Where are you from? Where do you live? Where is Your Home?

Whether your answer to all three questions is the same or you have three different answers, it is almost a certainty that at some point as life circumstances -- family, career, income, and health -- change, we will face the question about where we will live in the future.

Louisburg, Kansas has been our home for nearly 24 years and we have lived in our present home for more than twice as long as I have lived in any other house in my 84 years. Over the past few years we have had frequent discussions as to whether it makes sense for the two of us to continue living in a 4,000+ square foot home on three levels (lots of stairs) with the high maintenance, insurance, taxes and mortgage expenses involved.

Like the majority of our peers in similar circumstances we would love to simply Age in Place. Yet we know from an objective standpoint that is a short term answer, at best. At some point, probably sooner rather than later, we know we may not be able to continue living in our present home. Like most homes, including the majority of new homes built today, it was not designed with seniors in mind. The cost of modifications to make it senior friendly may be prohibitive.

According to The MetLife Report on Aging in Place 2.0, "basic design and structural modifications to a one-story home cost an average of $9,000 to $12,000". (If the alternative is a move to an assisted living residence, Genworth Financial estimates the average cost at $43,000 per year.)

A partial list of issues on the National Association of Home Builders "Aging-in-Place Checkilist" include:

• At least one step-free entrance into your home with a cover
• Non-slip flooring in foyer
• Main living on a single story, including a full bath
• No steps between rooms/areas on the same level
• 5-foot by 5-foot clear/turn space in living area, kitchen, a bedroom, and a bathroom
• Interior doors and hallways at least 36-inches wide
• A kitchen worksurface you can use while seated?
• Secure handrails on both sides of your stairs
• Smoke and carbon monoxide detectors on each floor of the home
• Well lighted exterior walkways and entrances
• Bathroom cabinets and shelves easy to reach
• Lever-style door handles
• D-shaped handles on cabinets and drawers
• Grab bars in the bathtub, shower, and toilet
• A comfort-height toilet (or toilet seat riser)
• Toggle style switches in place of slide or rotary light switches

You can download the full HomeFit Guide at the AARP website. The Center for Universal Design, College of Design, North Carolina State University has developed a set of Seven Universal Design Principles that you might find very useful.The full Aging-in-Place Checklist is available at nahb.org.

"While we focus on innovations to help make communities more livable and offer new solutions to help people age in place in their homes and neighborhoods, we also have to consider what happens when staying in one's home is no longer an option.

It used to be that the only options for an older person who could no longer live at home was to move in with family or into a nursing home, but today many more creative choices exist  and more are being created all the time." (Disrupt Aging, p. 124)

The stark reality is that none of us are going to live forever and unless death comes quickly and unannounced, we will most likely reach a point where we will need help with basic daily needs. Rather than wait for the day to arrive when we suddenly realize we can no longer manage without assistance, we are wise to arrange a time when we and our adult children and other relevant family members have a discussion about what we will do when that time arrives. Otherwise, we are delegating these decisions to others to make under the pressure of an immediate crisis.

In our own situation, we came to the realization that even if we found the perfect alternative and a buyer made us an offer we couldn't refuse on our present home, we had not done the requisite planning to make a move a smooth and relatively painless process.

It would not simply be a matter of deciding on what furniture and furnishings to keep and what to do with the rest. We have a lifetime of 'stuff' to sort out  and make the hard decisions that we have managed to avoid until now. The plain truth was we needed more time (sometimes referrred to as 'kicking the can down the road'). So, we will use the next few years to prepare for an orderly downsizing at some point in the not too distant future.

A care plan should identify what types of assistance are (or may be) needed, how those needs will be met and by whom. Some of the issues that should be covered in the plan:

• Managing and dispensing medications
• Providing needed in-home medical services
• Transportation to doctor's and other appointments
• Help understanding doctor's advice, health conditions, and making healthcare decisions
• Managing and paying bills and filing insurance claims
• Laundry, housekeeping and grocery shopping
• Meal preparation
• Home repair and maintenance
• Pet care
• Emergency response systems, such as a pushbutton bracelet or necklace
• Respite assistance for caregivers

Considering your Options

Many older adults are aging in place because they are unaware of alternatives they can afford. It is definitely a viable option for many seniors but should not be the result of a failure to plan for the future. This can lead to a more difficult and less satisfactory outcome when the tipping point of serious risks to health and safety or when unanticipated changes in financial circumstances demand an immediate change.

Downsizing

Downsizing is an alternative form of independent living that deserves consideration. It offers the choice of moving to a smaller, more senior-friendly home as long as health circumstances allow.

