Sunday, December 13, 2009

Caring for the Elderly

Caring for the Elderly - Who is Responsible?
Do Cultural Differences Affect the Decision?
Donna Webb
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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  1. great article...I suppose there is no right or wrong it sort of like the parent who cant decide if she should be a stay at home mom or return to work..who watches the child while Im gone? I believe in trying to handle it at home..make the person comfortable and loved but should it get too difficult then other arrangements unfortunately must be made. My husbands Uncle had no children..he lives about an hour from us and he is suffering from lung cancer and heart issues and is now in assisted living. He was smart and saved for his old age so is paying to be in a very nice place with dignity. We went to see him yesterday and what you said is dont handle this well at all. He basically just leaves his room to eat his meals and then heads right back up again. I wish there were social workers that encouraged them to participate more..we took him for lunch yesterday to get him out of the environment but he was very sad. It is so hard for them when they have a sound mind to lose their homes and all their possessions. I have learned not to say I understand so freely because I truly dont understand.I dont know what it is like to have my home now be one room...even if it is a lovely room where they come and clean every day and do your laundry..its a room...I can only imagine how he feels. Aging is a very hard thing...I think all of us at one time or another needs to spend time with the elderly...the chapters dont always end happily for these is a reminder to live your life each day fully. Your right though I think other cultures do respect the elderly a bit more than we do...Its a difficult decision but I will never say never...I say often my mom had a wonderful 91 years and I love her and will care for her with every ounce of strength I have however I am 50 also and I will be old one day as well and I still must have a life and be healthy and take care of myself once this is over and done. So I must figure ways to balance, my husband, my home, my mom...I plan my day and I work the plan but I only plan as much as I can do and should the plan change which it so often does then the least important thing comes off until tomorrows plan begins...that is my role today and I hope I dont have to make a decision ever to not do this here any longer but I wont ever say I never will because I may have no choice...

  2. Thanks Donna, I was very glad my instructor gave me the ok to report on this, since I knew a couple things about it,and how and where to research it! It is such a difficult decision for most 'children' to make as to where and how their parent(s) will be cared for. My husband and I made the commitment to mom years ago to look after her as she got older. We of course had no idea, we would be living with her after losing our home to fire, nor to what extent we would actually be 'looking' after her! I use to be very opinionated and even judgemental at times towards those who put their parent in a home rather then care for them at home. I have since repented! I know there are so many factors involved in caring for a person at home, and not everyone is able to do it, plus many just can't handle it physically or emotionally. Not to say that I can either, but it is the choice me made, and are following through till she passes.

  3. Oh, cool! This looks like a polished, expanded version of the essay draft you published at Daily Strength. Although I've got to hit the road, at the moment, I'm bookmarking it for reading later (probably in a few days...I'm traveling, tomorrow and have a lot to do today to prepare for being gone). SO GOOD TO SEE THIS!

  4. Happy happy joy joy! So, glad to hear from you again! lol Did I post this on Daily Strength? I guess I did, that would have been in the early part of the college days I think. A bit more writing has been done since then. I was compiling it all this year into a book, but decided to start up this blog site for now, as I can add to it consistantly, and not have to bring it to a conclusion. I am meeting some great caregivers to. Much has changed with mom since you and I last chatted. But we keep on going!

  5. I couldn't wait, so I took some time out from my necessary errands to read this all the way through.
    Bravo! Very interesting and informative. Thank you, too, for including the references you used. I'm especially intrigued by the idea of employing robots. Frankly, although I appreciate the strength I gained from being Mom's human walker when her walker wouldn't do, learning how to pick her up off the floor when she ended up there (rarely, actually) and learning, in the last months of her life, how to transfer her bodily from bed to wheelchair to chair and back, I can't help but smile when I think how great it would have been (and how much fun for my mother...she actually LOVED technology) to summon a robot to pick her up or transfer her about, when necessary. I think robot technology will be most valuable if it is combined with in-home family caregiving.
    I also have to say about the neck breathing thing...these types of incidents, which happened every day between my mother and I, as I'm sure they do in your home, are one of the high rewards of allowing elders to remain a part of the family within the family home. I WOULD NOT TRADE THEM FOR ANYTHING! They make the rough patches less rough and make the easy patches feel like gliding!
    I've often heard the statistic that 80% of caregiving goes on in-home and I'm pleased that the ratio is so high. I know it's hard (god, do I know how hard it is) but it renews my faith in the U.S., a bit, to know that, despite everything, 80% of us are dedicated to trying to keep our Ancient Ones from being isolated.
    The information about who does the caregiving is also eye-opening. It describes, almost to a T, how it is that my mother and I came to be companions in her last year of life; except for the helping-out thing. It is true, though, that since I was single, we carried on our life long relationships with none of the social restraints that tend to hackle relationships between married children and their parents, and none of the social problems, as well.
    I hope, as you add to this essay, you post alerts that you've added more. My intention is to continue to check back. So interesting and SO NECESSARY! Keep working on it...I'd love to see this covered in a full length book. I'd buy it. As I remember mentioning to you way back when, international attitudes toward and inclusion (or, sadly, exclusion) of elders is a subject that has intrigued me for a long time.

  6. Gail, the report I did for my college class is complete, but I add to this blog site frequently. I had been putting everything together into book format, but I couldn't bring it to a conclusion yet so I decided to go with the blog format and continue to write, and this way I have the interraction with other caregivers too.