The Gap Between Wanting to Stay and Knowing You Can
Margaret has lived in the same house for forty-one years. She knows which floorboard creaks. When her daughter asked if she’d consider moving somewhere “easier,” Margaret laughed and said, “No, thank you; she’ll take her chances with the stairs.”
She is not alone. Ninety-five percent of adults aged 55 and older say staying in their own home matters to them, according to U.S. News & World Report’s 2024 survey. Nearly everyone.
But wanting something and trusting you’ll get it are two different things.
Among older adults who hope to stay home with a caregiver’s help, only 37 percent feel it is extremely or very likely to happen, according to Pew Research Center. Another 18 percent think it’s not likely at all.
Picture that gap as a hallway. Your home on one end. Uncertainty on the other, dim and unmarked. Most people never switch on the lights until they’re already halfway through, often in a crisis and without a plan.
This article turns on the lights early. Six strategies. No vague promises.
Strategy One: Take an Honest Look at Your Home
Your home has quietly gotten older right along with you, and most homes were never built with aging bodies in mind.
Only about 10 percent of U.S. housing units meet basic aging-friendly criteria: a stair-free entry, a main-floor bedroom and bathroom, and at least one accessibility feature, according to Census Bureau data cited by Kiplinger. Falls are the leading reason older adults get hospitalized, and three out of four nursing home moves happen right after one.
Start at the bathroom. Two grab bars near the toilet, one vertical for pulling forward and one horizontal for steadying, cost far less than a hip fracture. Swap the tub for a walk-in shower if you can. Add motion-activated lighting from bed to bathroom, because getting up at 2 a.m. in the dark, tangled in sheets, tripping over slippers, is how falls happen.
Move to the kitchen. Replace the bottom cabinets with pull-out drawers so nobody has to crouch into a dark corner. Clear loose rugs, stray cords, and clutter from every path.
Widen a doorway with offset hinges if a walker won’t fit through. Consider a stair lift if the primary bedroom sits upstairs.
None of this happens the week after a hospital discharge. It happens now, while you can still climb a ladder or hire the person who will.
Strategy Two: Build Your Support Network Before You Need It
Nearly half of older adults, 48 percent, say they have no one to help them with personal care, according to the National Poll on Healthy Aging, as cited by Hayes Barton Place. Over half of adults 65 and older will eventually need daily assistance.
Build the network before the emergency. Talk to family honestly. Ask what they’re willing to do, what they can afford, and where their limits sit.
Look outside the family, too. Church groups. Neighbors. A geriatric care manager who spots problems before they become crises. Home health aides who can help with bathing, meals, and errands once the time comes.
Isolation does real damage. Staying connected protects your mind, not just your calendar.
Strategy Three: Get Your Finances and Legal Documents in Order
Round-the-clock home care can run close to $36,000 a month. Part-time aide help runs $35 an hour in most places, topping $50 in expensive markets, according to Kiplinger.
That number should stop you.
Financial planners suggest setting aside enough for two years of round-the-clock in-home care. Some homeowners tap equity through a Home Equity Conversion Mortgage. Roughly 20 percent of adults 65 and older own their homes outright, giving them flexibility they might not realize, according to Hayes Barton Place.
Paperwork matters just as much as money. An advance directive tells your family what you want if you can’t speak for yourself. A durable power of attorney names someone to handle bills. Sit down with a financial advisor who can guard against scams targeting older adults.
Have these conversations at the kitchen table on an ordinary Tuesday, while everyone can still think clearly.
Strategy Four: Plan for Your Health, Not Just Your House
A safe house with a body falling apart inside it isn’t safety.
Strong legs support the balance you need to stand up without grabbing the armrest like a lifeline. Walking, swimming, yoga, and tai chi build that strength, according to UC Health. If you grip furniture just to rise, mention it to your doctor. That’s a referral to physical therapy waiting to happen.
Get your eyes checked annually for cataracts and glaucoma. Review every medication with your pharmacist, since drowsiness or drug interactions cause more falls than people assume. Fear of falling alone drives many older adults to give up independence before a fall has even happened.
