By Marie Stella P Cruz
To be admitted into a nursing home run by a voluntary welfare organization, one must lack caregiving arrangements, be significantly disabled, and have few means of support. Such a nursing home is designated a voluntary nursing home, or VNH.
I think of the admission requirements as the three D’s: patients do not have a carer at home, are disabled, and are dirt-poor.
The Shattered Pitcher
A Chinese man in his mid-nineties admitted himself into a nursing home. A widower with five adult children, he had moved in because he did not want to “trouble” any of his children, and he had had a good impression of the nursing home years ago as a visitor. Months passed amidst the stark reality and mundane routine of the nursing home, and he increasingly desired to leave. He requested the social worker’s help to arrange for him to move in with one of his children.
A family conference was called. Not one of his children, who all lived in their own properties and were financially comfortable, agreed to accept him. One child said that if the nursing home discharged him, there were nursing homes in Johore Bahru and Thailand, implying that they would simply place their father there. The old man died in the same nursing home two years later, broken-hearted.
As his family physician, I optimized his medical care, but could only empathize with him over the family drama. What I did do were little things to brighten his day: visit him regularly, to make small chat, and once, I treated him to a McDonald’s breakfast, right there at his bedside.
Commentary
After years of working in a nursing home, I have a fourth D that describes the families of many residents: dysfunctional. For a host of reasons, many of which may be long forgotten, there are families who visit rarely, or are recalcitrantly uncontactable. The VNH may be the last port of call in a journey of strained patient-children and patient-sibling relationships. Children may have mental illnesses and other disabling problems of their own, or they may be incarcerated. Some children do not talk to one another. Some patients have been abandoned by their family.
What is a nursing home? It’s a place where professional care is provided round the clock, to patients who require skilled nursing care or assistance in activities of living. An increasing number of our frail elderly are being placed in nursing homes, as a result of greater life expectancy and growing complexity of illnesses, vis a vis a dwindling supply of caregivers in smaller families.
Whither filial piety? Surely the ideal setup should include co-residence by children and their aging parents. Unfortunately, reality is sometimes not ideal. Traditional values have changed. Some families have no alternative to placing their loved one in a nursing home. Some choose the easy option.
——Dr Marie Stella P Cruz
Marie Stella P Cruz provides care to patients in nursing homes. She is interested in care for the older adult, the institutionalized patient, and the home-bound patient, as well as end-of-life care. She also teaches undergraduates and postgraduates and is involved in assessment.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.