Senior citizen woman in wheelchair in a nursing home.

The Barriers to Aging in Place

By Renu Thomas and John Roth

The COVID-19 pandemic has highlighted the risks associated with institutionalized care for the elderly, and has further shifted sentiments toward a preference for aging in place. But most seniors and their loved ones don’t realize the barriers that make aging in place a difficult proposition until a crisis occurs and they’re faced with finding services.

Take our family, for example. My father was diagnosed with Parkinson’s disease and it was after his first fall and discharge from the hospital that our family realized my parents’ independence was severely limited. We knew their house was not wheelchair or walker accessible, but we also needed to address other issues as well; neither of them could drive anymore, so how would we get them to appointments, how would their prescriptions and groceries get picked up, and how could we prevent them from being socially isolated? Like many families, we do not live nearby, let alone in the same state, which made coordinating these services even more challenging.

To age in place safely, seniors and their families may need help with the activities of daily living, access to nutritious food, safe housing, reliable transportation, and ways to combat loneliness and isolation. Unfortunately, these services are often siloed and fragmented. It usually takes multiple phone calls and internet searches to find the help needed, and then more time, effort, and negotiations to secure the services — that is, if families are well-resourced enough to afford them. Many people assume that Medicare, the nation’s health program for people over 65 and younger people with disabilities, will pay for long-term care, including home-based services. However, Medicare coverage is extremely limited. It usually only pays for short-term caregivers if you’re recovering from a surgery, an illness, or an injury.

Thus, caregiving responsibilities often fall on family members. The definition of caregiver is a family member or paid helper who regularly looks after a child or a sick, elderly, or disabled person. According to The National Alliance for Caregiving (NAC) and AARP, in 2020 nearly one in five Americans, totaling 19% of the population, are providing unpaid care to an adult with health or functional needs.

Most family members, including our family, think of this as being a loving child or spouse, and not as being a caregiver. Unfortunately, caregiving does impact the caregiver in a multitude of ways; including lost productivity at work, added stress, and missed quality time with loved ones because of the demands of juggling appointments, running errands, and coordinating care on a regular basis. According to AARP, family caregivers on average devote about 24 hours a week to helping loved ones and spend around $7,000/year out of pocket on that care.

With over 10,000 Baby Boomers turning 65 each day in the United States, the need for comprehensive support for the elderly and their caregivers is large and growing quickly. Researchers estimate that about 70% of Baby Boomers will need some sort of assistance as they age.

When the Biden administration originally introduced the infrastructure bill, we heard about the much-needed caregiver support. The original infrastructure bill included a $400 billion investment over eight years for home and community-based services (HCBS) that help people age in place, as opposed to nursing homes or group homes. The revised Build Back Better Framework has reduced this investment to $150 billion. This investment will expand access to high quality home care and help strengthen the workforce of nursing assistants, home health aides, and personal care aides, occupations that are currently underpaid and in high demand. Most middle-income Americans won’t necessarily qualify for the benefits, but they will have access to a more qualified workforce.

While we continue to hope for comprehensive legislative support, we know families need help now. To help other families navigate the complexities of non-medical services, we left our corporate lives and attended Harvard University’s Advanced Leadership Initiative (ALI) in 2019, where we incubated THORO CARE. THORO CARE is a consolidator of the non-medical services needed to help seniors live with choice, independence, and dignity. We recently launched our pilot in southern New Jersey. To learn more, please find us at

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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