As more older adults continue to enter their “golden years” and retirement, an increasing number of these individuals are living alone and “aging in place”, a term that has grown in popularity almost as fast as the number of aging boomers. This leaves many wondering if their loved ones should live alone, and if so, what are the precautions and considerations. This article will explore this topic, and give you a better understanding of older adults living alone in the U.S.
Aging in place simply refers to helping people remain in their own homes or neighborhood as long as possible. In 2014, a survey conducted by the American Association of Retired Persons (AARP) found that 87% of individuals 65 years and older wanted to remain in their present home and community as they age.
Not surprisingly, research has shown that this makes sense from a financial standpoint as well since it is often cheaper to live and receive care in one’s own home as needed rather than move into some form of long-term health care. Nevertheless, families and friends have concerns about seniors living alone and there are a number of factors to consider when determining if this is a feasible option.
Concerns About Senior Citizens Living Alone
A number of concerns arise when considering whether senior citizens should be living alone in their own homes or not. Some of the important factors that should be considered when making this decision include:
- The functionality of the home
- Access to support and services
- Social connection
- Personal preferences
We will look at each of these factors below to determine how they affect seniors living in their own homes as well as some possible solutions.
Safety is a priority concern for elderly people as well as their family and friends when an individual wants to remain in their own home. A number of different issues can arise regarding safety such as:
- Cognitive decline
- Medication safety
- Vulnerability to crime
A brief look at each of these factors will provide a better understanding of whether an individual is safe to remain in their own home or if they or should consider other living options.
Fall-related injuries are one of the primary reasons that a senior ends up needing or choosing to move out of their home. The National Institute on Aging (NIH) has identified that 6 out of 10 falls occur at home. Serious injuries such as hip fractures and head injuries can occur which an individual may not recover from.
Falls may occur for a variety of reasons including improper footwear, vision impairment, hearing, and inner ear problems, foot and ankle problems, and loose items in the home environment such as area rugs that one can slip on.
If an elderly person is falling at home or in the community, they should be assessed by their physician or health care provider to identify why this may be occurring and possible solutions to reduce the number and/or likelihood of falls.
Home modifications may also be necessary to improve the home environment and reduce the number of fall-related injuries. The NIH suggests that seniors take the following measures to fall-proof their homes to improve safety:
- Place handrails on both sides of the stairs and ensure they are well-fastened.
- Hold onto the handrails when going up or down the stairs.
- If you have to carry something when on the stairs, be sure to hold it in one hand and hold onto the handrail with the other hand. Also, do not let what you are carrying block your view of the steps.
- Ensure there is good lighting. Be sure to have light switches at the top and bottom of stairs and at the end of long hallways. Be sure to use the lights.
- Ensure floors are kept tidy and clear. Remove all items from stairs and hallways including papers, books, clothes, boxes, etc.
- Ensure all carpets firmly adhere to the floor so they will not slip. Install anti-slip strips on wooden and tile floors (available in most hardware stores).
- Avoid using throw rugs or loose area rugs that can slide and cause falls.
Bathrooms and powder rooms
- Install grab bars beside toilets and inside and outside the shower/tub.
- Put non-slip mats, anti-slip strips, or carpets on all surfaces that could get wet.
- Install and use night lights.
- Install light switches and place night lights close to your bed.
- Store a flashlight on your nightstand close to your bed in case of a power failure and you need to get up.
- Ensure you have a phone close to your bed.
Other living areas
- Ensure telephone cords and other electric wires are kept near walls and out of hallways and walking paths.
- Ensure all carpets and large rugs are firmly secured to the floor.
- Organize furniture such as low coffee tables and other objects so they are not in your walking path.
- Ensure that chairs and sofas are the right height for you to get in and out of easily.
- Do not walk on wet or freshly washed floors.
- Store frequently used items where they are easy to reach.
- Use a “reach stick” rather than standing on a stool or chair to reach something up high. These are special tools for reaching for items that can be bought at hardware or medical supply stores.
- If you must use a step stool, ensure it has a handrail at the top and that it is steady on the floor before stepping on it. Have someone stand next to you if possible.
- Be aware of where your dog or cat is when you stand or walk to avoid tripping and falling on them.
- Have emergency numbers in large print near each phone in your home.
