Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 2811 When Loss of Independence Occurs In all matters related to community members who have lost some degree of independence, staff are particularly careful to continue to preserve choice, independence, autonomy, and self‑esteem. Since loss of independence may have already reduced control over many areas of life, those choices that remain are all the more important. We carefully preserve opportunities to make decisions consistent with abilities and encourage dressing, bathing, eating, and walking by oneself as much as possible. Caring for the Very Frail Caring for those who are very frail, cognitively or physically, is a particular concern. We are intensely aware of the need to respect the dignity and worth of these individuals regardless of their conditions. We care for these community members with an emphasis on each individual’s strengths and not on diminishments alone. We do not use physical restraints because restraints increase the emotional problems of an already anxious individual. Sedatives, tranquilizers, and other pacifying drugs are used only to treat medical conditions and not as another form of restraint. When medication is used, it is frequently and precisely monitored. Ensuring Dignity at the End of Life Dignity and the right of self‑determination for persons in the final stage of life receive our highest priority. In Kendal’s approach, death is treated as a normal part of the aging process. Community members are not hospitalized simply because they are dying. Depending on the circumstances, a terminally ill person may be cared for in the health center setting or in his or her own residence. Hospital care is chosen only if it improves the quality of the remaining life or is requested by the community member or family. There is mutual support in bereavement among community members and staff.