Aging in Place: Can Older Americans Afford To Stay in Their Homes? (2024 Report)

Deciding whether to enjoy their retirement years in their current home or start calling moving companies to relocate somewhere new is a common challenge for many older Americans.

America’s older population is growing faster than ever—the U.S. Census Bureau reports that the population aged 65 and over is growing five times faster than the country’s total population. As the elderly population grows, the availability of affordable housing that meets their unique needs—such as accessibility, proximity to healthcare, and social support—becomes increasingly important.

To understand how they plan to manage this transition, the This Old House Reviews Team surveyed 1,000 Americans aged 65 or older about their plans, priorities, and perspectives on aging in place. We then ranked 142 of the largest U.S. cities across 12 metrics to pinpoint the best cities for aging in place.

What Is Aging in Place?

Aging in place is when an individual chooses to remain in their home instead of transitioning to a care facility as they get older. This decision allows people to maintain personal independence and stay in a familiar environment. For many, aging in place means modifying their homes to meet their physical and emotional needs as they age, which can include accessibility upgrades.

Our survey of 1,000 seniors showed that 89% of seniors plan to age in place in their homes, with 45% saying they would refuse to live in a senior or assisted living facility. Nearly all seniors surveyed (95%) said aging in one’s home helps maintain a sense of dignity as they get older, and 70% of senior homeowners said that their home is a key part of their identity. 

“Older adults can develop deep attachments to their homes—and the content within their homes—and find that the space and things bring them comfort,” says Elizabeth Alicea Torres, assistant professor of occupational therapy at Springfield College.

For 54% of Seniors, Housing Costs Are Crucial

For 54% of seniors, housing costs are a top priority when planning to age in place. Nearly three in five seniors (59%) chose access to medical care as a top three priority, with an additional 29% choosing the cost of medical care.

Housing costs are especially important for seniors who don’t own their homes. In fact, according to a 2023 report from the Harvard Joint Center for Housing Studies, older renters have just 2% of the net wealth of older homeowners. Our survey found that among those who rent, 63% called housing costs a top priority, making it the most common answer choice for that group.

Additionally, our survey found that 50% of seniors who rent say they haven’t seriously considered where they’ll live toward the end of their lives, while 36% of homeowners haven’t thought about it.

58% of Seniors With Children Worry About Becoming a Burden

Seventy percent of seniors surveyed have adult children, with one in eight (13%) planning to rely on their kids as they age. Of seniors with children, 58% are worried about becoming a burden to them.

Concerns vary: 31% worry about becoming a financial burden, while 51% are anxious about becoming an emotional burden. However, 86% believe their children will take care of them as they age.

Of those who live with their children, 21% also share the household with their grandchildren, which means the middle generation is responsible for caring for both their children and their parents in these households.

70% of Seniors Have Aging-in-Place Concerns, Including Safety and Costs

Many seniors have concerns about aging in place, even though 97% consider themselves independent. A significant portion, 70%, worry about their ability to remain in their homes as they age.

Among these concerns, 44% are worried about getting hurt while alone, and 28% are anxious about adequately performing daily tasks. Anna Grasso, assistant professor of occupational therapy at Salus at Drexel University, recommends planning ahead: “I strongly encourage older adults and their loved ones to consider a professional home safety assessment by an occupational or physical therapist who will examine the current and future needs of the older adult and come up with a customized plan to support aging in place.”

Financial constraints also pose significant challenges, as 27% cite the inability to afford at-home care, while 22% express concern that their housing costs will consume their savings.

What Are the Best Cities for Aging in Place?

We ranked 142 of the largest U.S. cities to identify the best cities to age in place. Our survey of 1,000 seniors revealed that more than half value access to quality medical care and housing affordability the most, so we placed special emphasis on these factors. For a full list of the metrics we used to evaluate cities, see our methodology.

What Does It Cost To Age in Place?

Being financially prepared for aging in place is important, especially since 42% of seniors surveyed believe they will outlive their savings. This finding suggests that the long-term affordability of living options is a significant concern for many seniors. Two significant affordability concerns are housing and medical assistance.

Housing

If you’ve already paid off your home, not having a mortgage payment can make aging in place appealing. However, it may be necessary to modify your home for accessibility, such as installing ramps or walk-in tubs. 

