Magazine article USA TODAY

An Aging America Faces the Assisted Living Alternative

Magazine article USA TODAY

An Aging America Faces the Assisted Living Alternative

Article excerpt

"The challenge for society will be to provide affordable, safe, and high-quality facilities that respect the independence, dignity, and autonomy of the elderly."

AMERICA'S POPULATION is getting older and, along with it, there is a dramatic rise in the need for long-term care. Advances in medical science, greater access to health care, improved nutrition, and better living conditions have contributed to longer life expectancies. These improvements have made seniors, 85 and over, one of the fastest-growing sectors of society. This growth in the number of older people, coupled with lower fertility rates, has significantly increased the age of the population, contributing to the graying of America.

Another factor in the need for long-term care has been the increased survival rates for those born with serious disabilities and others who have been permanently disabled later in life. Many with diseases such as Alzheimer's, diabetes, or arthritis find themselves requiring assistance with activities associated with daily living, like bathing, dressing, preparing meals, and taking medications.

Dealing with the effects of chronic disease, disability, and aging present enormous challenges for society. The long-term care available for individuals in those circumstances has resulted in conflicts between some of Americans' most cherished values, in particular the desire to live independently and the need to be safe and secure. It has also raised questions about assuring quality of care and determining access to such services. Assisted living has developed in response to those issues as an alternative way for housing and caring for the frail elderly and disabled.

One of the greatest fears of the elderly is the loss of the ability to live independently. Their desire for autonomy can be thwarted by the reality of requiring regular assistance in their daily lives. This tension is often manifested as a conflict between the interested parties. Adult children and governmental regulators are typically concerned with the safety of the elderly. Their interests lie in protecting seniors from the possibility of a negative outcome such as a fall, even if that protection means a limitation on choices for the elderly. The latter, on the other hand, typically prefer more freedom, even if that means assuming more risk. To complicate matters, the elderly often suffer from chronic diseases that limit physical and cognitive functioning and raise questions in the minds of their children and professionals about seniors' ability to decide what is in their best interests.

My experience with my mother illustrates this conflict well and helps explain the growing popularity of assisted living as a form of long-term care. In 1969, she suffered the first of several severe strokes. By the time she died in 1979, she had spent the better part of a decade as a resident of many nursing homes. During most of this period, I was the person with primary responsibility for her well-being. It also happened that I was pursuing a career in gerontology, so I was well-armed with theory, data, and professional advice. Most of it was for naught. She wanted to eat what she had always eaten, smoke when she wanted, have her cat, and control her own medication. In short, she wanted to live a normal life as she defined it. I wanted someplace where they would take good care of her, even if it meant giving up most of the things that made life worth living for my mother.

Ultimately, this resulted in her moving herself from the nursing home I had selected to one that was more to her liking--without my knowing about it beforehand. The new place was a firetrap. She was on the second floor in a wheelchair with no elevator or ramp. The home smelled and showed evidence of rodents. Nevertheless, she liked it and wouldn't leave because it gave her more control over the things that were important to her.

Since that time, I have seen and heard many similar stories in other families. …

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