Aging-in-place: When it’s Time to Consider Caregiving Services

Growing older can seem daunting when life and circumstances change. From health issues to financial matters, it isn’t always easy to navigate the challenges. But it can be a lot easier to handle if your environment is conducive to these changes, and living at home during these tougher times can be a solution.

The stark facts: The population of Americans aged 65+ will increase significantly over the next 30 years or so. In fact, it is projected to increase globally from 830 million today to 1.7 billion by 2054. Much of this population are Baby Boomers, born from 1946-1964. By 2056 the number of seniors will outnumber those 18 and younger. Those aged 80+ will triple, going from 155 million in 2021 to 459 million in 2050.  

So what factors are driving these increases? Longer life expectancy and lower birth rates seem to be the main factors. Life expectancy is expected to rise from 68 years old to 76 by the year 2050. With that said, there will be an increasing demand for care of this senior population. 

So how does aging in place factor into all this? One recent poll by the University of Michigan National Poll on Healthy Aging said that 88% of those aged 50-80 want to stay in their homes for as long as possible. Aging in place means you don’t have to move from your home, and you can maintain your independence for as long as possible. You can be close to loved ones, frequent your usual spots, and do the things you normally do. 

Warning Signs to Look For

What can cause problems is if the senior is concealing their health or memory issues or is in denial, which may make it difficult to diagnose whether aging in place is a viable option. They don’t want to have to lose their independence, and admitting they have problems keeping up with the activities of daily living (ADLs) can feel devastating to them.

Some signs to look for include:

• Poor personal hygiene and cleanliness

• Bruises or wounds that indicate falls or loss of mobility

• Difficulty bathing or toileting

• Difficulty eating or drinking 

• Hard to transfer from a bed to a chair or moving around

• Losing interest in hobbies or activities 

• Changes in sleep patterns

• Spoiled food that doesn’t get thrown away

• Urine smell in the house, which can indicate incontinence issues

• Unsafe driving habits

• Forgetfulness

• Increased confusion

• Inability to remember names and places

But aging in place also requires careful consideration, especially when it comes to health matters. What care needs need to be met? Does the senior need long-term or short-term care? Are there mobility or walking issues? Does the home need to be modified to accommodate the needs of the senior? Are there family and friends close by to provide support if needed? Is there easy access to public transportation? Does in-home caregiving make sense or should they consider assisted living or a nursing home? 

These are decisions that must be made by close family members, which can be difficult to do if the senior is reluctant to give up their independence. By this time, the family member may be struggling to have an honest conversation with their loved one. But it’s important to do this early enough so one can plan ahead financially and avoid any safety issues. 

It is important to identify risk factors in order to develop a care plan to promote safety and quality of life. Understanding what it takes for an individual to perform ADLs will determine what type of in-home caregiving is necessary. Assessing the ability to perform ADLs can also apply to those with disabilities, as this can impact their eligibility to qualify for state and federal programs.

Here are five things to look for in a senior when considering changes to their living situation:

• Missed medications

• Confusion or forgetfulness

• Inability to manage hygiene

• Meal preparation issues

• Mobility (falling or balance issues)

When to Consider In-Home Caregiving Services

At this point, considering in-home caregiving services would be a viable option. 

Having in-home caregiving services can relieve the burden of caring for a loved one for family members. So just what is involved with in-home caregiving services? It is a great way to take care of those who need assistance with ADLs. These can include:

• Personal care & hygiene assistance

• Meal preparation

• Medication reminders

• Light housekeeping

• Transportation

In-home caregiving services can also include:

• Companionship and emotional support

• Alzheimer’s and dementia care

• Post-surgery and recovery care

• Respite care for family caregivers 

There is also another aspect to in-home care called skilled home health care, which can involve nursing, physical and occupational therapy, and speech therapy, usually prescribed by a doctor. This can treat an injury or chronic illness, and is usually covered by Medicare, Medicaid, or private insurance. Beyond these therapies, skilled nursing, medical social services, medical supplies, and home health aide services are also covered. They need to be provided by a Medicare-certified home health agency in order for Medicare to cover them.

