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A neuromuscular disorder has diminished Paul Dunham’s previously robust 160-pound frame to a skeletal 83 pounds over the past two decades. The Hayden man’s hands are strong, but he’s unable to lift his arms above his waist. Despite the struggles, he and Nancy, his wife of 60 years, live alone in their own home, a 70-by-14-foot trailer in a tidy park off Government Way. They are able to do so partly because of a national trend in long-term care that is growing as it becomes more apparent that most people want to remain independent for as long as possible.