Another important factor to consider regarding the safety of a senior living in their own home is their mental health. We all forget things from time to time and get distracted. But, the cause needs to be investigated if an individual is:
- Leaving the stove on
- Burning food in the oven that they forgot was cooking
- Leaving lit cigarettes in ashtrays
- Having difficulty finding their way home or through their community
It is important to discuss these concerns with the individual’s physician or current health care provider as soon as possible so they can assess the cause of their cognitive decline.
Although cognitive impairment is more common with increasing age, it does not necessarily suggest that an individual has Alzheimer’s disease or dementia. Medications and other medical conditions can also cause cognitive problems; however, if a health care provider determines that an individual is experiencing some chronic progressive cognitive impairment, it may be time to consider other living arrangements that can help support the individual while keeping them safe.
Another concern regarding seniors living in their own homes is the issue of medication safety. Many seniors take a number of medications which increases the chance that they will experience an adverse drug reaction or a drug-drug interaction, particularly if medications are not taken as prescribed.
Individuals who are taking medications at home should ensure they are following the medication safety tips for seniors recommended by the Food and Drug Administration (FDA) listed below:
- Learn about your medication(s). Be sure to read and follow the directions on all medication labels and package inserts. Do not hesitate to ask your pharmacist or health care provider if you have any questions.
- Discuss with your health care provider or pharmacist all your medical conditions, medications (prescribed and over-the-counter), dietary supplements, vitamins, and herbal products, and any questions you may have. The more they know about your medications and health, the more they can help.
- Write down any suspected side effects or drug interactions and discuss these with your health care provider or pharmacist as soon as possible. Be sure to include any changes in how you feel or unexpected symptoms you are experiencing.
- Ensure you attend all medical appointments and get all lab work and monitoring tests completed as recommended by your health care provider.
- Use a daily pill organizer or calendar to help remind you when to take your medications throughout the day.
- Write down important information that your health care provider or pharmacist tells you about your medication or medical condition so you do not forget.
- If you have difficulty understanding or remembering what the pharmacist or health care provider is telling you about your medications and/or medical condition, take a family member or friend with you.
- Complete a “Medicine Check-Up” at least once a year. Ask your health care provider or pharmacist to review with you all your current medications and why you are taking them. Make a list of all new supplements, herbals, and over-the-counter medications you have started taking since your last medication review and discuss these well.
- Dispose of old and expired medication from your medicine cabinet.
- Keep all medication where children cannot see or reach them.
Also, an individual should not take medication with alcohol or when they have been drinking alcohol. Medications and alcohol can be a dangerous combination, particularly for seniors. In addition, combining medication with alcohol can predispose seniors to falls.
Vulnerability To Crime
Another safety concern for seniors living alone is their vulnerability to crime. Seniors may feel uneasy living on their own because they do not know how to prevent themselves from becoming a victim of crime and/or they are unsure how to respond if they were the unfortunate target of criminal activity.
Fortunately, all individuals (including seniors) can do a number of things to reduce one’s chances of being targeted for criminal behavior. Awareness of one’s surroundings and taking some preventive steps can go a long way toward avoiding trouble.
The National Crime Prevention Council (NCPC) has a brochure titled Safer Seniors in which they outline the following tips for securing one’s home and making it safer:
- Install and use good locks on doors and windows in your home.
- Do not hide spare keys in planters, under doormats, or in mailboxes. Leave a spare set with a trusted neighbor or friend.
- Ask for photo identification when service or delivery people come to your door. If you do not feel comfortable, contact the company to verify who the person is.
- Be sure your address is large, well-lit at night, and in clear view so emergency personnel and police can easily find your home.
- Consider having a multi-purpose home alarm system installed for fire, medical emergencies, and burglary.
Please see this brochure for other crime prevention tips for seniors as well.
