Where should I live as I age?

Where should I live as I age? August 15, 2023


Zippia, an online career website shares some interesting facts about American nursing homes, the people who occupy them, and the future of the “nursing home industry”:

  • There are over 810,000 people living in assisted living facilities in the United States.
  • 4% of U.S. seniors live in nursing homes.
  • 2% of U.S. seniors live in assisted living facilities.
  • 52% of the U.S. assisted living population is over the age of 85.
  • The number of nursing home residents has risen to 1.4 million in 2023 after dropping from 1.39 million in 2010 to 1.29 million in 2020.
  • As of 2022, there are 26,514 nursing care facilities (nursing homes) in the U.S.
  • The market size of the U.S. nursing home industry is $146.9 billion in 2022.
  • About 69.3% of nursing homes are for-profit organizations.
  • The average monthly cost of a semi-private room in a nursing home in the U.S. is $7,756.
  • The average cost of a private nursing home room is $8,821 a month.
  • 54.6% of nursing home residents are women.
  • That means that just 35.4% of nursing home residents are men.
  • This ratio is similar to the ratio of male and female assisted living residents as well, where 70.6% are women, and 29.4% are men.
  • 47.8% of nursing home residents have Alzheimer’s disease or other dementias.
  • The majority of nursing home residents are non-Hispanic and white.

Keeping all of these numbers in perspective requires that we also remember that (according to the 2020 census) “there are 55,892,014 people aged 65 and over in the U.S. out of a total population of 331,893,745, or 16.8%”.  And it is useful to keep in mind where the nursing home industry is headed: “In the U.S., there are about 1.4 million people who live in nursing homes and 810,000 people who live in assisted living facilities. By 2050, it’s estimated that this number will more than triple, making the need for nursing homes and assisted living facilities more significant than ever.”

Whenever I find myself talking with parishioners or their families about planning for the future, I am aware that there are countless issues involved.   Some of challenge has to do with geography.  It is easy to insist that aging parents and grandparents live near their families but in order to do that parents and grandparents often lose friendships built over the years, they may shoulder increased living expenses, and such moves are predicated on the assumption that their children will stay put.  I know a couple that moved to Florida to be near their children and grandchildren and in the space of two years their children moved to other states.  As a result, they were the only ones living there.

Another challenge has to do with the size of the homes in which people live.  Some aging couples are left with homes that larger than they can maintain or navigate.  Others rely on housekeepers and yard services to help them maintain their homes and they value the space that a larger home provides for activities, including knitting, sewing, cooking, gardening, and model trains.

Health also has a bearing on choices of where we live as we age.  Some aging adults find themselves alone.  Illnesses like dementia may make it impossible for a spouse to care for the love of their life.  And other conditions make care a difficult task.

All that said, not everyone can or should move to nursing homes as they age.  Modern homes and strong neighborhoods can address the challenges posed by scattered extended families.  And in home nursing care, which 65% of people rely upon, can address many needs.

As we age it is important to avoid being subtly pressured into assuming that nursing homes are an inevitability.  In my experience, caring for parishioners in a variety of settings, if you consider a nursing home or a graduated care facility, there are a number of things to keep in mind:

One, not all facilities are equal.  Nursing homes and retirement communities do not pay as much as other parts of the medical and hospitality industries.  Staffing levels and competence can vary widely.

Two, what you judge to be a quality life and your own personality are significant variables.  Don’t lose cite of them, even if family members insist that the move to a nursing home or graduated care facility would be “good for you”.  Some people thrive with the activities on offer in a retirement community.  Others instinctively push hard against them.  It is not wrong to be drawn to orchestrated activities, nor is it wrong to find them lacking.  Take stock of your preferences and remember that you may need to have some candid and potentially difficult conversations if you belong to one cohort and your spouse belongs to the other.

Three, if you enter a retirement community that provides graduated care, take stock of what that journey is likely to entail.  It is one thing to enter a community with independent living, where you can live in a patio home or apartment, and continue to drive.  It is another thing to find yourself in managed care where you may be required to live across the hall from your spouse and live in separate rooms no larger than a small bedroom.  Such moves can have the effect of greatly diminished privacy, intimacy, and activity.

Four, evaluate what it will mean for you to live in a chronologically homogenous community and in a place where access to the communities and friendships you have forged may be lost or limited.  Loneliness is, itself, spiritually and physically hazardous.

Five, if you decide to remain in your home, do what you can make your home accessible and easily maintained.  And – if and when physical needs require attention – explore reliable in-home care.

Six, above all, consider the spiritual dimensions of the decision that you are making for yourself, in conversation with your spouse, and in conversation with loved ones.  A deeply materialist approach to negotiating our lives as we age has set in.  All too often we have prioritized medical care and supervision over relationships, fulfillment, and the cultivation of spiritual peace.  It would be sadly ironic if, in the face of improved life expectancy, we put in place well-intended layers of care that robbed those years of joy and spiritual growth.  Without ignoring the challenges you may face, keep these concerns at the forefront, and insist that loved ones remember that just because you are aging, does not mean you no longer have concerns that transcend basic, physical safety.

Finally, let me return to the point that I made near the beginning of the article.  Deciding where to live as we age is a complex decision, and there are countless variables.  There is no one, right decision.  But the decision warrants careful deliberation.


Photo by Nina Hill on Unsplash

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