Guides
Aging in Place Projects Planning: Five Steps
Aging in place projects planning means assessing daily routines, separating home and care needs, checking funding options, and sharing a written plan.
Aging in place projects planning starts with the home and care needs a household already faces, not a preference. Almost everyone says they want to stay put.
Households that manage it often do unglamorous things early: move a bedroom, sort out the entry, and work out who would help and how to pay for it. Waiting until a fall or discharge can leave less time to compare options.
What to take away
- Plan while the decision is still voluntary. Starting before a fall or discharge gives you more time to compare options and coordinate work.
- The three items that decide whether staying is possible are a step-free way in, a usable bathroom, and somewhere to sleep on the main level.
- Long-term personal care can create recurring expenses; standard health insurance generally does not cover custodial help when that is the only care needed.
- Build what is hard to add later, and rent or delay what is easy to add later.
Step one: work out what a normal week looks like
Not a medical assessment. Track one week: who shops, who drives, how often someone climbs stairs, when the house is empty, and what happens at three in the morning. Record which tasks are difficult, what help is needed, and whether each need comes up daily or occasionally. That list beats any checklist of features. It shows where the household is already stretched.
The VA's Veteran Decision Aid for Care at Home or in the Community can help veterans compare care options; search that title on VA.gov. Its questions may also help households who are not veterans.
Step two: separate the building work from the care work
List one-time building work separately from recurring care. For building work, get itemized written estimates from contractors and note which tasks need permits or must happen before walls are closed. For care, list the tasks and hours that may be needed, identify unpaid help, and ask local home-care providers how they bill and what services are available. Consider an occupational therapist's home assessment, and use the National Association of Home Builders' Certified Aging-in-Place Specialist (CAPS) directory to find a contractor with relevant training.
Building vs Care Work
Building work
- What it covers
- Entry, bathroom, bedroom
- Timeline
- Planned first
- Budget
- Separate
- Growth
- Fixed
Care work
- What it covers
- Bathing, dressing, meals
- Timeline
- Discovered late
- Budget
- Separate
- Growth
- Grows over time
Equipment
- What it covers
- Beds, chairs, bars
- Timeline
- As needed
- Budget
- Separate
- Growth
- Fixed
Coordination
- What it covers
- Appointments, paperwork
- Timeline
- Ongoing
- Budget
- Separate
- Growth
- Fixed
Households usually plan the building work and discover the care needs late. The care plan can change as needs and available help change, so review it regularly.
Step three: know what is not covered
Most plans break here. Medicare's page on long term care explains medical care versus custodial care: help with bathing, dressing and meals is generally not covered when it is the only help needed.
Check your state Medicaid agency's eligibility rules and ask specifically about Home- and Community-Based Services (HCBS) waivers; covered services vary, and some programs have waiting lists. The Eldercare Locator or a local Area Agency on Aging can help identify local options; ask whether the Program of All-Inclusive Care for the Elderly (PACE), state Assistive Technology programs, or home-modification assistance are available and relevant. Eligible veterans can ask the VA about Aid and Attendance pension benefits and the Home Improvements and Structural Alterations (HISA) grant; these are different benefits with separate eligibility rules. For tax treatment, IRS Publication 502, Medical and Dental Expenses, explains when home improvements may qualify as medical expenses; ask a tax professional about your situation.
Step four: do the irreversible things first
Blocking in bathroom walls should be installed before they are closed, and a shower should be planned to accommodate a seat. Prioritize a main-floor room that can serve as a bedroom and an entry with no step; these changes are often easier during other work, while rented or portable items can wait until needed. Before remodeling, ask the local building department which permits and codes apply. The Americans with Disabilities Act (ADA) does not generally govern the design of a private home's interior, while the Fair Housing Act has accessibility requirements for certain covered multifamily housing; neither is a universal checklist for every home remodel.
Our note on setting a realistic budget for this work breaks down the numbers. The patterns in five lessons from aging in place work show which of these steps people skip.
Step five: write it down and share it
Keep one page where an adult child or neighbor can find it. Include who to call; the home changes completed and still planned; itemized estimates and funding applications or decisions; what is rented and from whom; who handles each care task; and which room can take the bed. Review it when needs, finances, or available help change.
Common questions
When should I start?
Is a single-level home always better?
Will Medicare pay for a ramp or a walk-in shower?
How much help will we need?
In this guide
- How climate changes aging in place projects: slope, shade, ventilation and backup powerClimate shapes aging in place projects: ramp slope and cover for ice, shade and cooling for heat, ventilation for humidity, and a storm and power plan.
- Aging in place products: the trial worth running before you buyWe do not test brands. Here are the product categories worth trialling at home first, how to run a fair one week trial, and what to measure while you do.
- Five recurring patterns that go wrong in aging in place projectsFive recurring patterns in aging in place home projects: crisis starts, the caregiver left out, untrained help, unused equipment and the ongoing costs.
- Budget construction, care and equipment separately for aging in placeBuild a budget that survives contact with reality: one-off construction, recurring care, equipment replacement cycles, and the cost of the alternative.
- Questions worth asking every provider before an aging in place projectBefore hiring help with aging in place projects, ask therapists, care agencies, care managers and builders who employs whom, and what happens when nobody shows up.
