The Family Home or the Nursing Home?

At first it feels like I’m in a college dorm.

The lady at the front desk lets us in, and my boyfriend immediately signs me in as a guest. There’s a little convenience store with the same soft drinks and cookies and potato chips and sandwiches I gobbled in my own dorm. We make our way to the dining facilities, where a large sign outside the two closed doors of the dining room announces that dinner will begin at 5, with turkey and mashed potatoes as the main course. Yum. Ten minutes to go.

Some residents are chilling out in the lobby, chatting, looking through their mail, waiting for their friends to arrive so they can go to dinner together. It’s busy this evening; people are coming down and going up and asking each other how’s it going. We take the elevator to the third floor to get Mel. As I pass the laundry room I see the sign warning people to be considerate and not to leave their things in the machines for too long, reminding me once again of my freshman home.

We get Mel and head downstairs for dinner, and everyone is at their usual table in their familiar cliques – there’s friendly Gina at the “popular” table with her girls, and tall Sam with the other tough men at his “jock” table. Directly behind me sit the quieter ones who don’t say much to each other, focused on enjoying their meal.

After dinner, we head outside for some fresh air. Sam and Gina are sitting next to each other on the bench. They’re dating, you see, and their heads are bent together in conversation. They see us and wave us over, and though I’m shy about disturbing their couple time, we end up sitting with them in the twilight. Me, my boyfriend, Max, Gina, Sam. The college kids, hanging out together after a long day of activities and a big dinner. Or so I feel.

But in reality, Sam and Gina are 92 and 83 respectively. College is a thing of the past, their spouses gone, their children grown. Mel, my boyfriend’s grandfather and brother-in-law to Gina, is 96 years and 7 months old, as he proudly tells me every day that I visit. “Can you believe it?” he asks. He doesn’t look a day over 80, I say, and it’s the truth. An hour later, my boyfriend and I get up to leave, and the three elderly residents head back to their own apartments and go to bed at 9.

No, this isn’t a college dorm.

***

When I first learnt that my boyfriend’s grandfather lived by himself in a “home,” I was extremely indignant on behalf of this elderly gentleman I had never met. I imagined a vulnerable old Mel, cast aside and unloved, all alone in some cold, impersonal institution with bad food and sour-face nurses. A nursing home, the worst place for the elderly, a place of doom for those with the bad luck of having no family or a cruel family.

Of course I thought of homes for the elderly this way. In my Malaysian Chinese family, I’d been taught that taking care of your parents when they are old, having them live with you, is a responsibility that must never be questioned.

All around me were positive examples of this filial piety. A neighbor’s elderly father lived with him. My teacher’s widowed mother lived with her. An aunt uprooted her family so they could live with her husband’s aging parents in his faraway hometown. My maternal grandparents took turns living with each of their 12 children’s families. In my own home, I grew up with my dear paternal grandmother under our roof, and I watched my father lovingly cater to her needs, taking care of his mother as she had once taken care of him.

One day, my parents would live with me too. It was the right thing to do, I knew. On days when I fought with them, their angriest reproach would usually be, “You’re the kind of daughter who’s going to put us in a nursing home, aren’t you!” No! I thought when they mentioned those two “bad” words. I would never do that! Only the shameless, the ungrateful, or the thoroughly Westernized would put their elderly elsewhere… right?

But I was also confused by extreme examples of this filial piety at play in the cases of those who sacrificed their lives, careers and health so they could personally look after their parents during the most trying times. A personal example is another one of my aunts who decided to look after grandma after her health deteriorated. My father had two young children to handle; with no children of her own, Auntie was able to give grandma her undivided attention. She was a wealthy woman who could have put her mother in the best homes. She chose not to, putting her life aside to attend to her mother 24/7 after a series of strokes left my grandma with semi-paralysis and depression. I visited them in London six times in those six years, and I remember the feedings, the constant changings, how we would wake up one, two, three times in the night and rush to her side when grandma started wailing from nightmares. After two weeks of this, I could barely open my eyes. My aunt, already in her sixties, did this for six years, before finally crumbling from grief and exhaustion when my grandma died. It was a devotion I don’t think I will witness ever again.