Depending on the size of your home and the extent of the required modifications, home renovation costs can add up quickly. Remodeling a bathroom can cost $6,000–$15,000. However, there are many “low cost and high impact” modifications that can help, according to Kendra Heatwole Shank, assistant professor at Towson University. She suggests switching out knobs for cabinet pulls or door handles and adding storage options at waist height for ease of access. 

Among seniors, 47% report that their homes are not accessible for aging. Of that group, 36% say they can’t afford to make the necessary upgrades. Pamela Toto, a professor at the University of Pittsburgh, recommends looking into state programs that offer home modifications to older adults who qualify for Medicare and Medicaid. 

If you decide to move to a more accessible home, consider hiring a moving company to handle the relocation instead of risking injury by attempting to do it yourself.

Assistance

The cost of aging in place can increase depending on the level of assistance you need. If you require in-home medical care, your expenses will rise.

According to a survey by Genworth, the median monthly cost for a home health aide, based on 44 hours of care per week, is $6,292. In comparison, a full-time nursing home can cost $8,669 for a semi-private room and $9,733 for a private room per month. An assisted living facility, which may be a more moderate option, costs $5,350 a month on average.

Expert Insights

Elizabeth Alicea Torres

Assistant Professor of Occupational Therapy

Springfield College

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What impact can aging in place have on a person’s emotional well-being?

In my clinical experience, I have found that as individuals age and start to lose friends or family members, their emotional well-being experiences a significant decline. This decline is not always identified, accepted, or addressed. With aging and the passing of loved ones, older adults can develop deeper attachments to their homes—and the contents within their homes—and find that the space and things bring them comfort.

Another thing to consider is that the generation of people that are aging out are traditionalists or baby boomers—and these generations were not, and are not, as open to acknowledging or addressing issues that are emotionally rooted.

What tips do you have for older adults looking to age in place?

If you make any renovations to your home, make them with aging in place in mind. Widen doorways, remove step-over tubs, and install shower stalls. Make sure there is enough space on either side of the toilet to place grab bars. Consider the design of commonly used spaces and their abilities to accommodate devices, such as wheelchairs, walkers, or hospital beds.

Be mindful of the type of flooring you have, or the type of flooring you install if you change that part of your home. Carpet is harder to traverse. Tile or marble is slippery and can be cold, making fall risk higher.

Elizabeth Alicea Torres OT, OTD, MS OTR/L, is a Massachusetts-based occupational therapist with 18 years of experience focused on adults and older adults across a variety of clinical settings. She practices in the short-term rehabilitation/long-term care realm and currently works as an assistant professor and doctoral capstone coordinator at Springfield College in Springfield, Massachusetts. Research interests include but are not limited to aging in place, end-of-life/terminal illness, community-based practice, and role-emerging practice in occupational therapy. She has dedicated her career to giving back to the community, lifelong learning, and the progressing of the profession of occupational therapy for future generations.

Pamela Toto, Ph.D

Professor

University of Pittsburgh

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What are the key financial challenges and potential solutions for making aging in place an affordable option for seniors across different income levels?

For older adults who have the personal financial means, there is a broad variety of services and products that can help them maintain their independence and safety. For older adults who have limited financial means (e.g., those who are dually-eligible and qualify for Medicare and Medicaid), programs exist at state levels that offer home modification, services and technology to keep them in their homes (as the alternative, the nursing home, is a more expensive option). Those who are in between financial extremes may have the biggest challenge in funding.

Pamela Toto, PhD, OTR/L, BCG, FAOTA, FGSA, is a professor at the University of Pittsburgh and the director of the Healthy Home Laboratory, a community laboratory that brings the best science into home settings to maximize independence, health, and safety. Board certified in gerontology and a fellow of the American Occupational Therapy Association and the Gerontological Society of America, Toto’s interests focus on implementing effective strategies in everyday settings to promote aging in place.

Anna Grasso

Assistant Professor of Occupational Therapy

Salus at Drexel University

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As the population ages, the demand for nursing homes is expected to increase dramatically. How do you assess the potential of aging in place as a solution, and what key factors need to be considered to make this a viable option?

