Decisions in Aging: Home or Facility Care?

With the unique ways each person ages, the decision to remain at home or move to a facility can be complex. There are multiple costs to consider. Knowing the stages of aging can assist when choosing the best living environment to support an elder living their best life. With the unique ways each person ages, the decision to remain at home or move to a facility can be complex.

Key takeaways:

There are multiple costs to consider. Knowing the stages of aging can assist when choosing the best living environment to support an elder living their best life.

As individuals anticipate older adulthood, getting a clear idea about variables such as personal values, current family support, as well as financial resources are reasonable first steps. If a person is already experiencing aging changes, taking steps to provide proper support must quicken.

5 stages of aging

Yet, the path of getting older is often not a straight line. It does, however, progress in some predictable stages that those in geriatric care look to guide appropriate support.

1. Self-sufficiency

Looking ahead to older age usually starts from a position of independence. They may have any number of mild chronic diseases, but the symptoms are manageable and do not affect daily living in measurable ways. For example, their bills are paid on time, they're managing household chores, and self-care remains doable.

2. Interdependence

When older bodies and minds lose some of their more youthful resilience, an older adult requires extra assistance. For example, having someone prepare a weekly medication box will help promote drug safety and compliance or arrange transportation to appointments because the elder can no longer drive safely. When older bodies and minds lose some of their more youthful resilience, an older adult requires extra assistance. For example, having someone prepare a weekly medication box will help promote drug safety and compliance or arrange transportation to appointments because the elder can no longer drive safely.

3. Dependence

It is at this stage of aging that the Activities of Daily Living and Instrumental Activities of Daily Living become difficult or impossible on some level. For instance, an elder may forget they were cooking, creating a fire hazard. Furthermore, poor physical mobility can restrict safe, effective eating, walking, or transferring attempts.

4. Crisis management

The unpredictability of a medical crisis can create a stressful dilemma. For example, even with preparation, when a fall with injuries occurs, a domino effect often makes well-meaning plans tumble in unanticipated ways, compounding the multiple necessary decisions.

Another common situation involves progressive heart failure. This can lead to needing supplemental oxygen and fluid restrictions requiring immediate hospitalization. Returning home upon discharge requires paid in-home assistance, or facility placement may be a reality.

5. End of life

As any palliative and hospice medical provider will say, the length of a person’s end of life is not always predictable. The crisis from the previous stage may catapult an older adult straight to their final days quickly. On the other hand, the end of life may last longer than expected. Choosing home or facility placement is, again, at hand.

Nevertheless, solid planning makes juggling the fluctuating elements of getting older easier. No matter the stage, there are options for where an elder can safely live out their older years.

Aging in place

Aging in place, a concept first voiced in literature in the 1980s, became a focus of government policymakers and researchers who intuitively saw that older adults universally wish to stay in their own homes.

Few people reach older age believing that they’re ok with leaving the family home, representing independence, fond memories, and comfort. Families often promise to keep their parents out of a facility and in their own familiar place.

Living at home

Home may be best, but who is taking care of these elders in the home at all stages of aging?

Note that 80% of care received in private homes is by unskilled care providers, most likely adult children. The care an elder may require eventually becomes frequent, even hourly, and may be physically intense.

These informal care providers often reach a point of burnout, being “sandwiched” between caring for an older family member and running their own busy lives. This can strain even the most loving relationships.

If finances allow, hired agency care providers may be an optimal fit. The high cost of outside caregivers is prohibitive for some. It is, however, an ideal way to keep a dependent older adult in their private home safely.

In addition, staying home often requires changes to both the interior and exterior house environment to adapt to medical devices and equipment like walkers, wheelchairs, walk-in showers, and oxygen concentrators.

Staying home, often alone, comes at another price. Loneliness and the resulting clinical depression are not only mental health crises. Depression can affect the physical body as well, leading to cognitive decline, worsening of chronic diseases, and even death.

Evidence shows having frequent, meaningful social interactions reduces depression in elders. Some senior care housing systems are available to answer the call for senior living, which allows one to age in place with more opportunities for social support.

Aging-in-place housing model

Centralized campuses that provide different levels of housing and care provision are scattered throughout the US. While presentations vary, they seek to support the notion that while change is inevitable in older adulthood, an elder’s living situation doesn’t have to be part of that upheaval.

An example of this might be the availability of independent patio homes in one area. A resident may easily transfer to an independent apartment when a spouse dies or they can no longer care for the upkeep of a larger home. Assisted living is right next door when daily support is required. And, if necessary, nursing homes and memory care services are nearby where 24-hour nursing care is provided.

These efforts to acknowledge the unique needs of seniors prove aging in place is possible and valued. In addition, meals together and formalized activities can provide more meaning in life through social bonding.

Medicare, however, does not pay for independent or assisted living at the time of this writing.

Economic considerations

Even with the best preparation, the decision to remain at home or find placement in a senior care facility is most likely an eventuality. Whether due to a slow decline or a crisis, the financial costs of any choice must be considered.

Here are some useful statistics to keep in mind:

Senior care facility typeAverage cost
Independent living apartment$1500–$4000/month
Assisted living apartment$3500–$10,500/month
Nursing home with a private room$9000/month
Nursing home with a shared roomMedicare and the VA usually cover most or all monthly rent costs

Even with Medicare or VA benefits, the average cost of medical care over the age of 65 is estimated at $138,000.

Statistics show it is easier to meet financial and social needs when an older adult lives with other family members rather than living independently at home alone.

However, if the older adult has dementia or other high-impact medical needs, staying at home alone or with other family members can prove to be an economic and emotional burden over time.

Answers to aging support

The complexities of aging include physical, emotional, and economic considerations. The population of older adults growing by almost 20 million in the next seven years. Medical and governmental policies and programs are attempting to meet these needs and their variables.

For example, federal agencies are investigating increased funding for home care provision, keeping older folks in their private home, even as physical and medical demands escalate.

Advocates for seniors are clamoring for more, however, and see the road ahead will require a swift change in how care and housing seniors are approached.

Complex care is hard to plan for; it’s the unknown. In the long run, pre-planning is usually better than split-second decision-making. Knowing all the costs involved can set seniors up for successful aging at any stage, wherever that may be.



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