Functionality Of The Home
In order for a senior to remain living alone in their home, the physical space they live in must enable them to live safely and comfortably while meeting their daily care needs. There are some common home modifications that can make a senior’s home more functional and safe to live in such as:
- Door Knobs with levers
- Grab bars in bathrooms
- Grab bars in showers
- Faucets with levers on the kitchen sink
- Handrails on both sides of stairwells and on the front and rear steps
- Removal of all thresholds in doorways
- Adjustable shower heads for those who need to sit
- Portable shower chairs
- A bathroom with a bath/shower on the first floor
- A bedroom on the first floor
- Doors widened to accommodate wheelchairs
- Ramps installed for walkers and wheelchairs
When an individual is considering whether or not they are able to remain in their own home due to its functionality, making some of these home modifications have been shown to enable a senior to live at home longer. Many of these modifications will also enable caregivers to provide care more easily.
The American Association of Retired Persons (AARP) also provides two excellent guides to assist with home modifications for seniors and individuals with disabilities: the HomeFit Guide and HomeFit No-Cost Low-Cost Ideas brochure. Both of these resources outlined suggested home modifications to ensure a home is safe and functional regardless of a person’s age or physical needs.
If you are unsure which home modifications would meet your specific needs or the needs of a loved one, it is recommended that you contact an occupational therapist, a geriatric care manager, or a nurse who can come into the home and assess this for you.
When considering home modifications, three concerns usually arise. First of all, how will these modifications be paid for? Some home modifications are minor and inexpensive such as installing grab bars near a toilet in the bathroom. Other modifications can be much more expensive, such as installing a wheelchair ramp leading up to the entrance of one’s home.
Individuals often pay for these types of expenses out-of-pocket without thinking about it because it is a necessity for retaining their independence and remaining in their own homes. Nevertheless, programs do exist to help seniors pay for some of these in-home care modifications when needed to meet personal care needs.
What many people are also not aware of is the fact that paying out-of-pocket for necessary in-home care modifications can also count towards “spending down on care” which is a legal way of reducing one’s income in order to meet the income eligibility requirements for Medicaid. This may be a good option for seniors to consider if they are not eligible for financial assistance to make the home modifications they require in order to remain in-home. For more detailed information about “spending down on care” and the states that permit this, please see the information provided here.
Another equally important question that people have regarding home modifications is “Who will do this work and will it be done correctly?” It can be difficult to find skilled and trustworthy professionals to perform the home modifications that one requires. In addition, a senior will want to know that the modifications have been done correctly so they will be able to use the equipment safely.
It is also important that home modifications are done tastefully and with minimal disruption to one’s home because the time may come when an individual wants to sell their home and poor renovation work will detract from the value of the home at the time of sale and/or make the home more difficult to sell. For these reasons, it is important to be able to find reputable professionals to assist with any home modifications that may be required. For help with hiring a contractor, please see the information provided here.
A final consideration regarding home modifications is “Who will do the maintenance“ on equipment that has been installed in the home? Handrails can become loose with repeated or heavy use and wheelchair ramps deteriorate when exposed to the elements outside and the weight of occupied wheelchairs. Keeping all equipment functioning safely and properly is a critically important part of keeping a senior in their own home as long as possible.
Access To Supports And Services
Having access to a variety of supports and services can make the difference between allowing seniors to remain in their own homes or needing to look at long-term care options. These include personal support systems such as family, friends, and neighbors as well as various community supports and services such as home care, home health care, and Meals-on-Wheels programs to name a few.
Personal Support Systems
To identify a senior’s personal support systems, it is important to ask the following questions:
- Does the individual have a spouse/partner?
- Is the spouse/partner willing and able to help with the individual’s care needs at home?
- Does the spouse/partner have any health conditions that compromise their ability to care for themselves or their ability to help care for the individual?
- If the individual does have a spouse/partner who is able to help provide for their care needs, will their spouse/partner need some help to do this at home?
- If an individual is single or widowed or their spouse/partner is unable to help with care needs, are there family or friends who can help? If so, would these family or friends be willing to do this and do they have time to help provide care? If so, do these family or friends live nearby?
- Is the individual willing to accept help from family or friends to meet their care needs? Or will this make them feel uncomfortable or put a strain on these relationships?
- Does the individual live in a rural or remote area where there is social isolation, making it difficult for family and friends to help them?
Community Supports And Services
In addition to family, friends, and neighbors, there are several community support services and groups that offer information and assistance to seniors who require help in meeting their needs. Some of these supports and services are general in nature and provide informational support while others are specific for individuals with certain medical conditions such as Alzheimer’s disease, stroke, cancer, etc.
