Comparing Aging-in-Place vs. Assisted Living

Q. My father passed away last year, and my mother has lived alone ever since. Her colonial-style home is becoming difficult to navigate due to her mobility issues. She has fallen several times and we are worried about her.  She would like to continue to live in her home and age-in-place, but some major modifications would be needed to her home to make it livable for her as she ages. She is also considering moving to an assisted living community so she will always have help around when she needs it, and have others around to socialize with. So, she is weighing her options right now.  I know you must have other clients in the same situation. Any guidance you can provide to make her decision easier?  Thanks for your help!
A. Similar to your mother, polls show that 89% of Americans over age 50 wish to remain in their homes for as long as possible. However, for many, the choice to either age-in-place or enter an assisted living or continuing care community is a complex and deeply personal decision that depends on numerous factors, including the amount of health care needed, costs involved, and the availability of family assistance.
Aging-in-place is defined by the U.S. Centers for Disease Control and Prevention (CDC) as “the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income or ability level.” What this means is that a home must be built or modified to ensure that every facet of life is considered. As you know from your mother’s current situation, if it is not, it can lead to injuries from falls and other hazards, discomfort, and even avoidable fatalities.
To help you make your decision, let’s take a look at aging-in-place in terms of advantages, disadvantages, and costs involved, and then we’ll do the same for assisted living.
Advantages of Aging in Place
•Your mother won’t need to move anywhere, and she can enjoy the comfort of her own home;
•She will likely have more living space as compared to an assisted living community;
•She can more easily maintain her current friends, and enjoy her familiar neighborhood and surroundings;
•It will perhaps be less disruptive to her life, because it won’t require moving (but the renovations might be disruptive temporarily).
Disadvantages of Aging in Place
•There are limitations on the amount of medical care that can be provided;
•She may require an in-home care provider;
•There may be more burden placed on family and friends;
•She may experience isolation and loneliness;
•Home improvement to make the house livable may be difficult or expensive.
Risks Associated with Aging-in-place
•Lack of emergency response;
•Limited access to services;
•Vulnerable to abuse and thievery;
•Can become unaffordable (paying for home repairs and for in-home care, if necessary);
•Home ‘resaleability’ may be affected after renovations (Note: if done right, modifications can be made to blend seamlessly with the existing home and may actually add to the home’s retail value. According to the National Home Builder Association, homes that are suitable for multigenerational living are currently one of the top trends for people seeking housing.)
Cost of aging in place
The information presented below is based on “The MetLife Report on Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge.” It will give you a reference point for what you can expect in terms of cost if your mother opts to stay in her own home. It begins with data on national averages for an individual’s monthly expenditures when living at home, followed by a section on average costs for typical home modifications.
a) Average Monthly Expenses
The average cost for an individual’s bills at home are as follows:
◾$850/month for utilities, taxes, maintenance, etc.
◾$250/month for food
◾$456/month for three hours of daily assistance twice weekly at $19/hour
◾$804/month for three days per week in adult day services
Your mother’s yearly expenses may vary significantly from these averages based on the state she lives in, her ability level, and the size and condition of her home. In order to get a more realistic sense of what the cost will be for her to remain in her own home, she will need to add up her yearly expenses for utilities, taxes, maintenance, food, and caregiving services.
If your mother requires more continuous caregiver assistance, the national average rates for a live-in caregiver are $160-$250/day. Some of the cost for in-home caregiver assistance may be relieved by assistance from Medicaid and a federal program called the National Family Caregiver Act.
b) Cost to Modify the Home
According to an AARP study, only 13% of homes are ready to meet aging needs without modification (e.g. homes that have no stairs, wide doorways, and accessible bathrooms), which means that most people will need to make some structural changes to the home in order to successfully age-in-place. According to the MetLife Report on Aging in Place, the national average cost for basic design and structural modifications, commonly required to make a home suitable for aging needs, is $9,000–$12,000 for a one-story residence.
