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Carol Silver Elliott

Thinking Beyond

For those of us who work with older adults, and for those of us who have older adults we care for in our lives, the conversation about “what comes next” is often a complicated one.  It’s one that many of us, in our own families, would prefer to avoid and sometimes don’t have until the situation has become a crisis.

When we do reach that point of needing to make changes in our loved one’s care and/or living situation, the first thought is often to find a residential setting for the elder.  So often we get calls from family members who tell us that they think their loved one “needs to be in a nursing home.”  And there are times that is completely true.  The individual needs care and support around the clock and would benefit from an environment that supports health, both physically and emotionally.

But sometimes that is not the answer.  Perhaps the loved one is struggling to manage at home and is isolated.  Maybe assisted living is the right environment or independent living is the answer.  And maybe the answer is staying home with some additional assistance.  The answers are as individual as the elder.

How do we know the right thing for our loved one? How do we begin the dialogue before we are trying to manage a situation that feels, or is, out of control?  For all of us, professionals and family members, we must start with recognizing that the answers are not ours to determine.  The elder must have the opportunity to have a voice and to express their desires.  Asking the individual what matters to them can, and will, illuminate the path forward.

Often we place the priority on safety and, while that is important, that is not the whole picture.  Our caring and concern can cause us to take actions, and make choices, that are not in keeping with the wishes of the individual.  We think that we “have to” remove someone from their home or restrict their independence to preserve their wellbeing but we fail to take the time to have them define what wellbeing means on their terms.

I know of an elder who came to live in a long term care setting because his daughter was so anxious about keeping him safe.  He was able to care for himself and was happy doing that.  But his schedule for doing so did not coincide with what his daughter thought was right.  This was a man who, in his later years, had difficulty sleeping.  It became his habit to get up in the middle of the night, listen to talk radio and eat ice cream.  As a result, he rose later in the morning and sometimes had his breakfast closer to what others might call lunch time.

His daughter saw this schedule as signs of his inability to live alone and she insisted he leave his home and move into a residential care setting.  In that setting, in a room with a roommate, his life was forever altered, his freedoms compromised and his quality of life diminished.  Were there other options that might have served his needs better?  Would the daughter’s decisions have been different if she had understood her father’s choices and priorities?

It is vital that all of us begin to think beyond the box, beyond the standard answers, beyond the belief that “solving the problem” of an elder’s future has only one answer.  As Maya Angelou has written “We do the best we can with what we know, and when we know better, we do better.” It is time to “do better” and time to remember that doing better is within our grasp.

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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