Knowing what community supports and services are available in an individual’s local area and using these supports in combination with support from family and friends can be very effective in helping one remain in their home despite increased personal care needs. The NIH has identified that seniors may require support in the following areas in order to remain in their own homes:
- Personal care
- Home-delivered meals
- Health care
- Household chores/duties
- Money management
The following sites provide information about support, services, and financial assistance for seniors who wish to remain at home:
- Eldercare Locator for local Area Agencies on Aging
- Administration on Aging (AoA)
- Benefits.gov – find government benefits available in your state
- National Council on Aging (NCOA) Benefits CheckUp – find benefit programs in your state
- American Association of Retired Persons (AARP) Benefits QuickLINK – find public programs for a variety of needs
- Veterans Affairs benefits
- National Council on Aging (NCOA) Guide to Benefits for Seniors – find assistance for a variety of needs as well as information about qualifying for Medicaid and Medicare Savings Programs (MSP)
Personal Care Needs
As an individual moves into their senior years, they may begin to require help with personal care needs also known as activities of daily living (ADLs). This can include a variety of personal needs including assistance with eating, bathing, dressing, toileting, and mobility. They may also begin to require assistance with household chores such as housekeeping, laundry, paying bills, buying groceries, and meal preparation. If they have an acute or chronic health condition, they may also require assistance with things such as medication administration including insulin injections, blood glucose monitoring, dressing changes, wound care, etc.
If an individual requires skilled medical care for a health condition, these skilled services are provided by home health care and are covered by Medicare and Medicaid if an individual qualifies. Assistance with housekeeping chores as noted above is considered home care and is not covered by Medicare unless an individual also has medical care needs. Please see the information provided here about the important difference between home health care and home care including what Medicare covers.
Family and friends may be willing to assist with some housekeeping chores such as paying bills, laundry, and some light housekeeping to help reduce the out-of-pocket cost for a senior.
If an individual does not qualify to have services covered by Medicare or Medicaid, these services are paid for through private pay, long-term health care insurance, or other forms of insurance. Paying for these services out-of-pocket may also count towards a “Medicaid spend down” in many states which may assist an individual in reducing their income to qualify for Medicaid. Medicaid waivers are also available in many states which may help cover home care costs.
For detailed information about “spending down on care” and the states which allow this, please see the information provided here.
Rural vs. Urban Location
When trying to determine if older adults should remain in their own homes, it is also important to look at where they live. For example, if an individual lives in a small rural area, the number and types of services available to meet their care needs will be very limited. If this is the case, would the individual be willing to move to a larger center where their care needs could be better met? And if they are married, is the spouse willing to relocate too? If not, how will their spouse feel about the individual relocating to a larger center away from them? Will they be able to visit and see them as often as they would like? Or will this create yet more difficulties and problems?
Also, if a person moves from a rural area to a larger urban center to access in-home care services near family members, are they moving to a different state? If so, they may not be eligible for Medicaid or certain benefits if they move since Medicaid benefits vary by state. This is something that a certified Medicaid expert can help you and your loved one determine prior to any move.
Another area of concern when a senior wants to remain in their own home is their transportation needs. If an individual is driving, this may be a concern for family and friends particularly if the individual is becoming unsafe due to physical or cognitive decline. The ability to attend medical appointments, shop for groceries and other items, pay bills, and maintain one’s social connections in the community are very important for maintaining one’s independence and physical, emotional, and psychological well-being.
If an individual is no longer able to drive or needs assistance with transportation, there are a number of different services in communities to assist seniors with transportation. To find transportation services for seniors in your local area, please use the Eldercare Locator provided here.
When seniors remain in their own homes, another important factor to consider is their social needs. It is not uncommon for seniors to become more isolated as they experience some chronic health conditions resulting in increased disability and difficulty getting out into their community. Depression is a common concern for elderly people as is alcohol abuse.
If a senior is wanting to remain in their own home, some important questions to ask regarding their social needs include:
- Is the individual able to get out into the community and see their friends? If so, how often do they do this? Also, what form of transportation do they use, and are they safe doing this?
- Is the individual feeling “cooped up” in their home or a sense of isolation and loneliness?
- Is the individual displaying any signs of depression?
