Growing old isn’t for cowards. Just ask anyone who’s been there. While only in my seventh decade, I’m beginning to understand what they mean.
Average life expectancy in the United States in 2017 is 78.6 years according to the National Center for Health Statistics. That’s actually a decline of 0.1 years from previous studies in 2015.
The average life expectancy in 1967 was just 67 years. Therefore, in the last fifty years modern medicine has increased our life expectancy by nearly twelve years. That means a lot of people living longer and needing assistance in their later years.
The Rise of Eldercare
If you’re in your eighth or more decade, you realize that time is getting short. If you’ve enjoyed good health thus far, you might even live into your nineties, but you’re certainly on borrowed time. If you’re a man your chances of reaching 100 are 0.48%; if you’re a woman they’re 1.66%. Do you feel that lucky?
Fifty years ago most people lived out their last years at home with the help of family members, friends, and the occasional assistance of home nursing. Today, an increasing number of people will end up in nursing homes as their health declines.
Dr. Atul Gawande, a Harvard general surgeon, writes in his book Being Mortal that nursing homes proliferated after a 1954 law was passed that provided funding to relieve hospital overcrowding. Then Medicare was enacted in 1965, which raised the federal standards and provided additional government support for hospitals and nursing homes. The number of nursing homes exploded and by 1970 some thirteen thousand had been built.
Naturally this wave of nursing homes was followed by reports of elder-abuse and tragedies. Gawande reports a nursing home fire trapped and killed thirty-two residents in Marietta, Ohio, that same year. In Baltimore, a Salmonella epidemic in a nursing home killed thirty-six elderly residents.
All of us have heard such stories and all of us have probably visited a nursing home to see a friend or relative at one time or another. Most come away from such experiences thinking, “I’ll never live in a nursing home myself!”
The Value of Freedom
Many modern nursing homes are beautiful structures and boast of nutritional meals, exercise facilities, activities coordinators and readily available medical care when needed. But residents of these facilities yearn for one thing that is seldom available – freedom. The interests of the nursing home management are principally safety and efficiency and that means rules and regulations that minimize risk.
But the interests of elderly residents conflict with these institutional goals. Most residents want to retain the freedom to live their lives on their own terms – with assistance only when absolutely necessary. They want to get up when they’re ready, eat when they’re hungry, and sleep when it’s necessary. They want to retain their mobility as much as possible, even at the risk of a fall that might be serious.
Keren Brown Wilson originated the concept of Assisted Living in the 1980s to serve the needs of her mother who refused to live in a nursing home. The concept was built around a facility that was as much like home as possible. At home you decide how you spend your time, how you share your space, and how you manage your possessions.
Wilson opened Park Place, in Portland, Oregon, in 1983 and the concept was an immediate hit. The State of Oregon closely monitored the residents and in 1988 they issued their findings. The residents’ satisfaction with their lives increased, and their health was maintained. Their physical and cognitive functioning actually improved. The incidence of major depression fell. And the cost for those on government support was 20 percent lower than it would have been in a nursing home.
Since that time the number of Assisted Living facilities has grown tremendously. Wilson’s company, Assisted Living Concepts, went public. By 2000, the company had grown to more than three thousand employees and by 2010 the number of people in assisted living facilities was approaching the number in nursing homes.
But that’s when the good news stops. Since that time the concept became so popular that developers started calling all kinds of facilities “assisted living” but without following the model that made Wilson’s original idea so successful. These newer facilities fell into the same trap that made nursing homes intolerable for many before – the loss of freedom.
Concern over safety and lawsuits increasingly limited what people could have in their assisted living apartments and what activities they were allowed to do. In many places it became a mere layover on the continuum from independent living to full nursing home care. If you’re in the market for an assisted living facility be sure it will provide the freedom you want. Remember, it’s your life – make the most of it while you still can.
(Next post: Growing Old – Life’s Most Difficult Challenge – Part II)