Aging in place is a great solution to allow older adults to maintain their independence and decrease the need for nursing home care. However, it does require planning and support from professionals. I strongly encourage older adults and their loved ones to consider a professional home safety assessment by an occupational or physical therapist who will examine the current and future needs of the older adult and come up with a customized plan to support aging in place. Home modifications (whether minor or major) may eliminate environmental barriers and allow older adults to safely and successfully perform activities of daily living in their home.

What tips do you have for older adults looking to age in place?

It may feel overwhelming to think about modifying a home; however, sometimes simple adaptations such as strategically placed railings, grab bars, lights, and removal of trip hazards can make a huge difference in maintaining independence and preventing a fall.

Anna Grasso is an associate professor of occupational therapy and academic fieldwork coordinator for Salus at Drexel University in Pennsylvania. She is a certified aging-in-place specialist and has received the Executive Certificate in Home Modification from the University of Southern California. Grasso has volunteered extensively to perform home safety assessments for Rebuilding Together Philadelphia and is passionate about supporting home and community accessibility for older adults.

Kenzie Mintus, Ph.D.

Associate Professor

Indiana University Indianapolis

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What tips do you have for older adults looking to age in place?

I think older adults should be thinking about the cost of modifying their current home when weighing long-term housing options. For example, adding grab bars to one’s shower may be a few hundred dollars whereas adding a ramp could cost thousands of dollars.

What impact can aging in place have on a person’s emotional well-being?

If someone has a strong connection to their home and community, aging in place can be a very positive experience for their emotional well-being. By aging in place, they are able to maintain those connections. On the other hand, if someone ages in their home with few social connections, then it can be detrimental to their emotional well-being. Loneliness and social isolation are an epidemic among older adults.

Kenzie Mintus is an associate professor and the director of graduate studies in the Department of Sociology at Indiana University Indianapolis. Her research interests include health and aging with an emphasis on disability and the environment. In 2017, Mintus was selected as a fellow of The Gerontological Society of America (GSA). She serves as an associate editor for The Journals of Gerontology, Social Sciences and on the editorial boards for the Journal of Aging and Health and Research on Aging. She is currently working on a book, entitled “Growing Old at Home: How Inclusive Environments and Policies Keep Us Healthy and Connected,” which is under contract with Routledge’s Aging and Society Series.

Kendra Heatwole Shank, Ph.D

Assistant Professor

Towson University

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What are the key financial challenges and potential solutions for making aging in place an affordable option for seniors across different income levels?

Preparing your home for aging can happen at many price points. Big-ticket items [include] a kitchen that is accessible by wheelchair, a ramp, widening doorways, or addressing interior flights of stairs.

There are many low-cost and high-impact changes as well, such as switching out knobs for cabinet pulls or door handles, putting in motion-sensing lighting, adding seating and support bars at key locations in the home, and adding storage options throughout the home that are between the waist and shoulder height for ease of access.

Kendra Heatwole Shank, PhD, OTR/L, is an associate professor and director of the Post-Professional Occupational Therapy Program at Towson University. With a background in both nursing and occupational therapy, Heatwole Shank has focused on issues related to aging and well-being, specifically how older adults engage in and navigate their communities while aging in place.

Claire Mulry

Associate Professor

Kean University

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A 2023 Harvard report found the United States is not ready to provide housing and care to the growing number of seniors. How significant could this problem become?

This is a huge issue. The economic and social pressure on the families of these older adults will cause ripples throughout the economy and society. The health of the older adults and their caregivers will be impacted. By not being proactive we are setting ourselves up for huge social and economic costs.

What tips do you have for older adults looking to age in place?

Prepare your home now. It is very American to value independence and avoid help or assistive devices and to wait until modifications are needed. In truth, when you need it, you won’t have time to make the changes. No-step entrances, single floor living or an elevator, no-step showers, tall toilets, stylish grab bars, and 36-inch doorways should be the norm.

Claire Mulry, OTD, OTR, CAPS, FAOTA, (she/her/hers) is the 8th chairperson of the Department of Occupational Therapy. She has been a practicing occupational therapist for over 25 years. Mulry received her Bachelor of Arts in psychology from Rutgers University in 1988 and her Post Baccalaureate Certificate in occupational therapy from Kean College in 1997. She received her Certified Aging in Place Specialist (CAPS) from the National Association of Home Builders in 2009 and her Post Professional Master of Science in Occupational Therapy from Quinnipiac University in 2010. She earned her Post Professional Doctorate in occupational therapy (OTD) from Thomas Jefferson University’s School of Health Professions in 2012. She was awarded the American Occupational Therapy Association’s (AOTA) Roster of Fellows Award (FAOTA) in 2021.