***

Visiting Mel and seeing how he actually lives made me rethink what it means for senior citizens to live in a “home” away from their family. Maybe it’s not a shameless, ungrateful act by decadent Western children, as I’d been taught as a young Chinese girl. Sometimes, it’s may actually be for the best. Nursing homes are also on the rise in China, where one-child families have resulted in fewer relatives able to care for a growing elderly population. Perhaps my “Asian instinct” regarding what filial piety requires is incredibly unrealistic.

Mel’s residence is technically not a “nursing home,” but an exclusive assisted living facility, with a residential campus’s community feel. He has his own apartment, a spacious and bright two-bedroom pad that’s larger than the apartment I share with my boyfriend in Shanghai. Photos of his wife of sixty years are lovingly arranged on a shelf. Meals are provided for him in the dining room, and he also has a fully-equipped, well-stocked kitchen that I envy. There’s a flurry of activity at the home, enough to keep the more active residents busy, with buses heading to different destinations every day. Mel’s sister-in-law lives five floors up and checks in on him often, as do the smiling nurses three times a day. His family is always near — they go over to check on him daily, and his grandson practically lives with him when he’s back in the U.S. Mel may be in an “institution,” but there’s nothing impersonal or sinister about it.

Would the alternative necessarily be better? I imagine Mel living with his son in the large house in the suburbs, him navigating those stairs every day with his bad knee. What would Mel do all day when his son and daughter-in-law are at work, his younger grandchildren busy with school and extracurricular activities? Would technically living with family be worth more than what he has at his own apartment – his friends, the sense of community, his independence, his routine, round-the-clock healthcare and baseball at 7 p.m.?

After my visit to the U.S., I stopped in London to see my relatives, including my Auntie who had looked after my grandmother. Five years after grandma’s death, my aunt is still recovering from the toll of being a full-time carer. Her health is bad, her social life non-existent from the years of hiding her life from her friends. Of course she doesn’t regret looking after her mother – it was “the right thing to do,” but sometimes I wonder whether there could have been a balance between what was right for grandma, and what was right for herself.

***

In the end, despite changing my mind about the horror of nursing homes and the ambivalence I feel over whether intense self-sacrifice is necessary, I still want my parents to live with me when they are older and less able to do everything for themselves. It was the way I was raised. It’s what I want to do.

But surprisingly, they might not want to live with me after all. When I first told my mother that Mel didn’t live with family, she was horrified, like I knew she would be. “Harrumph!” she growled in a way that meant, “Why are you dating a useless American who puts his grandfather in a nursing home!” But after sharing with her my experience of visiting Mel, she seems to like the idea. “It doesn’t sound bad!” she said. “He has his own life, own friends, his independence. Maybe that’s what will keep him fit and alert. Maybe staying with family is not always the best thing.”

Are the elderly in your family living under “traditional family care” or “institutional care”? Is there “nursing home” stigma in your family? What do your parents want?

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  • We have a different solution in Israel. Hire a carer to live with the elderly parent in their home 24/6. This is what we did for my father – my mother was really too old to cope with him alone and now we have hired a carer for my mother. She has someone to keep her company, cook, and look after her. My brother’s family live very close. The government subsidizes the wage for the worker who gets a day off a week when we have to get someone else to take over. The workers usually come from the Philippines…

  • Seems a bit rich to say that observations at an assisted living facility can change one’s views of nursing homes altogether. But they’re two entirely different entities. Akin to comparing apples to oranges.

    One is for self-sufficient elderly folks who have a degree of independence, whereas nursing homes are usually the realm of chronically ill patients like your stroke-stricken grandmother.

    Nursing homes, in my experience, are terrible places to send one’s family members. Even with the best intentions of the employees, they are battle-hard and calloused from years of caring for people with a great deal of medical and daily needs. It’s difficult for them to be compassionate and genuinely caring when they see people come in and out each day. Sure, I can’t blame them, I would be the same too if I had to experience the reality of mortality each and every day.

