Many older adults want the same things as they age: to continue to stay in their own homes and maintain their independence for as long as possible. Understandably so, as home is a place of comfort and familiarity for many of us, and where we have community and social connections that are vital to our mental health. 2022 findings from the National Poll on Healthy Aging suggest that 88% of people between the ages of 50 and 80 said it was very or somewhat important to them that they live in their homes as long as possible — known as “aging in place.” 

But, only 15% said they’ve given a lot of thought to what they need to do to prepare themselves for aging in place, such as modifying their homes or planning for services they may need to make aging in place possible. 

‍Prepare Your Home to Age in Place 

The first step to aging in place is to confirm whether living independently is the best option for you and determine whether your current home can meet your needs, or how to modify your home to prioritize your needs as you age. According to the National Council on Aging, these are the considerations you should take into account:

• Safety: Does your home pose any health and/or safety hazards? Issues like steep stairs, poor lighting, and broken handrails can increase your falls risk. Use this checklist by the AARP to make sure your home is safe and prepared for your needs.
• Community: Social connection is even more important as we age. Do you have close family or friends nearby who will visit? Is there a senior center in your area that offers programs and activities for older adults? 
• Adaptability: Physical limitations may arise as you age. If you have two floors but can no longer use the stairs, are there a bedroom and full bathroom on the main floor? If you one day need to use a wheelchair or scooter, can you afford the modifications to accommodate it? According to Retirement Living, the average cost of a ramp installation is $1,110.
• Size: A larger house and/or yard usually means more upkeep and expense. Does your home make sense for the current size of your household? Can you afford to pay for ongoing maintenance services like lawn mowing, driveway plowing, and gutter cleaning? If not, you may want to consider downsizing to a smaller home in your neighborhood.
• Accessibility: Do you have everything you need for daily living (grocery store, pharmacy, doctors, etc.) easily accessible in your vicinity? If you do not drive, do you have easy access to public transportation?

Once you’ve prepared your home, the next step is to understand all the various services that can make aging in place smooth and easy for you. Almost 70% of adults ages 65 and older will need some long-term care services, such as help with activities of daily living (ADLs) like bathing and dressing, or skilled nursing care. Understanding your options can help you pick the services that are best for you, recognize the pros and cons of each, and determine how to pay for the services you need.

‍Home Care vs. Home Health Care

People often think home health and home care are the same thing. While the terms sound similar and both types of care are delivered in the home, there are important differences between the two. Learning the differences can help you decide which type of care is right for your needs and budget.

• Homecare includes companion care, personal care, and homemaker services. Companion care can provide emotional support and socialization, while homemaker services can help with chores, laundry, and cooking. Personal care can provide non-medical help with daily activities like dressing and bathing, as well as transportation services. 
• Home health care includes medical services that are usually prescribed for seniors who need skilled medical care at home. Home health care can include skilled nursing care, like wound care and medication administration, and skilled rehabilitation services, like physical therapy. 

‍How to Hire a Home Health Aide 

‍According to the AARP, home health aides (HHAs) help with monitoring your health condition, as well as assisting with activities of daily living, including bathing, dressing and using the bathroom. These aides can also provide companionship, do light housekeeping and prepare meals. There are three main ways to find an in-home aide, including:

• Through a home care agency: In every state, there are hundreds of Home Care Agencies that source, train, and hire aides. They vary widely, some are licensed by the state and some are not, some license and insure workers and some don’t, and some are covered by Medicare and/or long-term care insurance.
• Through a concierge home care company: In many zip codes, there are concierge home care companies that offer a more personalized home care experience. Similar to a home care agency, they hire and train aides, but also typically provide additional services, like on-demand access to nurses, personalized care plans, and even things like household management and light housekeeping. In most instances, these are not covered by Medicare, though many are covered by long-term care insurance.
• Through a private network: The alternative to going through an agency is to find and hire an aide privately, through a referral or word-of-mouth. If you go this route, you will be responsible for all aspects of employing them: hiring, insuring, vetting their credentials, taxes, etc.

