Most of us, most of the time, want to age at home. But the reality is not everyone can, or should. Sometimes staying in your own home as you become increasingly frail is a poor choice. It can be lonely and even dangerous. It can burn out family caregivers. And it even can be more costly than other options, especially for people with very heavy care needs.
Yet we often forget these risks in our zeal to expand the opportunities for older adults to stay at home. Yes, Medicaid often drives people to nursing homes because community-based care options are so limited. And, yes, we should expand home care options. Similarly, we should expand access to affordable, appropriate community housing for seniors as well as for younger people with disabilities. And we need to increase those supports and services–such as transportation, nutrition, and home visits by medical professionals– that make it easier to age at home.
Yet, we also need to acknowledge that many seniors, and even some younger people with disabilities, should not remain in their homes. That does not necessarily mean institutional care. But it may mean leaving their family home in the suburbs.
Tax Breaks to Stay at Home
The Bipartisan Policy Center’s generally well-reasoned suggestions for how government can help people remain in the community as they age got me thinking about this. The BPC report was, for the most part, relentless in its drive for new and improved programs aimed at helping people stay at home. But sometimes, no reasonable amount of support will make living at home the best option. As a result, government subsidies to encourage them to do so are at best a waste of limited public dollars and, at worst, only encourage poor choices.
For instance, BPC backs the idea of property tax breaks for low- and middle-income homeowners. The laudable idea is that these people should not be driven out of their homes by unaffordable property taxes.
The problem is tax breaks such as this and the mortgage interest deduction encourage older adults to stay in their homes even when it is otherwise a poor choice. It may make more sense for some people to sell their suburban homes and move into a senior living community or even into an apartment in an urban, walkable community.
But such a move is often defeated by the finances. In many booming urban areas, such as the Washington, DC area where I live, unsubsidized rents are far more costly than mortgages, especially for someone who has benefited from recent low cost loans or who has refinanced into a small outstanding balance on their mortgage.
Moving v. Staying
While prices vary widely among communities, it may not be unusual for someone to pay twice as much for a rental than for a mortgage on their single-family home, even before the tax breaks. The problem is made worse by the wave of new rentals that are being built for millennials, which is to say small studios or one-bedrooms—too much downsizing for many older couples.
Add the tax breaks and a move may seem to make little financial sense. The problem, however, is that staying in the ‘burbs comes with its own long-term costs—financial, physical, and emotional. For instance, public transportation often ranges from poor to non-existent for someone with limited mobility. That means cabs or uber or catching a ride with a friend or relative. Delivering services and supports to individual homes scattered throughout the suburbs is costly and inefficient. In winter, it may be impossible for days at a time. And suburbs are lonely when your old friends have moved or died and the new neighbors—who you barely know– are off at work or school.
This isn’t necessarily a plea for seniors-only communities, though there is some evidence that they many bring their own benefits (including better opportunities for sex, according to senior housing expert Stephen Golant).But even when older adults move into an urban apartment building with residents of all ages, they are more likely to find some neighbors their age. That increases their chances of making friends and creates opportunities to share services.
Moving and renting is by no means the right answer for everyone, any more than staying in a long-time family home is the best choice for everyone. But government policies that discourage people from moving may not be the best choice either. There is an important difference between making it possible for older adults to stay at home and discouraging those who would otherwise move from doing so.