Guide to Aging at Home Safely and Comfortably

Many people are increasingly opting to live out their years in the comfort of their own home, perhaps with help from relatives or with in-home skilled nursing care, rather than move to a care facility. Aging in place enables older adults to remain independent and keep their own schedule. It is also less expensive than living in a facility, though it takes a coordinated approach to create a safe environment with home modifications and family or paid caregivers.

As people stay healthier longer, aging in place is becoming more feasible.

Aging in place is an attractive option for many adults. As with any important choice though, there are pros and cons to consider.

Addressing safety concerns in the home is crucial for those who opt to age in place. Falls can be life threatening and are one of the most expensive accidents, with one out of five falls causing a serious injury. Here are some potential problems to consider and their solutions.

Although you may not need wider doorways today, it's important to modify your home before you might actually need to so the home is safe and accessible if or when the time comes. If you hire a contractor, be certain to use one who is licensed and bonded. Check with the Better Business Bureau and your local chamber of commerce for complaints against contractors you are considering. Always have a written contract that specifies the work you need done and the cost.

Consider the following modifications:

New technology is making it easier and safer for adults to age in place. Reminders from automated medication dispensers keep people on track with their prescriptions while voice-activated switches can adjust air conditioners, computers, and other types of equipment.

These are among the devices that families are embracing:

Aging in place may be your optimal choice but it's important to have a realistic idea about the costs involved. An important factor to take into account is that although you can calculate the type of care you need today, it is hard to know what the future holds. Your needs may stay the same or increase as years pass.

Source: Genworth 2019 Cost of Care Survey

• Will you need home care and what level of care? Aides, LPNs, and RNs have escalating rates.
• How many hours of care per day and per week will you need?
• How much care can you count on family members to provide and how many hours of professional care will you need?
• What kind of care can you predict needing in the future as you age?
• How much will your other health care costs be in addition to in-home care?
• Will you need home modifications?
• What kinds of technology do you need to invest in to make living at home feasible?
• Will you have transportation costs (to medical appointments, social events, errands, etc.)?
• Do you need homemaking services (cleaning, cooking, laundry, grocery shopping)? How many hours a week?
• Have you calculated your rent/mortgage, utilities, and home repair costs for the coming years and taken those into account?

A variety of programs provide payment for home health care services. Here are the top five you should look to first.

Medicare Part A and Part B cover home health care if a doctor states the patient is homebound and requires one or more of the following:

• Part-time skilled nursing care (less than eight hours a day for 21 days)
• Physical therapy
• Occupational therapy
• Speech-language services

If you have a Medicare health plan that is not original Medicare, check with your plan to determine what is covered. Medicare will only pay a Medicare-certified agency for your care, not an individual you hire. The agency should give you a Home Health Advance Beneficiary Notice, detailing how much of their services Medicare will cover and what you are responsible for. Medicare covers 100% of the home care and 20% of durable medical equipment. Home health aides are covered only if they are needed to support skilled nursing care. Homemaker services and meal delivery are not covered.

If you need full-time care, Medicare will not provide coverage for home health services. For help navigating your Medicare benefits, contact your State Health Insurance Assistance Program or BenefitsCheckUp.org. Also, read the Medicare and Home Health Care booklet.

Each state has its own program for Home and Community-Based Services (HCBS) run in partnership with Medicaid. Medicaid covers services to help you remain at home, such as personal care, laundry, cleaning, and case management. Medicaid's long-term care programs have health and financial eligibility that differ by program, so check with your Medicaid office to determine eligibility or use the Medicaid eligibility checklist.

U.S. Dept. of Veterans Affairs provides several types of services for veterans of armed services (as well as National Guard and Reservists) who served active duty and had other than dishonorable discharges. Skilled Health Home Services are available for short-term care. Homemaker and health aide services are available to post-9/11 veterans with medical discharges. The VA also offers home telehealth monitoring and respite care so family caregivers can take a break.

Program of All-Inclusive Care for the Elderly (PACE) is a Medicare program and a Medicaid state option that provides medical and social services to seniors who usually qualify for Medicare, Medicaid or both. It provides all the care and services covered by Medicare and Medicaid, as authorized by the health care team. It also covers additional medically necessary care and services not covered by Medicare and Medicaid that the team may decide you need. PACE provides coverage for prescription drugs, doctor care, transportation, home care, checkups, hospital visits, and nursing home stays when necessary. Services are available to seniors eligible for nursing home care who are able to remain safely in their communities. Find information about PACE in your area.

Your current private health insurance plan may have some coverage for home health care. Long-term care insurance policies provide coverage of home services as well and coverage will vary by policy. Medigap policies do not cover long-term care.

