At some point in our lives, we would have heard a senior say they’d rather die than live in a nursing home. I’ve also wondered: are nursing homes really that bad in modern day Singapore?

Awhile back, I visited Moral Home for the Aged Sick (Moral Home) on my quest to understand the problems that our elderly face in their golden years. I met two sisters who had, surprisingly, chosen to sell their house and to live there at the nursing home.

The unexpected decision came after one of them fell, making them rethink their living arrangement—two frail woman would not be able to cope should any emergency situations arise. After considering the risks and for their own safety, they decided to put themselves in a nursing home they trust.

Initially, they even chose to hide this from their family members as they knew that it will be met with disapproval, and they didn’t want to be persuaded to go home.

One of the sisters said “Back then, my nephew tried to stop us from coming here. They encourage us to stay with them, because they can take care of us. We tell them not to worry, because we are very happy here.”

The other sister added: “I tell them, youngsters nowadays should work hard, don’t worry about us.”

I was brought up to see nursing homes as a terrible place, yet there I was, speaking to two 80 plus year olds who tells me that they like it there. I was in mild disbelief, but also heartened to know that I may be wrong about my impression of nursing homes.

There’s a stigma that we attach to placing loved ones in nursing homes. Nobody will want to send their parents to homes if they can afford to and any decent Singaporean will tell you that they will only consider it a last resort.

A part of this stigma comes from our strong attachment to our cultural values of being responsible for our parents welfare. As Asians, old adages like “Never forget your roots,” and “Don't bite the hand that feeds you” continue to form the backbone of what is essentially our emphasis on filial piety.

We hold ourselves accountable for our parents’ lives when they grow old, and because of that, we associate sending a loved one to a nursing home as abandonment. We think of it as the most unfilial and shameful act one can do to our parents.

But is it really?

I remember only ever being in a nursing home or old folks home twice. The first was a compulsory CIP programme in primary school, and the second was to me, just a fun activity with a bunch of my polytechnic friends who organised it.

The only thing I remember taking away from those volunteering stints was also that I never want to send my parents there, ever, if I could. The ambiance there was just so dull, sad, and dreary. At least, these were the only parts that stuck out in my memory.

For most of us, these volunteer experiences will also probably be the only firsthand experience we base our impression upon. That is, until we are actually faced with having to consider these homes for our own loved ones.

However, when I was at Moral Home, I had the opportunity to speak to its Chief Executive Officer, Winnie, who changed my perspective.

At 72, she is well into her retirement years, but has been serving there for more than 15 years. Despite being at an age comparable to the residents in her home, she tells me that this job has become a commitment she made as she has grown attached to the residents.

Some families put their loved ones in a nursing home due to their inability to provide adequate care for their elderly parents who are ill, disabled, or require 24/7 attention, which is where nursing homes like hers come in.

“Nursing care is to give comfort. To ensure that in the last phase of [the residents’] life, we can make them happy before they pass on.”

However, Winnie acknowledges that there are cases of abandonment. In her home, these make up about a third of her residents.

“They don’t have a direct next-of-kin. Some of them don’t have children. Some may have nieces or nephews who aren’t close to them.”

There are also residents who struggle with coming to terms with being put in a home.

"Some don’t want to talk to their children when they do visit. There are also residents who would pack their stuff and want to go home everyday."

To alleviate such unsettling feelings in her residents, Winnie dedicates time to make her rounds every morning. This is also her way of giving residents “the comfort and hopefully a little strength” in knowing that there are still people who care for and love them.

Alvin, a social welfare worker who has been working in elderly homes, shared that such cases of abandonment happen more often than we would like to think. Over the years, he has seen numerous cases of family members doing their best, to place their parents in shelters homes, only to disappear.

“An unforgettable experience was this very well spoken and groomed lady, whom over the course of a couple of months, did her best to admit her dad, making frequent visits to the nursing home to speak to staff and to show us that she has a loving relationship with her dad.

Yet, less than a month after admission, she lost contact with us. After trying to contact her, we realised she had migrated with her family members to Canada.”

It is exactly such cases that makes a mockery of nursing homes and undermines its bigger purpose.

Besides the 24/7 general and medical attention, another aspect of nursing homes is to provide residents opportunities for social interaction.

In Singapore, it is “estimated that 83,000 elderly persons will be living alone by 2030, compared with the 47,000 seniors aged 65 and above in 2016.” There have been many reports highlighting the higher risk of social isolation and depression in elderly persons living alone.

Even elderly persons who live with their family face the risk of loneliness and depression, because most adults spend a large part of our days at work, leaving our elderly parents at home alone.

The extroverted ones aren’t a problem, but the ones who do not venture out to engage in their own community of friends at neighbourhood spaces or through community centre activities will face problems with healthy aging. The lack of social stimulation could easily cause their cognitive and physical abilities to deteriorate.

On my way to the Home, I also happened to meet Mr Lim, my Grab driver, who bemoaned about his wife and his painful decision to send his mother-in-law to a nursing home.

