Guest Editorial: The place of elderly persons and our responsibility for care
Samuel J Ujewe
On 16 May 2012, the BBC featured a brief documentary showing the negative impact of China’s one-child policy on the ageing population. It highlights a disturbing fact; whereas elderly people have been traditionally cared for in the family circle, China’s population policy, coupled with rapid industrialisation and urbanisation, is increasingly leaving elderly persons to care for themselves. As a consequence, the Chinese government, while providing some form of social welfare for the elderly, is now encouraging only-child parents to have more than one child in order to reinstate aspects of family involvement in care for elderly people.[1]
In New Zealand, increasing numbers of people are now being cared for in retirement villages and residential homes for the elderly. These services aim to provide a dignified place of care for seniors as they become more dependent on others and are unable or unwilling to live alone or with other family members. While there is, rightly, a significant focus on providing the appropriate level of financial and physical care for the elderly, their needs as persons also encompass the social, intellectual, emotional and spiritual spheres. One of the biggest challenges is not to lose sight of these aspects of care.
Many people continue to support their elderly parents or family members while in residential care homes. Nevertheless there is a concern that the high quality physical and health care provided is not always matched by the social and emotional support that people desire from their families. Thus, numbers of elderly people find themselves isolated from active family and social networks. The question arises as to whether the isolation some people experience is, at least in part, an accident of the social services provided for them.
What do I mean by this? A United States study on ageism notes that in primitive society, old age was frequently valued with older persons seen as providing knowledge and experience. In more recent times, as the number and percentage of older persons has grown, there has also grown a perception that the elderly are a burden to families and society. The very real concerns about the increasing costs associated with caring for the elderly in residential facilities carries with it the real risk that it will reinforce a perception of persons in care as financial liabilities. [2]
This has been further backed up by United Kingdom research which notes that even when societal agreement for material support of older persons is strong, ageist stereotypes abound that dictate how older persons are viewed and treated. In the study in question, persons over 70 were perceived as posing a greater threat to society by placing burdens on the economy rather than by affecting others’ access to services or way of life. In addition, respondents viewed people under 30 and over 70 as having little in common.[3] These perceptions potentially undermine the sense of moral responsibility we all have to provide care for the elderly. This responsibility is ultimately founded on the common virtue of gratitude as reciprocity that flows from our experience of family upbringing.
It is of particular interest to note that in 1995 Singapore passed into law the Maintenance of Parents Act in order to address cases of neglect of elderly parents. This Act imposes a legal duty on adult children to care for their elderly parents when they are unable to care for themselves.[4] It should be noted that the Singaporean law reflects the traditional family values of the people where care for elderly parents is provided by their children or close relatives: “parents who brought up their children should in turn be cared for by them”, says a one-time president of Singapore.[5] Singapore’s Ministry of Health affirms that the act is meant to codify the filial obligation that all sections of the community already recognize and which a vast majority of children gladly discharge.[6] Art Lee confirms this in noting that 95% of indigent elderly in Singapore are supported by their relatives.[7] The Singaporean approach recognises the fundamental place of elderly people in the lives of others who are family, and the corresponding responsibility owed to them for care.
Whereas countries like China and Singapore are aiming toward reviving or sustaining filial commitment in elderly care, it would seem that in New Zealand the emphasis on improvement is more often focused on increasing financial resources for services and/or better regulatory overview. For this reason it is worth reflecting on the efforts of countries like Singapore and China. While the provision of high-quality elder-care services may offset the financial and physical burdens of care experienced by families, a degree of holistic care may only be attained in conjunction with the continuous involvement of the people who are related to these elderly persons. The question arises as to how this can best be achieved in New Zealand.
In the African culture, individual identity is never considered apart from the wider family a person is part of. There is never a point in life where a person becomes completely separated from his or her family; an emerging family is always at the same time an extension of the existing families of the spouses. It is accepted by both the older-larger and newer-smaller families that they owe each other mutual support and reciprocity plays a substantial role. According to a Nigerian proverb, the child who does not say ‘thank you’ is a witch. Witchcraft is generally associated with ingratitude, and a thank-you for Nigerians does not end in mere words; it is active, expressed in reciprocal gestures for kind acts received. Although no one compels another to reciprocate any kind gesture, it is deemed a responsibility that one should embrace. Thus, in African communities generally, the care of elderly parents remains in essence a responsibility of their children and other relatives.
There are strong parallels between African approaches to family belonging and the Maori culture. As a visitor to New Zealand, it strikes me that Maori values of care and respect for the elderly could usefully inform broader attitudes within New Zealand society. I have also become aware that New Zealand’s laws are particularly sensitive to parents’ duty to care for their children. The challenge I see is to develop a greater societal awareness of adult-children’s duty to care for their indigent elderly parents. Many contemporary societal factors work against this, including the challenges of smaller families and the reality that children often live far away from their parents. The change that is required is a deeper attitudinal one; it is, of course, not as simple as passing a law because no law can possibly effect such a change if is not accompanied by a shift in cultural attitudes.
At the same time, great thought needs to be given to the impact any new laws might have on people’s broader attitudes towards the place and value of the elderly. I have followed with interest the discussions about legalising euthanasia and it occurs to me that one of the questions not being discussed is whether such a law change will make New Zealand a more inclusive and more welcoming place for the elderly and those who are at the end of their life, or a less inclusive and less welcoming place; will this enhance filial responsibility or further undermine it?
The virtue of gratitude as reciprocity demands that the care of elderly parents not be left solely to the responsibility of care-providers. We all have a responsibility – perhaps even a moral obligation – to be actively involved in the care of our parents and grandparents. Residential care services can sustain the dignity of elderly persons only if the people who are part of their lives remain actively and continuously involved. In light of this Lee’s tripartite approach may be worth considering: the state, the voluntary sector and the family, each giving the kind of support that it is best able to provide.[8]
The provision of social services by the state must be seen as a way of enhancing families’ ability to maintain the social and emotional bonds with elderly family members but there is a need for real vigilance to ensure that it does not unwittingly contribute to their greater social and emotional isolation.
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Samuel J Ujewe (BA Hons., MHealSc – Bioethics) is from Nigeria and a visiting scholar at The Nathaniel Centre. He recently completed his Masters degree at the University of Otago Bioethics Centre and is about to begin his PhD studies at the University of Central Lancashire, United Kingdom.