In our world of older adult services, it is far too frequent to hear the litany of “you can’t” or “they can’t.” We “can’t” give an elder with dementia access to the outdoors. We “can’t” allow people a choice of what they want to eat or do. We “can’t” provide something they have asked for because someone else has decided that they “can’t” have it. Our staff may voice these sentiments but often we hear this come from family members. These are words with good intentions. We want to keep people safe. We want to make sure they are protected and well. There is no question. But where do we draw the line? And where should we draw the line?
We often ask our staff to imagine what their lives would be like if they lived within the walls of any of our residential communities. What would any of us need to feel that our lives are our own? What choices would we make and feel entitled to make? Truly, it is a question that all of us should ask ourselves.
The ability to make choices is critical to everyone. Even an individual living with a diagnosis of advanced dementia has the ability to choose. Maybe they cannot articulate their choice but they can indicate which food they want when presented with options, what clothes they want to wear, what activity appeals to them. It gives them not only an opportunity to express their preferences but a sense of control of at least some aspect of their environment.
What we forget when we take away choice because we “know better” is that these are individuals who have lived long and meaningful lives. They are people who’ve had careers, raised families, cared for their communities and made an impact. They are not infants, they are not objects, they are not diagnoses, they are people. When we treat them with anything other than the respect that they have earned and deserve, we are failing them and, frankly, we are failing our future selves.
But what about keeping people safe and what about protecting them? In our work we talk about two interrelated concepts—excess safety and dignity of risk. Both concepts really mean that we must look at the decisions we make when caring for elders and think about what each elder wants and whether our commitment to protect them impinges on their rights and desires. When a child learns to ride a bike, we have to swallow our fear and let go. When an elder refuses to eat a pureed diet and insists on “real food,” we also have to manage our concerns and figure out the best approach to making it happen.
Older adults, regardless of age or stage, are still adults. They are afforded not just civil rights but also human rights. When we treat them as if they are devoid of any choices, devoid of any rights, we rob them of their self-determination and we compromise their quality of life.
As people who care for older adults in our professional lives, the challenge is to us, to reframe our thinking, to pause and ask ourselves if we are truly allowing our elders to determine their own course, if we are turning “you can’t” to “of course you can, we will figure it out.” The same challenge applies to all of us with older adults in our lives. If we can reframe the impossible to wondering what could be possible and how, we will enhance both the lives of both the elders and ourselves.