They had tried looking after his ailing mother-in-law as best they could, even hiring a maid to ensure that there was someone around when they were at work. However, his mother-in-law’s worsening dementia condition and erratic behaviour continued to overwhelm the couple.

For instance, they had to attend to his mother-in-law rattling their door and asking for help to find all sorts of the things in the middle of the night. The need for constant care and attention took a toil on them over time as they were both juggling a full-time job. It was with a heavy heart that they put his mother-in-law in a nursing home, which he emphasised “it was really, really hard for my wife.”

Mr Lim’s story is the classic case of the many Singaporeans who have taken to nursing homes as a last resort. For them, what makes it even more difficult is the stigma, judgment, and shame that they would have to face when they put their parents in a nursing home.

Of course, as with the case of any service-oriented industries, there have been and will always be real cases of mistreatment and abuse at nursing homes. It isn’t to say that all nursing homes are negligent or abusive.

At the end of the day, there are also cons to institutionalised care like nursing homes, like a loss of freedom or autonomy, because residents will be restricted to the confines of what the home draws out for them.

However, there are many other aged care facilities like senior activity centres, daycare and healthcare centres, and in-home care.

29-year-old Mel, who have volunteered at day care centres and nursing homes before, said, “I think the most ideal scenario would be for those in old folks' homes to have volunteered to go there, be it for companionship or having medical support.”

Are We Accountable For Our Elderly Persons' Happiness?

It does get complicated if the elderly persons refuse to be put in a nursing home, and it’s never easy to have to decide what's right and wrong when it gets so personal. It's even harder when you have to deal with the torment and guilt of having to go against your parents’ wishes.

Regardless, the purpose of nursing home is to make the last journey of elderly’s life safe, comfortable, and ensure their needs and wants are taken care of as much as possible.

As much as we have to complain about, these homes are another avenue for us to provide care for our parents.

People say that it’s a terrible place as it’s where children abandon their parents. But if a child has already got the intention to abandon their parent, isn’t it as sad for these elderly persons to continue living in a home where they are unwanted? How much better will such a life be?

Similarly, if one really has to put one's parents in nursing homes for the genuine good of one's parents and family, it doesn’t mean we’re any less of a decent person and a filial child.

Also read: It’s The 21st Century, Why Do We Still Treat Maids Like Slaves?.

(Header Image Credit: Kanal 247)

69-year-old Mr Zhen once attempted to take his own life. “Since there’s nothing [left] to do, I may as well die.”

In my attempt to learn about the lives of elderly in Singapore, I had spoken to five other seniors in their 60s to 80s. The one thing that struck me was how there is an unspoken, but very perceptible sense of aimlessness.

In an article by The Epoch Times last year, a 2008 research article was brought up, where all 19 interviewees “reported feeling lonely or depressed, and many said they live by the day and endeavour not to think of the future.”

Where one has pretty much fulfilled the most of our life goals, like getting a job, saving up, starting our own family, or seeing our grandchildren, it can be hard to fathom that there is nothing else to look forward to.

And Mr Zhen is just one elderly person who has struggled with his thoughts of mortality as he age. There has been studies on how there are more old people who struggle with loneliness and how socially isolated seniors have a higher risk of dying prematurely.

When I visited <a href=" Home for the Aged Sick last Saturday, I got to speak to 72-year-old Winnie Koh, who has been running the nursing home as Chief Executive Officer (CEO) for more than 15 years.

She shared that one of her residents has suicidal tendencies, and had once tied bedsheets and put it around his neck in a suicide attempt. Likewise, that resident did not see a point in living, “when [to him,] he’s already 90, nearing 100 years old, and does not have the ability to do many things himself.”

This resident has also went through certain rough patches as well, as a very close female friend of his had passed away.

“I can feel the loneliness in him. He doesn’t speak to [a lot of] people.”

I asked Winnie if residents fear death.

After a short pause, Winnie explains that the elderly do not fear death per se. For the most, those who fear death fear going to hell.

However, Winnie acknowledged that there are those who struggle to let go, in the sense where they could have unresolved wishes: people they want to meet, messages they want to tell their loved ones, or something they want to complete.

32-year-old Alvin, added that having worked in the eldercare sector for about six years, he has often hear elderly regretting not treating their family members better or not better providing for them, “they definitely fear for the people and the relationships they are leaving behind.”

This is where, at a nursing home, they play up their role of caring for the residents. Winnie explains, “it’s the comfort [they need], to affirm them that they are ok, and that [whatever they want accomplished will be taken care of.] I will arrange for family members to visit. Usually they do go off peacefully after that.”

Along with the physical or cognitive impairments, the elderly face a whole set of very personal and emotional hurdles as well.

Before working in the eldercare sector, Alvin, like many of us, never understood the stubbornness and ego that many elderly have. But now that he has got a glimpse into the lives of different groups of elderly through his six years, he explains that most elderly fear losing their independence, and when an elderly go from “a provider, a giver, a successful person on their own rights losing the respect, mobility and cognitive ability they have [when they age], the frustration they are going through can be very overwhelming.”