‍The Pros & Cons of Hiring a Private Caregiver

Hiring a private caregiver can seem like a more appealing option at first, but it  also comes with some downsides. Here are the pros and cons of hiring a private caregiver on your own without an agency.

‍Pros

• You select your favorite and have more flexibility: Once you decide to hire a private caregiver, you are in charge of the selection process. You have more control over the hiring process, including selecting the caregiver, negotiating pay, and determining the scope of their duties.
• More cost-effective: Agencies take a cut of the money you pay them before paying the caregiver. Hiring a private caregiver may enable you to pay a lower price, and allow your caregiver to keep more money for themselves. 
• Stronger relationship: Since you are directly involved in hiring, there’s often a more personal connection between the caregiver and the family, fostering better communication and care.

Cons

• Administrative burden: Hiring a private caregiver means taking on responsibilities like background checks, handling payroll, taxes, and possibly providing worker’s compensation insurance.
• Lack of backup: If your caregiver becomes unavailable (due to illness or personal reasons), there may not be immediate backup options unless you arrange one yourself.
• Liability: You may be legally responsible for accidents or injuries that occur during the caregiver's employment, adding potential risk.
• Limited oversight: Without an agency’s oversight, ensuring the quality and reliability of care is solely up to you. You might need to monitor performance closely.
• Training: Private caregivers may have varying levels of experience or qualifications, and you might need to invest time in ensuring they meet your specific standards.

‍How to Pay for Home Care

Paying for home health aides can be done through various methods depending on your financial situation, the type of care needed, and available resources. Here are the primary ways to cover the costs:

• Out-of-pocket: You pay the home health aide directly for their services. This often includes retirement income, savings, or income from the sale of a home. This is the most straightforward option but can be expensive. While paying out of pocket provides the most flexibility and control over who you hire and the type of care provided, it requires sufficient financial resources.
• Long-term care insurance: If you have a long-term care insurance policy, it may cover the costs of home health aides, especially if they are providing care for chronic conditions. Policies vary, so it’s important to check what’s covered, the daily limits, and any waiting periods before benefits begin.
• Medicare: Medicare may cover home health aide services, but only under specific medically-necessary conditions. The aide must be part of a plan of care that includes skilled nursing or therapy services prescribed by a doctor, and the care must be provided by a Medicare-certified agency. Medicare generally does not cover long-term home health aide care for personal or custodial care (help with activities of daily living like bathing and dressing).
• Medicaid: Medicaid can cover the cost of home health aides for eligible low-income individuals. The availability and extent of coverage vary by state. Some states have Medicaid waiver programs (such as HCBS Waivers) that can provide more flexibility for in-home care, though there may be waitlists or limitations.
• State and local programs: Many states and local governments offer programs to help seniors and disabled individuals cover the costs of in-home care services. These programs may be based on income or health needs. Availability and the level of assistance vary by location. You can check with your state’s Department of Aging or other local agencies for more information.
• Family contributions: Family members may pool resources to pay for a home health aide, either through direct payments or by setting up a care fund. This can be an option for families with the financial means to contribute, but it requires clear communication and planning to avoid financial strain.
• Reverse mortgage: A reverse mortgage allows homeowners 62 years or older to convert home equity into cash to pay for care. While it can provide immediate funds, this option reduces home equity and may impact inheritance plans. It’s important to fully understand the terms before pursuing this route.
• Life insurance policies: Some life insurance policies offer accelerated death benefits or allow you to sell the policy (known as a life settlement) to access cash for long-term care needs. Using a life insurance policy this way may reduce the amount left to beneficiaries, and the terms vary widely by policy.
• Supplemental security income (SSI): SSI is a federal program that provides financial assistance to low-income individuals who are elderly, blind, or disabled. Some states also provide additional SSI benefits. While SSI payments may not cover all the costs of home health care, they can help with part of the expense.

By exploring these options and possibly combining several, you can find a solution that fits your financial and care needs. Each method has its pros and cons, so it's important to consider factors like eligibility, coverage, and long-term financial impact. Planning ahead can allow you to prepare everything you need to age in place and stay in your home as long as possible.

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