Danielle Gagne, Ph.D.

Professor of Psychology

Alfred University

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What tips do you have for older adults looking to age in place?

Think ahead whenever possible. For example, my partner and I both have arthritis in our family. Knowing that stairs may be a challenge in our future, we opted for a ranch-style house with large hallways and an open floor plan that could accommodate walking aids. We got rid of our carpet and largely eliminated raised thresholds. When we remodel our bathroom, we’ll opt for reinforced walls to sustain grab bars.

A 2023 Harvard report found the United States is not ready to provide housing and care to the growing number of seniors. How significant could this problem become?

Unfortunately, America has been built by young, able-bodied people for young and able-bodied people. Take a moment to imagine being in a wheelchair in your own home. What can you reach? What would you need help accessing?

Much of the existing housing is not suitable for older individuals or those with disabilities: They have entryways with one or more steps, bathrooms and bedrooms are not on the first floor, bathrooms don’t have accessibility features, corridors and doorways are too narrow to accommodate walkers or wheelchairs, lighting is too dim or creates a glare, and floors and grounds are uneven, slippery, or not well-maintained.

Danielle D. Gagne is a professor of psychology at Alfred University, where she teaches introductory and advanced courses for both the psychology and gerontology programs on topics such as ageism, the psychology of death and dying, and cognition and aging. Danielle earned a Ph.D. and an M.A. in psychology from the University of New Hampshire and a Bachelor of Arts degree in psychology from Keene State College.

Methodology

We compared 142 of the largest U.S. cities across 12 metrics to rank the best cities to age in place. Our metrics are explained below, along with data sources:

• Housing costs: This is the city’s median monthly housing costs for homeowners with a mortgage. It includes mortgage payments, home insurance, and property tax and comes from the U.S. Census Bureau’s 2023 1-year American Community Survey.
• Regional price parity: This measures the cost of goods and services in the metro area. Values are a percentage of the overall national price level, with a lower value indicating a cheaper relative cost of living. Data is from the U.S. Bureau of Economic Analysis.
• Senior-relevant care providers per capita: This measures the availability of healthcare services in the city. It’s defined as the number of nurse practitioners, physician assistants, cardiologists, family practitioners, internal medicine, geriatric medicine, hospice/palliative care, pain management, pulmonologists, qualified audiologists, rheumatologists, urologists, and geriatric psychiatrists per the population aged 65+. Provider data is from U.S. Centers for Medicare & Medicaid Services.
• Home health aide care quality: This is the average care quality score of home health agencies located in the city from U.S. Centers for Medicare & Medicaid Services.
• Life expectancy: Population life expectancy at the county level is from the University of Wisconsin Population Health Institute’s County Health Rankings. 
• Crime rates: The sum of violent and property crimes in the city per 1,000 residents is from NeighborhoodScout. 
• Climate risk: The risk of severe natural disasters is from the Federal Emergency Management Agency.
• Air quality: This is an indicator of environmental health quality. The median air quality index, with a lower value indicating higher air quality and less pollution, is from the Environment Protection Agency. 
• Older adults with internet access: This measures the percentage of the city’s population 65+ with access to a computer and internet at home. Internet access is important to seniors in order to prevent social isolation. Data is from the U.S. Census 2023 1-year American Community Survey. 
• Medicare enrollment: This is the percentage of the city’s population 65+ enrolled in Medicare and offers insights into public health and medical affordability. Data is from the U.S. Census 2023 1-year American Community Survey. 
• Dependency ratio: This represents the availability of a working-age population to provide for the needs of non-workers; a low ratio indicates a better ability to support an aging population. Dependents are calculated as the city’s population below 19 and above 65 over the population between those ages. Data is from the U.S. Census Bureau’s 2023 1-year American Community Survey. 
• Tax friendliness: This measures if the state taxes income, social security, pensions, 401(k)s and IRAs from AARP. 

Questions about our study? Please contact the author here.

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