Aging In Place – Costs and Factors to Consider

Aging in Place - Costs and Factors to Consider
Elliott Appel, CFP®, CLU®, RLP®

Elliott Appel, CFP®, CLU®, RLP®

Welcome! I'm Elliott, the founder of Kindness Financial Planning, LLC, a fee-only, fiduciary advisor located in Madison, WI working virtually with widows and caregivers across the United States. When I'm not helping people live their ideal life, I'm often cooking for my wife, playing tennis, or hiking.

Many people I meet prefer the idea of aging in place. Unfortunately, aging in place is expensive and not possible for everyone. 

Besides the financial costs, there are costs to renovate a home, technology to implement, and the need to coordinate multiple levels of care instead of having it centrally located.

Plus, there are the social considerations of aging in place. It can be lonely and isolating. Not always, but sometimes. 

Aging in place sounds good in theory. After all, who doesn’t want to remain in their home for as long as possible? 

Despite this, going to a different care setting sooner may be a better option than aging in place for some people. This is especially true if a person’s health requires them to move later in life anyway, when in worse health and with even more limited financial resources.

Let’s explore the costs and factors to consider when choosing to age in place. 

3 Major Factors to Consider Before Aging in Place

The decision about whether to age in place depends on many factors, but if I had to boil it down to only three, they would be:

  • Financial resources available to you
  • Estimated financial costs for your illness/aging
  • Estimated life expectancy for you/your illness 

Much of what I am talking about has to do with permanent health issues, but it’s worthwhile talking for a moment about health issues that may seem temporary. For example, a broken hip with no other underlying health issues may seem temporary, but if the person is in their mid 70s, they may never go back to the same quality of life.

A broken hip may be the health event that sends them on a steady decline, so while the acute event may be temporary, it may be more of a permanent health issue with other complications later. 

The first question I like to ask people who are considering aging in place is, “what is the most common path for your illness?” 

If you have Stage IV Pancreatic Cancer, that has a much different timeline than a Parkinson’s diagnosis at the early stages of symptoms. The former is likely going to die within six months while the latter may live more than a decade. 

Once you have a grasp for estimated life expectancy, what you may experience, and what accommodations may need to be made to continue to have a good quality of life, you can start to put a price tag on what changes need to be made. 

Then, you can compare that to what resources you have available, whether that is retirement accounts, brokerage accounts, home, rental properties, Social Security, pensions, or other assets or income, and the odds of those assets supporting your potentially increased costs. 

For someone who has six months to live, it may not be unreasonable to pay for part-time help and then transition to 24/7 care near the later stages of an illness where it may cost more than $20,000 per month. 

For someone with more than a decade to live, aging in place may be cost prohibitive if 24/7 care costs more than $20,000 per month and another living situation is less expensive. 

Pro Tip: If resources are limited or may be limited in the future due to an expensive illness, consult an elder care consultant or call local facilities to ask if they take Medicaid funding. For example, some facilities never take Medicaid while others may allow you to pay for a certain amount of time, such as two years, and then if you run out of money, may be able to keep you in the same facility through Medicaid.

This is where careful planning is important because if you want to age in place, but have a very expensive illness with limited resources, it may be better to go to a different facility or adult family home, privately pay for a certain amount of time, and then have the option to stay through Medicaid. It’s not always guaranteed that a facility can keep you, as they may not have a Medicaid bed available when you go on Medicaid, but many will do their best to keep people who privately paid for a few years first. 

Aging in place can be extremely expensive. At the end, I’ll talk about estimated costs, but before I do, let’s talk about what you’ll need to do to age in place. 

Family Caregivers vs. Paid Caregivers

The first step is to understand how much “free” caregiving you have and how much paid caregiving you will need. 

I have very strong opinions about “free” caregiving because I’ve seen many families attempt to give care longer than they should have, leading to poor health outcomes for both the person giving and receiving care. 

This is where it is important to set boundaries upfront and stick to them. Caregiving may be manageable for a few months, but doing and being everything for a person is usually not healthy. 

If you have significant family and friend support, you may only need to hire paid caregivers for certain tasks. 

For example, if you have someone willing to cook, another who wants to clean, and another that will take you to doctor’s appointments, maybe you only need to hire someone to help with medication management and a few other tasks. 

The key is to be honest in your assessment of how much time and energy friends and family have to provide caregiving and come back to it regularly. As health changes, caregiving needs change. What worked in month two may not work in year two. The demand of caregiving is often not felt cumulatively, but exponentially. The smallest addition over a long enough period of time may be the event that changes relationships and causes fights. 

The other aspect to keep in mind is that sometimes a more neutral third party has a better ability to get someone to take their medications, shower, or do something to which they have told a family member or friend no. 

Sometimes it isn’t about the finances, but simply the power of an independent person who is more effective at helping a loved one do what is in their best interest. 

If you are hiring paid caregivers, check the costs in your local area. Care.com and AARP both have a calculator to help estimate costs. 

Many illnesses may require less care upfront, but as the illness gets worse, may require more regular care. For example, you might start with an afternoon a week for 5 hours, but as you get sicker, you may need someone three times a week, followed by daily. It’s important to account for those increased costs upfront because while it may be cheaper to age in place at first, there may come a point where it’s much more expensive to be at home. 

It’s critical to understand what family and friend caregivers are available to you and the impact you have on them, as well as what it will cost now and in the future for paid caregivers.

Renovating the Home for Safety and Mobility

Another added cost is renovating a home for safety and mobility to age in place. The renovation may be light, such as removing rugs, or extensive, such as putting in lifts and widening doorways. 

Multiple Levels

If you live in a home with multiple levels, you may need to move to one level, if that is even possible. For some people, that may mean moving a bed into a living room to be close to the kitchen and a bathroom. It may mean only using a portion of the house for mobility reasons. It may mean making small modifications to bathrooms to prevent falls. 

For some people, staying in their home and living on one level or even in one room is better than moving to a more accessible place. If you are looking to age in place, your home is going to influence how easy and possible it will be. 

Major Fixes

Aging in place may mean major changes to your home. Some people widen doorways, install ramps, and chair lifts to go upstairs. 

Some people may add a mother-in-law unit to have a family member stay with them to help with care. 

None of these major fixes come cheaply. Some may cost thousands of dollars while others cost tens of thousands of dollars or more. 

Small Fixes

If an illness is gradual, small fixes to age in place may be enough for a long period of time. 

Small fixes could include:

  • Install handrails in the bathroom
  • Removing rugs (fall hazard)
  • Installing automatic lights around the house
  • Adjusting the water heater temperature
  • Putting a shower chair in the bathroom
  • Installing a device to help someone off the toilet

Most small fixes are intended to help someone get around and reduce the chance of falling. A fall can drastically reduce the odds of being able to age in place. 

Managing Health Needs

Unlike a facility where they can help with medical care, aging in place may require help with managing a wide variety of health needs. 

Medication Management

If you are unable to manage your own medications and take them as prescribed, you may need someone to fill a medication box or order bubble wrap medicines. If you have cognitive issues, you may need someone to come once or multiple times per day to help you take your medication as prescribed. 

Many people have a minimum number of hours to come to your house, which means having someone come by your house can become costly very quickly. For example, if the hourly rate is $40 an hour and they require a 3 hour minimum, you may need to spend a couple hundred dollars per day if you need to take medications multiple times per day. 

Medical Tasks

Depending on your illness and complications, you may require more hands-on medical care, such as help with taking insulin, changing catheters, or other tasks an in-home nursing care aid may need to do. 

It’s important to recognize what path your illness may follow because you may not need help with medical tasks at the beginning stages, but at the end, you may need around the clock assistance with medical care. 

Meal Preparation

Another consideration for aging in place is how you will feed yourself. If you can no longer prepare meals for yourself, will you hire a private chef, have a family member cook, rely on frozen prepared meals, do meals on wheels, or hire an aid to cook for you? 

There are many options for meal preparation, but it is important to know how much each costs, how that fits in with your budget, and ensure there is enough variety for you to eat healthily within the context of aging. 

Chores

Aging in place doesn’t mean chores have gone away! They still need to get done. Whether it is your laundry, taking care of the yard, or paying bills, someone needs to do them.

Perhaps a family member can help with some, but it likely is too big of a burden for them to do everything. 

