Yes. Being unable to live completely alone does not automatically mean that a nursing home is the only choice. At age 83, there are several intermediate options, depending on how much help you need, whether you need medical care, your finances, and whether you want to remain in your own home.
The National Institute on Aging describes several alternatives, including in-home care, assisted living, board-and-care/group homes, continuing-care communities, adult day care, and programs such as PACE.
The main alternatives to a nursing home
| Option | Where you live | Amount of help | Medical care | Best suited for |
|---|---|---|---|---|
| Home with paid caregivers | Your own home | Low to very high, depending on hours | Some, but not usually 24-hour skilled nursing | You want to remain home |
| Family member moves in | Your/family home | Moderate to high | Limited unless professional help is added | Family is available |
| Assisted living | Your own apartment/room in a community | Moderate | Some nursing/medication support | You need daily help but not intensive nursing |
| Adult Family Care / small group home | Caregiver’s private home | Moderate to substantial | Usually limited medical care | You want a smaller, home-like setting |
| Continuing Care Retirement Community (CCRC/Life Plan Community) | Apartment/cottage on a campus | Varies | Multiple levels available | You want a long-term plan as needs increase |
| PACE | Usually your home | Potentially substantial | Comprehensive medical/social services | You qualify for nursing-home-level care but can safely remain in the community |
| Adult day care + home care | Home at night; day center during day | Moderate | Some health services depending on program | You need daytime supervision/socialization |
| Nursing home | Facility | Very high | 24-hour nursing | You require ongoing medical/nursing care |
1. Staying in your own home with caregivers
For many older adults, this is the first alternative worth investigating.
You remain in your own home, but someone comes in to help with things you can no longer safely do.
Help can include
- Bathing and showering
- Dressing
- Getting out of bed or a chair
- Toileting
- Preparing meals
- Eating
- Taking medications/reminders
- Laundry
- Cleaning
- Grocery shopping
- Transportation
- Companionship
- Walking and mobility assistance
- Getting to medical appointments
These are often called activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
The National Institute on Aging notes that professional caregivers can help with personal care and household tasks, while home-health services can provide certain medical services such as nursing, wound care, medications, and physical therapy.
A very important distinction
There is a difference between:
Home care/personal care aide
- Helps with bathing, dressing, meals, toileting, housekeeping, companionship, etc.
and
Home health care
- Usually involves skilled medical services ordered for a particular health need, such as nursing or therapy.
Medicare’s coverage of home health is limited and generally does not mean Medicare will pay for someone to stay in your home around the clock simply because you need assistance with daily activities.
Could you have someone there 24 hours?
Potentially, yes, but it can become very expensive if paid privately.
For someone who is unsafe alone, a combination such as:
Family support + paid caregiver during the day + overnight arrangement + emergency response system
can sometimes allow the person to remain at home.
However, if you need continuous hands-on assistance, have frequent falls, wander, cannot manage medications, or need skilled nursing around the clock, remaining at home may eventually become impractical or unsafe.
2. Having a family member move in
Another possibility is that a son, daughter, sibling, or other trusted person moves into your home—or you move into theirs.
This can work particularly well when:
- You need help every day.
- You don’t require professional nursing 24 hours a day.
- A family member is willing and able to help.
- The home can be made safe.
- Professional caregivers can be added when the family member needs a break.
It does not have to be all-or-nothing.
For example:
Daughter lives with you + home aide 4 hours/day + adult day program 2 days/week
may provide much more support than either living completely alone or entering a nursing home.
Family caregiving should be planned carefully, however. The family member can become exhausted or unable to provide the level of care required. The NIA recommends considering the person’s needs now and what may be needed in the future.
3. Assisted living
For many people who say, “I can’t live alone anymore, but I don’t want a nursing home,” assisted living is the most obvious alternative.
You generally have your own apartment or room while staff are available to help.
Typical services may include:
- Meals
- Housekeeping
- Laundry
- Medication assistance
- Bathing
- Dressing
- Toileting
- Mobility assistance
- Transportation
- Social activities
- Exercise programs
- 24-hour staff/supervision
The major distinction is that assisted living generally provides more help with everyday living and less intensive medical care than a nursing home.
Example
Suppose you can:
- Walk with a walker
- Feed yourself
- Talk normally
- Use the bathroom, perhaps with some help
- Take medications if someone organizes them
- But you cannot safely cook, shower alone, clean, or manage the house.
You might be a good candidate for assisted living rather than a nursing home.
