Families have always been the primary source of care for older adults who can no longer live independently. In medieval times, older adults who had no surviving family were relegated to residences in “poorhouses” or “almshouses.”
Even in more recent centuries, poorhouses paid scant attention to safety and sanitation. Neither were they designed to give individualized attention to older residents. As the National Academies of Sciences explains, “stigmatization of public assistance and of the populations of poorhouses perpetuated harsh conditions and served as a barrier to improving care.”
In the nineteenth and early twentieth centuries, older adults were diverted from poorhouses to state-sponsored institutions that were colloquially known as “old folk’s homes.” Older adults shifted into private institutions with the passage of the Social Security Act, which prohibited the payment of benefits to residents of poorhouses. When that ban was lifted in 1950, existing institutions evolved into the modern version of public and private nursing homes and assisted-living facilities.
Stigma Endures
While modern residential institutions do not resemble medieval poorhouses, the stigma attached to “old folks’ homes” remains. Seniors are often fearful of entering a nursing home. Horror stories about the spread of infections in nursing homes during the pandemic, coupled with anecdotal stories about the mistreatment and abuse of patients in a small part of the nursing home industry, contribute to the stigma with which potential patients must wrestle.
The adult parents of disabled seniors also worry about the stigma attached to nursing homes. Americans who come from a culture in which children are expected to care for their parents worry that placing them in a nursing home will be seen as a sign of abandonment that leads to “deep shame.”
Confronting Fears
Individualism and self-achievement have long been American values, but those values play into the fear that turning to institutional care for a parent will be perceived as giving up on the parent. The opposite is often true. While adult children are often willing to make the sacrifices that come with caring for a parent who has serious health problems, they may come to realize that they can’t provide the same quality of care their parents would receive in a nursing home.
When parents suffer from dementia, staying in their presence 24/7 to assure that they don’t wander away can prove to be impossible. A facility that caters to the needs of dementia patients may be better equipped than an adult parent’s child to assure the patient’s safety.
As one physician explains, adult children feel guilty when they place parents in an institution. Children feel they let their parents down, that they should have tried harder to keep them at home. When he feels it is warranted, Dr. William Coch tries to relieve that guilt by telling adult children that “sometimes that’s the best place for a person to be. It really is. Unless you have an overabundance of money and can hire shifts of two or three people to be there constantly, some people just need the environment of a nursing home.”
Americans value independence, but the value is often illusory. Most Americans depend on schools to educate their children. They depend on doctors to keep them healthy. They depend on employers to pay their wages. They depend on neighbors to watch their house when they’re vacationing. The phrase “no man is an island” reminds us that no man or woman can make it through life without help. Seeking institutional care for an adult parent is not a blow to independence. It is a recognition that we need to do the best we can for the people we love, and that others might be more capable of giving adult parents what they need than we are.