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Elderlies in Homes for the Aged as Caregivers of Orphaned Children

Article · November 2016

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Running head: ELDERLIES AS CAREGIVERS 1

Elderlies in Homes for the Aged as Caregivers of Orphaned Children

Erica Kimberly R. King

Ateneo de Manila University

ELDERLIES AS CAREGIVERS 2

Abstract

This paper explores the psychosocial framework and current social situation of elders in

Philippine society, with particular attention to those residing in homes for the aged. A review

of existing local and international literature on the role elderlies play in fostering, caregiving,

and volunteering follows. Two projects are proposed. The first is a community-based support

system for grandparents who foster their grandchildren in the absence or incapacity of the

parents. The second is a bidirectional foster program that pairs seniors in homes for the aged

with children in orphanages. Hospicio de San Jose in Quiapo is recommended as a possible

ground zero for the project since it houses both children and elderlies in the same institution.

The paper ends with potential implications and provide recommendations for further

research.

Keywords: foster grandparents, home for the aged

ELDERLIES AS CAREGIVERS 3

Elderlies in Homes for the Aged as Caregivers of Orphaned Children

The Philippines has always been known in recent memory as a country with a young

population. For this reason, there are relatively few research studies focusing on geriatrics. In

looking back at our own history, however, we will find that Filipinos have consistently held

their elders in high esteem and respect, viewed them as a source of wisdom, and delegated

upon them the role of keeping and passing on our customs and traditions (Carlos, 1999). For

all their contributions to society and humanity, the standards of living we impose upon them

reflect that we are guilty of not only neglect, but also ingratitude. In 2012, the number of

senior citizens had risen to 7 million, but there were only 4 Homes for the Aged being run by

the government. Private Homes for the Aged fared no better—they often lacked funds and

health workers, and had outdated facilities (“Golden Acres”, 2012). The purpose of this

article is twofold. The first is to identify in what ways Filipino elders can still be contributing

members of society. The second is to initiate interest in the value of this population subgroup

so much so that policy makers and organizations invest in elders’ welfare not just out of

obligation, but because of their unique value to society. I begin by exploring the psychosocial

issues experienced in the late adulthood stage, and follow with the current status of elders in

families and Homes for the Aged in the Philippines. I then present 5 empirical studies that

will serve as cases in point to argue that the elderly are an untapped rich resource for

caregiving. Finally, I end by suggesting projects that, when implemented, provide a possible

solution to some of society’s most chronic problems, and at the same time, improve the well-

being of elderlies.

Literature Review

As with all research undertakings, we begin with existing theory. What psychosocial

frameworks do elderlies operate in? Erikson, in his eight psychosocial stages of development,

characterized late adulthood as the period of Integrity versus Despair. The senior adult who
ELDERLIES AS CAREGIVERS 4

feels a sense of achievement over his life’s work as a member of mankind has achieved

Integrity, while the senior adult who experiences regret over his life’s choices is in Despair

(Miller, 2011). In Villegas’ (2014) in-depth interviews with 15 elderlies in Laguna, concrete

examples of despair and integrity can be seen in the context of dependency and

disengagement. Dependency is evident among the elderlies in that they are financially and

physically supported by their children, even when the family is in grim financial conditions.

The elderlies, however, feel a sense of obligation to relieve the pressures on their grown

children by helping out with household chores. They man sarisari stores, care for their

grandchildren, and help in housecleaning. Still, there is always an exception to the rule. One

of the respondents lived by herself and even supported her children’s family financially by

selling rags and curtains. By doing so, she has maintained her esteem and independence.

Other elderlies, despite living in the same households as their family, experience

disengagement. The younger generations live a different lifestyle and are often not at home,

leaving the elderlies feeling lonely. This leads the latter to believe that it is better to give

freedom to their grown children and allow them to live their own lives.

On a more macro level, what is the current situation of elderlies in our country? The

widespread phenomenon of transnational families cause many migrant parents to hand over

the responsibility of parenting their children to the grandparents. The disproportionate

number of women OFWs, who are incidentally the traditional caregivers of the elderly, also

increase strain on the latter. The elderly who are now possibly needing care themselves, not

only find that there is no care to be had, but are also put in the position of having to care for

others (Villegas, 2014). It is unclear whether it is more fortunate to live as a senior among

family, but under poverty, or to be alone in life, abandoned as a ward of the state, but have

access to medical care and shelter. That is the case, at least in Golden Acres. Surrounded by

greenery and far from pollution, this government-run home for the aged houses over 200
ELDERLIES AS CAREGIVERS 5

elderlies, and is relatively clean with good facilities. In Luwalhati ng Maynila, it is a different

story. Almost 300 residents are accommodated in this home for the aged that was built for

only 150. With a budget of P99 per resident per day, the elderlies suffer from skin rashes,

overcrowding, and a high caregiver to patient ratio. Thirteen other homes for the aged in the

country do not qualify for cash incentives and staff training from the Department of Social

