FAMILY AND AGED CARE
By Yaacob Harun
The family, has always been the place where one finds love, companionship, comfort, and solitude. Rapid change that occurs in all spheres of society does not reduce the status of the family as the basic institution in society. However, the process of structural differentiation has robbed the family of its major functions, notably the economic, the educational, and the protective functions, if not totally, but to share them with specialized agencies such as the factory, the school system, the police, civic bodies, welfare organizations, and others. Nevertheless, the basic reproductive, emotive functions, and to a certain the protective function (including care for the young, the aged, and the infirm) still remain within the confines of the family system.
This paper intends to discuss (briefly) issues related to aged care in the context of the changing family system. Modern families, especially those found in the cities are not able to provide or to extend such care for the aged and the infirm as it was expected of them to do so. Factors like urban residence, work demands and the changing conjugal roles, lack of resources, and new value orientations are some, but not only the likely constraints that hinder the extension of care to those mentioned.
By taking up urban residence, it means a person is physically detached from the family circle. Contacts with parents and relatives gradually become less frequent. Over the years of detachment, family obligations and expectations towards those who are still living in the villages seem to wither. Aged parents are normally left in the care of relatives, if there is any, who are staying in the same villages. Only, in times when the parents are critically ill do the children make their presence felt in the family homes. Even so, they are not there for long. It is lucky for the parents if they have a number of children who can take turn to look after them in times of need. Otherwise, they have to fend for themselves if they still insist on staying in the village and not move to be with their children who have migrated to the city or to other places where they take up employment.
A study carried out on 1614 urban Malay families in Klang Valley, Ipoh, Penang, Johor Bharu, Kuching, and Kota Kinabalu in 1995 shows that the majority (91.2%) of 1401 families who still have surviving parents aged between 60 and 90 and above, mentioned that their parents are staying on their own in their respective villages. Only 21 families or 1.5 percent of those families reported that their aged parents are staying with them. Quite surprisingly, about 7.3 percent of the urban families with surviving parents mentioned that their parents are staying in old folks’ homes. (Yaacob Harun et.al, 1997:113). This means to show that the majority of the parents prefer to be on their own their villages rather than move to stay with their children in the cities.
In fact, most elderly parents do not need much active care. They are quite capable of managing for themselves as they have done throughout the life-course. As Graham Allan says, “They may be that much frailer and find some activities harder to complete, but they generally have no desire to be seen as dependent on their children” (1996:63). However, there are limits to this. If elderly parents (especially so if both of them) become infirm, then at least one child, particularly the one who is staying nearby, either in the same village or in another village will become more involved in providing care and a level of support. The pattern of care is greatly influenced by the structure and nearness of the family. If daughters were available, particularly the youngest, they were the ones to help. If they were not, then the duty passed to daughters-in-laws, sisters and neices. (Townsend, 1957)
To move to stay with the children in the city is a decision taken after all possible alternatives have been exhausted. The constraint of space in urban living is one of the factors that hinder children to accommodate aged parents. Only very few can afford to provide proper accommodation to their folks as well to attend to their needs. The situation is made worse if their elderly is sick and bed-ridden. I am of the opinion, that, because of this consideration that a certain percentage (7.3%) of the respondents in our study mentioned that their elderly parents are placed in the old folks’ homes. To me, this is a better choice to make than to opt to stay in a crowded one or a two-roomed apartment with their married children in the city. A point to note that some of the elderly Malays of rural Malaysia especially those found in the northern states of Perlis, Kedah and Kelantan, will seek “refuge” in the institution of the pondok. The pondok is not only the place where one studies religion, but also a place for old people to stay among themselves, to be free from family obligations and commitments so that they can spend whatever time they have left to intensify their religious understandings and devotions to God.
WORK DEMANDS AND THE CHANGING CONJUGAL ROLES
The predominance of single income family whereby the husband is the only breadwinner is a phenomenon of the past. Today, more women are entering the job market outside the family. Based on our study (1995), out of 1397 families who responded when asked about the spouses’ occupations, 60.1 percent mentioned that both husband and wife are working, and only 39.9 percent of the wives are not working. The working wives are no longer confined to playing the traditional role as homemaker or as wife-mother. Alongside with their husbands they have become active contributors to family income, and not surprisingly, some are earning much more than their husbands. As a result, this gives them more voice in family matters, and at the same time, reduce the dominant role positions of their husbands. Generally, families today are more democratic where family decisions are collectively by both spouses.