The following are examples of the national averages for some of the more common home modifications: a grab bar $90- $170 per bar; stair lift $3,000 – 12,000; a ramp or vertical lift $2,500 – $20,000; door widening $800-$1,300; bathroom modifications $3,500 – $35,000.
The cost to modify your mom’s home will vary based on a variety of factors that may include whether she wants to stay on the first or second floor of the home, the number of stairs her house has, the type of mobility device she uses, her needs and abilities, and her personal style preferences. If she is unsure what it will take to modify her home, she should consider hiring a home accessibility specialist to help in identifying the right solutions for her home and needs.
Assisted Living
Assisted living offers more independence than a nursing home, but more care than a person receives living on their own. For seniors who have difficulty with many of the day-to-day tasks of independent living, an assisted living community may be a good option.
Advantages of Assisted Living
• Assisted living communities provide constant care, if needed;
• Assisted living offers a community of its own for residents to become a part of so your mom can make new connections;
• Scheduled activities and events;
• Specialty assisted living options are growing — you can find pet-friendly assisted living, eco-friendly assisted living, and assisted living on a college campus, just to name a few options;
• No need to maintain a home;
• Greater privacy and a home-like setting.
Disadvantages of assisted living
• A lot of seniors may be resistant to assisted living. However, many seniors find they like it more once they move in than they ever expected to;
• Can be cost-prohibitive;
• Some seniors have trouble adjusting to a group setting with rules and policies;
• Does not offer the level of care needed for many medical conditions.
Costs of Assisted Living
According to the AARP Long-Term Care Calculator, the cost of Assisted Living for a year in the Washington, DC Metro Area is, on average, $94,050.
How to Decide Which One’s Right for Your Loved One
Now you know some of the main differences between the two options, but your mother still needs to figure out which one makes the most sense. Here are a few steps your family can take to help her figure it out:
Talk to her doctor to get a better understanding of what needs your mom has now, and how they are likely to change in the next few years. Knowing what’s coming can help you make a more informed decision about what to do now.
Consider the resources your mom has at home now. Are there family members or close friends in the neighborhood? Is there good public transportation in the area for when she can no longer drive? Surveying what’s available to your mom now can help you figure out how well it might match her level of need in the future.
• Research your local options. In addition to considering the resources your mom has at home, also look into what her assisted living options in the area are. You can find details and reviews for both assisted living and in-home care agencies that can give you a good idea of what your options are.
Figure out what your mother can afford.  Assisted living is expensive enough that money’s got to be a consideration. In many cases, specialized insurance products designed to pay for long-term care can help (see this earlier blog post for information on these types of financial products) and many people are able to leverage their home by using a reverse mortgage to pay for assisted living. Compare the costs of your different options and determine which one makes the most financial sense for you. Be sure to talk to an experienced Elder Law Attorney, such as myself, about Medicaid implications when it comes to selling the house etc.
Have a family meeting. In most cases, this shouldn’t be a decision made entirely by one person. Talk it over with your mom and the rest of the family and weigh your options together.
The decision likely won’t be an easy one, but the most important thing is to make sure you do what’s right for your mom. Consider your options carefully to make the best choice that’s right for her quality of life and well-being.
When Aging-in-Place or Assisted Living are No Longer Options
Most people want to stay in their home for as long as possible, with or without the assistance of a home health aide, or are in an assisted living facility receiving some help, but not enough. If you or your loved one cannot live independently and are showing signs that living alone is a strain or assisted living is not providing sufficient care, it may be time to consider nursing care.
It is always wise to plan ahead for when the need for nursing home care eventually comes. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living community or in a nursing home. Please know that Farr Law Firm, P.C. is here when you need us — just call to make an appointment for an initial consultation:
Fairfax Medicaid Asset Protection Attorney: 703-691-1888
Fredericksburg Medicaid Asset Protection Attorney: 540-479-143
Rockville Medicaid Asset Protection Attorney: 301-519-8041
DC Medicaid Asset Protection Attorney: 202-587-2797
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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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