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Lex maniac

Investigating changes in American English vocabulary over the last 40 years

assisted living

(1980’s | doctorese? businese?)

But one of the host of expressions born in the last fifty years to cover the plights of the senior citizenry, but one of the most common. There were a number of rough synonyms when this expression was new, back in the eighties: “residential care,” “custodial care,” “catered care,” “respite care” (for people recovering from surgery). But then there were all the other terms that formed the ecosystem of which “assisted living” became such a prominent part. “Congregate housing” (i.e., dormitories with dining halls) and “barrier-free housing.” “Continuum of care” and “life care.” All manner of buildings, amenities, and services required to run the gamut from independent living to the dreaded nursing home (now there’s a continuum). Today, sprawling complexes for the elderly (“retirement communities,” an old expression, or “continuing care facilities”) offer a breathtaking array of options, designed to make progress toward the grave as pleasant as possible.

As usual, we need a lot of different terms (I’ve but scratched the surface) to match the growth in the number of ways to accommodate the elderly — it’s important to distinguish them precisely. (Many families take care of their oldest members at home, and those endeavors have produced new expressions like “caregiver,” but we don’t call it “assisted living.” It’s all a matter of who provides the care, and where.) In the industry, two acronyms have become current: ALF = “assisted living facility”; “ADL” = “activities of daily living,” normally plural. If you’re my age, you’ll remember a certain lovable sitcom character and the Anti-Defamation League when you hear those abbreviations. As the baby boom turns into the elder boom, who knows? Old understandings of acronyms are subject to replacement by new ones. In the 1930’s, NRA meant something completely different.

It was early in 1989 when the Washington Post announced an “important new American housing trend” whose “name is unknown among the general public and little known even within the home-building industry.” There were several instances of “assisted living” in the 1980’s press, actually, but it does appear that the phrase was pretty specialized for its first ten years or so. I don’t recall if I knew the expression before 1990, but if not, it probably wasn’t long after. Definitions of “assisted living” vary around the edges, but generally include help with basic living needs (food preparation, bathing, dressing) and housekeeping, social and recreational activities, maybe transportation, maybe some kind of licensed medical personnel on the premises, if only an unregistered nurse. The point is that you’re in a house or apartment, not a foul-smelling bed in an institution, but there’s always someone on hand if you need help. The goal is to preserve some crumbs of autonomy for people who can’t quite take care of themselves any more.

It seems irreverent to bring it up, but “assisted living” is not the opposite of “assisted suicide,” also a term not in general use before 1980. Not strictly speaking, anyway. The connection lies in the purpose of assisted living, which is to keep the old and infirm out of nursing homes and thereby discourage them from contemplating assisted suicide. Ethically, they’re on different planes. Assisted suicide makes nearly everyone at least a little uncomfortable, but only people who think the elderly ought to be put to sea on ice floes are troubled by assisted living. It’s hard to object to giving older people a chance to keep some cheer and dignity for a little longer. Which is why the elderly are big bucks now and getting bigger, and why investors concern themselves with housing the aged. There is no federal regulation of assisted living facilities, and not much at the state level, so levels and standards of care can vary wildly, and a local scandal blows up now and then. But a growth industry is a growth industry and serving retirees has been one for over thirty years now. As the vocabulary proliferates, the dollars proliferate, too.

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