What Do We (and Should We) Mean by “Assisted Living?”

Earlier this week I recommended Atul Gawande’s book, Being Mortal: Medicine and What Matters in the End,  and I offered an excerpt from his discussion of how doctors are impacted by practical limits on their goals as solvers of problems.  But the book is about more than just medicine. Another compelling chapter traces attempts to avoid “nursing homes” and the once cutting edge trend of “assisted living” as an alternative:

The idea spread astoundingly quickly.  Around 1990, based on [Keren Brown] Wilson’s successes, Oregon launched an initiative to encourage the building of more homes like hers.  Wilson worked with her husband to replicate their model and to help others do the same.  They found a ready market. People proved willing to pay considerable sums to avoid ending up in a nursing home, and several states agreed to cover the costs for poor elders.

 

Not long after that, Wilson went to Wall Street for capital, to build more places.  Her company, Assisted Living Concepts, went public.  Others sparing up with names like Sunrise, Atria, Sterling, and Karrington, and assisted living became the fastest growing form of senior housing in the country.  By 2000, Wilson had expanded her company from fewer than a hundred employees to more than three thousand.  It operated 184 residents in eighteen states.  By 2010, the number of people in assisted living was approaching the number in nursing homes. 

 

But a distressing thing happened along the way.  The concept of assisted living became so popular that developers began slapping the name on just about anything.  The idea mutated from a radical alternative to nursing homes into a menagerie of watered-down versions with fewer services.  Wilson testified before Congress and spoke across the country about her increasing alarm at the way the ideas was evolving….

For more, see Chapter 4 of Being Mortal, titled “Assistance.” The other intriguingly-named chapters are “The Independent Self,” Things Fall Apart,” “Dependence,” “A Better Life,” “A Better Life,” “Letting Go,” “Hard Conversations,” and “Courage.”