Originally published at Forbes.com on June 11, 2022.
Aging-in-Place — most of us think of this as the decision, as we get older, to stay in our longtime family homes, even as increasing infirmity or cognitive decline makes this harder. We know there are support programs available, providing home health aides, assistance with yardwork or a wheelchair ramp, a “senior freeze” to keep property tax increases at bay, and so on. And our homes hold so many memories and are a source of affirmation of the success we’ve had in our lives.
But is aging-in-place really the right decision? Or, put another way, does it “work”? Is it the right path for us all to take as we age, or would we be better off if we moved somewhere more suitable — a single-level house, or a condo in an elevator building, or a home near public transportation, or any of the communities designed for older adults? Would we miss our neighbors in our old communities, or quickly adapt and be glad we’d gotten past our hesitancy?
In the book Aging in the Right Place from 2015, author Stephen Golant provides a number of reasons why that “right place” might be the longtime family home:
•The advantages of a familiar neighborhood: the individual knows the shops and services and can navigate the area well even after physical or cognitive decline.
•The advantages of a familiar home: spatial competence (finding your way when the power goes out, navigating steps out of familiarity)
•Preserving familiar relationships – friendships and service providers.
•The attachment to possessions and pets is not disrupted (e.g., vs. moving to no-pets home); the home not only contains memories of the past but also reminders of past successes.
•The home affirms one’s self-worth; one fears (whether rightly or wrongly) that others will consider the person a “retirement failure” upon moving.
•Maintaining privacy, vs. moving from a single-family home to an apartment, or to Assisted Living, shared housing, or living with family.
At the same time, there are many quite considerable costs incurred in Aging in Place, not just direct financial costs, for which we can argue about whether the government should shoulder these, but less tangible costs:
•Financial costs: the cost burden of maintaining large older home with yard vs. smaller but newer space with maintenance covered by association/landlord
•Physical costs: the steps/stairs and narrow doorways can make home a prison for the physically-impaired or place the individual at risk of falls.
•Social costs: the idealized neighborhood relationships might not be real, and turnover in the neighborhood may mean that there is more likelihood of social connection with the intentional social opportunities of a senior community.
•Health costs: isolation can mean lacking help for medical emergency – even to the point of dying unnoticed. More mundanely, homebound seniors have less ability to cook healthy food, travel to doctors, etc.
•Finally, there are particular challenges for those experiencing cognitive decline, especially when there is no family member to notice or when decline is hard-to-notice.
Golant doesn’t beat around the bush, but writes that
“Older adults are now bombarded with a singular and unrelenting message: They should cope with their age-related health problems and impairments in their familiar dwellings. . . . Older people cannot turn on a TV, search n the Internet, read books about old age, or pick up a newspaper without getting this persistent stay-at-home message” (p. 63).
In a somewhat older article, in 2009, William H. Thomas and Janice M. Blanchard offered a sharp critique of the Aging in Place model, in “Moving Beyond Place: Aging in Community.” They acknowledge the fear of nursing homes but write:
“The bitter truth is that an older person can succeed at remaining in her or his own home and still live a life as empty and difficult as that experienced by nursing home residents. Feeling compelled to stay in one’s home, no matter what, can result in dwindling choices and mounting levels of loneliness, helplessness, and boredom.”
This is a stark message. But here’s an even more discouraging problem: in my research on the issue, I encountered one repeated refrain. There is no solid scholarly research which asks the question: “which choice is the better one, in terms of future quality of life, to stay or to move?” It’s not an easy question, to be sure: simply looking at the quality of life of the elderly and comparing those who live in single-family homes vs. various kinds of “elder-friendly” housing would not adequately distinguish between those who moved due to some sort of health problem and those who moved with the aim of preventing future health problems, for example. But there’s a data source that scholars have mined creatively to answer all manner of questions about retirement and aging, the Health and Retirement Study, and economists and similar researchers have been very creative in identifying “quasi-experiments” to answer this sort of question.
Discouragingly, though, given the relentless policy advocacy of supports for “aging-in-place,” it seems rather likely that this advocacy has discouraged researchers from considering that question in their research, depriving us all of what would otherwise be rather important information.
Author’s note: the terms of my affiliation with Forbes enable me to republish materials on other sites, so I am updating my personal website by duplicating a selected portion of my Forbes writing here.
Hi, I have just read your article Does Aging-in-Place Work.?
Well I am 72 years old and live in a 3 bedroom house I have a huge garden, which I cannot look after l have lots of stairs and no family living nearby, my parents who lived in this house for over 40years are both dead, and there are lots of memories both good and bad, and so I have decided this should be the time to leave and find somewhere smaller.
Reading you’re article helped me decide it was a very interesting read.
Thank you.
I think this article (and maybe Stephen’s book) starts from the wrong premise. Aging in Place is the ability to stay in the home one has chosen, even as health and mobility changes and you become differently reliant on paid services or family and friends. It does not mean necessarily staying in the home one has occupied for many years. It does require thoughtful, proactive decisions about where you want to enjoy your advancing years. It may be close to family…or far…close to a university, the sea or the mountains. Maybe that is near where you lived for many years or maybe it is the same house. The point is that the home you occupy works for you and the services and support you need are available so that your decision sticks. That you are not forced to move against your wishes. Preserving your choices, dignity, self esteem and joy are the hallmarks of successful aging in place.
