Medicare Advantage: A Powerful Tool for Aging in Place (Just in Time for Open Enrollment!)

As families plan for aging in place, maintaining independence at home rather than moving to a nursing home or assisted living facility is key. Medicare plays a pivotal role in either facilitating or frustrating aging in place plans. Original Medicare (Parts A and B) offers limited support for home-based care, but Medicare Advantage (MA) plans (Part C), offered by private insurers, significantly enhance options for home care, telehealth, and post-hospital recovery. These plans not only cover everything Original Medicare does but also provide supplemental benefits tailored to aging in place, often improving health outcomes and reducing costs. With Open Enrollment (October 15–December 7) approaching, understanding MA’s advantages is critical for  families committed to staying home.

Why Medicare Advantage for Aging in Place?

Aging in place involves services like home care (e.g., help with bathing, meal prep), short-term disability support (e.g., recovery from surgery), and long-term care (e.g., chronic condition management). Original Medicare covers short-term skilled home health care (nursing, therapy) if you’re homebound and a doctor certifies medical necessity, but it excludes ongoing custodial care, short-term disability income, and most non-skilled home care. Moreover, original Medicare incentivized institutional care by paying for institutional rehabilitation for a period of time following a three-day hospitalization. MA plans bridge these gaps with flexible, home-focused benefits, often reducing out-of-pocket costs and supporting independence.

Recent data underscores MA’s impact: studies show MA enrollees have lower hospital readmission rates compared to Original Medicare (even with shorter periods necessary for rehabilitation), thanks to enhanced care coordination and home-based services. For aging-in-place families, this translates to fewer disruptions and better recovery at home.

Key Medicare Advantage Benefits Over Original Medicare

Here’s how MA plans enhance aging-in-place elements, with specific advantages in telehealth, hospital-at-home programs, in-home physical/occupational therapy (PT/OT), and transitions from hospital to long-term care, plus other post-hospitalization perks:

●Home Care (e.g., aides, meal prep):

• Original Medicare Coverage (2025): Limited to skilled care (nursing, therapy) if homebound; no custodial care (e.g., bathing). 

• MA Advantages: MA plans can pay for help that isn’t strictly medical, unlike Original Medicare. This includes: aides (someone to assist with daily tasks like bathing or dressing), for about 20–40 hours per month (e.g., a few hours a week); meal delivery services that bring prepared meals to your home, helping if cooking is hard; and, home modifications like grab bars in the bathroom to make your home safer and easier to navigate.  These are typically limited to in-network providers (out of network may not be covered or might cost you) and prior authorization is often required. 

• Potential Cost Savings & Health Outcomes: Potentially saves $200–$500/month on meals or $4,000–$6,000/month on aides; reduces nursing home risk (average cost: $100,000+/year).

●Short-Term Disability (e.g., post-surgery): 

• Original Medicare Coverage (2025):  Up to 100 days skilled nursing/home health; 20% coinsurance after day 20 ($204/day in 2024) possibly covered by supplemental insurance.

• Medicare Advantage Advantages: Lower copays, durable equipment (walkers), temporary aides. Expenses typically counts toward out-of-pocket max ($3,000–$8,000/year).

• Potential Cost Savings & Health Outcomes: Caps costs vs. Original Medicare's unlimited coinsurance; 10–15% fewer ER visits due to better recovery support.

●Long-Term Care (e.g., chronic conditions): 

• Original Medicare Coverage (2025):  No custodial care; limited chronic management.

• MA Advantages:  Partial non-skilled care like bathing, dressing, or eating, which don’t require a nurse or doctor (unlike "skilled" care like wound treatment). Medicare Advantage (MA) plans may cover some of these non-skilled services for a limited number of hours (e.g., 20–40 hours per month) to help you stay at home. Original Medicare doesn’t cover this kind of help at all unless you’re homebound and need skilled care too.  Chronic Special Needs Plans (C-SNPs) are special types of MA plans designed for people with ongoing health conditions like diabetes, heart failure, or lung disease (COPD). These plans often include extra benefits like devices or services that check your health at home (e.g., blood sugar monitors or telehealth check-ins with a nurse). This helps you manage your condition without frequent hospital visits.  Pair with Medicaid/insurance for full coverage.

• Potential Cost Savings & Health Outcomes:  Offsets 10–20% costs ($100–$300/month); C-SNPs cut hospitalizations by 10–15%.