    Often, it’s better to hire a live-in or daytime caretaker, if need be. My grandmother is currently immobile due to advanced Parkinson’s, osteoporosis and dementia. But we would never send her away to a nursing home. Instead, she’s cared for by a daytime caretaker, and during the weekends, different children, on a rotation basis, care for her needs. It’s an imperfect solution, but it works.

    There’s an oft-repeated Buddhist saying: A son’s debt to a mother’s breast milk can never be repaid. (poor translation) Even as a second gen American, I would never have the heart to relegate my own parents to this kind of existence.

    • Patrick

      You have my sympathies for your grandmothers condition. I understand how hard that one can be, another grandmother of mine went through it, although I wasn’t as involved with taking care of her I saw the decline and forgetfulness. I wasn’t very close to her, she was a distant sort of person but watching her forget us all was hard. Her case progressed rather rapidly which I think was better for her in the end. The confusion for her was very heart-wrenching.

      Concerning nursing homes although I haven’t had a loved one in one I did an internship in one and it really depends on where you go. The one I interned in had a very devoted staff that truly cared and was dedicated to the people it cared for. I have some fond memories of that place although I admit I knew right away that I was not a good fit for this kind of work, even though I adored many of the people we cared for I couldn’t balance caregiving and emotional distance. Some people can do this very well.

  • M.N

    Song of the article
    Outlandish – In Good Hands

  • Pauline

    Great essay and much more interesting contribution to the than Diaspora series than yet another rumination by a self-aggrandizing man-child on sex! I agree, living in a facility where social interaction is constantly available sounds like a wonderful option for parents, as long as their children visit them frequently. But, the kind of assisted living group housing that you describe is also very expensive. I don’t think most elders have this option available to them.

  • Patrick

    I was a grandchild that took care of my grandmother starting at the age of 7. To be honest it didn’t feel like work to me and it wasn’t the emotionally exhausting experience then that it would be now. Strange to think of it that way I suppose, but it’s true. At 7 I cooked for her often, as her cancer progressed so did my jobs. By age ten I cleaned diarrhea and vomit more than a few times. It all seemed very worthwhile, I loved her very much. Although the work of it wasn’t emotionally exhausting the reality of life was. As a child I looked at life with the expectation of hope that children often do. To say that my grandmother would “beat this” (something often heard by her and my Aunts and Uncles) was something I took literally. Five years I tended her in this hope. I was at the hospital while they were removing the last of her cancer, she had in fact beaten it. She had fought hard and waded through more chemo treatments than I can remember. She died on that operating room table. A blood clot had loosened – it has always seemed like a cruel irony to me. Her death hit me very hard. It profoundly affected my life and how I interacted with others. I think caring for our elders is “the right thing to do”, but as a family. No one individual should be shouldered with such a difficult task. There are many people that are willing to martyr themselves for the cause but frankly speaking it’s not fair to them no matter how willing they are, it’s not fair to the loved one and it can be a more positive experience for a family to learn, grow and remember their loved one when they pass on.

    • JSakamoto

      That’s a good story. You were certainly more loving and selfless than i was at that age. I also agree that no one person should have to shoulder the whole load of caring for a relative, although that’s the way it often is, as i know from personal experience with my family.

      • Patrick

        I can’t really say it was selfless. She was my motivation. I appreciate what you’re saying don’t get me wrong. I think many people would at that age because at that time more than most times in our lives we are very giving. Children can be very motivated under certain circumstances.

        It’s funny, about five years ago my mother dropped this bomb on me: “I don’t really worry, I know you’d take care of me when my time comes.” To be honest it made me a little angry, the assumption that is. My grandmother had seven children, and I did the caregiving. The reason for this was that she was abusive to them when they were younger and they never forgave her for it. After my grandmothers death my mother continued the cycle beating the hell out of me until I was too big for her. But despite those things, she’s right. I would take care of her, hopefully with some help.

        • JSakamoto

          OK I get you. I guess we’re in different situation as I was never really that close to any of my grandparents, being that I only saw them a few times a year. Not sure how i would have reacted if I was in your situation at 7 years old.