- Is the individual drinking excessive amounts of alcohol at home?
- Have the individual’s family, friends, or neighbors expressed concerns about the individual?
- Does the individual attend any weekly programs or events in the community or are they involved on a weekly basis in a place of worship or with other recreational events such as bingo, a coffee club, a quilting or woodworking group, etc.? If not, would enjoy these things, and would they have transportation to get there?
If an individual experiences social isolation and is lacking social connection because they are unable to get out of their home to connect with others, this may be a good opportunity to discuss other living options such as assisted living or day programs for seniors. Many communities have volunteer programs with individuals who will come into one’s home to visit a senior which may also be an option to consider.
Although it may seem obvious, one’s individual preferences also play an important role in determining whether a senior should remain in their own home or not. While most seniors want to remain in their own homes as noted earlier, others choose to move into other living accommodations because:
- They are afraid to live alone.
- Isolation and loneliness.
- They prefer living with others.
- They require the assistance of others.
If an individual is adamant about remaining in their own home, it can be helpful to understand the reasons why they feel this way. By understanding one’s reasons for wanting to remain in their own home, it is possible to see if these needs and preferences can be accommodated elsewhere.
When trying to understand why an older adult wants to remain in their home, it can be helpful to ask the following questions:
- If you moved into a different place to live, what would you want to take with you?
- What do you think you might like about living in a different place?
- What do you think you would miss about living in your own home besides the fact that it is familiar to you?
- What wouldn’t you miss about where you live right now?
- What concerns or worries do you have about moving into a different place?
- If you are not ready to move into a different place right now, would you be willing to consider this option in the future? If so, what kinds of things would have to happen for this to become an option you would consider?
Life transitions and change can be difficult for many people, including older adults. By considering an individual’s personal preferences and needs as well as the services and supports that are available to meet these needs, it is often possible to help seniors living alone when they choose to “age in place”.
Seniors Living Alone FAQs
1. My dad has Parkinson’s and lives alone in a small apartment he rents. He seems to be getting weaker and he can barely get up from his chair at times without almost falling. Is this normal with Parkinson’s? How will we know when it’s time to get him some help?
Yes, unfortunately, the changes you describe in poor muscle strength and control with your dad are a normal part of the disease progression. It is important to know that other things can cause your dad to become weak too so if you notice anything else that seems “not right” with your dad or if he states he is not feeling like himself lately, it would be important to have him assessed by a health care provider.
In terms of getting your dad some help, it would be important to discuss this with him to find out what things he is having difficulty doing if he would be open to having someone help him, and who this might be. For more information about the stages of the disease and when your dad might need help, please see the information provided here.
2. I have a small dog that has been with me for years and I’m considering a move into assisted living. Will I be able to take her with me? I can’t bear the thought of being without her.
It is completely understandable that you want to take your dog with you. An increasing number of assisted living facilities are beginning to allow pets and some even provide pet care for an additional cost. This will be an important question to ask when you check out different assisted living facilities that might work for you. Be sure to ask what their policy is regarding pets and if there are any extra costs associated with this.
3. My mom wants to keep living in her home and she’s pretty independent except she’s lost so much weight because never seems to have any food in the house and doesn’t cook anymore. She doesn’t need any help with personal care yet but is there some type of service that could bring her something to eat every day?
Yes. One of the best-known programs that operates in many communities across the country is called Meals on Wheels. The program has been in existence for many years and provides an invaluable service to seniors across the country. For more information about Meals on Wheels in your mom’s local area, please see the information provided here. There are also other public and private options for accessing home-delivered meals for seniors in various communities. For more information about other meal options for your mom, contact your local Area Agency on Aging.
4. My kids think it’s time I quit driving but I don’t see why I should. I’ve had an excellent driving record my whole life except for a couple of minor things lately that weren’t my fault. How does a person know when they should maybe consider not driving anymore?
The fact that you’re even asking this question suggests that perhaps you have concerns about driving now as well. Although it can be hard to give up the independence of driving after so many years, your safety and the safety of others are most important. Some indicators that may suggest it is time to give up driving include having some “close calls” when driving or more frequent citations than usual, vision problems, hearing problems, problems with reaction time, and physical problems that make it difficult to turn your head and shoulder check or react quickly at the wheel.