When assisted living may not be enough
A facility may say you need a higher level of care if you require:
- Extensive two-person transfers
- Continuous skilled nursing
- Complex medical treatment
- Frequent medical monitoring
- Severe behavioral problems
- Extensive dementia supervision
- Care that the facility is not licensed or staffed to provide
This is why you should ask “What happens if my needs increase?” before signing a contract.
4. Adult Family Care — a particularly interesting option in New Jersey
If you are in New Jersey, there is an option called Adult Family Care (AFC) that is worth investigating.
New Jersey describes Adult Family Care as an arrangement in which a person who can no longer live alone moves into the home of a caregiver who can provide needed assistance and supervision. It is intended to provide a more home-like environment rather than a large institutional setting.
This could be an attractive middle ground:
Your own home → Adult Family Care → assisted living → nursing home
rather than jumping directly from independent living to a nursing facility.
AFC homes are overseen through licensed sponsor agencies in New Jersey.
If you are actually located in New Jersey, I would put Adult Family Care fairly high on your list to investigate.
5. Small residential care homes / board-and-care homes
Another possibility is a small residential home with several older adults rather than a large nursing facility.
The NIA explains that board-and-care homes are generally small facilities, often with 20 or fewer residents. They may provide:
- Room
- Meals
- Personal care
- Supervision
- Household assistance
- Social interaction
but generally don’t provide the same level of nursing and medical care as a nursing home.
This can feel more like living in a house than living in a large institution.
Advantages
- Smaller environment
- More home-like
- Potentially more personal attention
- Meals provided
- Someone around
- Less institutional feeling
Disadvantages
- Usually less medical capability
- Fewer activities/services
- Availability varies considerably
- You must carefully check licensing and staffing
6. Continuing Care Retirement Community (CCRC)
A Continuing Care Retirement Community, sometimes called a Life Plan Community, is particularly interesting if you’re thinking about the next 5–15 years rather than just today’s situation.
A community may have:
Independent living → Assisted living → Skilled nursing
on the same campus.
You might initially live in an apartment, then move to assisted living if you need more help, and eventually receive nursing care if necessary. Some communities can also provide home care while you remain in your independent apartment.
Why this can be attractive at 83
You don’t necessarily have to make another major move every time your health changes.
You could say:
“I want to live somewhere where I can get more help later without having to start over somewhere else.”
But be careful about the contract
CCRCs can involve substantial entrance fees and monthly fees. Contracts differ considerably.
Before signing, have someone knowledgeable review:
- Entrance fee
- Monthly fee
- Refund provisions
- What happens if you run out of money
- What happens when you need assisted living
- What happens when you need nursing care
- Whether healthcare costs are included
- Whether fees can increase
- Whether you can transfer between levels of care
The NIA specifically recommends understanding costs and carefully reviewing the contract before signing.
7. PACE — an option many people don’t know about
PACE (Program of All-Inclusive Care for the Elderly) can be extremely important for someone who needs a lot of help but wants to avoid a nursing home.
PACE is designed for people who would otherwise qualify for nursing-home-level care but can still live safely in the community with PACE support.
It coordinates medical and social services and may provide services both at home and at a community PACE center.
If you’re in New Jersey, New Jersey’s PACE program says eligibility generally requires being 55 or older, needing nursing-home-level care, being able to live safely in the community with PACE services, and living within the service area of a PACE organization.
This is potentially a very good option for someone who says:
“I cannot manage by myself anymore, but I don’t want to go into a nursing home.”
PACE may be able to coordinate:
- Medical care
- Rehabilitation
- Adult day services
- Social services
- Transportation
- Home care
- Other long-term care services
Eligibility and availability are location-dependent.
8. Adult day care + help at home
This is another combination that is sometimes overlooked.
You could live at home but attend an adult day program several days per week.
A typical program may provide:
- Meals
- Social activities
- Exercise
- Supervision
- Personal care
- Some health services
- Transportation in some programs
Then you return home in the evening.
The NIA notes that adult day care can be substantially less expensive than either extensive home care or nursing-home care, although coverage varies.
For example:
Monday–Friday
8:30 AM — transportation to day program
9:00 AM–3:30 PM — supervised activities/meals
4:00 PM — return home
Evening — family member or home aide
Overnight — emergency response system/family arrangement
This can provide considerable supervision without moving into a facility.
9. A combination of services may be better than one solution
You don’t necessarily have to choose one option.
For example:
Moderate needs
Your home
+
home aide 4 hours/day
+
family visits
+
meal delivery
+
medical alert system
Greater needs
Your home
+
home aide 8–12 hours/day
+
adult day program
+
family overnight support
Still greater needs
Assisted living
+
additional private caregiver hours
This is why I would first determine exactly what you cannot safely do by yourself.
10. How to decide which option is appropriate
Think about these questions.
