Downsizing for Aging in Place Guide (2024)

Key Takeaways

• In the United States, the number of seniors aged 65 and over is projected to nearly double to 95 million by 2060, representing over 23% of the total population. [14]
• 88% of US adults ages 50–80 want to stay in their homes as they grow older. [1]
• Moving to a smaller, more manageable home as you grow older is known as downsizing.
• Exploring the financial, social, and safety outcomes of downsizing is crucial before you make the decision to move.
• An estimated 44% of households need some type of accessibility modification to use their homes without difficulty. [15]
• Safety modifications are essential for aging in place and can be added to your current or new home.

As we age, staying in our homes as long as possible, also known as aging in place, is a common desire. In fact, a 2022 national poll found 88% of people age 50–80 say they want to stay in their homes as long as possible. ^[1]Older Adults’ Preparedness to Age in Place. University of Michigan National Poll on Healthy Aging. April 13, 2022. Found on the internet at https://www.healthyagingpoll.org/reports-more/report/older-adults-preparedness-age-place Helping this goal become a reality requires careful planning. Some older adults purchase a new home to meet their needs, while others renovate their current house.

Of course, there’s a lot to consider, including finances. To maintain financial security, there are several options that allow you to use the equity in your home. ^[2]Information for Senior Citizens. U.S. Department of Housing and Urban Development (HUD). Found on the internet at https://www.hud.gov/topics/information_for_senior_citizens You should also consider any chronic diseases you may have, such as diabetes or lung disease, which may require additional support. ^[3]Aging in Place: Growing Older at Home. National Institute on Aging. May 1, 2017. Found on the internet at https://www.nia.nih.gov/health/aging-place-growing-older-home

Creating a safe and secure home environment and maintaining financial stability is key to staying in your home for years to come. ^[4]Aging in Place: Tips on Making Home Safe and Accessible. National Institute on Aging. Found on the internet at https://www.nia.nih.gov/health/infographics/aging-place-tips-making-home-safe-and-accessible

To help make aging in place a reality, our Reviews Team put together the following guide.

Why age in place?

The Centers for Disease Control and Prevention defines the term aging in place as: “The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” ^[5]Healthy Places Terminology. Centers for Disease Control and Prevention (CDC). October 15, 2009. Found on the internet at https://www.cdc.gov/healthyplaces/terminology.htm Remaining in our homes as we age allows us to maintain quality of life, satisfaction, and self-esteem. ^[6]Overview of Aging in Place. Rural Health Information Hub (RHIhub). Viewed August 26, 2023. Found on the internet at https://www.ruralhealthinfo.org/toolkits/aging/1/overview#

Other potential benefits of aging in place include: ^[7]Aging in Place: Are We Prepared? Delaware Journal of Public Health. August 31, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495472/

• Maintain autonomy and independence
• Continue using existing services in your community
• Keep the familiarity of your environment and preserve memories
• Maintain contact with friends and neighbors throughout your community
• Maintain a feeling of safety and security in your existing environment
• Reduce feelings of loneliness
• Potentially save money because it is less costly than moving to a long-term care facility

Aging in place and memory care

Roughly 6 million people live with dementia in America. ^[8]Why aging in place can be the best option for dementia patients. AMA. April 27, 2023. Found on the internet at https://www.ama-assn.org/delivering-care/population-care/why-aging-place-can-be-best-option-dementia-patients To support dementia care, homes and families can be two important assets. Unfortunately, these assets are often underused, and many people with dementia live in long-term care facilities.

Six challenges to aging in place for people with dementia are: ^[9]Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline. Canadian Geriatrics Journal. June 1, 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137463/

1. Memory decline: Memory loss is progressive in people with dementia, becoming more pronounced as time goes on.
2. Low mood: You may notice a person with dementia is not participating in their usual hobbies or interests.
3. Social isolation: People with dementia may wind up socially isolated (physically alone) or experience loneliness due to feelings of shame or inadequacy.
4. Problems with mobility and completing physical tasks: In addition to the progressive cognitive decline with dementia, people often become less active. This leads to loss of muscle mass and can impact walking or other physical activities.
5. Issues completing activities of daily living (ADLs): Instrumental ADLs (IADLs) are activities like paying bills, driving, and maintaining a household, whereas basic ADLs (BADLs) include bathing, grooming, dressing, and feeding oneself. ADLs get more challenging with cognitive impairment, and BADLs often become more challenging later as the illness progresses.
6. Lack of education regarding cognitive impairment: Family, friends, and caregivers may not be educated about special considerations for people with dementia and their care.

