When I worked with older adults I visited clients at many levels of care – in their own homes, at senior residences that were just for independent living, or those that started with independent living and could move you to assisted living when the need arose; also at assisted living, board and care, and nursing homes.  My task was usually to asses the adequacy of the arrangement.  Often I had to suggest that the client be moved to a higher level of care – a step to less independence.  Ideally, I would also be able to recommend that someone be moved to a less restricted level of care, but to tell you the truth, I don’t remember that ever happening.  At best, I could sometimes recommend changes that allowed someone to remain at their current level – a caregiver in the home, a wheelchair, counseling and education, and sometimes a change of medication.

I don’t know how much has changed.  The multi-level place where my former roommate is staying is, to outward appearances at least, much the same as when I was working in the field of aging.  One of my friends lives in a senior residence that I first saw when I went there to visit my grandmother more than forty years ago.  The model of independent living embraced by that facility was leading-edge when my grandmother moved in.  The multi-level places were thought forward-looking when I was in the field.  I know that designers of these places often put their hearts and their best thinking into their design, both in architecturally and programatically, and still there is room for improvement.


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