Caring for the Elderly - Who is Responsible?
Do Cultural Differences Affect the Decision?
Axia College of University of Phoenix
Mom was passing by my husband while he was sitting at his computer; she stopped, and blew on his neck. “Mother, What are you doing?!” we asked her in disbelief. She said to him, “I’m just blowing on your neck.” “Have to do something funny once in awhile!” And off she went to her room. Of course we were cracking up to say the least!
This was a one of a kind moment. A moment that could only happen because mom was in her home, cared for by family and not in a nursing home. Does our culture dictate whether a parent will be cared for by their son or daughter, or placed into a nursing facility? In our country, there is an increasing need for caregivers for the elderly. The choices available are for them to stay in their home, and have a fulltime caregiver, or a son or daughter care for them, or to be placed in a nursing facility. Which is best for the parent? Which is best for the family? How do other cultures see their responsibilities to their elderly?
So, what happens in the United States when we get old? We are taught to love, honor and respect our mothers and fathers. Do we pack them up and tuck them away into a nursing facility, away from their home, family and friends? Because the truth is, once an elderly person is put into a facility, he or she are basically left alone and forgotten. Oh, no! We say that would never happen. But yes it does, and all too frequently. There are many elderly which experience relocation trauma, which happens when they are moved to unfamiliar locations. Moving an elderly person may become necessary because his or her health is declining and they require more supervision. That move can be either to a care facility or to the home of a family member. Men seem to respond even more poorly then the women. Relocation is very stressful. The people feel they have lost control over their lives and they do not know what to expect in the new location. If they have any type of memory loss then moving from what is familiar to them can add to the confusion and cause them to be more dependent on others and lead to frustration. (The Merck Manual of Health & Aging, 2007).
What are the choices for the elderly? Well, for one thing their choices depend on how wealthy they are. Carey (1983) states that” “about 6 percent of older people are affluent enough to live in luxurious, sunny retirement communities.” A third find it hard to meet their basic living expenses. So what are the choices as they age, and are unable to care for themselves? For some it will be assisted living homes then later on possibly a nursing facility. For others, they will stay in their homes or have to move in with a family member.
In other traditional cultures around the world, the elderly live with their children, an arrangement that is both of necessity as well as out of respect. “In many of these cultures, people have to work well into old age, and when they can no longer contribute, they are quietly pushed toward the grave.” (Carey, 1983).
The Japanese live in a culture that supports having reverence for the aged, so many of the elderly live with their children. But the elderly also live in the fear of obashiteyama, which literally means, “to abandon grandma on the mountain.” (Carey, 1983). The Confucianism teaching of filial piety, which teaches that children need to support and care for their elderly, helps to deter them from banishing grandma to the mountain! (Ritts, 2000) BBC News (2000) reports, “One in six Japanese (22 million) are elderly. By the year 2025 one in three will be elderly.”
“In Nigeria and other countries in Africa, the elderly must live with the eldest son or daughters because of low income. There are homes in Nigeria for the elderly who do not have families to care for them, but most try to return to where they were born when they are old. Nigeria, as with other developing countries, is faced with an increase in the number of elderly. Today, even though they are faced with a growing concern for the elderly, there has remained a positive attitude toward them.” (Ritts, 2000).
“In many American Indian families the grandmother is the center of the family. It is common for a woman to be a grandmother by the time she is 40. The life expectancy of American Indians is 45 years of age. Thirty-seven percent of the American Indian population die before the age of 45. The grandmother may assist in the child rearing of the grandchildren. Reciprocity is important and many grandmothers state that if they are not cared for by their children, they should have done a “better job” raising their children. Consistent with values that emphasize interdependence and the importance of filial relationships, the family is important in the caring for the elderly.” (Ritts, 2000). “It is estimated that by the year 2050, the number of elderly Native Americans could exceed 500,000 persons, representing 12% of all Native Americans.” (Ethnic Dimensions of Aging, pp.18-34).
“In the United States of the 96.6 households, there are 22 million or 23% involved in caring for someone who is 50 or older.” (Metzgar, 2004)). “By 2030, 70 million Americans will be over the age of 65. This is one out of every five Americans. 7,000 Americans turn 65 years of age each year. By 2011, 10,000 people will be turning 65 each year. And 85% will at some point require some sort of in-home caregiving assistance.” (ShirleyBOARD, 2007).
“Aging adults overwhelmingly want to remain in their own homes as opposed to living in a nursing home or board and care center. According to the General Accounting Office report, of the almost six million adults age 65 and over with long-term care needs, only 20% receive care services in a nursing home or other institutional setting, with the remaining 80% receiving assistance at home and in the community. Home and community-based care, allows individuals to maintain their independence and age with dignity in the comfort of their own homes.