In-home care can benefit people with dementia by keeping them in familiar surroundings, helping them feel safe, avoiding food insecurity, using available help, and providing brain activities. ^[8]Why aging in place can be the best option for dementia patients. AMA. April 27, 2023. Found on the internet at https://www.ama-assn.org/delivering-care/population-care/why-aging-place-can-be-best-option-dementia-patients# Some organizations have joined forces to maximize available help . For example, Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI), partnering with the American Hospital Association (AHA) and the Catholic Health Association of the United States (CHA). ^[10]Age-Friendly Health Systems. Institute for Healthcare Improvement (IHI). Found on the internet at https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx Many in-home care services are available to support aging in place for people with dementia. This initiative focuses on what is described as the four Ms:

• What matters: Focus on the person with dementia’s specific health outcome goals and care preferences.
• Medication: When necessary, ensure medication doesn’t interfere with the quality of life.
• Mentation: Prevent, treat, and manage dementia, depression, and delirium.
• Mobility: Encourage older adults to move safely daily to maintain function.

Keeping a care recipient with dementia at home can be challenging. Companion, personal care, and homemaker services are available to help families in caring for someone at home. Additional skilled care, like wound care or other medical care provided by licensed professionals, can also be provided at home. ^[11]In-home Care. Alzheimer’s Association. Viewed August 26, 2023. Found on the internet at https://www.alz.org/help-support/caregiving/care-options/in-home-care

Choosing an aging-in-place friendly home

Downsizing your home can be a difficult decision. Some recommendations for identifying when it’s time to downsize include:

• Your monthly housing expenses are greater than 30% of your income. ^[12]Rental Burdens: Rethinking Affordability Measures. HUD User. Found on the internet at https://www.huduser.gov/portal/pdredge/pdr_edge_featd_article_092214.html
• You don’t have much cash left each month.
• Your home no longer meets your needs. For example, entire rooms or floors of your home are unused.
• You have become the oldest resident in your neighborhood.
• You want to convert your home’s equity into income.
• You no longer have work or family ties to your current location.
• You wish to relocate closer to family members.
• You want a lifestyle change.

When choosing a smaller home, look for features to enhance your comfort, safety, and independence as you age. These features may include a home with a single-level floor plan to avoid unnecessary falls risk from stairs. A flat lot will make walking around your yard easier without fear of tripping on uneven ground, and avoiding lots with large hills or steep grades can help in cases of inclement weather. Opt for paved or concrete driveways and sidewalks, avoiding uneven surfaces, like rock or gravel. Choose a neighborhood close to your most frequently visited locations, like shopping centers or restaurants, as being within walking distance can be beneficial if you no longer drive regularly.

Assess your needs and preferences

Plan for home shopping by listing your must-haves and nice-to-haves.

• How many bedrooms do you want?
• Do you need a large kitchen, or would you prefer a kitchenette?
• Is having an outdoor space important to you?
• If you want an outdoor space, would you like an open patio or a screened-in area?

Consider the type of home to suit your needs. Would you like to live in a neighborhood with others nearby or on your own land?

You should also consider your mobility, health conditions, and lifestyle preferences. If you or your care recipient currently use a cane, walker, or wheelchair, make sure your home can accommodate this. Health conditions impacting breathing can be aggravated by extended periods of heat and humidity and should be considered when choosing the geographic location of your new home.

You should also think about your lifestyle. Are you outgoing and prefer to socialize with your neighbors and participate in block barbeques and other activities? Then you should seek out a neighborhood that can accommodate your social needs. Many areas also have community centers where you can gather to chat, play cards, or participate in other group activities.

