Independence, or the “freedom from outside control or support” (Merriam-Webster Dictionary), is one of the fundamental principles upon which our nation was founded. Independence continues to be a core value in American culture today, and thoughts of shared decision-making or recommendations of assistance/support from others can send some folks into a tailspin. They will do almost anything to avoid being “dependent” on others.
There are several factors which may contribute to the reluctance of older adults to admit that they may require assistance with certain routine tasks. My guess for the primary factor is pride. Most of us are socially programmed to always put our best foot forward, and to ask for help is perceived as a sign of weakness. As a result, we tend to minimize our difficulties and paint a picture that we are doing “fine”. For people who own long-term care insurance and want to utilize their policy to pay for assistance, especially in the home setting, one better be willing to admit during an assessment by the insurance company how much and how often help is needed. Otherwise, the assessor may determine that the individual doesn’t qualify for benefits, no matter how many years have been spent paying your premiums.
While we are on the topic of money, how many older adults do you know who express concerns about the costs of products or services? Even older adults who should be financially comfortable sometimes express a reluctance to pay for help, especially if they have memories of The Great Depression. A friend of mine was talking to her parents about obtaining some assistance after her father had broken his hip and became less mobile. Her mother told her that they couldn’t spend the money because they needed to save it for when they became old. Her parents are age 85! They were more concerned about the cost of care than the fact that the only bedroom and bathroom were on the second floor and he was going up the steps by sitting on his buttocks and pushing himself up backwards.
Another factor which may be present is fear. Older adults may believe that an admission of needing help will automatically land them in a nursing home. In reality, there are many different types of services which can be utilized to successfully support older adults in their homes. Since the long-term care system in the U.S. is fragmented, learning about what services are available, where to find them, how to access them, and how much they cost might be somewhat challenging and time consuming. Nationwide, efforts are being made to improve service coordination. One example is the development of aging and disability resource centers. In Pennsylvania, we have the LINK program (toll free helpline: 1-800-753-8827).
Individuals who engage additional services to help them meet their needs can experience several benefits. The most obvious one is the ease of daily living. Accepting help allows individuals to conserve time and energy to do other things which are important to them. People who live with multiple chronic health conditions may otherwise spend their days just trying to handle the basics of daily living. If doing a load of laundry leaves one exhausted for the rest of the day, one won’t be able to enjoy a visit from a grandchild or long-time friend. In this case, attempts to remain independent could lead to isolation.
Another benefit to receiving assistance is healthier living and a reduced risk for a catastrophic health event. In the example above, the individual who struggled to do a load of laundry may not have the energy to prepare a healthy meal later in the day. A pattern of poor eating habits can lead to malnutrition, which will compound the chronic health conditions already present. Or how about the older adult with questionable balance who climbs up on a chair to reach something in a closet or kitchen cabinet? You can imagine the outcome of this scenario.
These examples may seem extreme, but having regular contact with a “helper” also creates an awareness of an older adult’s usual routines. If the older adult begins to stray from these routines, the subtle small changes may be indicators of an impending illness. When recognized by a third party and caught early, a potentially prolonged and debilitating health event may be avoided or at least minimized.
The outward appearance and daily reality of independence for older adults do not always match. Theoretically, independence sounds like a desirable choice. But consider this question, posed by our attorney, Dave Nesbit, to many older adults: “Isn’t preserving your dignity worth sacrificing some of your independence?”
Our next free Thursday seminar will be on July 12th at 3:00pm. Attorney Ryan Webber will share the differences between Power of Attorney and Guardianship and how to best manage incapacity.
Karen Kaslow, RN, BSN