Our federal policies do not adequately recognize that the most cost-effective form of long-term care is provided through home and community-based services. Despite the substantial role that family caregivers play in providing long-term care, the U.S. lacks a coherent set of policies to assist informal caregivers.
By shifting national policies toward home and community-based services, the quality of life of older adults will improve, taxpayers will be spared the cost of premature and expensive institutional care, and our nation’s core values will be honored.”
(Tamara Thompson, 2005) According to Assuras (2000), “there is more public funding, particularly federal funding, for nursing home care than there is for care in the home.”
There are increasing numbers of families who simply cannot care for their aging parents and their only choice is to place them into a care facility. The family experiences much stress when faced with the realities of long-term care for their aging parents. How does it affect their household routine, their jobs or their children should they still have children at home? The biggest stress factor may indeed be how it affects their finances. Can they continue working or does one of them have to stop working to be the caregiver? Or do they have to hire full-time care, so they can keep their jobs? Adult children will often feel guilty about putting their mom or dad in a nursing home, after promising never to do that. But sometimes it just comes down to the reality that they can not care for their parent.
For many the only alternative in being able to maintain their normal lives is to place their parent in a nursing home, for most, a difficult decision. Adult children who decide to become their parent’s caregiver will often “find themselves on a roller-coaster ride, both emotionally and financially.” (Powell, 1998). “Statistics say that there are an estimated 120 million adult Americans either providing care to an adult family member or have provided care in the past. 56% of caregivers in this country are women over the age of 45 and they are taking care of an elderly parent.” (Strength for Caring)
The author is one of the 56%, “a kind of sacrificial lamb, the one who does it all, all the time.” (Stern, 2007). Not so much by choice, but because no one other then her husband helps. Her family wanted to put her mom in a nursing home, so she would not be a burden, a burden on whom? They take no responsibility, for her whatsoever. Much has been sacrificed to keep the commitment made to look after her mother but it is worth it. She is living longer; she is in her own home, even though sometimes she does not realize it. If no one else comes to see her, we are always here.
A study published in the Journal of Marriage and Family indicated a “strong commitment by Americans, particularly women born in the 1950s and ‘60s, to caring for their elderly parents. Baby boomers may turn out to be the most selfless and self-sacrificing generation American has ever known.” (Peck, 2007). But whose responsibility is it to care for the elderly, daughters, sons, or both?
“Mothers 65 to 75 are almost four times more likely to expect a daughter, rather than a son, to be their caregiver. They expected care from the child they felt closest to, and who had similar values. Studies indicated that the children the most likely to help are the ones who had received help from that parent in the past. The older mothers tended to name the child from whom they had received the most help – and that was usually a daughter. Mothers vastly expected that daughters would care for them, even if there were available sons. Daughters were probably named so often because mothers tend to feel closest to daughters, because of shared experiences also because of embarrassment if sons had to perform personal-care tasks.” (Medical News Today, 2006)
Are there any husbands or sons who fill the shoes of caregiver? Yes. “In the United States and Japan, social and demographic changes are placing pressure on men to become involved in eldercare. In Japan, 15 % of caregivers to the elderly are men compared with 28 % in the United States.
Culture is a factor in the social shaping of the caregiving experience through different societal expectations about the roles, coupled with different family structure, different caregiving ideals, different views on dependency, and different views on self-expression and on the need to maintain harmonious relationships.” (Harris, Long, Orpett, 1999).
What is the future of caregiving for the elderly? According to Ward (1999) “a Japanese-led research team said it had made a seeing; hearing and smelling robot that can carry human beings and is aimed at helping care for the country’s growing number of elderly. The five foot robot can already carry a doll weighing 26 pounds.” “The robot can detect odors, eight different kinds of smells, and can tell which direction a voice is coming from and uses powers of sight to follow a human face.” “A researcher at Japan’s University of Tsukuba has developed a robotic suit designed to make it easier for elderly people with weak muscles to move around.”
“One of the most labor-intensive nursing home tasks is bathing frail residents. For this job, Sanyo Electric has introduced what is essentially a robot bathtub. The tub closes around a patient who is seated in a wheelchair. The wash and rinse cycles operate automatically. A nurse’s aid takes care of the hair washing and toweling the resident off. Japan’s need for elder-care robots is partially driven by a falloff in its national birthrate, which has left the country with too few young to care for the old.” (Ward, 2006)
Well, robotics may be what is ahead for eldercare, and it certainly gives new meaning to the term ‘personal touch’ does it not? So, is there a right or wrong choice to be made concerning caregiving? Different cultures share many of the same ethics, and struggle with many of the same problems in deciding how to care for their elderly as the United States does. Ultimately, it comes down to what is best for the whole family. Hopefully, that will be what is best for the parent.
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