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Aging in place

GEM Healthcare Services > Blog > Aging in place
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Aging in place, Home care

Making plans for aging in place 

What to do when seniors say the only way they’ll leave home is ‘in a box’

When individuals express the idea that they want to stay in their own home until they die, family members must navigate the complexities of simultaneously respecting the person’s autonomy, ensuring safety, and managing ethical issues. 

The desire to age at home typically stems from wanting to stay where things are familiar and comfortable. It can be very hard for older people to admit they can no longer manage to live independently and many seniors do not acknowledge the risks of caregiver burnout when caring for a spouse until they are completely overwhelmed. 

“I hear this wish about aging in place expressed a lot, but people haven’t always thought it through, says Gaye Moffett, founder, president and CEO of GEM Health Care Services. “It is possible to stay in your own home until the end,” she adds, “but people need to understand the impacts—financially, emotionally and physically.”

GEM Health Care Services has some practical advice to offer when navigating this situation: 

Communication is key

  • Communicate collaboratively: Consider questions like, “What home care supports can we organize together to make sure you’re safe here?” 
  • Research options together: Modern senior living options may be unfamiliar. Taking a tour with aging parents can help them better weigh the benefits of making a move versus staying at home.
  • Consider the financial aspects: Gaye notes that a conversation she has often with families includes helping to identify the costs of home health care services versus retirement homes.

Important logistical steps

  • Conduct a safety audit and implement needed modifications: GEM can recommend home safety audit providers; they can identify and address physical risks, including necessary home modifications as well as monitoring services.  
  • Consider a gradual introduction of in-home care services: Seniors are often more willing to accept help if they understand it’s part of what is necessary to stay in their own home. A good way to begin is with house cleaning or social companionship, just some of the services GEM provides, or other non-medical services like grocery or meal delivery. 
  • Contact Ontario Health atHome: this organization coordinates local home and community care, long-term care placement and accessing community supports; they can also help families with equipment related to home health care.
  • Create a back-up plan: It’s crucial to understand what needs to happen should the primary caregiver become incapacitated due to illness or injury. GEM can help organize care in an emergency, but it’s always better to have a plan in place.

“We have encountered this aging at home situation hundreds of times over the past 30+ years GEM has been in business,” notes Gaye. “We have loads of experience working collaboratively with families plus medical and other professionals to implement a geriatric care management plan and ensure regular re-evaluations of the plan as needs evolve.”


“Aging in place can work for most families, with proper planning and execution,” Gaye confirms. “We have a wealth of knowledge to share, such as important questions to ask your accountant about tax benefits related to home health care. We can even facilitate some of the difficult conversations families in this situation typically need to have.”

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Advocacy, Aging in place, Family, Home care, Legislation

Why helping families pay for home care makes sense

For seniors, aging-in-place at home is the most comfortable, safe, and affordable option.

That’s why Gaye Moffett is on the board of Home Care Ontario, to work closely with other home care advocates to keep their work top of mind with every level of government.

Here’s what they’re working on right now to get families more support:

Home care co-payments and tax credits

Right now, anyone admitted to a long-term care facility only pays part of the cost. The government subsidizes the rest. 

As an alternative to moving people to a long-term care facility,  Gaye is advocating for a co-pay option to support clients at home. It’s a good investment for the government to make. With less overhead, providing care at home is more cost-effective than at a facility.

Other government incentives are also on the table, such as enhancing tax credits like the Ontario Seniors Care at Home (OSCAH) tax credit, and exempting family-funded care from sales taxes like the HST.

Raising the reputation, visibility and awareness of family-funded home care

One of the biggest challenges home care providers face is the invisibility of the work they do.

When you drive past a hospital or long-term care facility, you know there are people being cared for within those walls. It’s easy to forget that care is also being provided in people’s private homes.

Gaye and her colleagues are raising awareness by advocating for accreditation for family-funded care providers, agency licensing, an authority to over see allied health, and stronger enforcement of labour standards in the grey market to protect people from unlicensed ‘caregivers’ advertising their services on Kijiji.

