Most People Say They Want to ‘Age in Place.’ But What Does That Really Mean?

Ask people where they hope to live as they get older, and most say they want to age in place in their own homes.

That instinct has only increased over the past few years, amid the horrific death toll from the coronavirus pandemic on older people living in nursing homes or other institutional care settings.

But the phrase “age in place” can mean different things to different people.

“People toss around that phrase,” says Jennifer Molinsky, project director of the Housing an Aging Society Program at the Joint Center for Housing Studies of Harvard University. “But what does it really mean? And what do you need to be considering if that’s your plan?”

My last column considered ways to tap home equity as part of a retirement plan—a strategy that entails a move away from your current location, unless you opt for a reverse mortgage.

But your home is much more than a financial asset—it’s a key component of your lifestyle, health, and happiness. So let’s consider the flip side of the coin: how to evaluate your current living situation with aging in mind.

What Does Aging in Place Mean to You?

One thing that makes this question so challenging is that humans are not hardwired to think about the future, or our future selves. We tend to think about immediate needs and wants, rather than plan for what might be.

It can be a challenge to get our heads around our daily living needs as we age, slow down, and become less independent, both because it’s a difficult matter to think about, and because we don’t know exactly what those needs are going to look like.

To start, Molinsky urges people to unpack the phrase “aging in place.”

“For some, it means never leaving the house they’re in,” she says. “For others, it means staying in their community but living in a different house. And for others it means ‘anywhere but a nursing home’.”

Once you know what “aging in place” means to you, you can consider your living situation through that lens.

1. Physical Environment

Start with an evaluation of your physical environment.

A very small share of homes in the U.S. are accessible to people with mobility problems, according to research by JCHS. Just 3.5% have single-floor living, no-step entry, and extra-wide halls and doors that can accommodate wheelchairs. The figure drops below 1% if you include features like electrical controls reachable from a wheelchair.

Your odds of disability increase with age: One study found that 60% of household heads age 80 and higher had a disability that made it difficult to remain in the home and maintain self-sufficiency. The most common problems were walking and climbing stairs. Problems with hearing and lack of ability to run errands were also common.

Consider what a change in ability could mean for life in your current home. Will you be able to walk up or down stairs? Prepare meals? Get in and out of your shower or bathtub? Continue to drive?

Also consider affordability: Housing is the single largest category of spending for older households, according to research by J.P. Morgan Asset Management. Some retirees find themselves burdened with high housing costs that squeeze their budgets—especially if they need to spend money on remodeling to accommodate needs associated with aging.

Tally up your current living costs, not only mortgage, tax, and insurance costs, but also whether repair bills are getting more frequent and expensive as the house gets older.

How does that compare with your projected retirement income, and will housing consume too much of your budget?

2. Access to Care

If you’re hoping to stay out of institutional care settings, you may need to be able to get help with long-term care needs at home. Some people can rely on family members for care, if they live nearby and have sufficient flexibility to take time away from their own work and families.

It’s also important to note that Medicare does not pay for most long-term care services, regardless of where they happen; reimbursement is limited to a person’s first 100 days in a skilled nursing facility.

Medicaid, which covers only people with very low incomes, has long been the nation’s largest funder of long-term care. From its inception, the program was required to cover care in nursing facilities but not at home or in a community setting. The program has begun to reorient toward home-based care, but the pace of change has been slow.

3. Community Supports

It’s also important to consider what you will need in your community as you age, and whether your current location can meet those needs.

How will you get around if you no longer drive? Are there social opportunities that can help you avoid becoming isolated?

Innovations are also occurring nationally at the grassroots level that may offer a different kind of community than you’d previously envisioned.

A network of nonprofit “villages” devoted to providing support and a social network to people who want to age in their homes has been growing for years; it has 270 member groups and 70 more in development, according to the Village to Village Network, a nonprofit group that supports the villages.

Villages typically cover a specific neighborhood or town, but they are virtual support organizations.

A variation on the idea of villages can be found in Naturally Occurring Retirement Communities. Unlike villages, which are formed intentionally by residents, NORCs are communities of older people that form naturally, typically in apartment buildings or towns with high concentrations of older people. NORC residents can access medical services from visiting nurses and doctors, social services, wellness, and social activities, often with the support of a social service agency.

But none of these solutions has yet been able to scale to a level where they can help communities meet the needs of aging residents.

Molinsky argues that the unanswered questions around aging in place point to the need for a much broader policy discussion.

“These are difficult discussions to have, but we need to get better about talking about them,” she says.

Meanwhile, it’s important to approach housing decisions with eyes wide open, and a willingness to plan ahead for a time when your needs might change.