Caring for Our Own: An Immigrant’s View of Elder Care
October 26, 2017 | Published first in Institute for Family Studies
This past April, my husband and I moved within walking distance of my aging parents. Nine years ago, my maternal grandmother died from cancer in a room she shared with my cousin in my aunt’s house. An elderly uncle also recently passed away after being cared for at home. Many of my Iraqi friends have their widowed mothers living with them, or very close by.
Even living in diaspora, the Iraqi-Christian subculture continues to practice the tradition of caring for its elderly within the architecture of the family. The skeptic who believes such familial structures are due solely to economic necessity, lack of individuality, and cultural backwardness would be wrong. The elderly generation in my subculture is revered and loved; the hoary heads are cared for from a position of ethical strength.
The American version of elder culture and elder care has always felt foreign to me. I remember feeling grieved and confused when my first husband took me to see his father, who had Alzheimer’s disease and was living at a nursing home. His wife, my mother-in-law at the time, had taken care of him for some years until she could no longer do so without medical help and so decided to put him in a nursing home. I was faced with a culturally foreign situation: My mother-in-law was living in a retirement community (also foreign to me), and my father-in-law was in a nursing home. I don’t know if I was judgmental or not at the time—I certainly hope not—but I was at a complete loss as to how to respond. A year and a half into our marriage, my mother-in-law fell ill. We brought her to live with us, where my mother and I helped to take care of her. Even after my husband and I divorced, my husband’s mother continued to live with my mother, until she eventually went to live with my ex-husband until she passed away.
Although there are significant cultural differences regarding elder care culture, I recognize that there are situations that make it impossible for the elderly to be cared for at home. The causes are diverse: family breakdown and complexity, lack of finances, serious illnesses, incapacity, and so on. For some families, of course, a retirement community or a nursing home might be a necessity for elder family members.
Still, there are reasons to be concerned about the state of elder care culture in the United States. In my first year of law school, I studied a famous retirement community in America—Sun City in Arizona that opened in 1960—through Spur Industries, Inc. v. Del E. Webb Development Co., a well-known nuisance case that is studied by many first-year law students. As the population ages, the move to retirement communities increases among the Boomer generation. In these insular communities, the retirees live closed in on themselves—they usually have their own shopping centers, restaurants, and churches. This limits their exposure to a larger socio-economic mix. The drawbacks of this clustering are many, leaving the elderly defenseless to social ills which thrive in such a closed system, like loneliness and “gray divorce.”
It also leaves them vulnerable to those who would target the elderly to defraud them. A harrowing report in The New Yorker, “How the Elderly Lose Their Rights,” tells the story of strangers becoming “guardians” of senior citizens living in retirement communities, without the knowledge or permission of the individuals themselves or their families. The guardians gain sole custody over these elderly wards, transferring them to nursing homes, where they are over-medicated and cut off from access to their families, as the guardians take over their estates for their own financial gain.
Older people in my Middle Eastern culture do not separate themselves from the outside world or their children in their aging years. Rather, the family usually tries to find a way to live in close proximity to one another. Intergenerational living—coresidency—tends to give older Middle Easterners a wider social circle and can protect them from the abuses of strangers like those experienced by the elderly who fell prey to guardians.
Whether they live nearby, or in the same house, older immigrants from my Middle Eastern culture tend to be involved in child care, after-school pick up of grandchildren, cooking for the family, errand running, shopping, mentoring, marital support of the younger generation, and a host of other domestic services and familial needs. This is not some sort of Randian exchange of goods and services—this is what families do—they work together for a shared goal: the well-being of the entire family.
My experience is confirmed by a number of studies that show that older immigrants, in general, are more likely to live in “complex households” with other relatives and/or their grown children. Having experienced this myself, I was surprised to see the cultural element downplayed by a recent study titled, “Just Like in Their Home Country? A Multinational Perspective on Living Arrangements of Older Immigrants in the United States.” The study, by Zoya Gubernskaya, and Zequn Tang, stressed that the “unusually high coresidence among late-life migrants is likely to be driven by the unique family reunification policies in the United States.”
