First, the profile of the typical senior I'm working with: They've lived in their home for 40-50 years, purchased back when a dollar was a dollar, raised their family there, their kids are all gone, maybe their spouse is too. There's been a lot of turnover in the neighborhood, lots of young families moving in, new languages being spoken. They are still connected with their place of worship, maybe don't get there every week, a couple of old neighbors are still around here and there, they may still be driving (maybe not so well at night.) One or two of their kids live in the area, but they don't see them as much, what with their busy lives. It's getting a little lonely, a little isolating. The 4-5 bedroom house is getting older too, and requires attention in order to get through its own aging process. It's not that much fun when a handyman or contractor comes in to do a job. They worry about being taken advantage of.
Aging in Place: This is certainly the first option many folks consider, and try to make a go at it to various degrees of success. Health/mobility modifications can be made to the home ie. Ramps, grab bars in the shower, changing the tub for easy access, moving down to the first floor to avoid those darn steps. If some assistance with activities of daily living (ADLs) is needed, private caregivers can be brought it. If they get lucky they'll have one or two who are kind and attentive and will stay with them for a few years. If not, they may experience a revolving care-giver door, with one of their busy baby boomer kids managing that door from his smartphone. There are agencies that can be counted on to help counter isolation by connecting them with more reliable caregivers and contractors, maybe even providing transportation to doctor's appts or shopping. Aging in place has its pluses and minuses. Staying in your long-time home is comforting and proves to the world you can take care of yourself (with a little help from your friends). It also gives one the sense that they can put off the inevitable, a buffer against father time.
Moving in with the kids: Certainly a possibility in some instances. More often seen in certain cultures. Grandparents moving in can remain busy and "useful" (babysitting, taking kids to and from school, gardening, tinkering around the house.) Sometimes this can work for a while as long as folks are still relatively healthy, but can become a burden and distraction when care is needed. I don't usually get a lot of hands up when I ask the question at our senior living seminars to see how many folks think this may be a viable option. Even less when I ask how many think their kids would jump at this opportunity.
55+ Active Senior Community: Communities like The Villages in San Jose, usually built around a golf course for example, are geared for those newly or recently retired folks closer to 55 years of age. Very active lifestyle, clubs, clubhouse, community events are offered. Generally a buy-in or condo purchase with a monthly maintenance fee. Medical or caregiver services are not offered or not included.
Monthly Assisted Living or Independent Living rental communities: Numerous, multiple locations, varying quality of services and lifestyle. Generally geared to a working/middle-class population. No buy-in fees. Generally no long-term contract, basically month to month, which does lead to more turnover than you would see in a buy-in or equity purchase community, which can mean your neighbors are changing just when you've gotten to be friends. I've worked in an independent living community in Silicon Valley that was well-run, the residents were generally very satisfied, there were activities every day, transportation was provided. Biggest draw was probably having three meals per day included in the fairly reasonable monthly fee. Quality of the food I would rate a "B". Caregivers could be hired from an agency with an office in the building.
Continuing Care Retirement Communities: These communities provide all or access to the various levels of care one might require as they age: Independent Living, Assistant Living, Nursing/Rehab, Memory Care. Examples of these include Saratoga Retirement Community, The Moldaw Residences, the Vi and the Forum. The financial model is generally an 80% or 90% returnable entrance fee plus a monthly maintenance fee, or an equity purchase where you are generally using an in-house Realtor to buy and sell the unit, plus a monthly fee as well. If equity build-up is offered it may be shared with the community when you sell your unit. These communities usually offer numerous amenities, generally handsome, well-appointed apartment homes, a concierge service, valet parking, health and fitness clubs, one or two swimming pools, cultural and artistic opportunities. Basically for a more affluent clientele, fine dining is the norm. Whether purchasing the apts or paying an entry fee, the residents of these communities feel a sense of ownership and have a strong interest in the overall maintenance and upkeep of the community. There is also less moving in and out, so sense of community is fairly highly developed. In terms of the higher levels of care, some communities have a pay-as-you-need-it policy, while others in essence have you pre-pay for all or some of the care you may or may not require. Those communities generally have a higher entrance fee, monthly fee, or purchase price. Some communities may have a small number of below market rate (BMR) apts available. Keep in mind these are NOT low-income, subsidized apts, but rather sell for below the "market rate." For example: the full market rate for a 1 bedroom might be $600,000 with a monthly fee of $3300. This same unit in the BMR program could cost $350,000 with a $2400 monthly fee. The percentage of the returnable portion of the entry fee would be lower in the BMR program.
Getting back to my original question "Should I stay or should I go": the decision can become clearer once folks do some research, visit some communities, talk to those who have made the move, and build up their knowledge base about what's out there and what it takes to make the move once they've made the decision that now is the time. Note: To those who say "I'm going to wait until something happens" I can only say that if that's your plan of action (or inaction) when that time comes it may be too late to health-qualify to move into independent living communities or CCRC's that have the various levels of care. Some communities turn down 50% of applicants, some apparently healthy, who have diagnosed conditions which will sooner rather than later require higher levels of care, causing the community to use up more of its resources. Thus waiting can result in a sharp narrowing of your options. And who wants that?