Family caregivers can be key in an aging in place plan. Even if professional home health and homemaking services are used, family is essential for helping a senior remain at home successfully. Family members can assist with:

Even caregivers can become ill or suffer an injury. If you're a primary caregiver helping with a relative who is aging in place and depending on you, it's important to have back up support and people to rely on for assistance.

It's also wise to have a financial and legal plan in place (including powers of attorney, living wills, and health care proxies or powers of attorney) so the caregiver has the authority necessary to continue giving care no matter how the situation may change. Support and assistance is available from the Family Caregiver Alliance.

As many as 70 million people provide unpaid home care for family members. Medicaid's Cash and Counseling program, which is available in some states, gives funds directly to seniors aging in place and allows them to budget how they want to spend that money for their own care. This can be used to pay a family caregiver.

If an aging adult pays a family member — with his or her own funds or Medicaid funds — the pay is taxable income that must be reported to the IRS. The senior, as the employer, is obligated to withhold taxes and report the payments. The IRS provides information on hiring household employees.

Finding good home health providers can be challenging. Here are some tips and resources to help get you started:

• Your state long-term care ombudsman offers a list of agencies and providers in your area.
• Your physician's office or geriatric care manager may be able to provide you with a list of agencies.
• Medicare's Home Health Compare allows you to locate and compare Medicare-certified agencies in your area.
• The Eldercare Locator can also locate providers.
• Ask friends or local senior centers for recommendations.

• Determine which agencies are Medicare and/or Medicaid certified.
• Get references and check them.
• Find if the agencies do background checks on their workers.
• Make a list of services and special needs you need help with.
• Get a clear estimate of cost for the services and hours you need.
• Check with your state ombudsman for complaints against the agency, as well as your local Better Business Bureau.
• Use Home Health Compare to see how the agency stacks up against others in terms of the results they get for their patients.
• Ask what skills the caregivers have and what kind of education and training is required.
• Learn if the same caregivers will work with the senior on a regular basis.
• Request a documented care plan.
• Determine if the agency is bonded and insured.
• Ask what happens if a scheduled caregiver is ill or doesn't show up.
• Determine if the agency has experience with the particular medical needs involved in your case.
• Find out how the care is monitored and supervised. How often will a supervisor check in?
• Ask what kinds of records will be kept and how you can access them.

Con artists target seniors because seniors often have a nest egg, live alone, can be trusting, or may not be familiar with technology. The FBI lists the following as the most common fraud schemes older adults face:

• Door-to-door solicitations from people offering to do work around the house, saying they've been working at a neighbor's house and noticed your house needs repairs
• Telemarketing fraud where solicitors call and ask for money or personal information
• Lottery and sweepstakes schemes where con artists ask for money in exchange for the chance to win a prize or to pay for a prize to be mailed to a home
• Charity scams involving solicitations for causes and tragedies in order to get a credit card number

William Leahy, M.D., is a geriatric neurologist and the author of The Home Health Handbook. He is the founder of the High School Home Health Education Foundation.

Mary Languirand, Ph.D., practices psychology in Long Island, NY. She co-authored "How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement."

Michael Saunders C.Tech, CSAHD, is an architectural designer and home accessibility consultant. Saunders enjoys exploring the many ways our built environment impacts our lives, and helping people adapt their homes to meet their changing needs.

Sharona Hoffman, Professor of Law and Bioethics at Case Western Reserve University School of Law, is the author of "Aging with a Plan: How a Little Thought Today Can Vastly Improve Your Tomorrow," which discusses how to plan for aging or take care of elderly loved ones.

There's No Place Like Home For Growing Old
National Institute on Aging web page containing list of federal help available that older adults might want to consider to assist in independent living.

Healthy Aging & the Built Environment
Centers for Disease Control and Prevention (CDC) web page describing affordable, accessible and suitable housing options that can allow older adults to age in place and remain in their community. Extensive list of resources.

Healthy Aging Research Network Archives
List of resources covering environment and policy change, and brain health archives.

National Age In Place Council
Network of professionals from the private, public and non-profit sectors who can help older adults plan for their future housing and care needs.

AARP Aging in Place Survey
Survey of state and local livability policies and practices

Administration on Aging
The Administration on Aging promotes the well-being of older adults by providing services and programs designed to help them live independently in their homes and communities.

National Association of Area Agencies on Aging
Offers elder care locators, preferred providers and other links to develop livable communities for all ages.

Certified Aging-in-Place Specialists (CAPS)
The National Association of Home Builders (NAHB), in collaboration with AARP and other experts, developed the Certified Aging-in-Place Specialist (CAPS) designation. Certified Aging-in-Place Specialists understand the needs of the older adults and are knowledgeable about aging-in-place home modifications.