Welfare and Development because they have not completed the technical requirements for

accreditation as a nursing home. With a budget that barely covers the living expenses of its

residents, no resource can be spared in producing a manual of operations or a sanitary and

safety certificate that are required for accreditation (“Golden Acres”, 2012).

In order to identify a plan of action that can help the situation of elderlies in our

country, we look at other countries, wherein the role of elders is uniquely defined according

to their culture. Kasedde, Doyle, Seeley, and Ross (2014) conducted in-depth interviews with

13 foster children in rural Uganda, an area stricken with HIV. The researchers found that

grandparents who fostered their orphaned grandchildren experienced loneliness, despondency

and depression caused by the strain of caring. The parents, prior to their deaths, often

explicitly request older extended family to care for their children, acknowledging that older

people serve an important role in society as “caregivers, advisers, mediators and gatekeepers”

(p. 166). In the absence of social welfare from external sources, the theme of reciprocity also

appeared as older people use fostering as a strategy to ensure their immediate and future

security. As the children mature, they, in turn, will care for their grandparents.

Sheridan, Haight, and Cleeland (2011) used a mixed methods research design to study

40 children and their 31 caregivers in Illinois. This particular sample had parents involved

with methamphetamine abuse and production, as well as child neglect and physical abuse.

After administering the Child Behavior Checklist for Children (CBCL), researchers found

that children who had supportive grandparents scored lower in scales for social problems,
ELDERLIES AS CAREGIVERS 6

externalizing, and aggression.

Mhaka-Mutepfa, Cumming, and Mpofu (2014) explored the role of protective factors

(personal, social, and environmental) in supporting the health and well-being of

grandmothers as the primary caregiver. They used a cross-sectional survey design to study

241 grandmothers in Zimbabwe who fostered orphaned children, their parents having died of

HIV. Results show that personal assets such as mastery and high self-esteem were significant

factors in physical and mental health. “Grandparents with a positive attitude toward life are

likely to see caregiving as a challenge rather than a burden” (p. 1033). Grandmothers are

abler to cope with caregiving if they have resources available to them, regardless of their

social status. Finally, those living in urban suburbs also had better health and well-being than

those in rural areas, due to the suburbs’ proximity with clinics. For grandmothers’ well-being,

it was found that support from family and friends, as well as religiosity, improved well-being

and role satisfaction.

Fabry and Reid (1978) conducted an intervention in a US state institution that involved

teaching training skills to 5 volunteer foster grandmothers who were training multiply

handicapped adolescents with retardation. The teaching program included instructions,

prompts, modelling and praise, and researchers found that the frequency of grandmothers’

training increased. After 11 weeks, the frequency of training had not decreased, and 4 of the

adolescents demonstrated progress, increasing their number of skills by an average of 3.4

items as determined by the Skills Inventory (reaching, manipulating objects, head and body

movement). While a small sample size was used, this study shows that elderlies volunteer in

society to care for grandchildren not their own, and are relatively effective, with 80% of cases

showing improvement.

Kahana, Bhatta, Lovegreen, Kahana, and Midlarsky (2013) investigated the influence

of prosocial orientations on a large retirement community in Florida. Ordinal logistic

ELDERLIES AS CAREGIVERS 7

regression was used to determine the relationship of prosocial orientations on the

psychological well-being of elderlies. Results show that positive affect is predicted by

altruistic attitudes, frequency of volunteering, and informal helping. Volunteering and

informal helping also influences life satisfaction positively. Being female and having

functional limitations, however, predicted diminished well-being.

Discussion

After a review of related literature, it becomes clear that elderlies play an integral part

in society, first, in fostering grandchildren in the incapacity of the parents or lack of external

social welfare, and second, in volunteering to care for people in need in their community.