Prioritize accessibility and mobility in your floor plan

Choosing a new home with an accessible floor plan will help you stay in your new home for years to come. Pre-planning for potential wheelchair accessibility means ensuring you can install wheelchair ramps and there are no physical barriers to prevent you from moving throughout the home. Look for properties meeting the ADA standards for Accessible Design.

Homes featuring single-level living (like a first-floor full bath) and minimal steps are ideal for the reduced mobility that can come with age or illness. Bathrooms should include non-skid surfaces in the tub and shower and easy-to-use faucets. ADA-compliant single-handle faucets with anti-scald features are recommended for older adults. Another bathroom feature to look for are ADA-compliant toilets. These toilets have additional height, allowing for ease of use with or without wheelchairs. Ensure the kitchen, hallways, and all doorways are wide enough for wheelchairs or walkers.

Keep falls prevention top of mind

Falls and fear of falls can lead to injury and ultimately impact your quality of life. The NCOA Falls Free® Initiative includes a plan that focuses on increasing mobility, reducing medication impact, and improving environmental safety. Keeping your home safe will help you maintain your independence.

When choosing a home, look for these features of a safe environment: ^[9]Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline. Canadian Geriatrics Journal. June 1, 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137463/

• The carpet is firmly secured to the floor.
• You have a first-floor full bathroom.
• Grab bars are in each shower, tub, and near toilets.
• Handrails provide adequate coverage along indoor and outdoor steps.
• Light switches are located at each end of the stairs near handrails for ease of use.
• Non-skid strips and mats are included on tile, wood, or other flooring that may become slippery when wet.
• Floor-level nightlights are installed throughout the home.

More than one in four Americans 65 and older fall each year. Falls are the leading cause of fatal and nonfatal injuries among older adults.. Keeping safety at the forefront of planning your new home is essential to preventing you from falling.

Consider your proximity to essential services

When choosing a location for your new home, consider the travel distance to essential services and amenities. Even if you currently drive, there may come a time when you are unable or choose not to continue driving. It’s important to have a transportation plan to access your frequently visited locations, like shopping, restaurants, pharmacies, and medical facilities.

Examine the public transportation options available from your new proposed location. Other options for transportation include using taxicabs, Uber, or Lyft. Remember the cost of using these transportation services can quickly add up and impact your budget. Community transportation options may be available in some areas. Dial-a-ride, volunteer transportation programs, and assisted transportation are some programs partially funded by the government. These could provide little or no-cost options for your needs. In addition, some medical care plans, like Medicaid, are accepted by some transportation agencies.

Set yourself up for social engagement and community

Social isolation and loneliness can negatively impact your quality of life. When choosing to downsize your home, finding a location with a supportive community will help you avoid these challenges. The Village to Village Network is an organization that supports older adults who wish to maintain their independence and age in place. The site features information for various nonprofit grassroots organizations providing social support and access to services.

Many other organizations support older adults in maintaining social connections. Some of the organizations are:

• Foundation for Social Connection (F4SC)
• Far From Alone
• National Alliance for Caregiving
• Connect2Affect

Other means of socialization include engaging with neighbors, joining senior centers or clubs, and using social media to find other groups of older adults. Senior centers are hubs for social engagement and offer a range of activities and benefits for older adults with varying interests. Senior centers are a great place to meet new people and make friends.

Consider your finances

Financial planning and legal matters are two areas to address when downsizing and aging in place. If you anticipate taking on a mortgage for your new home, weigh the cost of staying in your current home against downsizing to a new home. Consider the amount of money you want to budget for mortgage payments. Also plan for additional housing costs, like property taxes and maintenance. Consider how long your finances will support your aging in place and potential long-term care needs. Plan for someone to take responsibility for your finances when you can no longer do so yourself. A legal power of attorney will be necessary for another person to care for your finances.

