For eight years, Thomas Smallwood got around relatively well for a man with no legs. Poor circulation had led Smallwood, 63 at the time, to a difficult choice: his legs or his life. He chose the latter. You don't need legs to be a man, he thought. The man makes the legs.
Or in his case, the arms. Until age 71, Smallwood used his arms to amble around his home. But the stairs — five to the front door, 13 once inside — were the problem. "I had to go up the steps on my nubs," says Smallwood. "If I wanted to go outside, somebody had to carry me out."
Over time, the steps turned from a challenge into an insurmountable obstacle. Smallwood got sick; he couldn't get out of bed. Then came the hospital stay and the determination that he could no longer safely live in his South Philadelphia home. Smallwood moved to a nursing home, where he stayed for two years.
"I didn't like it at first," Smallwood says. "I wasn't used to being cooped up. In the nursing home you can't go out like you would if you was home."
Over time Smallwood settled in, but he never lost his will to live on his own again. After all, he could still bathe himself, cook, get himself out of bed on his own. All he needed was a living space that was wheelchair-friendly. In 2008, he qualified to move into NewCourtland Square, a community especially designed to help older people transition out of nursing homes and back to independent living. He seized the opportunity.
"I go anywhere I want. I can ride the bus," says Smallwood. This includes visiting his friends and family in South Philadelphia. "They call it 'independent.'
"Yes, I am independent."
More older people could be living independently
Smallwood was among as many as 12 percent of nursing home residents — 168,000 out of the 1.4 million — designated "low-need," meaning that the assistance that they do need could conceivably be delivered in their own homes or in assisted living. And according to a recent November 2010 pilot study by researchers at Cornell University, more than half of that low-need population could transition back into the community with the right social supports.
"People just assume that a nursing home is a one-way street," says Rhoda Meador, associate director of outreach and extension at Cornell's College of Human Ecologyand author of the study. "But many practitioners don't accept that."