Hi Lam, recently there has been a lot of talk about our aging population. Some people suggest that creating old age homes is the best way to allow our parents to grow old with dignity. Others feel it is preferable to allow them to live with their children. Lam, as I’m planning to do research on the matter, I’d be grateful for your insights on how best to look after our aging parents. Thank you la.

Concerned citizen, Thimphu   

Well, decisions based on what is best for the elderly depend on circumstances, and there is no definitive right or wrong. Having said that, I feel it is of the greatest benefit for families and societies as a whole if the aged can continue to live with their own children and stay in the communities in which they are familiar.

In reality, it is very disheartening to see old people being unceremoniously carted off to a home for the aged as soon as they begin to lose their independence. Although this is now a common trend in the west, it wasn’t always the case, and I believe that the custom began after the Second World War. Basically, many young people were killed in the war, and so the elderly had no-one to take care of them. To address this situation, the state began to offer clean, simple, and communal accommodation where the childless elderly could live out their remaining years in peace and with security. In this respect, the original motivation for establishing homes for the aged was to support the elderly who had lost their children, and so prevent them from becoming homeless. It was a system based on compassion, but sadly as individual freedoms began to take precedence over family and community responsibilities, it became a norm to admit elderly parents in homes for the aged, even those with healthy and financially stable children. 

As I stated above, however, there is no definitive right or wrong about admitting an elderly parent into a home for the aged, and for a person with dementia or who needs 24 hour professional care, it may be the most compassionate and appropriate option.  

In general, however, I feel that keeping an elderly person within their own family and community not only offers them benefits, particularly psychologically, but also creates an excellent environment for their grandchildren to spend their formative years. I’ll relate a story. I had not long moved to Taiwan when a local family invited me to their home for dinner. The husband and wife were preparing the meal, while the teenage children were working and playing on computers. After some time I heard a noise for a side room, and the two kids immediately dropped what they were doing and entered the room. I asked my new friends what had happened, and they explained that the mother, the children’s grandmother, who was suffering with cancer, was resting in that side room and needed some assistance. Now, I knew that Taiwan has top quality medical facilities, which are free for the general public, and so I enquired why the old lady was not in hospital. They explained that she was in her final stages of the disease and so had been brought home to spend her last few months with her family and in familiar surroundings. They said it was common to do so in Taiwan, and that even in the big cities the elderly mostly stayed with their children, and only those with long-term ailments that required 24 hour care were admitted to care homes. Coming from the west, I felt that this way of caring for the elderly was so much more humane than merely admitting aging parents – those who fed us before we could even lift a spoon and carried us before we could stand on our own two feet – to state-sponsored institutions. In addition, I feel that youth who grow up in an environment of warmth and caring and where they learn to put the welfare of the elderly and sick before their own enjoyment is one of the best lessons youth can ever gain – far better, in fact, than learning maths or science or other academic subjects. Sadly, however, it is now becoming more common for parents to be taken out of households and communities when they reach old age, and, as a result, an entire generation loses the opportunity to nurture their innate goodness by putting others first, which, I believe, has a very detrimental effect on society as a whole.    

Furthermore, I notice that in rural areas of India, the elderly often sit outside their home, or, if they are infirmed, lie on a string bed. In this way, they remain at the centre of the community, with neighbours and friends greeting them as they pass or dropping by for chai and a chat. This keeps their minds active and enables them to retain a sense of purpose. 

Now, while the elderly are likely to live longer in western-style old-age homes with twenty-four hour care, we need to consider the purpose of living longer. Is it really just to tack on a few extra years to our life, or is it also about quality of life? Nowadays, due to better medical facilities and nutrition, people often live into their 80s or 90s, but are these years of any real value if they are spent in loneliness, mindlessly staring at a TV screen. Of course, everyone has their own specific idea of what is important, but if it were me, I’d rather die at a younger age sitting on a string bed in village or in a cave in Singye Dzong than add a few more years to my life while being isolated from friends or separated from Dharma activity in a modern care home, passing the days eating, sleeping, and staring blankly at a TV screen.   

So, what is the answer? As I said there is no one model that fits all situations, and it really depends on circumstances. Anyway, as you plan to research the subject, maybe you could consider the popular options. In Taiwan, as I mentioned, the elderly mostly stay with the family. However, as the cost of living in urban centres there is very high, both husband and wife tend to work full time. As a result, a system has been established that enables working families to maintain the tradition of keeping aged parents with the family. Basically, the government allows trained foreign care-givers, mostly from the Philippines or Indonesia, to be employed as fulltime attendants who live together with the family. Now, in countries with less demanding schedules and lower costs of living, families and communities in rural areas usually retain the role of taking care of the elderly. Then we have the western model, where the elderly are admitted to private homes for the aged, with the fees being paid by the elderly themselves, along with subsidies from the local city. Anyway, as society is an integrated network, strategies for caring for the elderly need to be explored as part of the overall picture, and not just viewed from one angle. This is the important point.