Friday, April 4, 2014

Rethinking what it means to be filial



In Asian culture, children are expected to welcome their ailing parents into their homes instead of placing them in residential facilities such as nursing homes.

That is being filial, but have we misunderstood filial piety? At the recent Economist Health Care In Asia 2014 conference, a speaker challenged the conventional wisdom, revealing results from a survey where seniors living with their children described their living situation as “no choice” and the children separately surveyed bemoaned their parent(s) living with them as “burdensome”.

Half tongue-in-cheek, he declared this a most unhappy situation, with the “parents unhappy, the children unhappy and both suffering shortened lifespans”.

“No choice” and “burdensome” — these are terrible words in the context of acting upon filial piety.

Perhaps in more than a few cases, parents do not want to live with their children, but have no choice as they are financially dependent, while children act almost purely out of a sense of duty to house their parents, but with deep unspoken resentment.

Is Institutional Placement still ‘extreme’?

As children, we want our parents to be happy, secure and comfortable in their golden years and this is often unthinkingly taken to mean parents living with us if they are unable to live independently.

Institutionalisation, or placing one’s parents in an aged care facility, is seen as what the 1982 Inter-Ministerial Committee on the Ageing Population describes as a last resort and most “extreme measure”. Three decades have passed, but I doubt this stance has softened.

As heretical as this sounds, there is merit in at least re-examining what filial piety operationally should look like and asking about the role of residential retirement facilities.

Is a senior living with children who are out working most of the day, with only a television for companionship, really happy? And secure?

Or is the senior in an aged-care facility constantly surrounded by peers and like-minded seniors under the watchful eye of trained health professionals better off?

In my work, I interact regularly with many individuals in their 50s and early 60s and I am struck by how many ask me about the availability of retirement homes in Singapore or the region. Are they close to their children? Yes.

But do they want to live with their children? Not really. Many are also mindful that work opportunities are global and are loath to “chain” their children to Singapore and “lesser” careers because of filial piety.

There are 200,000 Singaporeans living and working overseas, mostly between 20 and 54 years of age, said the National Population and Talent Division. The World Bank in 2010 estimated there were 300,000 Singaporeans considered migrants. It is likely that some of them have parent(s) living in Singapore with no other children here.

Redefining Ageing in Place

One point about “ageing in place”, which is a near-universal mantra of governments, is that while the vast majority of seniors report intent to live in their current residence as they age, I suspect what they really mean is that they want to maintain their current relationships and social circumstances.

Physical locality is only one factor in the overall consideration and perhaps not even the most important. Interestingly, Professor Angelique Chan of Duke-NUS in a recent study highlighted the paradoxical nature of loneliness in Singapore as sometimes being alone in a crowd, saying: “You can live with a big family and still feel very lonely. Or you could live alone, but feel wanted by family and friends.”

What then are the options? Around the world, retirement villages and their variants are gaining in popularity. A useful learning point I garnered from a recent study visit to Australia is the deliberate planning for aged care facilities to be five to 10 minutes by car to one’s original home. This promotes familiar social interactivity, while enabling appropriate medical supervision. There is no NIMBY (Not In My Backyard) Syndrome in the community; I even learnt that many relatives visited the seniors on a daily basis.

However, it is really not about the physical options. The crux, as articulated by Mr David Collins, an active adult and assisted-living consultant, is the need to take the “sense of guilt” out of the equation and focus on what Dad or Mum will be getting.

He said to online resource Perspectives@SMU : “One social stumbling block is that people don’t want a family member to be put into an institution. Getting away from the institutional feeling and the institutional mindset, and realising that what you’re doing for a member of your family is really a wonderful thing. You’re giving that person the opportunity to be with other people of their own age, (who have) similar ideas, similar discussions about life and health and happiness, and it can be a very happy experience.”

What then filial piety? An opinion piece in Ethos, the publication of the Civil Service College from almost a decade ago, puts it in its proper place and context: “The concept of filial piety can be used to raise awareness and garner support for a family approach towards caring for the elderly, but the provision and regulation of community and institutional care may need to be expanded, and should not be seen as an arrangement of last resort.”

Let us think about filial piety in terms of outcomes, regardless of location and false notions of “abandonment”. What should matter is what our parents want, be it living with us, living with their peers or living independently.

What should not matter is what we think they want or what will make us look and feel filial.

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