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​ What defines independence?

Thursday, July 12, 2018

As previously stated in this month’s blog and within significant reports related to seniors, older Americans are getting older, of course,….and comprise a greater segment of America’s population. It has been estimated that the aging population will soon double; and by the year 2030, 20% of the US population will be 65 or older (US Census). Until some medical breakthroughs, the natural consequence of the aging of America is an increase in chronic conditions. Dependent upon the type or severity of a chronic condition, the functional independence of an older adult may be diminished or even threatened.Is that true or just an assumption?

Walker Assistance


When studying functional independence, many empirical studies have used ADL’s or activities of daily living as the signature indicator of functional independence. If someone needs no assistance, then they are independent. If that is true, the counter assessment would be IF someone needs assistance in their ADL’s, they must NOT be independent. Even though that seems logical, is it true? If I am completely independent with the exception that I no longer prepare meals for myself, am I no longer independent? - I sure hope not because my husband has been the primary meal preparer for so long, I’m not sure I could find my way around in the kitchen. –  Rather than define independence in that narrow, outdated fashion, I would suggest that functional independence is defined by the ability to provide for your needs on your own or by managing your independence with the assistance of others.


Functional independence allows for one to be completely independent, devoid of any assistance OR to make decisions and actively participate in retaining the assistance that you need. However, the ability to maintain independence has grown tremendously with the continued evolution of technology-based health care products. Once set up, many tasks can be automated so that independence can be maintained or extended. With the proliferation of at-home services since 2008, many services once provided only in senior living communities can be retained in the comfort of your home. So is the person living at home with a “cook” and a “housekeeper” independent? I would suggest that they are. To go a step further, if this same person functions independently most of the day but needs assistance to put on and take off their T.E.D. hose, are they independent? They are receiving home-health. Again, I say YES to independence.


And how does that affect us? Admissions.


In the last decade, many conversations have evolved regarding using the term “independent” and using that measure as a qualifier for admission.

If people can maintain their independence in their own homes by self-managing services, shouldn’t they be allowed to move into our independent living residences with the same moniker of independent living residents?As the Boomers progress through our system, they will expect a level of control to maintain their independence. They do not want to consider themselves old or infirmed and will use all means to delay or ward off dependency. So be ready. Self-managed independence will emerge, and we must be ready to welcome it….and them to our neighborhoods.

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