●Telehealth: 

• Original Medicare Coverage (2025):  Covers office visits, mental health via video/audio; home-based until Sept. 30, 2025, then rural-only for non-mental health. 20% coinsurance.
• MA Advantages:  With MA plans, you can use telehealth (like video or phone calls with doctors) from your home at any time, regardless of where you live (urban or rural); original Medicare, however, may limit home-based telehealth after September 30, 2025, to rural areas for most non-mental health services, requiring you to visit a clinic or hospital for telehealth in urban areas. MA plans often allow telehealth visits using just a phone call (no video needed), which is great if you don’t have a smartphone or reliable internet. Original Medicare covers audio-only for mental health and some services through September 2025, but MA plans may extend this option for more types of visits (like routine check-ups) even after that date. 

MA plans also cover a wider range of telehealth services than Original Medicare. Beyond standard doctor visits or mental health sessions, MA might include quick check-ins with nurses, medication reviews, or chronic condition management (e.g., diabetes monitoring). MA plans may cover telehealth for routine check-ins, follow-ups after hospitalization, chronic disease management (e.g., COPD or diabetes), and even physical/occupational therapy (PT/OT) guidance. Original Medicare sticks to a narrower list, like office visits and mental health. For example, an MA plan might let a nurse call to check your blood pressure readings, reducing the need for in-person visits.

These extra services help keep you healthy at home without frequent in-person visits.

• Potential Cost Savings & Health Outcomes:  Improves access (43% fewer missed follow-ups); vital for rural Ohioans post-Sept. 2025.  MA plans often have $0–$20 copays for telehealth, compared to Original Medicare’s 20% coinsurance (e.g., $50 for a $250 specialist visit). Some plans waive copays entirely for telehealth to encourage use. Telehealth counseling, often expanded in MA, improves post-hospital recovery by addressing depression, common in 20% of elderly post-discharge.

●Hospital at Home: 

• Original Medicare Coverage (2025):  No dedicated program; skilled home health only if homebound.

• MA Advantages: Covers acute care at home (IV meds, monitoring) as inpatient alternative. 

• Potential Cost Savings & Health Outcomes: Reduces readmissions by 20–30% in pilots; lowers infection risk vs. hospitals.

●In-Home Physical/Occupational Therapy (PT/OT): 

• Original Medicare Coverage (2025):  Covers if medically necessary (no cap, $2,410 threshold); 20% coinsurance.  Medicare will pay for in-home PT (to improve movement, strength, or balance) or OT (to help with daily tasks like dressing or cooking) only if a doctor says it’s needed for your health. For example, you might need PT after a hip replacement to regain mobility or OT after a stroke to relearn daily activities. For in-home coverage under Part A (home health benefit), you must be homebound (hard to leave home without help) and need skilled care (like therapy from a licensed professional). A doctor must certify this. If you’re not homebound, Part B may cover PT/OT as outpatient services, even at home, as long as it’s medically necessary.  

In 2025, Medicare starts paying closer attention once your PT or OT costs hit $2,410 per year (this applies to PT and speech therapy combined, or OT separately). After this threshold, providers must add a special code (KX modifier) to your claims to confirm the therapy is still needed. Medicare usually keeps paying if justified, but it’s a checkpoint to ensure necessity.

You pay 20% of the cost for each PT/OT session, and Medicare covers the other 80%. For example, if a session costs $100, you pay $20 out of pocket. This applies after you meet the Part B deductible ($257 in 2025). If you’re getting in-home care under Part A’s home health benefit (and you’re homebound), there’s no coinsurance for those services. 

• Medicare Advantage Advantages: Lower copays ($20–$50), extended sessions, non-homebound access. MA plans often reduce the 20% coinsurance to a fixed copay (e.g., $20–$50 per session) or waive it entirely, saving you money compared to Original Medicare’s uncapped 20%.  Some MA plans cover in-home PT/OT even if you’re not strictly homebound, making it easier to get therapy at home for aging in place. MA plans may also include virtual PT/OT (via telehealth) or home safety modifications (like ramps) to complement therapy, boosting recovery compared to Original Medicare.

• Potential Cost Savings & Health Outcomes: Unlike Original Medicare, MA plans have an annual out-of-pocket maximum ($3,000–$8,000 in 2025), so your PT/OT costs won’t spiral indefinitely. MA’s coordinated care (e.g., therapy paired with nurse check-ins) reduces hospital readmissions, as therapy continuity prevents setbacks like falls (5–8% of readmissions).