Medicare doesn’t solely cover in-home caregiving for non-medical services like hygiene assistance, meal preparation, or transportation. They only cover them if it is part of a physician prescribed home health care plan that also includes skilled care. It also limits how long the care is paid for. 

One must pay 100% of the care if it includes:

• 24 hour care

• Help with ADLs (such as bathing or using the bathroom)

• Meal preparation and cleaning

• Family caregiver wages

Based on the condition of the senior, one would determine whether they qualify for in-home caregiving or home health care. 

There is also Medi-Cal, which covers essential caregiving services and in-home support services. The primary program is IHSS (In-Home Supportive Services) which can be provided by a family member, spouse, or hired caregiver. This special program is available to Medi-Cal recipients, those disabled or over 65, and living at their home. 

These in-home caregiving services serve non-medical needs, including hygiene assistance, housekeeping, meal preparation and feeding, medication management, and monitoring to prevent injuries.  

Technology Usage Among Seniors

Managing aging in place wouldn’t be complete without a discussion on technology, which has driven the senior market, with nearly 66% saying that it has helped make life easier to adapt to, helping manage finances, health, and social lives. Technology has really boosted just how they adjust to aging. In fact, 91% of seniors own a smartphone, and 75% of those aged 65 and older are online daily. 

For caregivers over the age of 50, 55% of caregivers use digital devices for care coordination as well as managing communication, shopping, and medical assistance. They readily accept technology as a way of life, understanding that it is vital to making things convenient and safer for the senior. In fact, 62% of caregivers say that technology makes aging much easier. It is interesting to note that those caregivers aged 50+ are more likely to use communication tools and use medical apps for caregiving purposes as opposed to those caregivers aged 18-49.

Putting things in place before living at home becomes an option is critical. It is also important to have the home safe for the senior, and technology can help with that. Identify any hazards and safety issues before they become a major concern. About 15% of seniors have given much consideration to the modifications they would need to make in the home. Of this, those aged 65-80 have given a lot of thought to the modifications (59%), compared to 48% aged 50-64.

How can technology help manage their lives? What aspects need to be considered? Things like bad lighting, rugs, steep stairs, and lack of handrails can cause safety hazards for the individual. So any tool that provides convenience, safety, and peace of mind, especially those that give the senior the feeling of independence while aging in place, are critical. About 70% of caregivers like using smart home devices, which can include smart lighting, smart locks, security systems, and voice-activated assistants.  

Another popular device for seniors are fitness trackers and wearables, which can monitor things like vital signs, sleep patterns, and stress management. Things like smart glasses and hearing devices can also help with age-related degeneration.

Beyond technology, much attention has been given to accessibility remodeling, which can include things like grab bars, non-slip flooring, and curbless showers. For those wheelchair bound or with mobility issues, having an entryway ramp installed can make life much easier. All of these play an integral role for those who want to age in place.

Financial Considerations

Another thing that many families need to consider are the financial costs of aging in place. Unfortunately, a lot of care such as assisted living and nursing homes aren’t covered by Medicare or private insurance. This may make it difficult to get the necessary care for their loved ones. Pricing on care such as in-home caregiving can vary based on home modification and care needs, but are generally less expensive than using an assisted living facility or nursing home. 

Consider current monthly expenses. Is there enough money to cover monthly bills and regular expenses like food? Could one handle an unexpected expense? If you own a home and cash is an issue, one option to consider is a home equity loan, which allows you to borrow against your home equity and free up extra cash that can help you remain in your home. A home equity loan can give you a lump sum upfront and has a fixed interest rate. You can also take out a HELOC (home equity line of credit), which works like a credit card where you only pay interest on the amount you withdraw.  

One can also consider a reverse mortgage, which allows you to convert some of your home equity into cash, and is designed for seniors over the age of 62. The loan becomes due when you move out, sell the house, or pass away. Besides paying existing mortgages, this money can help cover the costs of in-home care, home modifications, healthcare, and daily living expenses. 

Overall, there are many factors to consider when aging in place. Whether it’s having the right care, preventing safety hazards, or having money lined up to take care of things, planning ahead is always key.