          I do know that if my mom treated me like your mom did I definitely wouldn’t take care of her when she was older. If and when I have kids i also don’t really expect them to take care of me to the extent of a live-in nurse. That’s why I’m hoping I stay healthy. I guess your situation is different than mine as I’m not really close to anyone in my family. Always been like that I don’t know why. There is no animosity it’s just that my thinking is so different from theirs. Oh well, it’s ok, i’m still pretty happy with life now.

          If how you treat your mother is an indication of how you treat others, you seem like you have a good heart.

          • Patrick

            Or I’m just a chump that doesn’t have the ability to say no. Personally – I’m pretty sure I’m a chump.

  • revoltingbrain

    I’ve asked myself whether I would dump my folks into a retirement home in the future. It’s a tough decision.

  • Soldano

    This is a very interesting article, hats off. I like the fact that you’re open minded and actually intersting in listening and sharing your experiences.

    It’s a very common idea in China that foreigners don’t have strong family values. But it’s absolutely false. It just takes different aspects. For example, Chinese dads are not involved much in raising their children. How is that strong family values ?

    If you think about it, not too long ago, families in europe were similar to Chinese families. And China is changing already. China being different is just a bad excuse and an easy answer to everything.

    We’re not letting the old ones die alone, in fact governements have huge plans and budgets for taking care of them, medically, but also by adapting the cities, transports, houses, food products etc. Every hour we work, we pay taxes that are dedicated to retired people. You can also plan ahead, for your own retirement, to make it easierfor your own children when the time comes, in particular financially.

    In china, it’s up to you to help your family, but no one’s really doing anything to help. You think it’s normal to take care of your father, but you never think about helping your children taking care of you by planning ahead. You just leave it up to them. It’s a huge responsibility, and not everyone can take it.

    Contrary to what you might believe, a lot of families here (in France i mean) choose to take care of the elderly. That’s what we did. My GF’s (chinese) grandfather on the other hand, said having a nurse taking care of him is like losing his face. In the end, it becomes a burden more than anything. Everyone has to act so he doesn’t lose face, but it creates a distance between him and his sons instead of bringing them closer.

    I lost my Grandfather this year. My Gf lost her grandpa Too. When it happened, her mom said i was much closer to my grandfather than she was to her own father. Ironically, i didn’t spend much time with him at all when he was old. But the time we spend was extremely intense in quality and in depth. Medical stuff or everyday life just take the focus off more important things.

    So really, what chinese people need to do, is let everyone do things their way. Not everyone has the same answer to a problem.

  • excellent article! i was directed here by my daughter. she pledges that she’ll take care of me when i’m old but her work (she’s working in shanghai) takes her away. my 84-year old mom lives with me. mom’s easy to take care, it’s me who’s the problem. i tend to lord over her because she’s so mild-mannered. i’ll get upset when she eats too much (she’s diabetic n hypertensive) n so on.

    the daily ‘rubs’, more because of my arrogant attitude, makes me wonder at night is she’s happy living with me. ok, it’s not so bad but i wish i can be better. sometimes i think she’ll enjoy a nursing home better because she’s very friendly. she goes to the widows’ association n church cell group n so on. i think she’ll be miserable in a home bc of the taboo. i’ll be miserable too.

    why is it tt we take care of the next generation (our bratty kids) so well, but the older generation is made to feel like we are dong them a favor when they live with us? how can tt be since our kids don’t care for us as much as our parents did? tt’s a really strange thing about humans.

    i’m malaysian too btw. my conclusion having read your article is this: upbringing, the old folk’s preference and the availability of good homes are all important in making the decision to stay home or go to a nursing home. there’s no way i’ll put my mom in a nursing home here after seeing the conditions. my own grandma in Hong Kong was found tied to a potty chair because she had colon obstruction. my friend’s FIL lies in a bed of pee in a nursing home. no way.

  • Thank you for all your personal stories and opinions on the family home/nursing home issue!

  • JEng

    I recently watched Derek by Ricky Gervais and Changi from Australia and we still have residents in senior citizens homes like Alastair Urquart (who lives independently) who experienced the Japanese when they were decloaked.

    I want everyone nice to be taken care of and protected and made happy and kept involved.

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