Older people in my Middle Eastern culture do not separate themselves from the outside world or their children in their aging years. Rather, the family usually tries to find a way to live in close proximity to one another.
The authors do acknowledge a variety of studies that show that reasons for coresidence include financial difficulties, as well as a strong belief that family members should take care of each other, which is a matter of cultural conviction. These studies also show that older immigrants are more likely to co-reside than U.S. born Americans. In their study, Gubernskaya and Tang look at the habits of three immigrant groups, specifically those from Mexico, Vietnam, and the Dominican Republic, and compare them with the habits of the elderly who stayed behind in their home countries. They also compared immigrants who came as children or young adults, with those that came after 50 years of age, showing that acculturation and socioeconomic integration makes these immigrants more likely to live independently into old age. Their goal was to provide a more precise answer to why there is a higher rate of coresidence among immigrants compared to their U.S. born peers. The authors surmise that if older immigrants coreside at the same level as their counterparts in their country of origin, then the answer is indeed cultural. However, their results show that the older immigrants coreside at a higher level than their counterparts in their country of origin; thus, the authors conclude it is the family unification policy in U.S. immigration law that is the deeper cause.
It’s true that the family reunification policies make it possible for adult children over the age of 21 and with a certain annual income to sponsor their parents from their country of origin. And it’s also true that often, although not always, these older immigrants will reside with their reunified family. I’ve known many immigrants who have made use of this law to keep the family together when possible. It may be anecdotal, but from watching this immigrant subculture, often those who do co-reside are widowed. But married or widowed, older immigrants, especially in my Middle Eastern immigrant community, tend to live near their adult children, and this is at least partly due to the high value they place on family and elder care.
As an immigrant, I think Gubernskaya and Tang misunderstand the immigrant mind and misconstrue the situation. The family reunification policy is helpful, but it is only a means to act on a highly held cultural value: the taking care of elderly parents by their adult children. In that sense, it is a policy that harmonizes with existing values; not a policy that encourages any novel behavior. If there is any discrepancy between older immigrants and their counterparts in the country of origin, I would stress it is most likely due to the destabilization of migration. Gubernskaya and Tang call for state programs, but I recommend policy and cultural changes that emphasize the goodness and benefits of strong families rather than programs that have the potential to separate the elderly from their families.
In Iraq and throughout the Middle East, there are a few retirement communities and nursing homes, but there is a heavy social stigma to using that route. Generally, families take care of their own, sometimes with the help of home care assistants; this is a hallmark of the culture and is not dependent on religion. That is: Muslims, Christians, and other minority religions in the region hold the same value regarding elderly care. Due to migration and/or death of family members along with the economic breakdown in Iraq, there are now some elder-care homes. But before the collapse of Iraq, dropping off an aging relative at a retirement community or nursing home was unthinkable, and this cultural value was so prevalent that no enterprising businessman or government bureaucrat would even consider building one.
There is a deeply human element to these familial arrangements within immigrant communities, most certainly as I have experienced them in my Middle Eastern circles—an element that is missing in the study by Gubernskaya and Tang. It’s true that sometimes family members take advantage of each other, and there are unhealthy components to co-residency, particularly for some families as they mention. But this is part and parcel of family life in this world. We don’t abandon something good because it may be used with ill will.
In his encyclical Centesimus Annus, Pope John Paul II wrote, “the family [is] a community of work and solidarity.” This is exactly how my Middle Eastern immigrant community sees the structure of the family and the role of its members: It is a community—albeit an imperfect one—where each member is valued and has an irreplaceable part, especially the elderly. We all know that squabbles happen, that some family members can be ungrateful, unkind, and may meddle too much in their children’s marriages. Yet for all the hardships and the dysfunction, no one gives up on the institution. The multigenerational family, as Pope John Paul II put it, is a community of work and solidarity.