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The Place You Call Home

6 options for contemplating where you’ll live as you get older

By Terry Fulmer, PhD, RN, FAAN and The John A. Hartford Foundation
An older couple sitting down and planning their future. Next Avenue
Credit: Adobe

We know that the prevailing wish for almost all of us is to age at home, among our familiar belongings, neighbors and memories. However, it is vital to take into consideration the context, such as your finances and abilities to live at home. Understanding and communicating about preferred options for future housing and care assistance are important steps in long-term planning.  

Your goals, preferences and values will help determine the right options and prepare you to discuss them with your family, friends and formal or informal financial advisors, and have them documented appropriately.  

Here are six options that rise to the top of the list for many who are contemplating the next phase for living arrangements. These are listed as a continuum of care and services:  

  • Independent living means you can live at home without help from others. Examples include staying in your own home or moving to a retirement community without built-in health care services. This is sometimes referred to as “aging in place,” which is what nearly 90% of people over 50 say they prefer
  • Living with family members is another option. Millions of older individuals who eventually need assistance with daily activities like dressing and bathing receive their care from friends and family, with or without the assistance of paid home care workers. If your expectation is to move in with family members or have a family member live with you to provide care if you need it, those are discussions to have as early as possible.  
  • Continuing care retirement communities offer independent living options as well as assisted living, memory care and skilled nursing, so the community can meet most future health needs. These communities offer flexibility and social engagement, but they can also be costly and have complex contracts.   
  • Assisted living serves older adults who need help with everyday activities like walking, getting in and out of bed, going to the bathroom or eating and offers select health care services, along with group activities for residents. Continuing care retirement communities may include assisted living residences as part of their options.  
  • Nursing facilities and skilled nursing facilities, otherwise referred to as nursing homes, which offer the most health care services of all senior living options. Nursing homes offer different levels of skilled nursing and options for short-term and long-term rehabilitation depending on needs. They are staffed by trained medical professionals who can provide more intensive care.

Caveats for Consideration 

Living alone may increase health risks, especially those related to social isolation. Remaining in your own home may mean you need home-based care. While efforts are underway to expand access to in-home services, a shortage of home care workers and the cost can make it challenging to acquire. Retirement communities, assisted living and nursing homes can all be expensive and financial planning is important. Similarly, home health attendant care needs to be carefully budgeted.  

Nursing homes experienced unprecedented pressures in the last decade leading to closures across the country. The COVID-19 pandemic led to many more nursing home closures resulting in a lack of options for older adults who need this type of care, particularly in rural communities and other places where older adults already had few care options. In states such as Kansas and Nebraska, the closures are concentrated in rural areas so you may be asked to move to another state or region to find an available nursing home.  

How Much Will It Cost 

Long-term care can be expensive. For instance, the average monthly cost of a home health aide delivering daily care in your home is nearly $4,600, and an assisted living facility will cost about $4,300 a month. Nursing homes run about $7,800 a month for a shared room and about $8,800 for a private, single room. 

If you are a Medicaid recipient, nursing home costs are covered.  

How Can I Pay For It? 

Medicare does not cover most long-term care, and Medicaid eligibility kicks in only when an individual's income and assets drop below a certain level. You may want to look into whether a long-term care insurance policy makes sense if you don't think you will have the savings to cover the cost.  

What Can I do to Prepare for my Long-Term Care Needs? 

The first step is planning early and understanding your options based on your specific circumstances. This requires determining what matters most to you and identifying which option can help meet your future care needs.  

Talk with your friends and family about what matters most — is it living in the same city as you do now? Or is it moving in with a family member or to an area with several senior living options so your needs will be met regardless of your health? Be sure to document your wishes and share plans with your family. AARP compiled a long-term care workbook to assist families with planning.  

Now is the right time to begin thinking about your long-term goals for housing and home life. The sites listed above can help you with your planning and we look forward to you sharing your vision for what it looks like to have a satisfying plan for aging in the setting of your choice.  

Terry Fulmer, PhD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN, a Next Avenue Influencer in Aging, is President of The John A. Hartford Foundation in New York City, a national philanthropy dedicated to improving the care of older adults. Dr. Fulmer is nationally and internationally recognized as a leading expert in geriatrics and the topic of elder abuse and neglect, and her vision is catalyzing the Age-Friendly Health Systems social movement. Read More
The John A. Hartford Foundation
By The John A. Hartford Foundation

The John A. Hartford Foundation is a private, nonpartisan, national philanthropy dedicated to improving the care of older adults. The leader in the field of aging and health, the Foundation has three priority areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care.

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