In 2018, 13% of all homebuyers over age 50 purchased a home in senior-related housing. Among homebuyers aged 64 to 72, the percentage was 16% and for buyers in the 73 to 90+ age group, the percentage jumped to 29%. In all age groups over 50, the percent of buyers who purchased detached single-family homes ranged from 61% to 81%. The next highest category ranged from 9% to 14% who purchased duplex/apartment/condo  units in 2 to 4 unit buildings.

Among all age categories, slightly less than 50% purchased homes in the suburbs or a subdivision. The remainder was spread over small town, resort/recreation area, urban/central city, and rural area. Small towns were favored by younger seniors whereas urban/central city areas were favored by seniors 54 and older.

A frequent refrain I hear from seniors is they want to remain in touch with their long-time friends and thus prefer to continue living in their own home in the same general area they have lived in but they no longer want to spend the time, energy, and money to maintain the home they now occupy.

They don't want to spend their time on lawn maintenance in the summer or shoveling snow in the winter. They don't want the cost of heating and cooling rooms they no longer need. They don't want to pay high property taxes and insurance on a home that was perfect when their children were at home but has now become a drain on their resources.  Many of them describe themselves as 'house rich and cash poor'.

An option that is being discussed a lot is a Reverse Mortgage. Having spent a lot of time investigating this option, I know it is not the solution for everyone. I also know that it is the right option for many but even in those instances when a Reverse Mortgage is the right choice, it should only be considered in consultation with an advisor who has experience in this area and can help you avoid the pitfalls that can turn a good deal into a bad deal.

For some, the solution is a maintenance-free condo where they can spend their leisure time enjoying grandchildren, relaxing with friends, volunteering for causes they believe in, pursuing a hobby or taking classes, or turning a hobby into a business.

The decision to downsize or not and the type and location will vary widely. But whatever the decision, it should be preceded by thoughtful and informed consideration of the alternatives. Downsizing also provides the incentive (or necessity) of decluttering while physically able to be more than a passive observer of the process.

Sooner or later, most seniors will reach the point when independent living may no longer be practical or even possible. Not so long ago senior housing alternatives were severely limited.  Today the range of options is rapidly expanding.

At one end of the spectrum, there are communities that offer little or no care; at the other, facilities that provide continuous care. Between those extremes are a wide range of housing choices that can meet changing needs.

Creative new options, such as intentional senior retirement homes and communities and co-housing environments, are available, as well as more traditional senior housing choices, including:

• Independent Living

Condos, townhouses, and single family homes that are smaller and more maintenance free than large family properties are usually the first choice of seniors if they are healthy and active. As referenced above under Downsizing, they make Aging in Place possible for many seniors who are no longer interested or able to maintain a more traditional family home.

• Active Adult Senior Retirement Homes and Communities

Active adult senior retirement homes and communities aim to service the interests of active adults over the age of 55. Housing types often include condos, townhouses and single-family properties, and all are designed with an eye toward delivering a maintenance-free lifestyle for residents. Such communities offer a vast array of on-site activities, including exercise, social clubs, art instruction and lecture series.

• Assisted Living Senior Retirement Homes and Communities:

Residents live in their own apartments, but have the benefit of an on-site staff, meal service in communal dining spaces, and planned activities and outings. Some assisted living communities also offer access to nurses and daily living assistance. Others may offer more extensive medical and personal services.

• Adult Family Senior Retirement Homes

Such properties are licensed to care for up to six residents in a home setting. Services typically include meals and housing maintenance and attending to residents' safety and care. Facilities may specialize in addressing specific health concerns and provide care and an environment tailored to those conditions.

• Alzheimer's and Dementia Care

Facilities specialize in caring for patients with dementia and Alzheimer's disease offer programs that address residents' needs and provide an environment where they can live safely. Housing services typically include personal care, such as bathing  and dressing and administering medicine, along with dining and housekeeping. In addition, many buildings incorporate over 50 design features, such as safe wandering paths and color coded areas to help with way-finding. Such designs provide comfort and ease residents' anxiety.

• Continuing Care Retirement Living Communities

A Continuing Care Retirement Living Community offers progressive levels of assistance, depending on a person's needs. They include independent and assisted living and nursing care.

"Ultimately, where you live and how much support you choose will depend on your physical and mental conditions, personal preferences, interests, financial resources, family and your willingness to adapt to change." (Mayo, p. 334)

As more options have become available, nursing home (or skilled nursing facility) use is declining. Their role is often temporary while a patient recovers from a severe injury or are the necessary location for people who need full care for a condition that may not improve. More than half of the residents of nursing homes are suffering from dementia, primarily Alzheimer's disease.