Ask the experts

Professionals, including certified financial planners and elder law attorneys, can help you navigate the many nuances of downsizing and aging in place and help you make the best decisions for your future. Organizations that can help include:

• Certified Aging in Place Specialists (CAPS) are trained in home modifications for aging in place and certified by the National Association of Home Builders.
• National Aging in Place Council is a network for older adults that connects service providers, like experts in health care, financial services, and home remodeling, with older homeowners, their families, and caregivers to help them age in place successfully.
• Through the Habitat for Humanity Aging in Place program, older adults can get help aging at home in their chosen community. The organization works with human services organizations to meet individual needs, like home repairs and modifications.
• The National Association of Realtors (NAR) recognizes working with older adults seeking to downsize requires a specific skill set and provides education and certification. When looking for a realtor, look for one with a Seniors Real Estate Specialist (SRES) designation.
• The Aging Life Care Association represents Geriatric Care Managers (GCMs). GCMs help older adults find resources to make their daily life easier.
• Rebuilding Together offers services to make homes safer.

Navigating the moving process

Moving can be a daunting task. This is particularly true when you have been in your current home for many years. Sorting through years of belongings and memorabilia can be a time-consuming process. It becomes even more difficult if you have storage areas in attics, crawl spaces, or where there are multiple stairs involved. Ask friends or family if they can help you access these hard-to-reach areas. Once you have decided to downsize, you should start decluttering and packing as soon as possible, maximizing the time before you take ownership of your new home.

Hiring helpers can lighten your workload and stress when downsizing your belongings and memorabilia. Here are some tips to help you downsize successfully: ^[13]White, Marian. 10 Tips for Moving an Elderly Parent. Moving.com. Dec. 27, 2017. Found on the internet at https://www.moving.com/tips/10-tips-for-moving-the-elderly

• Approach the task when in a good state of mind. Parting with keepsakes will be challenging, and it will be difficult to do if you aren’t in the right mindset.
• Take your time. Don’t plan this all in one weekend. If you know you’re going to be seeing family members for a holiday or special event, give yourself the goal of having a box of keepsakes for each person you’re going to see.
• Set limits on how many items you can keep for a particular memory. Choose one sentimental item from a group and part with the rest.
• Snap pictures of items with your cellphone or digital camera. This will allow you to keep a record of the memory while letting the physical items go.
• Take old photographs and make them into physical or digital albums. Digitizing can also be done with old videotapes, movie reels, and important documents.
• Refurbish old furniture or other items usable in your new home. This will alleviate some of your storage needs and save on furniture costs for your new home.
• Donate furniture, clothes, or any other unused and lightly used items. Many organizations will pick up unwanted items for little to no charge.
• Call a junk removal service (like 1-800-GOT-JUNK) to get rid of unwanted or broken items.
• Not ready to get rid of certain items? Look into renting a storage unit. But don’t forget your budget.
• Consult a senior moving manager from the National Association of Senior Move Managers. They can help oversee the entire process and have expertise helping older adults move.

Remind yourself that you will make many memories in your new home and don’t need to take everything with you.

Aging-friendly modifications

If you decide to stay in your current home or have purchased a new downsized home, consider modifications to make aging in place more manageable. Seeking out Certified Aging in Place Specialists to assist in home modification can help alleviate some of the stress from planning. Consult with your local contractors to see which ones specialize in home modifications for older adults. Some of the items to consider are:

• Adding a ramp with a hand railing to the home’s main entrance
• Placing non-skid solutions on indoor and outdoor steps
• Putting a light switch at the top and bottom of each set of steps
• Installing a walk-in tub or shower
• Installing grab handles in the tubs, showers, and near toilets
• Replacing existing toilets with ADA-compliant models
• Securing carpets to the flooring and ensuring no bunched-up areas could be trip hazards
• Optimizing the bedroom with an adjustable base and a bed designed for specific ailments, like a doctor recommended mattress for back pain.

When purchasing a new home, have the inspector check for ADA-compliant features and provide a list of recommended upgrades. While these modifications may not be immediately required, health changes, like decreased mobility and cognitive function, may occur quickly. When you have been hospitalized for an extended illness, modifications might need to be completed in your home before your discharge.