When women are active participants in the job market, they can no longer devote their time solely to handling family matters including child and aged care. Research literature which have been built up since the early 1980s demonstrates very clearly that daughters and daughters-in-law carry a far heavier burden of caring than sons or sons-in-law. Nissel and Bonnerjea’s (1982) finding that women in households in which there lived an infirm elderly parent spent on average two to three hours per day providing active care, whilst their husbands spent on average only eight minutes (c.f. Allan, Op.cit:72). Tania Li in her study on the Malays in Singapore (1989) also says, daughters are thought to be a more reliable source of support in old age than sons. I believe this is due to the fact that in most societies, particularly Asian societies, culture still assigns the women the primary responsibility for household management including child and aged care. Their entry into the labour market definitely poses a strain on the family in view of the demands of the occupational sphere. As Hoffman (1983) puts it, “Although it has been shown that husbands of working women are more likely to contribute to household management, the burden falls unequally on the wives”.
LACK OF RESOURCES
Another factor that limits the provision of care for the aged and the infirm is the lack of resources which include time, money, and space (as already discussed). When family members are too involved with their daily routines at work, they have little time to look after or to pay more attention to their aged parents, irrespective of where the parents stay. The situation is, of course, worse is the parents are staying in the village far from the city. It is only during the weekends or during public holidays, the children will have the time to visit aged parents and to attend to their needs.
Every family has its own financial commitments. The relatively high cost of living in the city leads to the situation where most people are not able to give enough financial support to their parents on a regular basis. In Graham Allan’s words, “The educational careers of adolescent children might be given priority over caring for an elderly parent; or already providing care for, say, a disabled child would be the reason for not taking on responsibility for the welfare of elderly parents” (1996:79). In fact, strains are imposed on married children and they are placed in a conflicting situation between their responsibilities to their children and those to their parents. Such difficulties are not always admitted and are difficult to define precisely.
Only those who can afford can hire maids to specifically look after their elderly folks, or send them to specialized centers for the infirm. However, children feel that they have an obligation and a moral duty to support aged parents as a way of thanking and paying back after all the parents have done for the them over the years. Although our study shows that only 29.1 percent of the urban families mentioned that they have given financial support to their parents, but I believe these families have done so on a regular basis. For those who did not respond, it is probably because the parents themselves are financially self-supporting or they have received support from other sources, for example, from other children who are on better economic and financial positions.
NEW VALUE ORIENTATION
Conjugal nuclear families found in the cities are both economically and socially independent family units. Intervention from relatives and parents from both sides are minimal. Thus, these families are more concerned about the welfare of their immediate family members. This new value orientation results the families being branded as selfish and less sensitive on matters that involved wider kin circle, which include concern and attention given to aged parents. Unless and until the parents are really infirm or critically ill do such care and attention are given. Even so, as it was already mentioned, the attention given is temporary, only during the time the children are back at the family home.
Modern families place a high value on privacy. They need the freedom to do things their own way. Encroachment into the private and personal family affairs by any adult family member (for example by an aged parent or parent-in-law), is something to be avoided. Sometimes, bitter conjugal querrel erupts from direct intervention from parents into the affairs of their childrens’ families. To my mind, it is better for both parties if parents choose stay on their own rather than to be under the same roof with their children.
New values accrued through years of urban living make a person difficult to revert to old traditional value system of the gemeinschalf type where elements of family cohesiveness and collective consciousness are the norms. The degree of individualism one enjoys in the city gradually makes him feel that the welfare of other people outside his immediate family is secondary, and sometimes, a burden. The situation is more stringent if he or she could not fulfill demands from wider family circles with regards to aged care. To opt for resignation and to go back home to take care of the infirm is unimaginable. Hence, parents have to fend for themselves until they die. It is true as the adage says, “one parent can take care of ten children, but ten children cannot take care of one parent”.
Generation gap is another related factor that extension of care for the aged is affected. Grandparents subscribe to a set of (traditional) values different from those of their grandchildren who are born and raised up in the city. Not only grandchildren feel uncomfortable with the presence of their elderly grannies in their homes, who tend to voice out their criticisms towards their behavior or ‘misbehavior’, grandparents too are not pleased with the situations they encounter in their children’s city homes. Not many will want to prolong their stay, unless circumstances force them to. Tania Li says, “the powerlessness and peripherality of the old people in the child’s household is an incentive for the old to continue to maintain a separate dwelling .. for as long as the are able” (1989:60)
Rapid social change that occurs in our midst today has resulted in a breakdown of the family system with negative effects. Most devastating is an erosion of family values, mutual aid, support, care, feeling of togetherness, and shared sentiments are no longer the same as they were in the past. We cannot predict what the situation will be in the ensuing years. In the case of Malaysia, the effort taken by the government in its Vision 2020 to create a caring society built on a stable and resilient family system is really a good move. In my opinion, irrespective of the pace and rate of change, the family and kinship institutions have to be strengthened, and kinship values, especially with regards to sustaining kin and family unity, have to be preserved. The bad experience encountered by the family institution in the West, which threatens to lead to its “demise”, is a lesson to be learnt by all members of society who still place a high value on love, affection, companionship, selflessness, cooperation, mutual help, family protection, and the like.
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