Caregiving can help elderlies maintain their integrity and independence and avoid despair and

disengagement. Two projects are proposed: one is to establish a community-based support

group for grandparents fostering grandchildren that would provide resources in caregiving,

and maintain protective factors identified by Mhaka-Mutephfa et al. (2014). These resources

include modern parenting seminars that teach grandparents in the community to watch out for

parental abuse and neglect. Furthermore, since grandparents have also been shown to be

capable of training children (Fabry and Reid, 1978), and have considerable wisdom (Carlos,

1999), they can be given training to tutor or mentor children in the community. Establishing a

support group for foster grandparents help maintain their mental well-being. Additionally,

involving the local parish in launching family first programs can help provide grandparents

the necessary external support they need in caring for their foster children.

The second project is a foster program that pairs seniors in homes for the aged with

children in orphanages. The fostering is bidirectional, such that seniors benefit from altruism

and volunteering, and children benefit from the caregiving. A possible institution that could

implement this project is Hospicio de San Jose, located in Ayala Bridge, Quiapo. According

to one of its senior residents, Milcah, the hospice houses both elderlies and abandoned
ELDERLIES AS CAREGIVERS 8

children, and serves as a temporary home for expecting mothers who do not want to, or are

financially unable to raise their babies (personal communication, October 1, 2016). Currently,

there is little interaction between the children residents and senior residents in Hospicio de

San Jose, since there are staff to take care of the needs of both. When compared to other

Homes for the Aged, Hospicio de San Jose is one of the cleaner, adequately staffed and well-

funded hospices. There is no shortage of volunteers, either. It would therefore most likely

have the necessary resources to train or retrain able elders in caregiving for abandoned

children. A screening procedure for determining the best candidates for foster grandparents

should be put in place, taking into consideration the physical, psychological, and mental

health of the seniors in question. Caregiving responsibilities range from simple tasks such as

reading storybooks to groups of children to more complex tasks such as feeding and bathing.

For older children, tutoring, teaching, and mentoring can also be an option. Staff supervision

is needed to ensure the well-being of both children and elderlies.

Conclusions and Further Study

Looking forward, if this project proves successful, there may be a shift in the structure

of institutions that provide care for the marginalized. Organizationally separate but

geographically nearby Orphanages and Homes for the Aged may pool their resources to

merge as one institution. Instead of living in wards, elders may form foster families with

‘adopted’ children and live in small community homes, but still have access to assistance

from staff. More research is needed before the proposed projects are implemented. For

example, an interesting research question would be whether caregiving helps prevent the

onset or progression of dementia among older people. The possible positive implications for

the well-being of the country’s orphans and seniors are cause enough to keep researchers and

practitioners moving in this direction of improvement.

ELDERLIES AS CAREGIVERS 9

References

Carlos, C. R. (1999). Concerns of the elderly in the Philippines. Philippine Social Sciences

Review, 56, 1-40.

Fabry, P. L. & Reid, D. H. (1978). Teaching foster grandparents to train severely

handicapped persons. Journal of Applied Behavior Analysis, 11, 111–123, DOI:

10.1901/jaba.1978.11-111

Golden Acres, isa sa mga home for the aged na may malinis at maayos na pasilidad para sa

matatanda [Video file]. (2012, Nov. 9). Retrieved from:

http://www.gmanetwork.com/news/video/140196/stateofthenation/golden-acres-isa-sa-

mga-home-for-the-aged-na-may-malinis-at-maayos-na-pasilidad-para-sa-matatanda

Kahana, E., Bhatta, T., Lovegreen, L. D., Kahana, B., & Midlarsky, E. (2013). Altruism,

Helping, and Volunteering: Pathways to Well-Being in Late Life. Journal of Aging and

Health, 25(1), 159–187. http://doi.org/10.1177/0898264312469665

Kasedde, S., Doyle, A. M., Seeley, J. A., & Ross, D. A. (2014, Jul). Social Science &

Medicine, 113(100), 161-168, DOI: 10.1016/j.socscimed.2014.05.002

Mhaka-Mutepfa M., Cumming, R. & Mpofu, E. (2014). Grandparents fostering orphans:

Influences of protective factors on their health and well-being. Health Care for Women

International, 35, 7-9, 1022-1039, DOI: 10.1080/07399332.2014.916294

Miller, P. H. (2011). Theories of developmental psychology (5th edition). New York; Worth

Publishers.

Sheridan, K., Haight, W. L., & Cleeland, L. (2011). The role of grandparents in preventing

aggressive and other externalizing behavior problems in children from rural,

methamphetamine-involved families. Children and Youth Services Review, 33(9),

1583–1591. http://doi.org/10.1016/j.childyouth.2011.03.023
 ELDERLIES AS CAREGIVERS 10

Villegas, J. A. (2014). Graying Matters: Aging in Contemporary Philippine Society.

Philippine Sociological Review, 62, 139-157.

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