●Hospital-to-LTC Transition (MMI): 

• Original Medicare Coverage (2025): Medicare only pays for skilled care if it’s helping you get better or maintain your abilities. If your doctor decides you’ve reached a point where more care won’t improve your condition (called “maximum medical improvement”), Medicare stops covering it. For example, if you’re recovering from a stroke but can’t make more progress with therapy, Medicare will say the skilled care isn’t needed anymore, even if you still need help or assistance, even if needed on a daily basis throughout the day. Skilled care means specialized care from trained professionals, like nurses giving injections or physical therapists helping you regain strength after surgery. It’s different from everyday help (like bathing or cooking), which can be provided by non-professionals like family, and for which Medicare doesn’t cover.  

If you’re in a skilled nursing facility (like a rehab center after a hospital stay), Medicare Part A covers up to 100 days per “benefit period” (a specific time frame tied to your condition). But this coverage stops earlier if your condition isn’t improving. For the first 20 days, Medicare pays 100%; for days 21–100, you pay a daily copay (about $204 in 2024). If you hit 100 days or stop improving before that, Medicare stops paying, and you’d need to cover the full cost (often $300–$500/day) or find other help, like Medicaid.

• Medicare Advantage Advantages:  Flexible prior authorization, extended SNF days, care managers for transitions.  MA plans offer advantages over Original Medicare for managing care, particularly when moving from a hospital to a skilled nursing facility (SNF) or home. It’s about making transitions smoother and potentially extending coverage for certain services.

Prior authorization is when your MA plan needs to approve certain services (like therapy or nursing home stays) before they’re covered. Unlike Original Medicare, which has strict rules about when care is “medically necessary,” MA plans can be more flexible in approving these services. For example, they might okay extra therapy sessions or specialized care if it helps you stay out of the hospital, even if Original Medicare would deny it. Extra days can give you more time to recover without paying huge out-of-pocket costs (SNFs can cost $300–$500/day without coverage). This supports aging in place by helping you return home stronger.

MA plans often assign a care manager (like a nurse or social worker) to guide you through transitions in care, like when moving from a hospital to an SNF, home, or another care setting. They help coordinate things like therapy schedules, medication plans, or follow-up doctor visits. They also make sure everyone (doctors, therapists, family) is on the same page.  These managers reduce confusion and mistakes (like wrong medications), making your move from hospital to home smoother and safer. This can prevent you from going back to the hospital.

• Potential Cost Savings & Health Outcomes:  Flexible Prior Authorization  means you might get extra PT/OT at home to avoid a nursing home,  reducing reliance on institutional care.  MA care managers reduce hospital readmissions by significantly by ensuring proper medication and follow-up care (e.g., >15% fewer heart failure readmissions with MA coordination).  By way of illustration, a care manager might arrange telehealth check-ins or home PT to keep you stable after leaving an SNF, cutting risks like medication errors (reducing hospital readmissions).

●Utilization of Technology: Remote Patient Monitoring (RPM) and More: 

• RPM Defined: RPM uses devices like blood pressure cuffs, glucose monitors, or wearable heart rate trackers that send data to your doctor from home. MA plans, particularly Chronic Special Needs Plans (C-SNPs), often cover these for conditions like diabetes, heart failure, or COPD.

• Original Medicare Coverage (2025): Limited RPM coverage (only specific codes like 99453–99457 for chronic conditions).

• Medicare Advantage Advantages:   Unlike Original Medicare, which has limited RPM coverage, MA plans may include RPM as a supplemental benefit, covering device costs or monitoring services. For example, a 2025 Humana MA plan in Ohio offered free glucose monitors and monthly nurse check-ins for diabetic patients.

• Potential Cost Savings & Health Outcomes: RPM significantly reduces ER visits  by catching issues early (e.g., high blood sugar spikes). A 2024 study showed MA’s RPM programs improved blood pressure control in 60% of hypertensive patients within 6 months.  For example, If you have heart failure, an MA plan might provide a scale to monitor weight daily (fluid retention is a red flag). Data goes to your doctor, who can adjust meds via telehealth, preventing hospital trips.

• Other Technologies: 

• Smart Home Devices: Some MA plans cover or subsidize devices like motion-sensor lights or fall detection systems (e.g., integrated with Alexa or Apple Watch) as part of home safety benefits. These reduce fall risks, a leading cause of readmissions (5–8% of elderly cases).

