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How to Decide: Aging in Place vs. Assisted Living

Help clients evaluate the pros and cons

A part of our series, Quality of Life

 


 

When those diagnosed with life-threatening illnesses are asked by their doctors to make lifestyle modifications, only 9% make changes.1 They find it too hard to change even when they know it’s good for them. Likewise, many of your clients may resist change, especially when that change could affect where they’ll live as they age.


Why Your Clients Like to Age in Place

Ninety percent of people plan to age in their homes.2 Why? We’re comfortable in our homes. We like our routines, privacy, and freedom that comes with home ownership. At home, we don’t have to ask if we’re allowed to have a dog or a cat. We enjoy having lots of space to spend time with friends and family. We don’t like the thought of being crammed into a small living place and having to get rid of lots of our stuff. And those of us who like to cook would be disappointed having to do it exclusively with a microwave.

Many of your aging clients are confident in their ability to age in place. They don’t feel they’ll need support because they see themselves younger than they actually are. Sixty percent of adults 65 and older say they feel younger than their age. Of those surveyed between the ages 65 of 74, a third say they feel 10 to 19 years younger than their age.3 As a result, clients in their 40s, 50s, and even 60s can find it hard to anticipate the physical ailments ahead. This mindset can push the thought of moving to an assisted living community or nursing home off the table.

 

We Feel Young—Of Course We Can Age in Our Homes

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Among adults 65 and older, fully 60% say they feel younger than their age, compared with 32% who say they feel exactly their age and just 3% who say they feel older than their age. 

Source: Pew, “Growing Old in America: Expectations vs. Reality,” 06/09. Most recent data available.

 

The Health Risk of Aging in Place

Since most homes weren’t built for aging people, aging in place can increase health risks. As clients age into their 70s, 80s, and 90s, their risk of falls, and resulting injuries, in their homes increases. One in four people over age 65 falls each year.4 More than 300,000 people are hospitalized each year from broken hips, and 95% of these fractures are a result of a fall.4 Most of these falls occur in the home for a variety of reasons, including clutter, loose rugs, limited access to railings and grab bars, or poor lighting. A broken hip can force people to consider moving to an assisted living facility.

The Social Risks of Aging in Place

Loneliness can be the most severe outcome from aging in place.5 As clients age in place, their mobility and access to transportation can decrease. This can result in going out less frequently to participate in social activities, which can lead to isolation. During a six-year study, the loneliest people in the study were nearly twice as likely to die as the least lonely.
 

Clients’ Homes Aren’t Ready for Aging in Place

For clients with no mortgage(or a low mortgage) and enough income to cover expenses, aging in place might seem like a no-brainer. But you can help clients think farther into the future and evaluate if their home will be a good place to live as they age.

A recent study from the Joint Center for Housing Studies of Harvard University found that less than 25% of homeowners age 55-plus have a bedroom and full bathroom on the first floor of their homes, a way to get into the house without steps, and no steps between rooms—universal design features that make life easier for all ages.6 The house that works today may not work as well in the future. Home modifications may be needed. Not doing the necessary modifications could put your clients or their loved ones at risk for an accident that could ultimately cost more than the modification, and could result in significant health issues.

Our Homes Aren’t Ready for Aging in Place

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Source: Homeowners Get Ready to ‘Age in Place,’ The Wall Street Journal,5/31/15. Most recent data available.


The Cost of Home Modifications

The cost of home modifications can get pricey. But, when compared to the cost of assisted living, they may be worth it. To get a better idea of types and expense of home modifications your clients may need, they could meet with a certified aging in place specialist (CAPS). The CAPS program was developed by the National Association of Home Builders in collaboration with AARP. Find a local CAPS professional and ask to meet with them. In addition to helping you understand and prioritize the housing needs of aging clients, you can introduce them to clients who may need a personalized aging-in-place plan.

The expense range of home modifications varies greatly. The amount of modifications needed can depend on your clients’ needs. Basic modifications can cost up to $10,000,7 including installing:

  • Grab bars
  • Sturdy handrails along stairs
  • Replacement rugs
  • Better lighting
  • Lever-handled doorknobs

More extensive modifications can cost up to $100,000 or more, including:7

  • Removing (or reducing the height of) steps
  • Widening hallways
  • Adding a ramp
  • Lowering cabinets
  • Installing no-step showers
  • Installing a generator to protect against power loss

For deeper insights on aging in place solutions, check out The Hartford’s Simple Steps to Stay Independent web page. You’ll find a consumer-friendly PDF called Simple Solutions: Practical Ideas and Products to Enhance Independent Living.

