Is Aging in Place the Impossible Dream?
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Like everyone else I know who has given the matter more than two seconds of thought, I want to spend my final years in my own comfortable home, thank you very much. More than 70% of American adults over 50 and 100% of Canadians over 65 agree. And, on the flip side, you will be hard pressed to find any North American adult who is happy with the thought of spending his last days in a nursing home.
But are we kidding ourselves? Is “aging in place,” as it’s technically known, really possible?
No one questions the advantages, not least among them the financial. It takes a heap of money to join most Retirement communities. Continuing care facilities – which offer a range of options from independent living apartments to assisted living to full-time nursing care or “memory care” as needed – are also expensive. The national median cost of an assisted living unit in 2020 was $51,500 annually, and median for a private nursing home room was $105,850. Even with a full complement of caregivers, aging at home can be significantly less expensive.
But choosing to age at home also has its costs and its obstacles:
Home may be comfy today, but how practical will it be years from now, when your balance can desert you without notice at any moment? If stairs are a problem, is there a bedroom and bathroom on the ground level? Are the doorways and hallways wide enough to accommodate a wheelchair? Are there grab bars and grips in the bathroom? Do you need a walk-in tub or shower? Can you upgrade the lighting? Can you remove all the throw rugs and install nonslip flooring?
Guess what else is aging in place? Your home! If you’ve always been a do-it-yourself type, maybe it’s time to rethink whether you ought to be. Are you really okay to mow the lawn and shovel the snow? And do you have any business being on a ladder fixing the gutters – or even changing lightbulbs?
How will you get to places when you can no longer drive? Are you comfortable with public transportation or ride-sharing services? Is your home an easy walk to grocery stores and shops?
Are friends and family nearby? If mobility constrains your ability to maintain social ties, will you find yourself isolated in your home?
Do you have reasons for concern about crime in your neighborhood? If you become ill, is there anyone around who can help you?
Getting medical services
Many regular medical services can come to you at home (and Medicare will cover some of the cost.) But keep in mind that home health care is one of those areas with severe worker shortages, so there may be delays and other inconveniences. In 2021 the national median rate for home health aides was $27 per hour. Do the math.
Getting personal services
At the point where you need an aide to help you with such tasks as bathing, dressing, cooking, or cleaning, you can hire people to come to your home. These non-medical services, however, are not covered by Medicare. A supplemental insurance plan or a long-term care insurance policy might defray some of these expenses. The 2021 national median rate for homemaker services was $26 per hour.
What about family?
Aging in place is far easier if you can depend on your partner, your children, or other close family to devote copious amounts of their time to your care. In the old days (and still today in some cultures), family members felt an obligation to care for their elders at home. Will your spouse, your children, even your grandchildren be up to the task of providing daily care and attention?
And in the end…
Ultimately, you may reach a point when you need more care than you can receive at home. Despite your best efforts, you may have to spend your final days, months, or years in an institution of one kind or another. But by that time, your choices are narrower. In other words, if you are considering a move to a Retirement community, make your decision before you reach the point when you absolutely cannot remain in your home.
Planning, planning, planning. Those all-knowing advice-givers always say you should plan ahead. Some even say you should have started planning for old age in your 20s. I don’t know what planet they live on. I’m in my early 70s and I still find it difficult to imagine a day when I can’t move freely around the house, drive when I want, walk where I choose, and enjoy the companionship of friends and family. Deep down, I know I can only expect another 10 years before aging’s steady toll starts cramping my style, but even at this late date it is hard to think about it or do anything proactive to prepare for it.
If you, on the other hand, are a better planner than I am, and you have enough resources to give you choices, by all means consider these factors as you anticipate whether to age in place or make the leap to a Retirement community.
If your resources are limited, however, so are your options. In that case, if you cannot depend on your family members, then, like Blanche DuBois, you will have to depend “on the kindness of strangers.”
My Personal Scorecard
Fifteen years ago, my wife and I sold our three-story, 100-year-old Victorian house and downsized to an apartment in a housing co-op. At the time, we congratulated ourselves on landing in a place where we think we can live the rest of our days. It is a ground-floor unit, all on one level, with just eight stairs from the walk to the front door and another six out the back door. Belonging to a co-op means we are not personally on the line for roof repairs, plumbing infrastructure, snow removal or mowing the grass. Two grocery stores are within easy walking distance, along with a bookstore, dozens of restaurants and take-outs, and an art museum. The nearest bus stop is a five-minute walk. There already are sturdy grab bars in the showers, thanks to the previous owner.
I would like to credit this to our foresight and thoughtful planning, but in fact it was mostly a matter of great timing and dumb luck.
Looking at our apartment now with fresh eyes, it’s clear that we’ll need to replace a few throw rugs and come up with clever ways to handle the stairs since I can’t see descending them on a skateboard. Also, I doubt a wheelchair can negotiate through all the doorways, so there’s likely some serious remodeling in our near future.
But as another fictional heroine famously remarked, “I’ll think about it tomorrow.”