THIS TIME of year, it can take a stout heart to resist the phrase “home for the holidays.” A certain frayed rug or sticky drawer can be essential to feeling connected to the world. The more we age, the truer this is.

Many Americans have incorporated nursing-home visits into their December routines. But often, it is not by choice. No matter how caring the staff or festive the decorations, families and residents alike typically wish for a better alternative — if not home itself, then something more like it.

To those doing the wishing, these longings may feel hopelessly isolated. But quietly, like mounding snow, they are taking collective shape. Consider:

• In Vermont, a new program called Choices for Care allows government dollars to pay for home care rather than nursing homes.

• In more than 100 communities across the nation, neighborhoods are banding together to pay for services that can help older people remain in their homes longer. The organizations being formed charge dues to cover an array of services, from transportation to home repairs.

• In Massachusetts, an association of nonprofit organizations has begun setting up small group homes for frail or disabled elderly people. The homes are in residential neighborhoods rather than attached to health-care complexes, and include a live-in aide who can assist with special needs. The residents are people who can no longer live on their own but who thrive with a degree of independence they would not get in a nursing home.

• Gay elderly people who have felt themselves shunned in traditional nursing homes — and sometimes packed off to live with the severely disabled — are finding more adult facilities specifically geared toward them. In some places, caregivers are receiving special training in how to deal more sensitively with this population.

All of these efforts are in their early stages. But they are bound to pick up steam as Baby Boomers age, and increasingly demand more humane setups for the aged. So far, their demands are being made on behalf of their parents. But soon they will be speaking up for themselves, and in the longer run, for their children.

The cultural shift toward nursing-home care began accelerating a few decades ago, when more and more families found that they needed two paychecks. That left fewer people free to care for aging parents at home. Just as important, government policies created new incentives: Billions in federal dollars were funneled to nursing-home care, while other types of help received little or no support.

While nursing homes will remain vital in caring for the weakest and most chronically ill, too many older Americans resort to them prematurely. Health problems may make it hard to bend down and repair a sink, or to change a light bulb high overhead. But why should the inability to perform such minor tasks force a person into a shrunken, institutional existence — one that is likely to be more expensive at that?

In the private neighborhood model, first launched about six years ago on Boston’s Beacon Hill, some 400 members pay dues of $600 to $800 a year for a group of service providers they can reach with a single phone call. Compared with the costs of an assisted-living facility, the arrangement is a bargain. And members are able to hold on longer to the familiar comforts of home.

Vermont’s program has been authorized by the federal Older American Act. Recognizing that caring for the elderly at home is both cheaper than nursing homes and better for morale, it encourages states to experiment.

In Vermont, family members can receive hourly wages for providing care. Divorced spouses have gotten into the act, some reporting that they are getting along better this way than when they were married.

Such an approach is long overdue. Often with little help, hosts of Americans still heroically care for loved ones at home, forgoing wages and putting their own health at risk, because they find nursing homes an unacceptable alternative. Their situations tend to be stressful, lonely and hidden from view. Yet they have helped restrain the overall costs of federally subsidized nursing-home care.

Aside from paying these people, states that follow Vermont’s lead could find multiple ways of helping them. Elder day-care centers can give caregivers a rest, as can transportation systems geared to the elderly. The dollars currently allotted to nursing homes could buy a lot of assistance.

By and large, the nursing-home industry is resisting such changes. But some in the business realize that the old institutional model is dying. In some places, nursing homes are already being converted into assisted- or independent-living facilities.

In the near future, we are apt to see a broadening movement that makes more in-home options available — and makes more people aware of them. What’s hopeful is that Americans are putting new thought into how they want to age. Making the later years more fulfilling begins with an idea of home, a determination not to despair and, most of all, a willingness to speak up.

M.J. Andersen is a member of The Journal’s editorial board.