Carol Silver Elliott

Finding Freedom

In the world of older adult care and services, the process of evolution has been a constant.  In the words of Maya Angelou, “Do the best you can until you know better.  Then when you know better, do better.”  It’s a process that’s been followed, at varying speeds and over varying obstacles, over the course of many years.

There was a time when those working in long term care saw elders as helpless and without choices or preferences.  The elders were “herded” here and there, shared rooms with one, two or even three other individuals and had everything determined for them.  It was not just staff-driven, it was fully a model based on the decisions made by the staff. The elders were seen as a commodity and they were cared for in that way.

Eventually the world began to shift.  Elders began to speak up and express themselves and families did the same.  Change was in the air, and it resulted in an emphasis, both in the elder care world and by regulators, on elder focused care.  That meant we’d finally recognized that these were individuals who needed to be seen as individuals.

Fast forward to the world today in which we talk about elder-directed care, taking the next step and understanding that neither age nor disability erases the opportunity and desire for choice.  Neither age nor disability erases individual preferences and a need for purpose.  Caring providers know this and work hard to see each person as just what they are—a person.

When we do that, when we recognize that each elder is an individual, we also begin to acknowledge that their wants and needs may produce a conflict with our commitment to safety.  As an example, what if an elder wants to take an independent walk every day?  Well, if they live at home in the community, that is no problem.  But if they move into a licensed facility, from assisted living to, especially, long term care, we begin to worry about safety, about someone getting lost, about falls, about elopement.

We have to balance risk and rights and those scales are difficult to manage.  As adults, we are very accustomed to our self-determination.  We know what we need, and we know darn well that no one better stand in our way if this is something we strongly want.  But once we cross the threshold of a facility, perhaps because we need more help, perhaps because our multi-story home is too much for us, perhaps because our children are worried, all of our choices seem to be subject to someone else’s control.

For those of us who work in the field of aging services, this is a frequent and challenging discussion.  I often find myself asking others “What would YOU want?” and “What would matter to YOU if you lived within our walls?” As professionals, as family members, as human beings, we must learn that older adults are not “them” but, rather, they are “us.”  They are not diagnoses or room numbers or problems to be solved. Rather, they are people who have given greatly in their lives and deserve respect and recognition and dignity and freedom.

About the Author
Carol Silver Elliott is President and CEO of The Jewish Home Family, which runs NJ's Jewish Home at Rockleigh, Jewish Home Assisted Living, Jewish Home Foundation and Jewish Home at Home. She joined The Jewish Home Family in 2014. Previously, she served as President and CEO of Cedar Village Retirement Community in Cincinnati, Ohio. She is past chair of LeadingAge and the Association of Jewish Aging Services.
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