Trying to decide where to live as one grows older presents new challenges for many older adults. Anticipating our need is difficult because how we will age and how long we will live is unpredictable. However, the average life expectancy is growing longer, and with increased longevity the potential for chronic health conditions that may threaten independence also increases.

Also in this article: Choosing the Most Appropriate Living Arrangement Types of Housing

The number of households headed by a person over 65 is expected to rise by about 300,000 per year in the next decade. Of the 5 million households that now include a senior citizen with disabilities, 2.1 million express the need for home modifications, and only half of this 2.1 million say they have the modifications they need.

Despite the infirmities that accompany increased longevity, the majority of seniors can and do remain in their own homes. The cost of maintaining that home and the ease of access to shopping, services, family and community support is crucial to the reality of "aging in place." Remaining in one's own home may be the best choice, but a realistic assessment of affordability, the available support system and the physical environment are critical components of making realistic decisions.

Changing circumstances such as the death of a spouse, debilitating illness or the limitations of a fixed income may force a change in living arrangements. Hasty decisions can result in a series of disruptive and difficult transitions for a person who is already frail and vulnerable. The personal dilemmas of deciding where to live are compounded by a constantly changing market place. Planning for and choosing a suitable place to live as we grow older deserves careful thought and a serious, on-site exploration of the housing options available long before retirement.

Although most older Americans are among the best housed citizens in the nation, many continue to live in run-down housing that lacks day-to-day essentials while absorbing a large portion of a modest income. Some facilities may lack the kind of supportive physical features that would accommodate increasing physical limitations. The current environment needs to be evaluated to determine whether home modification is practical or whether relocation is the best option.

Choosing the Most Appropriate Living Arrangement

Questions to answer in choosing the most appropriate option are:

• Does this arrangement provide a supportive environment for retaining maximum independence?
• Is it easy to move about in the home environment or can home modifications enhance continued mobility?
• Is this a comfortable and safe place to live?
• Is the cost affordable?
• Is there access to in-home and community services when and if needed?
• Is the location convenient and accessible to transportation, shopping, and health services?
• Are there opportunities for socializing and participation in daily life adequate, including family, friends, church, and community activities?

Types of Housing

Until recently, few alternatives to nursing homes existed for people who could no longer take care of themselves. Some people are placed in nursing homes simply because neither they nor their family know about the alternatives to nursing homes. Today, people who cannot live completely independently may choose from a variety of living arrangements that offer different levels of care. For many, these alternatives are preferable to nursing homes.

• Home and Community Care: Most people want to remain at home as long as possible. A person who is ill or disabled and needs help may be able to get a variety of home services that might make moving into a nursing home unnecessary. Home services include Meals on Wheels programs, friendly visiting and shopper services, and adult day care. In addition, there are a variety of programs that help care for people in their homes. Some nursing homes offer respite care - when they admit a person for a short period of time to give the home caregivers a break. Depending on the case, Medicare, private insurance, and Medicaid may pay some home care costs.

• Subsidized Senior Housing: There are federal and state programs that subsidize housing for older people with low to moderate incomes. A number of these facilities offer assistance to residents who need help with certain tasks, such as shopping and laundry, but residents generally live independently in an apartment within the senior housing complex. In this way, subsidized senior housing serves as a lower cost alternative to assisted living -- though assisted-living communities are frequently newer and more luxurious.

• Assisted Living (non-medical senior housing): Some people need help with only a small number of tasks, such as cooking and laundry. Some may only need to be reminded to take their medications. For those people who need only a small amount of help, assisted-living facilities may be worth considering. "Assisted living" is a general term for living arrangements in which some services are available to residents (meals, laundry, medication reminders), but residents still live independently within the assisted-living complex. In most cases, assisted-living residents pay a regular monthly rent and additional fees for the services that they require.

• Board and Care Homes: These are group living arrangements (sometimes called group or domiciliary homes) that are designed to meet the needs of people who cannot live independently but do not require nursing home services. These homes offer a wider range of services than independent-living options. Most provide help with some of the activities of daily living, including eating, bathing and toileting. In some cases, private long-term-care insurance and medical assistance programs will help pay for this type of living..

• Continuing Care Retirement Communities: CCRCs are housing communities that provide different levels of care based on the needs of their residents - from independent-living apartments to skilled nursing in an affiliated nursing home. Residents move from one setting to another based on their needs, but continue to remain a part of their CCRC's community. Many CCRCs require a large payment prior to admission, then charge monthly fees above that. For this reason, many CCRCs are too expensive for older people with modest incomes.

• Nursing Homes: A nursing home is a residence that provides room, meals, recreational activities, help with daily living, and protective supervision to residents. Generally, nursing-home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional).