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Who Cares For Our Elderly Today?
The Roundtable Open Forum #145






My 91-year-old mother-in-law is a wonderful person, with most of her faculties reasonably intact. She lives in an assisted living home, where the care is excellent and the staff are kind.

The place reminds me of a Holiday Inn, except that all the patrons are elderly and need help with the functions of everyday life – and it isn’t cheap.

Although my mother-in-law gets the best of care, her quality of life is much better because she has children close at hand. My sister-in-law runs small errands, brings her books and knows her medications by heart. When something goes wrong, as it often does at that age, we’re often the first to notice and make sure the problem gets dealt with promptly. My husband helps her with the television. We do her banking and buy her wine – she likes a glass with dinner – and remind the staff that she likes her bacon crispy.

We know her better than anyone else ever will, and we care more.

My husband and I don’t have children. When one or both of us are her age, we will probably depend entirely on the kindness of strangers.

We try not to think about that too much.

Who will take care of all the old people?

Until now, the answer has always been: their families. Grandma would grow old at home, tended to by a niece or daughter.

In many cultures, taking care of your parents is a sacred obligation. That’s the reason it has always been so crucial for Chinese parents, to take but one example, to have a son. A son is their old-age insurance.

But as traditional extended families pass into history, Confucian values are breaking down. China has attempted to address the crisis in elder care with a law saying that grown children are obliged to visit their parents and provide them with emotional support. (There’s widespread skepticism that it can be enforced.)

In the West, the modern welfare state has dramatically reduced the family’s role as the original social safety net. As family bonds become less and less vital for survival, people are fleeing from the burdens of family ties at breakneck speed.

Marriage, children, elder care, sacrifice, duty – all are giving way to what political economist Nicholas Eberstadt describes as “the seemingly unstoppable quest for convenience by adults demanding ever-greater autonomy.”

Writing in The Wall Street Journal, Mr. Eberstadt shows how fast these changes are happening and how astonishingly widespread they are.

In Italy, one in four forty-something women is childless; in Berlin it’s almost one in three.

Marriage rates are plummeting, too. Across the West, the fastest-growing type of family is the single-person household. In Western Europe, nearly one household in three now consists of a single person. In Norway, it’s nearly 40 per cent. In Canada, about 27 per cent of us live alone.

European demographers call this the second demographic transition.

The first transition was from an age of high birth and death rates to low ones. Now we are moving to a world of short-term, low-obligation unions and sub-replacement fertility. Having children is no longer regarded as an investment that will pay off when you age, but as a very costly discretionary expense that will impose a substantial burden on your income and lifestyle.

Nor are these trends confined to the developed world. They are sweeping across lower-income countries, too.

The devastating effect of the family’s decline on children is well known. But we’ve barely begun to understand its effect on the elderly. Sure, we know the demographics are pretty dire – people are living longer than ever and the baby boomers are getting old at the same time the working-age population is dramatically shrinking, and who is going to pay for it all?

But we’ve scarcely thought about the social effects, starting with the question of who will care for these boomers as they become increasingly dependent.

One thing I know for sure: Just like the state can’t take care of your kids as well as you can, it can’t take care of your parents as well as you can.

To begin with, people are willing to spend far more on themselves and their own families than they are on other people’s families, which means that state-paid elder care will never come close to the standards my mother-in-law enjoys in her geriatric Holiday Inn.

Many (if not most) of us will have to settle for extremely basic services, delivered by low-wage caregivers of varying competence and compassion. Currently, such places range from depressing to downright grim.

Are there any ways to bend the demographic curve?

Not that I can see.

Maybe if we had universal daycare, more flexibility for working parents and more dads pitching in around the house, we could persuade people to have more children. Or maybe not. Compared to our new-found quest for personal autonomy and freedom, these ideas seem comically inadequate. Besides, we don’t even know how to increase the marriage rate.

Sometimes I ask my childless friends what they plan to do when they get old and frail. Their answers vary. Some have no intention of living that long. Some are hoping that a kindly younger niece or nephew will take pity on them, at least at Christmastime. Some say they plan to go to Switzerland. Quite a few are in denial.

Personally, I’m thinking of adopting. Maybe it’s not too late.

Or maybe we can teach our cat to drive us to the doctor.


We invite our readers to post their comments on the issues raised here.

Have you or your family had to face such a dilemma -- that is, of making a decision as to the care of an aging family member? What route did you take? What were the alternatives, if any, that you considered? What has been your experience to date?

Do you have hopes of how you would like to live in your own senior years? Made any plans?

*   *   *   *   *

[Courtesy: The Globe and Mail. Edited for]
March 8, 2015

Conversation about this article

1: Irvinder Singh Babra (Brampton, Ontario, Canada), March 09, 2015, 12:03 AM.

A good, caring article by Margaret Wente shows that caring of the elderly, disabled and handicapped in and out of Canada is not easy now. Those who are taking care of them, the family caregivers, themselves need caregivers; and that the caregivers today are wanted more than ever. But the caregivers are both unpaid and low wage people of varying compassion and competence, and their job is still not well regarded. It's at the lowest of low professions. Ever heard that "I want to become a caregiver." But it's time when we need to have a college or university making and graduating caregivers for the world and work place, which has become a very stressful and dangerous place, and more. No need to go to Switzerland to die or have yourself mercy-killed there. Canada and other countries are embracing Euthanasia, mercy killing or end of the life 'solutions'. But who wants to see your loved one done to death, just because your family cannot care. That is murder and not a welcoming, universal solution. So the family members have to take care of those who are in need, and should learn how to do the basics from bed to bathroom trips, food, medicine and all the chores daily. Make your home a small nursing home. Nursing homes are expensive and not affordable by most people in need of care. Health care and travel insurance is also costly, and often denied for the high risk involved. Or just out of the reach by most. With some 19 years as a caregiver, I can say that caring is a family thing, prepare yourself and for your family members in need of care.

2: Sangat Singh (Kuala Lumpur, Malaysia), March 14, 2015, 6:59 PM.

'Birdh bha-i-aa oopar saak sain ..." [GGS:266.19] -- "As you grow old family and friends are there to feed you as you rest." How you treat your parents comes back a full circle when you yourself arrive at that stage. In Asia generally and in particular the subcontinent and China it is a long tradition of filial piety to provide care and financial support for the elderly as a sacred responsibility of the family. Unfortunately, urbanization and migration for work does create a situation where the earning adults have to live apart, thus affecting their ability to provide family care for their parents. The decline in fertility and smaller family sizes further reduce the number of children to share both social and financial responsibilities for the elderly parents. Where both husband and wife work, it adds to the problem. But, there is a happy situation where there are small kids and grandparents are there to keep eye on them and, as a bonus, tell them stories. The bond between grandparents and grandchildren is usually very strong. There is a saying: "Why do grandparents love their grandchildren so much? Because, they don't have children of their own." Given the changing trend, there might be a good case for homes for elderly that would cater for health care and social needs. But that would not absolve the children from their duty to visit as often as possible.

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The Roundtable Open Forum #145"

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