• Health Apps and Portals: MA plans often provide apps for scheduling telehealth, tracking vitals, or accessing care coordinators. For instance, UnitedHealthcare’s 2025 MA plans include a portal for real-time medication reminders, boosting adherence significantly.

• Virtual PT/OT: Some MA plans offer virtual physical or occupational therapy sessions, guiding exercises via video to maintain mobility after in-person sessions end. This is rare in Original Medicare.

MA plans don’t cover all non-skilled care needs, especially if you need help 24/7. To fill this gap, you can combine MA with Medicaid (a state program for low-income people), private long-term care insurance, or spend-down of your personal assets and property. For example, Ohio’s PASSPORT program (through Medicaid) can cover more in-home aide hours if you qualify (income under $2,901/month in 2025). Private insurance can also help pay for ongoing care costs that MA doesn’t fully cover.

Moreover, some plans present challenges that only a Medicare Specialist would know.  It is imperative that, in addition to conducting your own investigation, you consult with a Specialist who can guide you based on "inside" information that might be unavailable to you, or at least hard to access and assess.

In short,  MA plans can give you some help with daily tasks and tools to monitor chronic illnesses at home, but they too are limited. To get full support for staying at home long-term, you’ll likely need to add Medicaid, private insurance, or asset spend-down to cover the rest.  If you select the latter, your assets will last longer, leaving a greater chance that assets will pass to heirs rather than being consumed by long=term care expenses. 

Additional MA Benefits for Post-Hospital Recovery

When Original Medicare’s benefits cease (e.g., after 100 skilled nursing days or when PT/OT no longer shows “progress”), MA plans offer unique supports to maintain health and prevent setbacks:

• Care Coordination: Dedicated managers ensure medication reconciliation and follow-ups, reducing readmissions by 8–20%. For example, a 2025 study by Providence VNA Home Health showed medication reconciliation cut 30-day hospitalizations from 12% to 9% for heart failure patients.

• Supplemental Benefits: Meal delivery, transportation, or flex cards ($50–$300/year for OTC items) support nutrition and mobility, reducing malnutrition-related readmissions.

• Behavioral Health: Expanded telehealth counseling addresses post-hospital depression, improving physical recovery by 10–15%.

• Out-of-Pocket Caps: MA caps annual costs ($3,000–$8,000), unlike Original Medicare’s unlimited costs, ensuring affordability for ongoing care.

Ohio Context: Why MA Matters Now

Recent Ohio developments, like the September 2, 2025, Ohio Supreme Court ruling previously discussed on this blog, (State ex rel. LeadingAge Ohio v. Ohio Dept. of Medicaid), highlight Medicaid funding shortfalls for nursing homes ($527 million in 2024-2025), threatening care quality for 66,000 residents. MA’s home-based benefits offer a buffer, reducing reliance on facilities and aligning with programs like Ohio’s PASSPORT waiver, which supports in-home aides for those with income under $2,901/month.

Steps to Leverage MA for Aging in Place

Assess Needs: Consult a doctor or geriatric care manager to outline required services (e.g., PT/OT, home mods).

Compare Plans: Use Medicare.gov’s Plan Finder to identify plans with telehealth, in-home care, or C-SNPs. Prioritize low out-of-pocket maximums and strong Ohio networks.

Speak with a Specialist: A Medicare specialist is a must, not only to access your needs and goals, but to advise regarding which plans are best, and which specific plan is best for you and your circumstances.  

Enroll Strategically: Switch during Open Enrollment (October 15–December 7). Check for Special Needs Plans for chronic conditions.

Maximize Benefits: Request prior authorization early; combine with Veterans benefits, Area Agencies on Aging, or long-term care insurance. Track annual allowances.

Plan for Gaps: Budget for premiums ($0–$200/month) and copays; use trusts (e.g., $154,140 Community Spouse Resource Allowance in 2025) or Medicaid planning to cover full custodial care.

Monitor Health: Use MA’s telehealth and care coordination to prevent setbacks, leveraging data like 43% fewer missed follow-ups.

A Call to Action

Medicare Advantage plans empower Ohio families to age in place with dignity, offering cost savings, flexible care, and better health outcomes, like  fewer readmissions and !improved recovery. Amid uncertainties like Ohio’s Medicaid disputes, MA’s home-focused benefits are a lifeline. Don’t wait!  For tailored strategies, consult an elder law attorney or your State Health Insurance Assistance Program (SHIP). Secure your aging-in-place plan now to avoid facility costs and thrive at home.

