What’s in a Word?


by Cynthia Hancock, Ph.D. & Dena Shenk Ph.D. 

Many people who work in aging services spend countless hours caring for and caring about older adults in the community. From direct care workers to administrators to policy makers to educators, we all play a role in enriching and improving the lives of older adults. As we communicate with one another, the community in general, and our elders, the language we use helps to define reality. We don’t generally give much thought to the meanings and implications of our words. In the language of caring for and caring about older adults, some commonly used words include “facility” “independent” and “patient.” These words come from what we call a medical model of care – a model that is framed to think of the older adult as a person who needs our help and assistance to enjoy a good quality of life. Let’s consider each word individually:

“Facility” is often used to refer to a long term care place of residence. Nursing homes, assisted livings, and continuing care retirement communities are all generically referred to in this manner. What comes to mind when we say this word? Some kind of functional environment created to serve a specific purpose? The focus is on the need for care rather than a sense of home and community. As gerontologists we prefer to use the word “community” in place of facility. Typically we think of a community as a social grouping of individuals who share a common interest. If we frame long term care environments as communities rather than facilities, we honor the idea that this is a place for older adults to live together as a social grouping rather than co-existing in a functional environment. In addition, using the language of Assisted Living Community vs. an Assisted Living Facility honors and stresses the fact that this is a home.

What about the word “independent?” This word is widely viewed as the goal of long term care. “Move here and we will help you maintain your independence.” Independence is, of course, the opposite of dependence, which is what we are all taught to believe we don’t want. Dependence is the state of not making your own decisions or being responsible for yourself. The problem is no human being is an independent human being and it sets up a false goal instead of focusing on relationships. From the moment of conception until death we are in interdependent relationships with other human beings. Whether it is family, friends, or community, our lives represent a give and take with those around us. We are never truly independent; we are interdependent from birth until death. It is possible that the ways in which we give and take with others changes over the life course. However, when we set “independence” up as a goal or standard to achieve or maintain, then the older adult who is perceived to be “dependent” can feel they have failed. Recognizing our basic need for social relationships and interdependence emphasizes the give and take through which every one of us can be successful no matter their age or abilities.

Finally, the word “patient” also comes from the medical model of care. Labeling as a “patient” emphasizes a need for care and places the person in a less powerful position in order to receive that help. The doctor or caregiver is seen as the one with something to offer. When we shift and think about older adults as just that, ”older adults,” they become members of the community not unlike the rest of us in many ways – just older.

In the Gerontology Program at UNC Charlotte, we work very hard to teach our undergraduate and graduate students language that gives power back to older adults and recognizes what they have to give, not just what they have lost. Words like community, interdependent, and older adult are first steps in using language that empowers older community members and focusing on what they retain, rather than what they have lost.