An experienced older adult home care nurse or occupational therapist consultant can be an excellent resource when considering helpful amenities that are needed now and/or may be needed in the future. You can ask for an order for this type of in-home consultation from a health care provider. Even if the home doesn’t have all the amenities wanted or needed, durable medical equipment (DME), such as an over-the-toilet frame to raise the seat height, can be ordered with an appropriate assessment. DME can be helpful to work around parts of the home not ideal for aging.

Bottom line

If you’re choosing to remain in your home, you’re not alone. But taking the right approach to downsizing can help you maintain your independence as you grow older. Choosing a new home can be daunting, but many resources are available, including Certified Aging in Place Specialists (CAPS) and real estate agents familiar with downsizing. If you decide to stay in your current home, you can install aging-friendly modifications to improve the home’s safety and functionality. Careful planning to address the financial, social, and safety of your new environment is critical to maintaining your quality of life for years to come. Following this guide can help you achieve your goal of aging in place and provide you with the happiness and independence you seek.

Have questions about this article? Email us at [email protected].

Sources

1. University of Michigan National Poll on Healthy Aging. Older Adults’ Preparedness to Age in Place. April 13, 2022. Found on the internet at https://www.healthyagingpoll.org/reports-more/report/older-adults-preparedness-age-place
2. U.S. Department of Housing and Urban Development (HUD). Information for Senior Citizens. Found on the internet at https://www.hud.gov/topics/information_for_senior_citizens
3. National Institute on Aging. Aging in Place: Growing Older at Home. May 1, 2017. Found on the internet at https://www.nia.nih.gov/health/aging-place-growing-older-home
4. National Institute on Aging. Aging in Place: Tips on Making Home Safe and Accessible. Found on the internet at https://www.nia.nih.gov/health/infographics/aging-place-tips-making-home-safe-and-accessible
5. Centers for Disease Control and Prevention (CDC). Healthy Places Terminology. Oct. 15, 2009. Found on the internet at https://www.cdc.gov/healthyplaces/terminology.htm
6. Rural Health Information Hub (RHIhub). Overview of Aging in Place. Found on the internet at https://www.ruralhealthinfo.org/toolkits/aging/1/overview#
7. Maggie Ratnayake, et al. Aging in Place: Are We Prepared? Delaware Journal of Public Health. Aug. 31, 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495472/
8. Timothy M. Smith. Why Aging in Place Can be the Best Option for Dementia Patients. American Medical Association. April 27, 2023. Found on the internet at https://www.ama-assn.org/delivering-care/population-care/why-aging-place-can-be-best-option-dementia-patients#
9. Chantal D. Mayo, et al. Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline. Canadian Geriatrics Journal. June 1, 2021. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137463
10. Institute for Healthcare Improvement (IHI). Age-Friendly Health Systems. Found on the internet at https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx
11. Alzheimer’s Association. In-Home Care. Found on the internet at https://www.alz.org/help-support/caregiving/care-options/in-home-care
12. PD & R Edge. Rental Burdens: Rethinking Affordability Measures. HUD User. Found on the internet at https://www.huduser.gov/portal/pdredge/pdr_edge_featd_article_092214.html
13. White, Marian. 10 Tips for Moving an Elderly Parent. Moving.com. Dec. 27, 2017. Found on the internet at https://www.moving.com/tips/10-tips-for-moving-the-elderlyhttps://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx

Steven MarshallAuthor

Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services. He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.

Christopher NormanMedical Reviewer

Christopher Norman is a Board-Certified Geriatric Nurse Practitioner and Holistic Nurse. As a nurse’s aide, registered nurse and now nurse practitioner, he has loved working with older adults since 2004.

Kathleen CameronReviewer

Kathleen Cameron, BSPharm, MPH, has more than 25 years of experience in the health care field as a pharmacist, researcher, and program director focusing on falls prevention, geriatric pharmacotherapy, mental health, long-term services and supports, and caregiving. Cameron is Senior Director of the NCOA Center for Healthy Aging, where she provides subject matter expertise on health care programmatic and policy related issues and oversees the Modernizing Senior Center Resource Center.