“Fate Worse Than Death”: Long-Term Care’s Independence Crisis: Aging-in-Place Planning Offers Solutions

A recent study highlighted by NBC Right Now, titled “Fate worse than death: Many long-term care residents lose all independence, study says,” paints a grim picture of life in long-term care (LTC) facilities. The headline is attention-grabbing, and for seniors and families planning for the future, the subject study underscores the importance of aging in place strategies to preserve independence and autonomy.

THE STUDY

Published on April 23, 2025, "Cognitive and Functional Decline Among Long-Term Care Residents," is a retrospective cohort study (meaning an observational study that uses existing data to examine individuals by looking back in time to assess how past variables relate to specific outcomes) involving more than 120,000 Canadian residents followed for up to 5 years.  One aspect of the study was interviewing residents to determine their goals in seeking long-term care and their feelings about long-term care. The study provides a compelling glimpse into older adults’ fears of losing independence, and the trajectories of needs while in long-term care. 

Study Results: Some of the key findings of the study include: 

• Many people lose all independence soon after entering long-term care;

• About 20% lose the ability to make everyday decisions within five years of admission, and 13% become totally dependent for all personal care including bathing, toileting and eating;

• Residents living with dementia may be at risk of spending more time living in states of impairment than residents who have no cognitive impairment; the increased survival of residents with dementia may reflect the natural history of dementia as a progressive terminal disease with great variability in survival time, ranging from 3 to 15 years.

• Advance directives may play an important role in reducing time spent living with severe disability; residents with Do Not Resuscitate (DNR) or Do Not Hospitalize (DNH) orders experience shorter periods of institutionalization while suffering profound impairment associated with a loss of all independence.

• The standard care practice of providing longevity can leave residents in states that they consider "worse than death," contradicting the goals that residents view as most important.

• Despite advance care directives, 25% of long-term care residents have at least 1 transfer to the hospital every 6 months, and many die shortly after a hospital transfer. 

Indeed, in the introduction to the study, the authors write:

"Patients, including healthy outpatients and those with serious illness, consider states such as being “unable to get out of bed,” “unable to communicate,” or “unable to reason or remember” as worse than death, and yet these outcomes are rarely explicitly discussed. [citations omitted].  Pursuing longevity-focused care when a person is living in a state they consider worse than death is contrary to resident-centered principles for which LTC homes strive. However, pursuit of longevity against a patient’s wishes may occur because preferences change when death is imminent and because substitute decision-makers and clinicians are partial toward life-prolonging treatment when clinical outcomes or resident preferences are uncertain."

Researcher Assessments: The researchers released statements regarding their findings and assessments:

• Dr. Ramtin Hakimjavadi, lead researcher, a resident in internal medicine at the University of Ottawa in Canada, and one of more than fifteen medical professionals that authored the study, characterized the findings:

"In interviews, long-term care residents have expressed that loss of independence is more distressing to them than the thought of dying. [Residents aren’t receiving the best care] if we don’t talk about the possibility of severe disability and ask about the circumstances when life prolonging treatments would not be acceptable."

• Senior researcher, Dr. Daniel Kobewka, an investigator at Bruyère Health Research Institute and adjunct scientist at the Institute for Clinical Evaluative Services in Ottawa, advised that: 

“[r]esidents, their family members, and care teams should have open discussions about what quality of life means to the resident, considering the possibility of prolonged disability. Planning ahead can help ensure that future care aligns with personal values, including the choice to prioritize comfort and dignity over life-prolonging interventions.” 

Call to Action: The study represents a call to action. 

• The Health Care Industry:  Clinicians and health care professionals are called to consider critically  life-prolonging treatment, appropriate for the healthy and recovering, as being contrary to the wishes and consent of residents that "follow a frailty trajectory with no clear terminal phase...experienc[ing instead] a progressive decline in cognition and physical function after admission due [for example] to the accumulation of chronic conditions." Care for these residents must be guided by their wishes and goals, ensuring dignity and quality of life for residents and care partners. 

• Residents: Residents should make their wishes and goals explicit.  At a minimum that means executing Durable Powers of Attorney for Health Care, Advanced Directives in the form of a Living Will and Advanced Directives for Dementia, and a broad form HIPAA release in favor of trusted health care decision-makers. Residents and their families should consider a DNR, DNH, and where appropriate, Physician Orders for Life-Sustaining Treatment (POLST). Residents should also consider aggressive, comprehensive aging in place planning, and a robust estate plan to protect a resident's independence, decision-making, and dignity.   