How much will a laundry service cost or will you bring in an aid to help with other household tasks? Will you hire a bill paying service or put as much as possible on autopay? Who will clean the house regularly? If you have a pet, who will be responsible for feeding it, taking it to the vet, or taking it for walks if necessary? 

Chores don’t go away as you age in place. In fact, chores that once used to be easy may be a big challenge. 

Hired Care vs. Family Caregivers

As you think about your care needs, reflect about how much of it should be done by hired caregivers instead of family caregivers.

While family members may want to help, they may not want to help with everything and all the time. Caregiving is exhausting – physically and emotionally. Putting the burden of care on a spouse, child, or close friend is a huge responsibility. 

If you do have a family member giving care, I recommend checking in frequently with them to see if care needs to be shifted to a hired caregiver. Some people may be willing to help with temporary caregiving needs, but don’t want to do it for months or years. Others may have a schedule that shifts, so while they may be willing to help you now, they may not be able to later. 

While family caregivers can help save money, they can also put a very tight strain on relationships and cause resentment. 

I normally recommend hiring caregivers sooner than you think you need it. It’s usually much better for family members to coordinate care and spend time with you rather than focus solely on your caregiving needs. 

Each situation is unique, and there may be family and friends who don’t want to be denied the opportunity to be your caregiver, but more often than not, family ends up caregiving longer than is healthy for anybody involved. 

Social Considerations of Aging in Place

Another main component to aging in place is your social connections. 

If you are aging at home, how will you see friends and family? How will you stay connected to your community?

If you can’t go out regularly and you lose some of your independence, you may need to find a way to recreate your social interactions at home or regularly go somewhere. Some people live very close to multiple family members, and for them, this may be less of an issue; however, for many people who live further from family and friends, staying at home, alone and isolated, is a recipe for depression and bad health outcomes. 

There are senior centers you may be able to visit frequently or even hire an aid for companionship. 

This is where living facilities are really helpful because there are other elders and staff around to fill your social cup. Plus, with people around, you may be less likely to fall victim to elder financial exploitation. Aging in place at home requires more careful planning to have those social connections. 

Technology to Help In Home Care

Aging in place may warrant new technology. 

You may want a fall or medical alert button, which could be $20-$40 per month. Your family may want to implement voice activated and locking pill boxes. You may want someone to check in on you from time-to-time remotely using an Echo Show.

Thankfully, there are many tools today that make aging in place safer and easier to check in on a loved one. The challenge is making sure it works for the person who wants to age in place.  

Total Costs to Age in Place

Aging in place isn’t cheap. At first, it may seem inexpensive if you only require a few hours of care a week. For example, if it’s $40 per hour for an in-home aid and you only need them four hours a week, that’s only $160 per week, or about $640 per month. 

However, if you start needing daily care, that can quickly add up. If you need someone for 6 hours a day, that may be $6,700 per month. At that point, an assisted living facility or memory care unit may be a safer and more inexpensive option, depending on your area. 

If you are near the end of life or have a debilitating illness where you need 24/7 care, that may cost more than $20,000 per month. At that point, it can be challenging to arrange and coordinate 24/7 care. If it’s short term, that may work, but if it’s long-term, that may not be feasible. 

Many people will start out not needing much care, but over time, they may need more care, need to make more adjustments to their house, and get lonely at home. Aging in place works well for some people, but I often see it as the default option without first considering the benefits of other living arrangements. 

Sometimes, other living arrangements can be more cost effective, safer, and easier on loved ones. 

Final Thoughts – My Question for You

Many people I meet want to age in place, but many have not thoroughly thought through what it means to age in place. 

Whether it is the social connections that break living at home or the difficulty in finding and scheduling care or the costs of care, aging in place is not a walk in the park. It takes serious effort to age in place well. 

There are many factors and costs to consider before deciding that aging in place is the right option for you. I encourage everybody to explore the various options, think carefully about their illnesses, and the impact their care plan will have on loved ones. 

I’ll leave you with one question to act on. 

Have you considered other living arrangements besides aging in place?

Disclaimer: This article is for general information and educational purposes only and should not be considered investment, financial, legal, or tax advice. It is not a recommendation for purchase or sale of any security or investment advisory services. Please consult your own legal, financial, and other professionals to determine what may be appropriate for you. Opinions expressed are as of the date of publication, and such opinions are subject to change. Click for full disclaimer.

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