Ask a retiree where they plan to live at 85 and the answer is overwhelmingly "right here." Ask how the house will be paid to accommodate that, and the plan usually stops.
The Preference Is Nearly Unanimous. The Confidence Isn't.
A Pew Research Center survey of 2,582 adults ages 65 and older, fielded September 2–8, 2025, found that 93% currently live in their own home or apartment. Asked where they would prefer to be cared for if they needed help, 60% chose staying in their home with someone caring for them — more than three times the 18% who picked assisted living.
But preference and expectation diverge sharply. Among those who want to age at home, only 37% called it "extremely or very likely" to actually happen, and 18% said it was "not too or not at all likely." By comparison, older adults who expected to move in with family were far more confident, with 58% rating it highly likely.
The financing gap helps explain the hesitation: just 21% of adults 65 and older hold long-term care insurance.
What the House Actually Needs
AARP's Home & Community Preferences research has found that roughly 43% of adults 50 and older believe their current home would need modifications to be safe and accessible — even as 75% say they want to stay in it.
Those modifications are not trivial line items. Contractor pricing for 2026 puts a curbless walk-in shower at $6,000–$10,000, a fully accessible bathroom at $8,000–$25,000, a straight stair lift at $2,200–$8,500, and a whole-home retrofit anywhere from $18,000 to $75,000. AARP's own estimate for a meaningful home modification project runs $10,000 to $50,000.
The Medicare Misunderstanding
Here is the assumption that quietly wrecks the budget: Original Medicare does not pay for this. Grab bars, ramps, stairlifts, walk-in tubs and bathroom renovations are treated as home improvements, not medical care — and they are excluded regardless of medical necessity. Medicare Part B covers durable medical equipment that is medically necessary and physician-prescribed, which captures hospital beds, bedside commodes and shower chairs, but stops at anything permanently attached to the house.
Some Medicare Advantage plans do fill part of the gap, typically with allowances in the $500–$2,500 per year range. That coverage is now thinning. KFF's 2026 Medicare Advantage analysis found the share of Special Needs Plans offering bathroom safety devices fell to 47% in 2026 from 54% in 2025. Among individual (non-SNP) plans, only 21% offer the benefit at all, and just 7% offer in-home support services.
Running the Math Anyway
The case for spending the money is that the alternative costs more. CareScout's 2025 Cost of Care Survey, based on provider data collected July through November 2025, puts the national median for assisted living at $6,200 per month — $74,400 a year, up 5%. A non-medical home health aide runs a median $35 an hour, or roughly $80,080 annually at 44 hours a week.
Against those figures, a one-time $25,000 retrofit is roughly four months of assisted living.
There is a safety return as well. The CDC reports more than one in four older adults falls each year, producing about 3 million emergency department visits and 1 million hospitalizations annually. The average hospitalization following a fall cost $53,889 in 2021. A 2025 systematic review of 20 home-modification studies found 65% confirmed effectiveness, with one trial measuring a 39% reduction in falls.
Practical Takeaways
- Budget it as a real expense. Treat a $10,000–$50,000 modification reserve as a planned retirement outlay, not a contingency — ideally funded before you stop working, while cash flow and borrowing capacity are strongest.
- Verify before you enroll. If you rely on a Medicare Advantage home-modification benefit, confirm it during open enrollment each year. These benefits vary by county and are being trimmed.
- Start with the cheap wins. Grab bars run $100–$350. Improved lighting, handrails and non-slip flooring address the majority of fall risk for a fraction of a full retrofit.
- Sequence the work. Bathrooms and entry access deliver the most risk reduction per dollar; elevators and whole-home retrofits rarely need to come first.
- Don't confuse DME with construction. A prescribed shower chair may be covered; the walk-in shower it sits in will not be.
Sources: Pew Research Center, KFF Medicare Advantage 2026 Spotlight, CareScout 2025 Cost of Care Survey, CDC Older Adult Fall Prevention, AARP Home & Community Preferences Survey