Most of us want to “age in place”—live in our homes as long as we can as we grow older. It’s where our memories are, where we raised our kids. It’s what our parents did, and we intend to do the same.
So every time I’m asked where a person should live as they age, my answer is, “It depends!” It depends on a hundred thousand details that seem insignificant when we’re healthy, but can take on unexpected importance when our health fades.
Your current home can be the smartest, cheapest, and easiest place to grow old in, especially in the beginning, when you’re relatively healthy. It can also be the most complicated, expensive, miserable, and difficult.
Yet few of us want to think bad things will happen. After all, voices on TV, online, in ads, and from “authorities” like AARP and the government tell us that aging in place is the right thing to do. It’s also what we want to hear, so we assume we’ll do it—without giving it much thought.
We are a society that deeply denies we’re getting old. From this denial comes a profound ignorance of the physical, mental, and practical changes that being old can bring. Most of us have little knowledge of what happens to people who were once strong and vital but are now ill or frail or have dementia. We’re content to live as we always have and let life happen—until reality hits. When the bottom drops out, you can hit hard.
In my work with thousands of older people over the last 40 years—including my own parents who were adamant about staying at home—I’ve seen many serious barriers to successful aging in place, including:
~ Mind-numbing loneliness and depression due to long stretches of isolation.
~ Thievery or exploitation (financial, physical, and psychological) by family members and paid helpers.
~ Poor nutrition due to not eating properly (whether there’s little appetite, no food in the house, or it’s too much trouble to cook).
~ Lack of exercise leading to falls and premature frailty.
~ Homes that were never designed for people with disabilities (too many stairs, narrow doorways, huge yards, slippery bathrooms, far away from stores, etc.).
But the biggest challenge of aging in place is the profound shortage of people—both family members and paid—to care for us. By definition, aging in place requires you to obtain the human assistance you need when you can no longer get groceries, clean house, mow the grass, get to the bathroom, and so on.
Family members provide 70 percent of this care, and most of it is free, at least in dollars. But there are often other unanticipated costs, including poor quality of care (not every adult child can or should care for an aging parent) and other issues affecting the caregiving son or daughter: strained marriages, postponed careers, financial loss, depression, and high levels of stress.
Another problem: Many of us don’t have children to care for us, because they live far away, have difficulties of their own, or were never born. An estimated one in five Boomers has no children. In 2010, there were more than seven family caregivers for every person 80 and older. By 2030, estimates say, there will be only four, and by 2050 there will be fewer still.
Many spouses are caregivers, which can happen naturally as couples decline together. This can work well for a time but fall quietly apart as the unhealthy spouse becomes more seriously ill or demented, or as both spouses become ill. An 84-year old wife who cared for her gravely disabled husband told me, “Nobody understands how hard this is until they’ve gone through it.” Indeed, studies show that caregiving can lead to the premature death of healthy older caregivers due to the stress and strain of caregiving.
The same demographic trends trimming the number of family caregivers will cut into the ranks of those who are paid. A severe shortage of these workers has affected home care, assisted living communities, and nursing homes for decades, but now the trend is becoming dire. In the next decade alone, it’s estimated that more than 1.3 million new paid caregivers will be needed—and by 2020, paid eldercare workers will be the largest occupation in the United States. However, given the low pay and difficult nature of the work, vast numbers of these jobs will go unfilled, and some regions and communities will have greater shortages than others.
These statistics show that we all need to plan much more strategically for our aging than ever before. Reality is daunting, but it’s a better lens than ignorance and myth—and knowledge and action can offer a clearer path toward a safer, more satisfying old age for everyone.
Liz Taylor, an eldercare specialist for 40 years, lives in the San Juan Islands, where she is semi-retired. She wrote a popular column on aging for The Seattle Times for 14 years, and has consulted with thousands of older adults and their families. Liz can be reached at lizt@agingdeliberately.com.