Study Limitations: The authors acknowledge key limitations:  

• First, all studies that use administrative data have a risk of bias from misclassification or incomplete capture of variables, which the researchers addressed by using validated definitions when possible and maintaining consistency with previous research. 

• Second, the study did not stratify data by the type of dementia (e.g., Alzheimer, Lewy body, or frontotemporal dementia) given the available data. Although different dementia subtypes carry distinct trajectories and prognoses, the researchers concluded that their findings reflect residents living with Alzheimer dementia given its prevalence relative to other subtypes.

• Third, the length of stay observed in the study is subject to local admission and aging-in-place policies, which vary by jurisdiction.

• Fourth, while the study aimed to inform resident-centered decision-making in LTC through the identification of resident-important cognitive and functional impairments, resident and caregiver perspectives may differ from those of the patient partners who informed this study. The researcher believe that, nonetheless, their data provides a foundation for communication and future studies to consider functional and cognitive impairments as outcomes for prognostication. 

• Fifth, the  study has limitations in generalizability. The findings are generalizable to regions with a similar LTC population of mostly older adults with frailty and chronic conditions requiring continuous care. However, the  population studied may be older and have higher levels of frailty and health burdens at admission because of the prioritization of home care in Canada compared with regions with less emphasis on home care or with more flexible LTC eligibility criteria. Additionally, the publicly funded single-payer system in Canada may result in a more homogenous population compared with regions using a third-payer system, which may have a more diverse LTC population. This difference may limit the generalizability of our results to other regions.

The Study Is Worthy of Serious Considerations Despite the Limitations

There are number of reasons that this study deserves attention despite the acknowledged limitations.

1. Peer Review and Credibility: Published in JAMA Network Open, a peer-reviewed, open-access journal with a strong reputation the study benefits from rigorous editorial oversight. The authors are affiliated with reputable institutions  and have expertise in health policy and aging, enhancing credibility. No funding conflicts are disclosed, reducing bias concerns.
2. Methodology: A retrospective cohort study afforded the researchers an immense sample size, and a fairly long period over which to follow subjects. The weakness of these types of studies, data quality/bias, was addressed by using validated definitions when possible and maintaining consistency with previous research. 
3. Generizability: There are obvious differences between the Canadian health care model and the U.S. model.  Aging in place planning is public policy in Canada and is heavily subsidized.  The concern was that Canadian residents might be older and in worse health than, say, in the U.S.  Although U.S. commitment to aging in place in Medicare  may not be as robust, there is some semblance of public support, for example, in the adoption of alternatives available in Medicare Advantage Plans, the recent "Hospital at Home" initiative of Medicare, and Medicare/Medicaid's Program of All-Inclusive Care for the Elderly (PACE) program for adults 55+ who need nursing home-level care but can live safely in the community, which provides comprehensive services (medical, social, home care) through an interdisciplinary team, centered at an adult day health center, with in-home support.  More importantly, with the risk of asset loss from long-term care spend down, U.S. residents are much more likely to avail themselves of institutional care alternatives, meaning the populations of LTC residents may not differ dramatically.  Moreover, it appears to me that the quality of care in Canada is higher given that the rehospitalization rate described in the study was an average of every six months, while U.S, residents run an almost one-in-three risk of rehospitalization in the first 28 days of care from just medical "mistakes."
4. Is the Headline "Fair?": The headline, “Fate worse than death: Many long-term care residents lose all independence, study says,” is undeniably dramatic. The phrase “fate worse than death” is emotionally charged, invoking despair and finality. While it risks overgeneralizing, implying that all long-term care leads to catastrophic outcomes, the headline isn’t entirely unfair. Loss of independence is a profound fear for seniors, and the study’s emphasis on this issue aligns with documented concerns. For example, a 2023 New York Times article notes that many aging Americans struggle to stay independent due to a fragmented long-term care system, supporting the study’s premise. The hyperbolic tone serves a purpose: it grabs attention and sparks discussion about a critical issue.

Aging-in-Place Solutions to Preserve Independence

The study’s findings underscore why many seniors prefer to age in place—remaining in their homes or communities with support tailored to their needs. Aging in place planning, a cornerstone of this blog, empowers seniors to maintain independence, dignity, and control. Below are solutions commonly explored here, designed to address the risks highlighted by the study:

• Home Modifications for Safety and Accessibility: Modifying the home to accommodate mobility or health challenges is a proactive step. Common upgrades include installing grab bars, widening doorways, adding ramps, or creating single-level living spaces. These changes reduce reliance on institutional care by enabling seniors to navigate their homes safely. For example, a walk-in shower can preserve independence in bathing, directly countering the loss of control noted in the study. 