Personal care
Can you independently:
- Get out of bed?
- Walk safely?
- Get into and out of a chair?
- Bathe/shower?
- Use the toilet?
- Dress yourself?
- Eat?
- Take your medications correctly?
These are particularly important because difficulty with several basic activities of daily living often indicates that you need substantial assistance.
Household safety
Can you safely:
- Cook?
- Turn the stove off?
- Manage your finances?
- Shop for groceries?
- Do laundry?
- Clean?
- Get to appointments?
- Answer the telephone?
- Recognize an emergency?
- Call for help?
Medical needs
Do you need:
- Regular nursing?
- Wound care?
- Injections?
- Physical therapy?
- Oxygen?
- Complex medications?
- Frequent medical monitoring?
- Assistance transferring from bed to chair?
Cognitive/safety issues
Also consider whether you:
- Get confused about medications
- Become lost
- Forget to eat
- Leave appliances on
- Fall frequently
- Have difficulty recognizing danger
- Become confused at night
These issues can change which living arrangement is safe.
11. The most important question: “What happens if I fall?”
If you’re considering staying at home, don’t just ask:
“Can I live at home today?”
Ask:
“What happens if I fall at 2 AM?”
A medical alert/fall-detection system can help, but it cannot replace a person in every emergency. The NIA specifically cautions that emergency alert systems are not appropriate substitutes for regular supervision in every situation.
Similarly, ask:
“What happens if I suddenly become weaker?”
“What happens if I get pneumonia?”
“What happens if I need help getting out of bed?”
“What happens if I develop memory problems?”
The best arrangement is one that has a plan for those changes.
12. Paying for these alternatives
This is often the most difficult part.
Medicare
A common misconception is that Medicare pays for long-term custodial care.
Generally, Medicare does not pay for ongoing assisted living or a long-term nursing-home stay simply because someone needs help with daily activities. It can pay for certain medical services and limited qualifying home-health services.
Medicaid
Medicaid can potentially help with long-term care, but eligibility and covered services depend on the state and your financial circumstances.
Long-term-care insurance
If you have an existing long-term-care insurance policy, find it and read it carefully.
Depending on the policy, it may cover care:
- At home
- In assisted living
- In a nursing home
- Sometimes in other residential settings
Coverage varies substantially between policies.
Other resources
Depending on your circumstances, there may also be:
- Veterans benefits
- State programs
- Local aging services
- PACE
- Medicaid programs
- Community nonprofit assistance
- Personal savings/income
- Family contributions
13. If you’re in New Jersey
Since you may be in New Jersey, there are several things I would investigate specifically.
Adult Family Care
As mentioned above, New Jersey has an Adult Family Care program for people who can no longer safely live alone but may be able to live in a caregiver’s home with assistance and supervision.
New Jersey Division of Aging Services — Housing Options
PACE
New Jersey also has PACE programs for eligible older adults who need a nursing-home level of care but can safely remain in the community with appropriate services.
The exact programs available depend on your county and circumstances.
14. What I would do before choosing a nursing home
I would not make the decision simply based on age (83).
Instead, ask a doctor, geriatrician, social worker, or care manager to assess:
“What level of care do I actually require?”
Then investigate options in this order, depending on your situation:
If you mostly need help with household tasks:
Home care
If you need daily personal assistance:
Home care, adult day care, or assisted living
If you want a smaller, home-like setting:
Adult Family Care or a small residential care home
If you need substantial assistance but want to stay in the community:
PACE, if available and eligible
If you want a long-term housing plan:
Continuing Care Retirement Community
If you require continuous medical/nursing supervision:
Nursing home may ultimately be the safest option
15. Don’t automatically think of a nursing home as “giving up”
A nursing home can actually be the right choice when someone needs 24-hour nursing care. The goal isn’t to avoid nursing homes at all costs.
The goal is:
The least restrictive setting that is still safe and provides the care you actually need.
If you can live safely with appropriate assistance at home, that’s wonderful.
If you need assisted living, that’s not a failure.
If you eventually need skilled nursing, that isn’t a failure either. The appropriate level of care can change over time.
The NIA recommends considering both your current needs and the possibility that your care needs will increase, and visiting facilities personally before making a decision.
A very practical next step
If you tell me (1) what you can and cannot do by yourself, (2) whether you have family nearby, (3) whether you use a walker/cane or wheelchair, (4) whether you need help with bathing/toileting/medications, (5) whether you have memory problems, and (6) whether you are in New Jersey or another state, I can narrow this down to the 2–4 most realistic alternatives for you, explain the likely level of care, and show you how to investigate the costs and available programs in your area.