Pros and Cons of Aging in Place


A report published in June with the US Census Bureau reveals that this increasing wish of older adults to “age set up” is mirrored through the shift of Medicaid dollars favoring home- and community-based long-term care over institutionalized care.

The report, titled 65+ in the United States: 2010, shows that funding for home- and community-based services increased from 13% of total Medicaid funding in 1990 to 43% of total Medicaid funding in 2007. Accordingly, funding for institutional care decreased from 87% of total Medicaid funding in 1990 to 57% of total Medicaid funding in 2007.

In the report, the Census Bureau cites that almost 90% of adults aged fifty years and over want to stay in their home as long as possible. The report suggests aging set up has become very popular and more feasible on account of advances in assistive devices along with the availability of alternative settings, like assisted living residences, for anyone needing less comprehensive care in activities of daily living. Also, many older adults may prefer receiving care from a paid provider (eg, home health aid) or informal caregiver, such as an adult relative.

Cost can be another likely factor influencing the excitement of aging available. According to 2006 data, nearly half long-term care funding originated Medicaid (43%), then out-of-pocket expenses (28%) and Medicare (18%). The report notes that below one-fifth of older adults have enough money living in a nursing home for 36 months, and two-thirds of older adults can't afford to live for twelve months in a elderly care facility.

But simply because more older adults want to age available, does that mean they should? Please tell us what you think by sending a letter to the editor at, or twenty-four hours a day post comments below.

We asked several members of our editorial advisory board what you thought about this trend:

“The belief is the care is cheaper in home...but actually I am not sure we really have the full answer to that question. Compared to acute care, the care cost less. Assisted living or group home sort of care may in reality be a more cost-effective manner in which to go. Individuals alone, acquainted with limited care, social activities and stimulation, and cognitive impairment may not the truth is be cheaper home alone. More importantly they may not be happier home alone or with limited help. It is not expensive medical interventions though the care and structure that comes from institutional living. Someone to help tell the average person what to do every day; where to look to eat; what to consume; and how to proceed after that. Someone to ensure adequate bathing each day to prevent infections. Someone to notice quickly when there is an indication of the medical alternation in status....along with the list goes on and on. For some, home may be the best place but that is not so for many. Many blossom in institutional care.

Barbara Resnick, PhD, CRNP, FAAN, FAANP

Professor of Nursing

University of Maryland School of Nursing

Geriatric Nurse Practitioner

Roland Park Place, Baltimore, MD

“I am pro aging set up. The issues, as I see, are: educating the older adults and also the general public what this concept is. Individuals are waiting a long time to enjoy and partake from the amenities provided. Costs of the programs/facilities are from financial range for many. Alternative settings do provide socialization and opportunity for most who have outlived their friends and neighbors. They also allow couples to be the “same place” if one requires a higher level of care, thus allowing frequent visitations.”

Peggy Szwabo, PhD, ACWS, RN

Clinical Associate Professor

Division of Geriatric Psychiatry and Geriatric Medicine

St. Louis University School of Medicine

St. Louis, MO

“There are two things that are necessary for aging set up: (1) regulations that support the concept. This requires that if a person is assisted living but has skilled needs, the facility can maintain them in assisted experiencing support without nervous about adverse licensure actions; and (2) the family/patient must consider and accept the risk of falls or pressure ulcers in this setting and agree that this risk will not outweigh the concept of aging in place.”

Ilene Warner-Maron, PhD, RN-BC-CWCN, NHA

Assistant Professor

St. Joseph’s University

Philadelphia, PA

President, Alden Geriatrics




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

The Interdisciplinary Team; The Role of the Psychiatrist

by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication