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Aging in Place: What is Independence?

by Louis on December 8, 2010

We often talk about Aging in Place as if it is synonymous with independence. Then some people, pointing out the need many older folks have for assistance, say it cannot work. Why the discrepancy? We must get a handle on what independence is to figure it out.

I have built houses and much more, but never cut down a tree. I rely on others to cut the trees, get them from the woods, dry the logs, turn them into boards and deliver them to my job site. I use milk in my coffee but have never milked a cow. The milk I use comes from cows I will never see through a long supply chain to my grocery store. When I was a kid the supply chain extended all the way to my door.

No one thinks I am not independent because I rely on these networks. They think I am independent because I chose my career and decide how to have my coffee. Independence is not feats of self reliance, but the fact of control and choices.

As Judith E. Heumann, cofounder of the World Institute on Disability, put it, “Independent living is not doing things by yourself, it is being in control of how things are done.”

The mechanism by which Aging in Place bestows independence is by providing control.  You decide when to go to sleep, wake up, when and what to eat for breakfast and all manner of other things. In contrast, when you live in a facility others decide about the menu,  eating arrangements and schedule, visiting times, bathing and lights out. Decisions and choices are the essence of self respect and provide the feeling of independence.

Some will counter that even in your home you may have to fit to the schedule of those providing assistance, meals, transportation and more. To explain this seeming paradox we must understand the importance of choice.

To do so I refer to Katherine Freund, a dedicated advocate and founder of the Independent Transportation Network, the grandest, most innovative and respected transportation alternative for seniors living independently. Whether the world joins ITNAmerica or ITN merely serves as the model, Kathy’s contribution will be remembered for a long time. I met and grew to like her at the recent Aging Means Business conference attached to the Gerontological Society of America meeting in New Orleans last month.

Kathy operates with incredible respect for her client base. She understands and cares how people feel about their situation. Kathy recognizes that making individual decisions about where to go and when fuels our love affair with the car. It is about independence. As a transportation system operator she also knows that scheduling is key to her system. How to marry independence and the need to schedule? Choice. Kathy gives folks the choice of having same day trasnportation OR cutting the fee in half for trips scheduled more than 24 hours in advance. And it works.

Given a choice we can feel good about our decisions. That makes us independent. When we have no choices we lose self respect, self esteem, may grow depressed. Similar results come from the Cash and Counseling programs. Clients given choices about how to spend limited dollars were more satisfied with the results than clients who had no choice.

So, why do we prefer Aging in Place? Because we choose to do so, because we choose how to spend our time in our own home.  That choice is Independence.

{ 2 comments… read them below or add one }

Patrick Roden December 9, 2010 at 4:25 pm

Key distinction on independence Louis, thanks for bringing language to it–helps the rest of us in the service to others.

Best, Patrick


J Steele, CAPS, CGR, CGP December 10, 2010 at 2:32 am

Very well put Louis! now tweeting….


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