• Multigenerational Living: Multigenerational living is a powerful strategy for aging in place, offering financial savings, emotional support, and caregiving flexibility. By reducing reliance on institutional care, families can avoid spend-down and preserve assets, aligning with elder law goals. However, success requires planning. For more see the article: Aging in Place: Multigenerational Living as a Strategy to Avoid Institutional Care and Support Family Caregiving.

• Deploy Technology for Safety, Health, and Communication: Technology serves two purposes.  First, technology use supports cognitive health. Second, technology offers solutions to challenges faced when aging in place that otherwise might demand institutionalization. 

• Revocable Living Trusts for Asset Protection: A revocable living trust, as discussed in our recent article “The Dangers of Last-Minute Estate Planning.” ensures assets are managed and distributed per the senior’s wishes, even if they become incapacitated. Unlike wills, trusts are transparent in asset titling (e.g., on deeds or accounts), deterring manipulation and supporting financial independence. Trusts can also fund home care or modifications, avoiding the asset depletion that forces some into long-term care, and protect against guardianships, and abusive guardians.

• General Durable Powers of Attorney (GDPOA): A GDPOA appoints a trusted agent to handle financial and healthcare decisions if a senior becomes incapacitated. This prevents the need for court-ordered conservatorships, which can strip autonomy, as seen in the Autry case. By ensuring a trusted person manages their affairs, seniors maintain control indirectly, aligning with the study’s call for personalized care.  Structuring trusts to prevent third-party guardians access to trust assets disincentivizes guardians, and helps prevent control of assets being wrestled away from trusted advisors and agents.  

• Aging-in-Place Care Coordination:  In-home care, such as nonmedical caregivers or telehealth services, allows seniors to receive support without leaving home. Emerging technologies like tele-dentistry or remote monitoring, noted in LTC News, enhance access to care for mobility-challenged seniors. Coordinating care through family, agencies, or professionals ensures needs are met without the institutional routines criticized in the study.

• Guardianship Protections and Nominations: Nominating a guardian in a GDPOA or trust ensures that, if guardianship is needed, a trusted individual is appointed. Structuring trusts to limit guardian access to assets, as discussed in “The Dangers of Last-Minute Estate Planning,” preserves the senior’s plan. This protects against the loss of control highlighted by the study, as seniors retain influence over their legacy.   Structuring trusts to limit guardian access to assets, as discussed in “The Perils of Last-Minute Estate Planning,” preserves the senior’s plan. This protects against the loss of control highlighted by the study, as seniors retain influence over their legacy.

• Medicaid Planning for Long-Term Care Costs:  Strategic Medicaid planning, using trusts or asset transfers, can preserve resources for in-home care rather than nursing home costs. Unlike the hasty Medicaid attempts in the Autry case (Dangers of Last Minute Estate Planning), a well-crafted trust allows crisis planning without disrupting the estate plan, supporting aging in place. Consideration of and implementation of asset transfers permissible to qualified family members under Medicaid are more certain and less expensive and disruptive than either monolithic irrevocable transfers so common from trust mills, or crisis planning planning.

• Lifestyle Changes: Simple lifestyle changes can support, protect, and improve cognitive and physical health as well as  emotional and psychological well-being, and build a broader community and social safety net thereby removing barriers and creating opportunities for home and community based care. 

These strategies and solutions, regularly featured on this blog, empower seniors to avoid the institutional settings critiqued in the study. By planning proactively, families can create environments where independence thrives, reducing the risk of a “fate worse than death.” 

Executive Order Expanding Apprenticeships Could Ease Staffing Shortages in Nursing Homes, Assisted Living Facilities

An executive order to consolidate federal workforce programs could address workforce shortages among senior living and other aging services providers by expanding apprenticeships, according to an article penned by Kimberly Bonvissuto, writing for McKnight's Senior Living. This comes at a critical time given that Biden era staffing mandates have been stuck down by a federal court.

Trump signed an executive order, “Preparing Americans for High-Paying, Skilled Trade Jobs of the Future,” on April 23 with the goal of expanding and improving job training for skilled trades. The order directs the Labor, Education and Commerce departments to streamline and consolidate federal workforce programs, with a focus on expanding registered apprenticeships to more than 1 million annually.

