October 30, 2020
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Aging in Place vs. Step Up In Care Model

Keep mom safe at home is an idea built around the concept of aging in place. It is a simple concept, live at home. But in practice, it becomes more and more difficult as we age.

Ninety percent of those born before 1965 state that they would like to stay in their own homes as they age. But the everyday tasks and chores which used to be part of the routine can become exhausting requiring planning and energy conservation for mom to get through the day. Shopping and meal preparation may begin to require assistance to ensure she is eating well. Fall risks within the home is another topic but one that often leads to an inability to age in place. So for mom to be able to stay at home longer, there are many factors to consider. 

Before we decide to commit to Aging in Place, we need to know what the other options would be. 


If not aging in place, then what? The alternative would be the step up in care model. In this alternative the first step when leaving home would be to transition to an independent living facility (ILF). This is a group living environment where mom would have her own apartment, but some services such as housekeeping, meals and laundry could be provided for additional cost. She is free to come and go as she pleases and would have her own parking spot if she is still driving. Often there are daily activities for the residents which can be quite stimulating and create needed social time. 

If/when the time comes and mom needs additional care, transition to the assisted living facility (ALF) would be the next step up in care. This increase in care comes with increased cost. Care services provided for the additional expense include: meal preparation, housekeeping, laundry, utilities, and maintenance. Additional care services such as medication management and assistance with bathing and/or dressing can also be provided. 

The last level of care in the step up model is the Skilled Nursing Facility (SNF). This level of care is needed when IV medications, wound care or other nursing concerns are present. 

Here, your mom will have nursing staff available around the clock as well as a therapy to provide physical, occupational or speech therapy as needed. Many people at this level will need total care, but there is also a percentage that are relatively independent. Daily activities, games and events help provide needed stimulation and socialization.

The step up in care can also be a temporary solution to a recent decline in independence following a hospital stay. People often leave acute care and transition to a SNF or ALF for short term rehab to allow for return home or to one of the lower levels of care. 


Important to consider pros vs. cons when considering aging in place.

Pros of aging in place

  • Cost: The cost of living at home (mortgage or rent) is usually significantly less than monthly expenses in a supervised setting. 
  • Services geared toward helping out in and around the home have become much more affordable and readily available in the past few years.
  • Familiarity: Having good habits and knowing what to do and where to go in the event of an emergency can help mom stay safe at home.

Con’s of aging in place

  • Isolation: Being alone all the time or nearly all the time can have a negative impact on mom psychologically leading to increased risk of depression and anxiety.
  • Lack of stimulation: The exact same routine repeated day after day can be good for consistency, but the lack of stimulation can lead to decreased cognition and increased difficulty and frustration in unfamiliar situations.
  • Safety Risk: Most of the time, mom’s home is not optimized for safety. Too much furniture, unsecured rugs and poor lighting can all increase risk of falls and injury.


  • Supervision: Someone is always around if something happens.
  • Often have in house therapy teams to identify and work on potential issues before they become significant problems.
  • Lots of other residents in similar situations and coordinated activities make socializing easy.


  • Cost: A semi-private room in an average nursing home costs $6,300/mo. With top notch facilities costing much more potentially.
  • Limited access to family members. With the recent COVID-19 pandemic, many facilities have eliminated the ability of family and friends to visit.

The goal is to keep mom safe at home forever, or until a time when that is no longer an option and a decision needs to be made about the next level of care. Often the need for more care is thrust upon mom and primary caregivers after an illness or an injury that exposes the difficulties she was having at home. If we know what to look for and plan ahead, we can keep mom safe at home as long as possible. 

That is all for today.

Take care, keep mom safe and have a great day!

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