Since the range of expenses for home modification is so great, and the impact on the quality and safety of clients’ lives is significant, it makes sense to involve a CAPS professional to create a holistic aging-in-place plan.

For younger clients who are remodeling their homes, suggest that they make age-friendly adjustments, such as widening doorways and corridors, eliminating walls to accommodate wheelchairs and scooters, or even creating space in a multistory home to add an elevator later. The additional costs during a remodel can only cost an average of 5%.8


The Cost of Aging in Place Support

As your clients age in their homes, at some point they may need help getting things done, e.g., housekeeping, laundry, heaving lifting, lawn care, gutter cleaning, grocery shopping, changing light bulbs, and air filters, and more. Fifty-two percent of those age 70 and older say that their health makes it hard for them to do home maintenance or repairs.9 Clients can hire people to help with these activities.

Similar to home modifications, the cost of home-care support can vary. Apps like Hello Alfred (monthly fees start at $279/month) and Task Rabbit (hourly rate) can help clients get things done, but they’re only available in certain locations. For other apps sites and devices to help aging clients get things done, check out this page.

For clients who need more support, expenses will be higher. Between 50 and 70 percent of people over the age of 65 will eventually need significant help with their day-to-day tasks and overall care.7 The average monthly cost of a homemaker is $3,994, assuming 44 hours of care per week.10 Homemaker service includes household tasks that clients can’t complete on their own, including cleaning house, cooking meals, or running errands. The monthly cost of a home health aide is $4,099.10 They offer more extensive personal care than family or friends are able to or have the time or resources to provide.


Discussing the Possibility of Assisted Living

There can come a point where clients can’t care for themselves, or it’s not safe for them to live in their homes. Then assisted living can be a good solution. Determining when that point comes is usually a family decision, but families tend to procrastinate this decision. Fifty-four percent of people surveyed would rather have “the bird and the bees talk” with their kids than “the senior care” talk with their parents.11 Most aging clients don’t like the idea of adult children trying to push them out of their homes and into assisted living.

You can help by starting discussions about senior housing options with aging clients. If you bring it up, let clients know that you realize it’s not an easy topic to discuss. But remind them that it’s better to discuss it sooner rather than later, when their options for insurance or care may be fewer and the costs may be higher.
 

Clients Really Don’t Like Discussing Eldercare With Their Parents

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Source: How Senior Care Impacts Families Financially, Emotionally and in the Workplace, Care.com, 2016. Most recent data available used.


Build a Recommended Partners Network

Senior housing choices can get complex and may require expertise. If you lack that expertise, consider referring clients in need eldercare advice to a Certified Financial Planner. Build a recommended partners network, including:

  • Elder care attorneys
  • Family counselors
  • Senior housing leadership
  • Specialists in long-term care financing
  • Home care experts
  • Geriatric care managers


The Cost of Assisted Living

The average national monthly cost of assisted living is $3,750, and a private room in a nursing home is $8,121.11 Assisted living facilities provide personal care and health services for people who may need assistance with activities of daily living (ADLs). The level of care provided is not as extensive as that which may be provided in a nursing home. Nursing homes provide higher levels of supervision and care than in an assisted living facility. They offer personal care, room and board, supervision, medication, therapies, rehabilitation, and skilled nursing 24/7.

Each assisted living community has its own pricing model, but monthly costs typically cover:

  • Taxes
  • Insurance
  • Utilities
  • Repairs
  • Appliance repair or replacement
  • Meal plan
  • Recreation and entertainment
  • Fitness center
  • Library
  • Beauty salon/barbershop
  • Craft workshop
  • Scheduled transportation

Finding prices for assisted living can be challenging because of the complexity of individuals’ needs. It’s rare to find baseline pricing online. To get accurate pricing, clients, and their families, should visit a community, get a full tour, talk with the residents, and then have a conversation with the facility staff about their needs and financial resources.


