Most older adults want to remain in their own homes as they age, but for many the dream of “ageing in place” collides with the practicalities of health, money and the physical state of the property. A February survey by the Pew Research Center found that 93% of US adults aged 65 and over live in their own home or apartment and would prefer to stay there. In the UK, similar desires are widespread, and the demographic pressure is mounting: the number of people aged 85 and over is projected to double to 3.2 million by 2041, making the question of how to grow old at home an increasingly urgent policy challenge.
For some, the decision is made early. In one account, a 77-year-old woman who runs an interior design business, plays pickleball and walks five miles a day chose to downsize to a townhouse with a first-floor bedroom and bath after her husband died 22 years ago. She and her 83-year-old husband now live there, deliberately planning for a time when stairs might become a problem. But not everyone has that foresight — or that luck. The reality is that people aged 65 and older face a 69% chance of needing some form of care and support as they age, according to the same Pew survey, and the ability to live independently depends on a complex mix of factors.
Health, support and the risk of loneliness
Health is the first variable. Francisco Lasta, an occupational therapist and inclusive design lead at the architecture and engineering firm GFT, asks clients to consider whether they can go to the supermarket without assistance, and whether a chronic condition might limit their ability to interact with their environment. The support network matters just as much: a spouse, adult children or neighbours who can help with practical tasks and provide social contact. Loneliness is a particular threat for older adults. In the UK, more than 1.4 million older people regularly experience loneliness, and nearly half of those aged 75 and over live alone. Research has linked social isolation to dementia, depression, heart disease and stroke, with some experts noting that loneliness can be as harmful to health as smoking 15 cigarettes a day. For those with a disability — 45% of UK adults over State Pension age — the challenges are compounded.
The financial implications of home modifications
Even for those in good health, the home itself must be safe and accessible. Falls are the leading cause of injury for people aged 65 and older, so simple measures such as task lighting, non-slip flooring and grab bars in the shower can make a significant difference. Lasta recommends a top-to-bottom review: no stairs between rooms, doorframes wide enough for a wheelchair or walker, walk-in showers without a tub or curb, and accessible countertops in the kitchen. A certified ageing-in-place specialist, with credentials through the National Association of Home Builders or the University of Southern California, can advise on the work required, notes Emily Nabors, associate director of innovation at the Center for Healthy Aging at the National Council on Aging.
The cost of these modifications varies widely. In the US, the Fixr home-improvement platform puts the cost of adapting a home for ageing in place at between $3,000 and $15,000, with a national average of $9,500. More extensive renovations push the price much higher: a bathroom renovation averages $25,000, a kitchen $50,000, a bedroom $12,000 and stair modifications $45,000. In the UK, the numbers are similarly steep. A straight stairlift costs between £2,510 and £5,635, while a through-floor lift can reach £15,000 to £40,000. A walk-in shower costs £2,500 to £7,000; a full wet-room conversion in an older home starts at £6,500. Widening doorways adds £700 to £2,500, and a combination of major adaptations — such as a wet room, stairlift and widened doorways — can total £25,000 to £40,000. Habinteg, a UK housing charity, estimates that adapting an older home for three common needs costs almost £27,000.
Funding is available but often means-tested. In England, the Disabled Facilities Grant (DFG) covers up to £30,000 for essential adaptations; Wales offers up to £36,000 and Northern Ireland £25,000. Minor adaptations costing £1,000 or less may be provided free of charge by local authorities following a care needs assessment. Charities such as Rebuilding Together and Habitat for Humanity also offer help in the US, while in the UK organisations like Independence at Home provide grants for equipment and adaptations. VAT relief applies to accessibility work, and an occupational therapist assessment is usually required to qualify for grants. For those who rent, the Fair Housing Act in the US protects the right to request handrails, ramps and other basic accommodations; in the UK, the Equality Act 2010 requires landlords to make “reasonable adjustments.”
Assistive technology — from personal alarms and fall detectors to voice-controlled smart speakers and automatic lighting — can further support independent living. Age UK’s AgeCo service assisted more than 76,000 people in 2021 with personal alarms alone. Medication reminders, video-calling devices and smart clocks are among the tools that help older adults manage daily life and stay connected.
Home care costs and the tipping point
When care is needed at home, the expense can become unsustainable. According to a 2025 survey by the care provider network CareScout in the US, non-medical home services average $35 an hour, or $80,000 annually; skilled nursing costs about $90 an hour, nearly $206,000 a year. In the UK, hourly visiting care costs between £20 and £38, with a national average of around £32 per hour. Live-in care typically runs from £900 to £1,600 per week, averaging £1,200–£1,500, and can increase to £1,800–£2,200 for more complex needs. By comparison, residential care homes cost £1,300 to £2,500 per week. Kate Granigan, a geriatric social worker and CEO of the life care management practice Alder in Boston, notes that the funding of care is often the moment people hit “a tipping point” and are forced to leave their home — not by choice, but because they can no longer afford to stay. In the UK, local authorities may contribute to care costs for those with capital below £24,000, and NHS Continuing Healthcare can fund care for people with complex health needs. Benefits such as Attendance Allowance and Carer’s Allowance are also available.
Relocation options: from granny pods to retirement villages
If modification or home care is not feasible, moving to a more suitable property is a serious option. In the US, “granny pods” or accessory dwelling units (ADUs) can be built on existing land at an average cost of $180,000. Community-based models such as the Village to Village Network help people stay in their homes by establishing local support networks. Senior cohousing combines independent housing with shared social spaces, and shared housing schemes match older adults with spare rooms in other homes. Continuing care retirement communities (CCRCs) offer a full continuum of care, from independent living to assisted living to nursing, but require a high initial buy-in — $402,000 on average.
In the UK, a wider range of alternatives exists. Sheltered housing provides self-contained flats for people aged 55 or over with a scheme manager and an alarm system, but no personal care. Extra care housing (sometimes called assisted living) offers on-site care staff available 24 hours a day, while close care housing is situated on the same site as a care home. Homeshare schemes match an older person with a spare room to a younger person who provides a set number of hours of help per week. Retirement villages are larger developments with shops, restaurants and gyms, often with personal care available. Co-housing communities, such as New Ground in North London — the UK’s first mixed-tenure cohousing for women aged 50 and over — are gaining interest as a way to combat isolation. Older People’s Shared Ownership (OPSO) allows those 55 and over to buy a share of a property, and almshouses and Abbeyfield provide charitable accommodation with varying levels of support.
Planning ahead: professional guidance and directives
Whatever path is chosen, experts emphasise the importance of early planning. Granigan advises clients to consider whether their current home — especially one with period features — can be adapted without losing the character they love. If not, moving may be better. She also urges people to prepare a full set of directives, including a healthcare proxy, power of attorney, and financial and estate affairs, and to involve family members or friends in the conversation long before a crisis hits. “You want to make sure that those things are lined up, articulated early, and reviewed often,” she says. “This is about letting your wishes be known, because then people can follow through.”
For those weighing the options, the starting point is often an occupational therapist’s assessment. That assessment can determine whether the home can be adapted — and at what cost — or whether a more fundamental change of address is the sensible course.