Manage chronic conditions too. Heart problems, memory changes, nutrition. Ask directly whether you’re eating enough, since appetite quietly fades until weight loss forces the issue.
Strategy Five: Stay Connected to Your Community and Plan Your Transportation
A house full of grab bars means nothing if you’re stuck inside it, cut off from everyone you know.
Identify future transportation help before you lose the ability to drive, whether that loss is temporary or permanent, according to Hayes Barton Place. Being confined to your home this way quickly damages independence and well-being.
Check into grocery delivery programs. Use an electronic medication reminder. Video call family and friends regularly to avoid isolation, according to UC Health. Join a class, club, or adult day program at a senior center or church.
If your spouse is the one who drives, plan for their possible limitations too. Losing your household’s only driver without a backup plan is how independence quietly slips away for two people at once, not one.
Strategy Six: Bring in a Health Navigation Specialist or Death Doula
Here’s the piece almost nobody mentions.
A health navigation specialist or death doula woven into your local community brings something a checklist cannot: relationships. They know which home care agencies show up on time, which assisted living facilities have open beds rather than year-long waitlists, which hospice teams treat families with patience rather than paperwork, and which local resources nobody puts in a brochure.
Think of this person as a guide who has already walked the hallway between “wanting to stay home” and “not sure if I can,” with dozens of families like yours before them. When your caregiver moves away or your health changes faster than your home can adapt, this is the person who knows who to call.
And in the worst case, when staying home is no longer safe, no matter how many grab bars line the bathroom, this specialist helps make the transition to a facility feel less like defeat and more like the next right choice, with time to say goodbye properly.
This strategy costs something different than the others. It costs humility to admit, ahead of time, that you might need a guide.
Start With One Conversation
You don’t need to solve every strategy this week. Start one conversation.
Call a family member and ask what they’re actually willing to help with. Walk through your own bathroom and count the trip hazards. Look up whether your area has a local health navigation specialist or end-of-life doula who knows the community’s resources inside and out.
Margaret didn’t plan everything at once either. She started with one grab bar and one honest conversation with her daughter. The rest followed, piece by piece, on her own timeline.
Ninety-five percent of us want what Margaret has. The confidence to get there comes from starting now, while you still get to choose the pace.
Free Daily Symptom Tracker: Each headache, flare, or fatigue spike reveals a clue. This two-page Daily Symptom Tracker records sleep quality, food intake, triggers, severity, and effective relief methods—all in one place. Use it daily for 31 days and share the pages with your healthcare provider or health navigation expert. Together, you can move from guessing to addressing the root cause. Instructions on how to use the free daily symptom tracker and the free daily symptom tracker.
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Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.
The Death Deck is often a wonderful conversation starter.
Compassion Crossing, LLC, via Peter M. Abraham, BSN, RN, EOLD, offers on-site services in Madison County, KY, as well as in the seven nearby counties—Clark, Estill, Fayette, Garrard, Jackson, Jessamine, and Rockcastle—and provides virtual options when no local provider is available.
Hospice Buddy: Although Jamie Haberman, RN, CHPN, isn’t a certified end-of-life doula, her virtual services are highly valuable.
Currently, no official organization regulates end-of-life doulas (EOLDs). Remember that some EOLDs listed in directories may no longer be practicing, so it’s important to verify their current status.
End-of-Life Doula Schools
Before you consider a death doula school, please volunteer with a local hospice provider as a “companion volunteer” to gain experience with strangers who are dying, as well as with family and staff dynamics. The author also recommends reading the article Economic rant: The death doula crisis we aren’t talking enough about, as most death doula schools do not emphasize that being a death doula is a calling rather than a career.
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Compassion Crossing Academy: Although it isn’t a dedicated death-doula school, it offers unique classes that can help death doulas expand their practice. It serves as an important resource for individuals looking to deepen their understanding and grow in this meaningful profession.
Remember that there is no official accrediting body for end-of-life doula programs. Certification simply shows you’ve completed an unaccredited course and received a certificate of completion. It’s advisable to have discovery sessions with any death doula school you’re considering — even if it isn’t listed here — to see if it meets your needs. Also, ask questions and reach out to references, such as former students, to assess whether the school provided a solid foundation for launching your own death doula practice.
