Haims: Aging in place vs. assisted living facility

The decision process of choosing between aging at home and moving to an assisted living facility is complex and emotional. I speak from both personal experience and an acquired experience over almost a decade and a half. This is what I have learned — the decision is personal and unique for everyone.

My mother had Parkinson’s. She passed away in 2019 just prior to the COVID pandemic. At that time, her long-term care insurance paid about $6,500 a month for 24-hour home care and she paid out of pocket about an additional $7,500 per month. Although this $14,000 a month is a lot of money, it only covered her personal care — it did not include living expenses nor the cost of running her home. That was all extra.

Her care did not start out like that. Rather, it gradually evolved. When her need for in-home care had begun, she only needed a few days a week. Over about seven years, her need(s) evolved and ultimately became 24 hours. As it did, at least once a year, she asked (“ask” is a euphemism) that my brothers and I come to her home and discuss the issue, “as a family.” These were tough visits.

Discussing her mortality and personal finances with her sons must have been hard for her. For me and my brothers, it was emotionally heavy, saddening, appreciated, and evoked guilt and fear. Few adjectives can nearly convey the conflict of emotions. However, at the end of the day, we were all united in the planning process. This was a gift of which she may not have fully known. I’m so thankful for it.

As we age, one of the most significant decisions many of us may face is whether to “age in place,” relocate to independent, or an assisted living facility. All options involve financial implications and emotions that are very personal. Further, the choice may also depend on various factors like personal health, the availability of either family, spouse, or friends, housing market trends, and social needs.

Aging in place can be an appealing option for many seniors. Staying in one’s own home allows for independence and familiarity. However, this choice isn’t without its challenges, especially when it comes to caregiving.

For those who require assistance with daily activities such as bathing, dressing, transportation, meal preparation, or medication management, hiring home health aides may become an option. The cost of in-home care can vary widely depending on the level of care needed. Per the 2023 Genworth Cost of Care Survey, the median hourly cost for an in-home care provider is $42/hr ($45-65/hr in the Western Slope mountain towns). Thus, for the average person starting care at five hours a day at four days a week (20 hrs/wk), the cost may range from about $43,000 to $67,000 a year. While many home care companies offer monthly, pre-paid, and annual discounts, at rack rate, 24/hr care can be extremely expensive. Referring back to the 2023 Genworth Cost of Care Survey, the median cost of an ALF in Colorado is about $6,000 a month ($72,000/year), though this can vary depending on location, facility amenities, and the level of care required. However, these costs can increase as one’s health deteriorates or if they require more personalized care, such as memory care for those with Alzheimer’s or other forms of dementia. For higher levels of care, including memory care units, the cost can climb well above $12,000 a month ($144,000/year).

Clearly, both are expensive. Deciding between aging at home and moving to a facility involves significant financial considerations. Aging at home may initially appear more cost-effective, particularly if the individual owns their home and requires only minimal in-home care. However, expenses can quickly escalate with the need for home modifications, part-time or full-time caregivers, medical equipment, and ongoing healthcare services.

Conversely, independent living and ALFs often come with a predictable monthly cost that includes housing, meals, social activities, and on-site medical support, which can offer more financial clarity. Families must assess current and projected healthcare needs, long-term affordability, and available insurance or government support options before making a decision.

Emotionally, the choice is deeply personal and often complex. Many seniors have a strong attachment to their homes, where they’ve built memories and feel a sense of independence and identity. Leaving this behind can trigger feelings of loss or anxiety. On the other hand, ALFs can offer a renewed sense of community, safety, and relief from daily burdens, potentially improving overall quality of life and reducing isolation.

Together, families must navigate these emotional dynamics with empathy, considering both the aging loved one’s preferences and well-being. Open, ongoing conversations are key to ensuring that the final decision aligns with both the elder’s emotional needs and practical care requirements.

If this topic is germane, please read next week’s article where I will share some suggestions and items that may need to be considered when making about Aging In-Place vs. a facility.