An Aging America Faces the Assisted Living Alternative.

• Author: WILSON, KEREN BROWN

"The challenge for society will be to provide affordable, safe, and high-quality facilities that respect the independence, dignity, and autonomy of the elderly."

AMERICA'S POPULATION is getting older and, along with it, there is a dramatic rise in the need for long-term care. Advances in medical science, greater access to health care, improved nutrition, and better living conditions have contributed to longer life expectancies. These improvements have made seniors, 85 and over, one of the fastest-growing sectors of society. This growth in the number of older people, coupled with lower fertility rates, has significantly increased the age of the population, contributing to the graying of America.

Another factor in the need for long-term care has been the increased survival rates for those born with serious disabilities and others who have been permanently disabled later in life. Many with diseases such as Alzheimer's, diabetes, or arthritis find themselves requiring assistance with activities associated with daily living, like bathing, dressing, preparing meals, and taking medications.

Dealing with the effects of chronic disease, disability, and aging present enormous challenges for society. The long-term care available for individuals in those circumstances has resulted in conflicts between some of Americans' most cherished values, in particular the desire to live independently and the need to be safe and secure. It has also raised questions about assuring quality of care and determining access to such services. Assisted living has developed in response to those issues as an alternative way for housing and caring for the frail elderly and disabled.

One of the greatest fears of the elderly is the loss of the ability to live independently. Their desire for autonomy can be thwarted by the reality of requiring regular assistance in their daily lives. This tension is often manifested as a conflict between the interested parties. Adult children and governmental regulators are typically concerned with the safety of the elderly. Their interests lie in protecting seniors from the possibility of a negative outcome such as a fall, even if that protection means a limitation on choices for the elderly. The latter, on the other hand, typically prefer more freedom, even if that means assuming more risk. To complicate matters, the elderly often suffer from chronic diseases that limit physical and cognitive functioning and raise questions in the minds of...