Aging in place used to refer only to the preference of seniors to remain in their own homes while they age. However, today the definition has expanded to include a number of housing options that support older adults as they age. Former US Secretary of Housing and Urban Development Henry Cisneros defines the term as a “lifelong home,” no matter what type of home it is, where it is located, or what services may be included within the community.
Ninety percent of older Americans would prefer to live in their own home as they age, according to AARP. In prior decades, many seniors had paid off their mortgages by the time they reached retirement, and that security and reduction in monthly expenses contributed to their ability to remain at home. However, this may not continue with baby boomers.
The strong desire to remain in one’s own home can generally be attributed to place attachment, or a deep connection to home. Place attachment describes a special bond between people and specific places. Many older adults have spent years or decades in their current homes; some of their most memorable moments happened there with children, family, friends, and community. Contemplating the idea of packing up those memories and moving somewhere new can therefore pose a huge emotional hurdle.
Resistance to change may contribute to any potential lack of planning for the years ahead. A paper published in the Journal of Aging and Social Policy points out that Americans have a culture of not preparing for old age. Older adults tend not to plan ahead, particularly when this means facing fears of change, downsizing, and a decline in health and mobility. However, healthcare professionals can work with their patients to evaluate the variety of housing choices and services available, determining the optimum circumstances that would meet their patients’ needs.
Options for Living at Home
While an overwhelming number of seniors prefer to stay in their family home, some may not see this as a choice. Some older adults remain in their homes because they do not know of other options or cannot afford them. Others want to stay because of their familiarity with the area: They know their way around, and their physicians are close by. They may also be part of a strong social network in the area. However, staying in the family home may require renovations or the use of home- and community-based services in order for seniors to continue living in a healthy and safe manner. Other options for senior housing that may fit their needs include:
Active Adult Communities
Active adult communities are designed for active, healthy seniors. They do not offer services, though residents may hire in-home care providers if needed. These communities are either age-restricted, only allowing in an older age demographic (typically 55-plus), or age-targeted, marketed to older adults.
Cohousing is a group of about 20 to 40 residences situated around a common area. That shared area usually includes a courtyard, green space, and common house with a kitchen and dining space for shared meals. A new trend in cohousing is emerging that focuses on the needs of older adults. In senior-only cohousing, residents assist and care for members of their community.
Accessory Dwelling Units
Accessory dwelling units, also referred to as mother-in-law suites or granny flats, are small living areas or separate buildings on the same property as a single-family home. These homes might be specifically designed for aging in place with features that support those with decreased mobility. Adult children may live in the primary house on the property and provide caregiving support to their parent or parents.
Independent Living Communities
Independent living communities, also called retirement communities, cater to healthy older adults, similar to active adult communities. They also offer services such as housekeeping and meals. These communities are not staffed to provide assistance with activities of daily living, but a resident can bring someone who provides this kind of care. Some independent living communities are part of a continuing care retirement community, where a senior can transition to an assisted living facility within the community or receive a higher level of care in her independent living housing.
Housing Plus Services
Adults living on limited means often have limited housing choices. In these cases, rental assistance may be an option. Section 202 of the US Department of Housing and Urban Development offers subsidized housing for low-income seniors. This housing is designed for people who can live independently, but it may also offer supportive services. Managers of these buildings may coordinate with local transportation, housekeeping, and other services for residents. These integrated services support low-income seniors aging in place.
The village movement is a grassroots, consumer-driven effort that was created by residents of the Beacon Hill neighborhood of Boston in 2001. It began with the idea that older neighbors could help one another and live in their neighborhood for as long as possible. They developed a membership-based program with access to affordable services that the neighbors deemed important. Due to its success, the movement has spread across the United States and into Canada, Australia, and the Netherlands, with more than 120 communities in existence and 100 in development.
Given that most seniors would like to remain in their home as they age, steps need to be taken to ensure safety and comfort. The typical single-family home is built with younger families in mind, and these homes may not be easily adaptable to the needs of older adults. However, planning ahead can ease the stress of renovations, moving, or bringing in additional support. One of the biggest risks of aging in place in the family home is the risk of falling. Falling can have serious consequences; according to the Centers for Disease Control and Prevention, falls are the most common cause of traumatic brain injuries.
For an older adult or couple who would like to live independently, various technologies, renovations, and modifications can be considered to help prevent falls and provide other support.
Medical alert systems continue to advance their technology; in addition to summoning help at the press of a button, some of the newer systems like Lifeline’s HomeSafe can automatically detect falls. This could be a life-saving measure if your patient is not able to activate the help signal after a fall. Other systems are mobile, able to track seniors when they are outside of their homes. And baby boomers adept at using technology may rely on smartphone apps for immediate medical support.
Smart home technologies that support convenience, security, and assistance in the home are starting to gain popularity. The specific technologies that assist aging in place will likely be a growing niche. Home sensors connected to smartphones for opening and closing doors and smart refrigerators that sense spoiled food are just two examples of the technologies already available. Future smart home designs by LeadingAge include sensors to measure sleep quality and monitor breathing, heart rate, and motion.
Telemedicine or telehealth technologies set up two-way communication between patients at home and physicians in the office, supporting those with complex chronic conditions or those who are restricted in their ability to reach the physician’s office. This ongoing medical support has been found to reduce depression and improve general health and social functioning when compared to standardized care. Regular contact may also mean better communication between provider and patient regarding medications and any side effects, noncompliance, or financial strain. Incorporating a medication dispensing service in addition to these technologies may help seniors adhere to their prescriptions, in turn supporting their health and ability to remain independent.
When adults move later in life, they often look for a home that meets certain livability requirements, such as a one- or no-step entrance to the house and one level that includes a bedroom, full bath, and kitchen. If these accessibility requirements are met, modifications may be added to further improve comfort and safety.
According to the MetLife Report on Aging in Place 2.0, the following are the top three tiers of priority modifications:
1. Falls prevention:
- Steps: Install sturdy handrails on both sides; secure or remove carpeting.
- Bathroom: Install grab bars and grips; remove throw rugs here and elsewhere in the house.
- Lighting: Ensure proper lighting and light switches, particularly in hallways, entryways, and stairs; install soft path lighting for nighttime.
2. Ease of movement:
- Steps: Reduce the number of steps or step height; increase horizontal step depth for easy side-stepping.
- Pathways: Remove steps to the bedroom and bathroom; clear the pathway to these rooms.
- Furniture: Reposition furniture, entertainment systems, and other potential obstructions to movement.
3. More substantial remodeling:
- Kitchen: Install multilevel or seated food prep areas.
- Bathroom: Install a heated sink, toilet assistance space, and a no-step shower or bath lift mechanism.
- Outdoors: Install sun and rain protection.
- Power sources: Ensure backup in case of a power outage.
As your patients age and potentially face decline in health, many questions may arise concerning their living situation. For those who strive to live independently, good planning and a smart use of technology, design, and supportive care can set them up to realize their desire to age in place.