care required.

Many home health care services are covered by Medicare. Other government programs, such as Medicaid and the Department of Veterans Affairs, can also help pay for this care. Once you understand your needs, you can start exploring your options.

Keep in mind that Original Medicare will not pay for full-time home care or homemaker services if this is the only care you need. It also doesn’t pay for extended long-term stays at an assisted living or skilled nursing facility.

An important part of aging in place is thinking about how you are going to afford the help you need.

Some services and equipment may be covered by Medicare or other health insurance. Some may not.

If you’re eligible, Original Medicare will pay all costs for home health care services ordered by a doctor and provided by a certified home health agency. To qualify for Medicare home health services, you must be homebound and under the care of a doctor.

Additional services may be provided by Medicare Advantage, which are plans administered by private health insurance companies that contract with the federal government.

In 2019, the Centers for Medicare & Medicaid Services allowed Medicare Advantage plans to begin offering expanded in-home support services that Original Medicare doesn’t cover. This can include nonmedical transportation, adult day care programs, caregiver support, nutrition programs and home modifications.

It can also include nontraditional offerings. In California, SCAN Health Plan offers Medicare Advantage members a free Fitbit activity tracker every two years to monitor fitness goals.

“There’s a lot of little things they can work into those Medicare Advantage plans now that you don’t get typically with traditional Medicare,” said Tara Ballman, the program director at the National Aging in Place Council.

Several major insurers offer Medicare Advantage plans with enhanced benefits, including Cigna, Anthem, Humana and UnitedHealth Group.

About 40% of all Medicare beneficiaries are enrolled in a Medicare Advantage plan. For those enrolled in Original Medicare, supplemental plans known as Medigap can help cover out-of-pocket costs, including deductibles, coinsurance and copayments.

People who plan early may buy insurance policies that cover expenses related to aging in place. This can include long-term care insurance or a life insurance policy with a rider for long-term care, often referred to as a hybrid policy.

Annuities are another option that may help fund future costs. An annuity is a contract issued by an insurance company that converts your premiums into a guaranteed fixed income stream.

Annuities can be complex and expensive. It may require an initial investment of $100,000 or more, and purchasing one gets more expensive as you age.

Program of All-Inclusive Care for the Elderly (PACE) is a program run by Medicare and Medicaid. It helps provide services to people who would otherwise need care in a nursing home. PACE can also cover some or all the long-term care needs for people with Alzheimer’s disease.

PACE covers in-home care, adult day care, doctor visits, hospital and nursing home stays, prescription drugs and some medical transportation. It can also pay for training and respite for family caregivers. There may be a monthly charge for services.

In 2023, there are 144 PACE programs operating in 30 states and D.C., and more than 60,000 Americans participated in some type of PACE program. You can use the online PACEFinder tool or call 1-877-267-2323 to see if there’s a PACE program near you.

Nearly every community in the U.S. has an established network of services that allow older adults to age in place. Most of these are available to all seniors, regardless of income.

There are 622 Area Agencies on Aging in the U.S., and each coordinates a complex local service delivery system to reach millions of older adults and caregivers.

Common services offered by local Area Agencies on Aging include:

Resources such as Benefits.gov and BenefitsCheckUp from the National Council on Aging can help you discover benefits you might qualify for.

These programs can help pay for prescription drugs, heating bills, housing, meal programs and legal services.

Nearly 80% of adults ages 50 and older want to remain in their current homes as they age, according to AARP.

Aging in place is often more affordable than transitioning to institutionalized care and allows someone to retain independence in a comfortable, familiar setting. However, aging in place isn’t right for everyone. It requires careful planning, research and coordination.

The resources below can connect you with experts and other helpful advice on aging in place, as well as alternatives — and help you decide what’s right for you.