Health Advantages of Assisted Living

Assisted living communities are designed for mobility and accessibility while also offering expert care and medical attention, if needed. Residents are served three meals a day that are tailored to the specific health needs of seniors. Maintenance is taken care of, so the risk of falls are reduced, e.g., there’s no need to climb up on a chair to change a light bulb.


The Social Advantages of Assisted Living

Assisted living offers socialization through planned activities and outings, such as field trips, dancing, and cultural events. Daily living in the common areas also offers fun and socialization for seniors. Plus, there’s a better chance to stay engaged living in a community of people of similar age dealing with similar issues.


Should Advisors Really Get Involved in Senior Housing Conversations?

It takes time and effort to initiate senior housing discussions with clients. But, because of demographic trends, advisors who don’t participate in these conversations may miss a business opportunity. By the year 2030, 20% of our population will be 65 and older.12 At that point, clients will be less interested in golf, travel, and beaches and more focused on where they want to live.

Dr. Joe Coughlin, director of the MIT AgeLab says it’s imperative to focus on the needs of aging clients. “Because population aging will manifest in such dramatic-yet-predictable ways, when companies make long-term plans for the future, there should be nothing higher on their priorities list than preparing for an older world,” says Coughlin. “It’s worth planning for the unexpected, after all, but only after you prepare for the guaranteed.”

Even if your current clients in their 50s aren’t concerned about senior housing for themselves, they’re probably dealing with these issues for parents. Becoming knowledgeable and willing to have conversations about senior housing can help differentiate your practice and can help you retain clients who are concerned about their housing options.

You can help by starting discussions about senior housing options with aging clients. If you bring it up, let clients know that you realize it’s not an easy topic to discuss. But remind them that it’s better to discuss it sooner rather than later, when their options for insurance or care may be fewer and the costs may be higher.


To summarize, we’ve covered:

  • Aging in place: Cost, social, and health impact
  • Assisted living: Cost, social, and health impact
  • Why advisors should have these conversations


Help Clients Plan for Change 

Change is hard. However, taking action and making plans for tomorrow can actually make tomorrow easier. At some point, aging clients will have to decide whether to age in place or move to an assisted living community. Some will to refuse to discuss the possibility of moving, while others will more open. Be there to begin the conversation. Help them anticipate their senior housing needs including, health, cost, and social impacts of those decisions.


Next Steps

  1. Download or order the client white paper below
  2. Research the costs of senior communities in your area. Set up meetings with the leaders of a few communities and begin building relationships.
  3. Identify three clients and ask if they’ve started thinking about senior housing options either for themselves or their parents
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Please enter your email address to download Aging in Place vs. Assisted Living client white paper

Order this white paper >

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Source: Important Facts About Falls, Centers for Disease Control and Prevention, 2/10/17


1The neuroscience of change: Why it's difficult and what makes it easier, Langley Group, 5/23/12. Most recent data available used.

2Can You Afford to Age in Place? AARP, 2017

3Growing Old in America: Expectations vs. Reality, Pew Research Center, 6/29/09. Most recent data available used.
AARP Public Policy Institute, 6/15. Most recent data available used.

4Important Facts About Falls, Centers for Disease Control and Prevention, 2/10/17.

5An Advisor’s Guide To Aging in Place vs. Community Living, wealthmanagement.com, 6/29/17

6Homeowners Get Ready to ‘Age in Place,’ The Wall Street Journal, 4/9/18

7Reasons Why Aging in Place May Not Be Cheaper, myLifeSite.net, 8/15/16

86 Things You Must Know About Aging in Place, Kiplinger, 5/15. Most recent data available used.

9New Survey From The Hartford And MIT AgeLab Finds Homeowners Age 50+ Delay Home Maintenance, The Hartford, 4/4/18.

10Compare Long Term Care Costs Across the United States, Genworth, 2017

11How Senior Care Impacts Families Financially, Emotionally and in the Workplace, Care.com, 2016. Most recent data available used.

12Aging Parents With Lots of Stuff, and Children Who Don’t Want It, New York Times, 8/18/17

 

The information in this presentation is provided for informational purposes only. Hartford Mutual Funds may or may not be invested in the companies referenced herein; however, no endorsement of any product or service is being made. Hartford Funds is not associated with the entities referenced in this presentation.

The MIT AgeLab is not an affiliate or subsidiary of Hartford Funds.

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