I made the decision to move to a more senior-friendly home and neighborhood in my early 60’s – well before the move was strictly necessary. My decision was based on watching my mother hang on to her home well into her 90’s. Although the home was small, it lacked accessibility and required exterior maintenance. Finally, her dementia required moving her to assisted living. I swore I would never put my son through the emotional hardships that move cost both my mother and myself. My home should serve me well if in the future I require a walker or even a wheelchair to get around. Only severe physical or cognitive disability will force me to move to assisted living, and I have made financial plans for that as well.
I have a similar story. My mother’s increasing dementia got her to the place where it was hard for her to accept helpers in her home, eventually leading to isolation despite my daily visits. She got a serious UTI that landed her into ICU. She was septic, in ICU for 7 days, came out the day my dad in a nursing home died. With advice and a push from a counselor who saw me overwhelmed, I made the decision to place her in assisted living. It was the worst decision I have ever made. Despite daily visits, the negligence and lack of educated staff caused direct harm and led to the fall that caused her death. If I could do it over, I would have rented or bought a condo or townhouse in a Senior living community and lived with her. I would have hired help. After I removed my mom from the assisted living, we lived and she died in such a place. I would have given anything in the world to have tea and cookies, gone to the local park, and just enjoyed life with her in such a home, instead of her spending the last years in suffering, anxiously awaiting my visits, and her being scared and alone, never recognizing the assisted living as “home”. I will always regret my inadvertently shaving years off my precious mother’s life with my assisted living decision. Once I knew it was wrong, I wish I had the confidence to change it, but as the author said, there is no research for determining these life changing decisions!
It’s silly to think such a complex decision can be made in the abstract, as a hypothetical. To make a good decision about whether to move or not requires drilling down to the pros and cons OF A SPECIFIC PAIR OF CHOICES. If only life were so simple that there could be a clear answer to questions like this . . .
Very factual article, but nowhere is there any mention of what the affected person might want. Does old age alone preclude self-determination?
We’ve just been through this with an older relative who was persuaded by all the aging-in-place messages and it was a disaster. She began to cognitively and physically decline and stubbornly clung to the idea with no alternative plan. She’s now in an assisted living that we chose for her, but honestly missed out on what might have been some happy and carefree years in a senior living environment before her decline — and the interaction and stimulation of such a setting might have slowed her decline. Plus we are the ones dealing with all of her stuff — 6 bedrooms and 5.5 baths, stuffed to the gills — because she is no longer able to be involved and I feel certain she would have preferred to make these decisions herself. Fear of change kept her in her home but you know what? Aging means inevitable change. Staying isolated in a huge home as your ability to cope with it declines is ignoring the changes that are happening to you. Embrace that it’s a new season and look for a new and welcoming place to settle before you can no longer decide for yourself.
The costs of senior care are astronomical. The cares are paid nothing. Your aren’t guaranteed any safety or real care. No one will believe if your things are stolen. If you run out of money in there you’re lot is yet worse. You have a tiny amount of space. Who wants to live without their pets? Out for other to decide what you eat, when , and if you can have a glass of wine. Much less decide you’re done with care? They don’t treat you as fully human. There may be more people around but with your own failing of hearing and sight and mobility there is no guarantee that would make relationships. The distance from your room in one of those places can seem like miles to the main areas or outdoors. This is such an ugly flip glib little article that hasn’t really confronted any of the horrors of our existing options.
I agree completely. There is no mention of the incredibly high cost for assisted living and nursing home care. The high cost is not always substantiated by good care or maintained/safe surroundings. One should look at the corporations who own these facilities: profits for the shareholders, pay for executives and pay for the staff who are usually stretched by downsizing their force in order to increase profit share. Make note of what happened during Covid. Be aware of the regulations that are being discussed now regarding size of nursing staff. The US could do better than asking a profit driven system to provide quality care when it benefits that same system to withhold it.
As a senior citizen and gerontologist, I know how bored people are in assisted living places. The old age, use it or lose, is very apt as the elderly are encouraged to depend on walkers and wheelchairs for the convenience of the staff. Soon the senior becomes weaker physically and socially isolated as they are not allowed to be independent. For a period of time, I lived in a condo with no stairs, bad idea. When I returned to my 3 story house, it took months to rebuild my agility and strength to easily climb stairs again. We encourage younger people to push their physical limits and tell seniors to sit and rest, or in other words just fade away quietly. Seniors can enjoy learning new skills and exercise as do those younger.
I’m in the process, with my daughters, of shopping around for a smaller home with accessibility features near them. A shocking cultural fact is the complete avoidance of legislation and planning for appropriate housing for differently-abled people! whatever their age. When I researched Fair Housing laws put in place decades ago, it made me want to weep for the overwhelming callousness and crassness of those entrusted with providing for the needs of citizens. I hope to enjoy a multigenerational, diverse neighborhood as long as I’m able to…but finding a suitable place–full bath on the first floor etc–is like searching for hens’ teeth. WHY? Co-housing communities are another possibility, but they don’t seem to have caught on the way they have in Europe.
This is a really good article, l am very interested in staying in contact with, janetheactuary.
Aging in Place needs a good preplanning stage long before there is either a cognitive or physical decline. Meeting with an attorney, who specializes in Aging matters may be a first important step. POAs and Advanced Directive’s and how to handle finances are 3 important factors. If the older person has a financial advisor meeting with that person and discussing how assets can be assigned. Beneficiaries can be assigned to investments. It is good to assign how the home is to be handled upon death, also. There are many other areas that need to explored-to many to go into here. PLAN AHEAD-a difficult talk that is necessary to have a safe caring elder years in a place of your choice. Good article to open these discussions.