Contributing to health system transformation

With health system transformation underway due to the pandemic, Gaye wants people to know how family-funded care providers are contributing to those efforts.

That’s why they’re sending educational materials to Ontario Health Teams (OHTs) about their work. 

They’re also engaging the OHTs directly to explain why enhancing home care services is a better option than creating ‘add-on’ services via retirement homes, which come with overhead costs similar to long-term care facilities.

For Gaye and her fellow advocates, investing in home care just makes sense.

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Aging in place, Family, Home care, Long term care

How to talk to your family about future planning

“The only way I’m leaving my home is in a pine box,” is what people often say when the topic of future planning is broached, no matter how sensitively or carefully.

Gaye Moffet’s response to that comment is, “Okay. Let’s plan for that.” 

Because the only way to truly safeguard our autonomy and independence as we age-in-place is to have a plan.

Fortunately there are tools we can use to make sure we’re taken care of the way we want. That said, it’s not an easy topic to broach with your family over dinner. 

Here are a few tips to be proactive when it’s time to start this difficult conversation.

Keep it practical: start with low hanging fruit

Before delving into any conversations about home care or long-term care, start by encouraging or helping your loved one choose their Powers of Attorney, including a Power of Attorney for Personal Care and a Continuing Power of Attorney for Property.

Designating a trusted person who will respect your wishes if you’re unable to make them yourself is the best way to prevent the government from stepping in and taking over. 

Inviting your loved ones to talk about Powers of Attorney can also open the door to completing other documents, like advance directives and a will.

What’s critical is keeping your loved one’s wishes at the heart of the conversation and emphasizing that writing them down will make it easier for someone else to know and respect what they want. 

Respond quickly during crucial moments

Often the first big loss of autonomy and independence comes when a doctor has to suspend a patient’s driver’s licence for safety reasons.

It’s a big blow, but it could be a chance for the family to come together to make sure their loved one will get what they need and stay engaged with the community.

It can also be the catalyst to talk about downsizing and moving closer to family, or possible to an easy-to-manage residence with the amenities they need.

And if the rest of your family isn’t engaged in future planning yet, moments like this can be a good time to pull them in so everyone is thinking about how they can help. 

Getting everyone involved will prevent caregiver burnout and possibly another crisis where your loved one’s choices are suddenly limited.

Continuing to emphasize that your loved one’s autonomy and independence is what’s most important. 

Connect and engage by listening first

While broaching the right topic at the right time is a good start, it can still be easy for emotions to get high. 

Gaye’s advice applies here as well: let’s plan for that.

Don’t forget that these are tough topics. The future we’re discussing is one where someone we love can’t live independently or worse, is no longer with us. Who wouldn’t get emotional? 

When feeling run high, we bring our own personality and ways of coping into the mix, whether it’s responding with anger, sadness, grief, or denial. These are just normal reactions to difficult situations, so don’t judge yourself or anyone else for how they’re reacting. 

Just know yourself and prepare, because what happens when we’re not grounded isn’t always pretty. We’re all capable of being patronizing, irritated, manipulative or dramatic. And it could lead us to call in reinforcements and make our loved one feel like we’re ganging up on them.

All that can be prevented by simply listening. 

Start by asking your loved one questions about what they want, then listen carefully and repeat back what was said so they know they’ve been heard before you weigh in with your own thoughts, opinions and needs. They’re important too, but your loved one needs to know they’re the one who’s in charge of what’s going to happen. You can show that by listening.

Other ways to keep the conversation constructive are:

  • using other people’s situation as an example
  • providing print materials so they have something to refer to while reflecting
  • writing down your concerns if having a conversation isn’t working
  • offering to help with research into their options
  • avoiding words like ‘a home’ or ‘nursing home’

Remember to ask for help if you need it

If you’ve tried everything and feel like you’ve hit a wall, it could be time to bring in a third-party expert who your loved one will trust to be neutral and provide straightforward, helpful information.

Gaye Moffett has been advising families with care planning for decades and has likely heard a story similar to yours.

You can get in touch with Gaye by calling 613-761-7474 in Ottawa or in 905-836-6999 in GTA.