There is a significant gap between the number of U.S. adults who want to age in place and those who actually believe they will be able to do so.

That’s according to a new national survey involving 2,750 U.S. adults conducted by Edelman Research on behalf of Fresenius Medical Care North America (FMCNA), a product and solutions company specializing in kidney care.

Specifically, 65% of surveyed adults say they want to age in place. But only 33% — roughly half — believe they’re equipped to make that happen.

“We wanted to explore the perceptions of aging in place and uncover barriers, including social determinants of health and misperceptions around feasibility,” FMCNA CEO Bill Valle said in a report on the survey. “Given an aging population and an increase in chronic disease, innovations that help more people remain in their homes for longer will be welcomed by patients and the health system alike.”

There are a variety of reasons some older adults doubt their ability to age in place.

Of the survey participants, 29% said they don’t think they’ll have enough money to stay in their homes as they grow older. Another 24% of the adults said they don’t believe their homes are suitable to their needs as they age.

Nearly one-fifth of surveyed adults identified loneliness as an issue, with another 17% identifying proximity to family and friends as a challenge.

Generally, the FMCNA survey found that both preference and perceived ability to age in place increased with age, with the greatest generation and baby boomers being more likely to pursue aging in place than millennials or those in Generation Z.

Although not by a large margin, rural citizens are more likely than urbanites to want to age in place.

On average, in-home care costs about $50,000 for a full year, about half of what a nursing home facility would be.

Aging in place and SDoH

The survey also highlighted the significant role that social determinants of health play in whether people are able to age in place. The key takeaway: the more determinants they’re challenged with, the less likely they are to believe they can age in place.

“This research further demonstrates the importance of addressing social determinants of health to improve patients’ quality of life and the chances for aging in place successfully,” Felicia Speed, corporate director of social work services at FMCNA, said in a statement. “It also suggests we must continue to help educate patients about all the resources now available for people to receive care in their own home.”

The survey results may have been impacted by seniors’ general lack of knowledge about what kind of care can be delivered in the home and how well it can be delivered. Kidney patients, for example, still aren’t so sure whether they can receive dialysis anywhere other than a clinic or hospital.

Roughly 30 million people in the U.S. have chronic kidney disease (CKD).

In-home dialysis and kidney care is typically far less expensive than facility-based treatment. That’s why the Trump administration has experimented with implementing incentives for companies that have kidney-related home offerings.

But barriers remain: 50% of dialysis patients believe the quality of care would be better in a clinic or hospital, compared to the only 25% who believe the quality would be better at home, according to the FMCNA survey.

However, 54% said that they would choose at-home dialysis if they knew that the quality of care would be equal to what they receive in hospitals or clinics.

More than 80% of CKD patients prefer to age in place, but fewer than half of them believe they will be able to.

“With adults living longer than ever before and a looming shortage in caregivers, it is critical for the health care community to commit to a future where older adults can age on their own terms,” Valle said.