Should "senior safety" be our priority?

Atul Gawande’s Being Mortal is required reading for people joining the WalkWise team. One of the major themes is the continual struggle between safety and independence. It’s a struggle that plays itself out our entire lives, from our days crawling around the floor as a toddler, to riding a bicycle in a busy metro, to where we end up as we age. The heart of the issues is this: as we increase our safety our independence decreases.

As a child our freedoms are artificially restricted in an attempt to keep us safe and healthy. How many of us were told “no” by our parents when we asked to ride our bikes on a busy street to a friend’s house? As we grow into adults, our independence is generally limited by the law. The government says we can’t do dangerous things, such as speed at 100 mph or build a house with no fire safety mechanisms. We also choose not to put ourselves in dangerous situations, but you could always change your mind and decide to climb a cliff with no rope. You have independence when you are allowed to determine your own acceptable level of risk, when you can choose what you will and won’t do, and when you can make decisions that affect your own life. As you can see, the more your independence is restricted, the safer you are.

Society generally tries to limit a person’s independence for their own good. A child cannot by tobacco or alcohol. A distressed psychiatric patient is not allowed to leave the ward. A struggling mother cannot take out a loan at 100% daily interest. But once you turn 21 in the U.S., the state generally has a fairly hand-off approach. Why then, do we find it acceptable to limit a person’s independence when they enter their “golden years”?

The answer is safety. What could be more important? As a family, we would blame ourselves if Mom slipped on the kitchen floor and broke her hip. We would say, “why didn’t we do something to prevent this?” Unfortunately, it is this fear that drives many of the conversations about moving Mom or Dad out of their homes. Would this move be an effort to ease our guilt rather than to improve their quality of life?

Safety is obviously important. Reducing falls and detecting health issues can greatly improve quality and length of life. But when safety comes at the cost of independence, it is a tradeoff we should not take lightly. A lack of independence is one major reason why seniors are terrified of nursing homes. They eat, sleep, and toilet on someone else’s schedule. They can’t interact with other patients at all hours of the day. They must be quiet to avoid waking their roommates. Visiting hours are restricted. They can’t call an Uber and go to the movies!

Senior Living, more specifically Assisted Living, was invented as one way to free people of these restrictions. Sure, you can get help with what you need. But no one is supposed to tell you “No, you can’t do/eat/watch/say that”. There are obvious exceptions, of course, but for the most part independence takes precedent. Over time, however, many assisted living communities have come to look more and more like nursing homes with nicer rooms.

Offenses come in many forms, such as moving the walker or wheelchair away from the bed so that residents can’t get up whenever they want. Open door policies remove privacy while increasing “safety”. Scheduled meals, with little flexibility. Not allowing a glass of wine with dinner. Assigned seating at the tables. The list goes on. Some of these are done with the very best of intentions, and some are done because of excess regulation or fears about fines. Regardless of the cause, families and caregivers need to do a better job of thinking about independence, rather than simply safety.

Technology can help. Discrete, non-intrusive solutions exist that allow for predictive analytics or emergency response without sacrificing privacy or independence. In future blog posts we will explore the wide breadth of “senior technology” on the market, but always through the lens of independence vs safety. We hope you join us!