Although the initiative is most directly aimed at the  administration’s goal to revive US manufacturing, LeadingAge Director of Workforce Policy Amanda Mead said in a written announcement that it could help alleviate critical workforce shortages in the aging services sector: 

“While the president’s executive order is widely seen as part of the administration’s push to revitalize US manufacturing, the initiative to expand apprenticeships could also benefit direct care workers — such as nursing assistants and home health aides — by offering enhanced training and alternative educational pathways beyond traditional four-year degrees.” 

Argentum is a national trade association representing senior living communities across the United States. It advocates for policies that benefit the senior living industry and its residents, serving companies that own, operate, and support professionally managed senior living communities. Argentum’s mission includes promoting quality care, operational excellence, and workforce development within the sector.

Back in 2020, Argentum  touted the success of the Healthcare Apprenticeship Expansion Program, which served more than 7,600 incumbent workers through a $6 million Closing the Skills Gap grant from the Department of Labor. The association also petitioned the Centers for Medicare & Medicaid Services (CMS) to include assisted living in an incentive program geared toward attracting registered nurses to skilled nursing facilities.

Since the 2020 grant, staffing challenges in the senior living industry have persisted and intensified, particularly due to the COVID-19 pandemic. In response, several efforts emerged to bolster the workforce:

• Workforce Development Initiatives: Argentum has continued to prioritize workforce development, launching initiatives such as partnerships with educational institutions in 2022. These programs aim to create career pathways, offering training and opportunities for individuals entering the senior living field.

• Legislative Actions: At both state and federal levels, there have been efforts to address staffing shortages in healthcare, including senior living. These include funding for training programs, loan forgiveness for healthcare workers, and incentives for employers to hire and retain staff. For instance, discussions around immigration reform in 2023 have explored allowing more foreign workers to fill caregiving roles, while some states have introduced minimum staffing requirements for nursing homes, potentially influencing senior living practices.

• Improved Compensation and Benefits: To attract and retain staff, many senior living providers have increased wages and enhanced benefits, recognizing the competitive labor market and the need to make these roles more appealing.

• Technological Innovations: The industry has also turned to technology to supplement staffing needs. Solutions like telehealth services and remote monitoring have been adopted to enhance care delivery and reduce the workload on existing staff.

In late 2023, a survey I conducted for an article (I never published) suggested that  38 states and the District of Columbia had established their own minimum staffing standards for nursing homes, but that figure was gleaned from internet searches; I could find no readily available source cataloguing the states and their staffing regulations.  I was surprised that the information wasn't more readily available since federal staffing mandates were then a hot topic.  

An Argentum spokesman told McKnight’s Senior Living:

“There are far too few caregivers to meet the needs of our rapidly aging population, and it will take an across-the-board approach to recruit and retain more than 20 million workers who will be needed across long-term care by 2040.” Three million of that 20 million will be needed in senior living alone, according to Argentum."

The American Seniors Housing Association (ASHA) told McKnight’s Senior Living that  the aging population demands a steady pipeline of workers to serve older adults living in senior living communities and other long-term care settings. ASHA Vice President of Government Relations Jeanne McGlynn Delgado appears optimistic:  

“Identifying and implementing federal training programs that can attract and grow this workforce, whether it be in retooling existing grant programs or expanding apprenticeships specifically for senior living workers, shows much promise,” ASHA ."

The American Health Care Association/National Center for Assisted Living told McKnight’s Senior Living that it continues to support making apprenticeship programs more available and accessible, including supporting the recently introduced American Apprenticeship Act to provide tuition assistance to fund apprenticeship programs:

“We’ve seen the value they can bring through our own apprenticeship partnership with Equus Solutions, who has supported some of our long-term care providers with the process. Apprenticeships are one of the many solutions we need to help recruit and retain more long-term caregivers, and we appreciate this effort to help address the nation’s growing caregiver shortage.”

Despite these efforts, staffing remains a critical and ongoing challenge in senior living. The effectiveness of these measures is under evaluation as needs increase, and the industry and governments continue to seek innovative and sustainable solutions to ensure high-quality care for residents. 

You can help.  Develop a plan to age in place.  To the extent possible, relegate institutional choices to "when and if it is absolutely necessary, and there is no available alternative."  You and your loved ones will likely experience better outcomes, and you will relieve an already burdened system.