Between independence and full-time assistance, there’s a continuum from being able to manage with taxis and in-home services at one end to regularly needing skilled medical or custodial care at the other. How long you can stay in your home will be influenced by many factors but unless you’re wealthy, it will ultimately be difficult without friends or family contributing unpaid services. As your care needs grow, without someone paying attention, you’ll be more vulnerable to theft and mistreatment by in-home caregivers.
If you’re reasonably well off, you can hire geriatric care managers, who’ll act as surrogate children. They’ll screen in-home aides, advocate for you when necessary and decide on the best place to put you. This is a good option if you can afford it since care managers are paid to act in your best interests following your express wishes. Unlike real children, their decisions will be more objective and they’ll know the local options.
If you’re neither wealthy nor poor, you’ll be at the mercy of circumstances. What’s possible will depend on your finances, your needs, and the services available in your community. People needing non-medical assistance may have few good choices since Medicare won’t cover the costs of an assisted living facility nor pay for home health aides whose assistance is not medically required.
People nearing retirement are often advised to consider long-term care insurance and/or a reverse mortgage to offset the costs of home health care. Both of these have many drawbacks.
Metlife’s Mature Market Institute provides a useful guide (PDF) to the challenges of remaining in your home as you age. It includes questions for assessing your care needs and how well your home will support aging-in-place. It also provides tables of relative costs for the most common home retrofits (in 2010).
Old people at home alone may become lack the social contacts necessary to provide feedback and mental stimulation. Do you want to end up home-bound, seeing only aides and deliverers of meals-on-wheels? If not, you need to plan ahead.
Speaking personally, when I informally assessed my own home’s “senior-friendliness,” it didn’t fare too well. Nonetheless, I have no immediate plans to move. (See Selling Your House).