Supporting others in the choices they make

Among those of us who are in the business of providing human services, we often talk about the differences between client or person-centered programs and client or person-directed programs.

The language of “personcentered” programs may seem obvious today. However, when it first began to be used, it was a muchneeded movement to ensure that those who were likely to be the recipients of our services were our focus as programs were being designed and implemented. At that time, it invited human service providers to consciously put client needs above agency needs.

An example of a personcentered approach could be something as simple as an agency’s hours of operation, i.e., keeping an office open until 8 p.m. or 9 p.m., recognizing that clients might not be able to get to an office before 5 p.m. It could be as complicated as involving the consumers in the process of designing the programs or services that would eventually be offered.

Person-directed programs take this client focus even further. Person-directed programs invite us to shift the decision-making from those of us who offer services to those who receive the service. The agency’s role is not to decide for the client but to educate, inform and support the client as he or she makes her own decision. This has obvious significant and far-reaching implications.

So what does all this have to do with older adults?

It has everything to do with older adults because, at some point as we age, society decides that we are no longer capable of making our own decisions.

The technical language is that we “infantilize” older adults, i.e., we begin to treat older adults as children, incapable of making decisions, and in need of our protection.

Let’s consider a few examples:

Example #1 - Mom wants to buy a new car and has the money to do so. She doesn’t really need a new car but she wants one … and why not enjoy herself as she drives here and there?

Her children, however, think it is a waste of money to buy a new car at her age. They continue to argue against it until Mom simply gives up.

At what point did it become okay to belittle Mom to the point that she gives in and doesn’t get what she wants (and can afford)?

Example #2 - Dad is in his 90s and lives alone. In recent years, his world has gotten pretty small. He rarely goes anywhere and doesn’t see many people. But he loves his ice cream. He never eats a lot at one time, but he might eat it twice (sometimes 3) times a day. Eating ice cream makes him happy and gives him pleasure.

This worries his daughter who thinks that this can’t be good for him. She tries to get him to eat less ice cream and sometimes “forgets” to buy it at the grocery store.

Why is it okay for his daughter to tell Dad what he can or cannot eat?

Example #3 – Uncle Frank is a man with an appetite for living. He loves people and parties and food and drink. He’s had several heart attacks and his doctor keeps encouraging him to eat less, drink less, and exercise more.

But Uncle Frank’s view is that if he can’t eat and drink with gusto, he doesn’t want to live. And he did give up smoking cigarettes (though he still has the occasional cigar). He knows the lifestyle he wants and is willing to live with the risks of dying from another heart attack.

At this point, Uncle Frank’s family no longer expects him to change … but that doesn’t mean they don’t continue to nag him … incessantly.

And here, in the example of Uncle Frank, is the dilemma that is often cited in a person-directed approach: what if the older person is making choices that might have a bad outcome? Should we not step in to protect our older friend or family member?

This is a complicated issue that won’t be solved in one newspaper column. [For example, we will have to hold over the issue of how to support choice-making by those who have dementia for another column.]

For now, I would offer the following for your consideration:

As older adults, if we want others to respect our choices, we need to earn that respect. So, first and foremost, it is incumbent upon us to know ourselves. What is important to us? What do we want … and why?

We then need to be willing to share our thoughts, our values, and our opinions with our friends and families. We can’t expect others to read our minds or understand our point of view unless we tell them. We also must be willing to engage in dialogue with those who love us – especially when the choices could be seen as controversial.

For those who love and support an older adult, I would ask you to consider why their choices are so important to you. Why does it matter if Dad eats ice cream 3 times a day or Mom buys a new car? How does that impact you? What is it you fear?

You might also put yourself in their shoes: would you want your choices taken from you just because you were of a certain age?

Choice-making is complicated business. For older adults, it can quickly reveal the tension between our right to choose and our right to choose even if there are risky or negative outcomes.

Or maybe – just maybe – the choices we make after 60, 70 or 80 years of life experience, are the best-informed choices of all. And for those of us who have not yet lived so long, we simply have not learned enough about what matters.

Promoting Senior Wellness is provided by The Hickman, a Quaker-affiliated licensed personal care home in West Chester. This month’s column was written by Pamela Leland, PhD, Executive Director.