Assisted Living: The Trade-Offs

Assisted Living The Trade Offs

Human needs and wants usually are few and simple, especially as we age and learn to appreciate life’s small pleasures. What we really want to do in our last years is to be able to interact with family and friends, make our own beverages when we want to, enjoy our pets’ companionship, and finish projects we started long ago. In Atul Gawande’s book, Being Mortal, the story is told of a person who said he was willing to experience much uncomfortable treatment if it would just allow him to eat chocolate ice cream and watch football games on television.

Such simple, wistful pleasures, however, are often denied to the elderly when they are institutionalized. The original ideal behind providing seniors with assisted living was to help them enjoy life’s little pleasures and freedoms even when they required institutional help. Unfortunately, that is not always the reality of assisted living now.

Keren Brown Wilson developed the first assisted living home for seniors. A stroke left her fifty-five-year-old mother paralyzed on one side of her body, with impaired speech and limited ability to perform daily life’s activities. Wilson was 19 years old at the time, and her father had been dead since her elementary school years. The only alternative Wilson, a student, could find was a nursing home for her mother. Wilson witnessed what institutionalization did to her mom. It broke her heart when during every visit to the nursing home, her mother pleaded with her to remove her from the institution.

“Why don’t you do something to help people like me?” her mother would ask her daughter, who had become a gerontology graduate student after a few years. Her mother described the ideal living situation she had in mind for herself: she would have a kitchen to make coffee in, she would be able to keep her pet, and she could close the door for privacy, but know that needed help was just around the corner.

This was the birth of the assisted living idea. By 1983, Wilson and her husband had designed, built and opened the first assisted living facility. Residents could control the temperature in their apartments, lock the door, and keep their pets. They were in charge. However, there was an electronic alarm in each apartment that each resident could press when they needed urgent assistance. Aides would come in to help with the tasks of daily living. However, the aides always knew they were entering someone’s private living space. Unlike most institutions, where the institution’s imperatives come first, the residents’ wishes were the top priority. When Wilson’s center was examined by state monitors five years later, the residents were doing well on all counts.

The idea spread and there was a clamor to replicate Wilson’s center for assisted living. Unfortunately, Wilson found that the purpose of bureaucracies often becomes their own preservation and perpetuation. Likewise, institutions sometimes tend to serve their own needs before those of the residents. Sometimes it is easier for the institution to do something for a resident than to take the time to coach and assist residents to do it themselves and thus foster a degree of independence. Institutions sometimes tend to take the path of least resistance even when it compromises the satisfaction and autonomy of the residents.

When assisted living situations began to surface in greater numbers, insurance companies intervened and placed safety concerns over the wishes of the residents. The compromises of the freedom and autonomy of residents were such that Wilson repudiated the new assisted living concepts. While the safety of the residents may be of utmost importance to the peace of mind of the relatives, a life without risks is not realistic or even satisfactory. In Wilson’s original ideal, the desires and freedom of the residents were paramount.

One is reminded of Born Free, in which the naturalist, Joy Adamson, said that like the lioness she raised and released into the wild, she herself would be safer in a cage, but she would not be happy. She admits in the book that the freedom of Elsa the lioness was dearly bought, but “when she rubs her face against mine she is trying to comfort me by saying in her own way: ‘But I was free born.’”


We are, all of us, born free. As our bodies age and we lose freedom of movement, judgment, and the ability to take care of ourselves, we become dependent on others. At the same time, seniors dislike institutions for the same reason we all do. We were born to be autonomous and to be who we are without much interference from others. We are free born, and age should not take that wholly away from us.




Adamson, Joy. (1960). Born Free. New York: Pantheon.


Gawande, Atul. (2014). Being Mortal. New York: Metropolitan Books, Henry Holt and Company. P. 183.


The Jessie F. Richardson Foundation (Keren Brown Wilson, founder). About Us – Mission Statement. Available online at:


The Jessie F. Richardson Foundation (Keren Brown Wilson, founder). About Us – How We Started. Available online at: