Staying or going? A worksheet for the biggest decision
There is no right answer, only the one that fits. Most families decide in a crisis, with the fewest options; doing this worksheet a year early is the best thing you can do. Look at five things together: health and care, the house, money, people, and timing. On the Cape, add septic, winter isolation, and where care actually exists.
- Decide before a crisis — options shrink afterwards.
- Five areas: health, the house, money, people, timing.
- Staying with help works until the hours grow towards round-the-clock.
- Affordable senior housing has long waiting lists: apply early, as a parallel track.
- The Cape adds septic, winter isolation and scarce local care.
Paying for it: every way to pay for care, with 2026 limits.
A quick self-check
Tick each that is true today. The more ticks in the right-hand column, the more a move deserves a serious look.
| Points to staying | Points to a move |
|---|---|
| ☐ Bedroom and full bath on the main floor, or could be | ☐ The only bath is upstairs and can’t move |
| ☐ Can still drive, or rides are easy | ☐ No longer drives and the house is isolated |
| ☐ Family or friends nearby who help | ☐ Nobody close enough to notice a problem |
| ☐ Care needs are a few hours a week | ☐ Care is heading towards round-the-clock |
| ☐ Upkeep is manageable or affordable | ☐ Roof, yard, snow and septic are overwhelming |
| ☐ Winters feel fine | ☐ Winters are lonely or frightening |
1. Health and care
- What help is needed today, and what is likely in two years?
- Could the person be safe alone overnight? After a fall?
- How far is the doctor, pharmacy and hospital — and who drives?
2. The house
- Is there a bedroom and full bathroom on the main floor, or could there be?
- Who does the roof, gutters, lawn, snow and the septic?
- How isolated is it in January, with summer neighbours gone?
- What would it cost to adapt? See why Cape houses are hard to grow old in.
3. Money
- The monthly cost of staying, including help at home — see what care costs on the Cape
- The monthly cost of the alternative
- What the house would leave after a sale, and how long it would pay for care — the Will the house cover care? calculator does this in a minute
- Unclaimed help: tax relief, fuel help, veterans’ benefits
4. People
- Who is nearby, and how much can they really do?
- If there is no family close by, who would notice if something went wrong?
- What would the person lose by moving — friends, church, the view — and what would they gain?
Your Council on Aging knows the town and the options, and talking it through is free:
| Barnstable Barnstable Adult Community Center (Senior Ctr) | 508-862-4750 |
| Bourne Bourne Council on Aging (Veterans' Memorial Community Ctr) | 508-759-0600 x5300 |
| Brewster Brewster Council on Aging / Senior Center | 508-896-2737 |
| Chatham Chatham COA / Center for Active Living | 508-945-5190 |
| Dennis Dennis Center for Active Living (DCAL) | 508-385-5067 |
| Eastham Eastham Council on Aging / Senior Center | 774-801-3151 |
| Falmouth Falmouth Senior Center | 508-540-0196 |
| Harwich Harwich Council on Aging (Community Ctr) | 508-430-7550 |
| Mashpee Mashpee Council on Aging / Senior Center | 508-539-1440 |
| Orleans Orleans Council on Aging / Senior Center | 508-255-6333 |
| Provincetown Provincetown Council on Aging | 508-487-7080 |
| Sandwich Sandwich COA (Center for Active Living) | 508-888-4737 |
| Truro Truro Council on Aging / Senior Center | 508-487-2462 |
| Wellfleet Wellfleet COA / Adult Community Center (WACC) | 508-349-2800 |
| Yarmouth Yarmouth Senior Center (Div. of Senior Services) | 508-394-7606 |
5. The options, side by side
| Option | Works well when | Watch out for |
|---|---|---|
| Stay and adapt the house | One-floor living is possible, and help is nearby | Septic limits on adding a bedroom |
| Stay with help coming in | Needs are a few hours a day | Cost if needs grow to round-the-clock; agency minimum visits |
| Move to something smaller on the Cape | The house is the problem, not health | Few small, single-level homes come up |
| Move near family off-Cape | Family can’t travel here | Starting again at 80+ |
| Independent or assisted living | Isolation or daily care is the problem | Few Lower Cape options; see levels of care |
The parallel track most families miss
Affordable and subsidised senior housing on the Cape has long waiting lists, and you usually apply separately to each housing authority or development. So families who might need it should apply early, to several lists at once, while staying put — not wait until a move is urgent.
| Help applying for affordable and senior housing Housing Assistance Corporation (HAC) — Senior Housing | 508-771-5400 |
The questions only the Cape asks
- Septic. Selling usually needs a Title 5 inspection; transfers within the family can be exempt. See the septic article.
- Timing. The Lower Cape market is seasonal, but less than people assume, and carrying an empty house costs money every month. See does the season matter?
- Where the care is. Most Lower Cape towns have no assisted living of their own, so “staying in town” may not be an option later.
- The order. Sell first or move first? See the trade-off.
Mistakes families make
- Waiting for a fall or a hospital stay to force the decision.
- Deciding for a parent instead of with them.
- Comparing the cost of care with nothing — staying has costs too.
- Waiting to apply for affordable housing until it is urgent.
- Assuming selling is the only way to use the house.
For professionals and organisations
Care managers, Councils on Aging, social workers: the self-check and the options table make a good structure for a family meeting, and print on three pages without our sponsor box. See how to use these guides.
Common questions
How do I know if it is time to move from my home?
Look at health and care needs, whether the house works on one floor, money, who is nearby, and how isolated winters are. If several point to a move, explore options early rather than waiting for a crisis.
Is it cheaper to stay at home with care or move to assisted living?
It depends on how many hours of help are needed. A few hours a week at home usually costs less; round-the-clock care at home often costs more than assisted living. Compare actual monthly costs for your situation.
How long are waiting lists for senior housing on Cape Cod?
Often long, and each housing authority or development keeps its own list. Apply to several at once, early. The Housing Assistance Corporation helps people apply.
General information about how things work in Massachusetts and on Cape Cod, not legal, tax, financial or medical advice. Figures and rules change: the date each fact was checked is at the top of the page. How we check facts · Report a mistake.