As sad as it sounds, these seniors turn to stubbornness and ego as a way of holding on to that last bit of control that they still have.

Although, there are also “difficult ones,” those who who choose to isolate themselves, and who refuse to interact with people. In such cases, Winnie explains that in the nursing home, they still try to show the elderly their presence and care in one way or another.

Drawing similarities between elderly and babies, Winnie said, “once you make them feel safe and comfortable, they are easily cared for.”

At Moral Home, the residents may suffer from different illnesses and each, their own sets of disabilities, but Winnie tells me that most of them are generally happy.

Having reached the point where they know that they are old and are ready to die, most of them would live every day to their fullest in the little ways they can, like eating, reading, or praying.

“Once, I have this resident who [had severe dementia and] is, on the whole, a very happy person. One day, she was just resting in the lounge after her coffee, then she just said to me in Cantonese ‘I am going to sleep, bye bye.’ She never woke up after that.”

“I think it’s better that way,” Winnie said, on passing on peacefully.

When I visited the home I also got to speak to this two sisters who had sold their house to live at the nursing home.

For 82-year-old Tan Nya Nya and her 83-year-old sister, their choice to live in a nursing home is for convenience, and to ensure that they get the physical support they need at their age. This came after Nya Nya fell down once and both her sister and her realise that they were unable to manage on their own if anything were to happen. Being able to socialise with the other residents of the home are perks that they enjoy too.

Nya Nya added, on seeing residents who don’t share the same happy-go-lucky attitude she has on life, “if you naughty, throw tantrum, [your family] also won’t [feel happy to visit you]. Correct? No point [being so gloomy]. Don’t think so much. Must be happy.”

Like Nya Nya, 82-year-old Uncle Lee also have an optimistic outlook on life, despite the fact that he lives alone in a one-room flat in Toa Payoh

His daily routine includes waking up in the wee hours of dawn for a walk around the small park right beside his home, going for his meals, and watching TV. Sometimes, he would hop on a bus that would take him to Jurong, Pasir Ris, and even Changi.

As he regaled me with his accounts of these ‘mini adventures’ he goes on when he is bored, he emphasised that at his age, there is nothing much to do except eat and watch TV, “what else can I do at this age?”

When I visited him with three volunteers on a Sunday night, he had cooked a pot of Bak Kut Teh for us. And as we sat in his living room savouring the soup, I felt a little like I was in my grandmothers’ old house again.

Although he lives alone, his house is filled with knickknacks. Chinese New Year decorations still adorn his walls and the side of his fridge. I couldn’t help but noticed that he also has four clocks on one wall.

“He really likes clocks. There’s more in his bedroom,” one of the volunteers laughed when I asked.

These volunteers first knew Uncle Lee through a programme initiated by Youth Corps Singapore, but have since grown closer to Uncle Lee and for the past two years, have been visiting him every month.

Once a driver who made a livelihood off driving for commercial and private businesses, Uncle Lee retired more than 20 years ago, when he sprained his hip. This work injury, however, has become a permanent problem at 82 years old.

“I cannot really walk long distances, unless I take breaks.”

Curious about my own mortality when I reach his age and avoiding being so rude as to ask Uncle Lee - whom I just met - about how he feels about death, I asked if there is anything he fears now that he is this old.

“No lah! Scared of what? Don’t need to be scared of anything [at this age].” He jested, “Last time, scared of my mother, but mother not around already, so there’s nothing to be scared of [anymore].”

Ever since his elder sister passed away, Uncle Lee’s only other family members are his nephew and nieces, whom still visits him occasionally.

Most days however, his humble lifestyle revolves around watching TV and eating, which he loves doing.

“Uncle is a food king!” One of the volunteers teased, “whenever we go out, he will tell us what’s good and where to find good food.”

Unable to comprehend living alone at his age, I asked Uncle Lee if he ever feels lonely.

“Won’t lonely lah! [If I’m] lonely, then I’ll just watch TV, or put on a DVD, or go out and eat lunch. Lonely for what?”

His positive reply showed very much his outlook of life and in a way, it was also a reminder that happiness is a choice. He could very well dwell on what some would assume as unfortunate - he is old, never married, and living alone and off financial support from the government - but he had chosen to lead a simple and happy life instead.

A study done in 2004 found that seniors living alone were twice as likely as their peers to develop depressive symptoms. In the last stage of their lives, it can be very easy for seniors to feel frustrated and aimless.

Which is why, it is important not just for seniors to be able to adopt a positive mindset, but also for the people around them to empower them to do so.

Besides, our elderly citizens may be old and frail, but they have so much to offer in other ways.

Yong Shin, one of ‘Uncle Lee kids’ said, “They always say ‘seniors are a wealth of knowledge’, and I think [Uncle Lee] really displays that. You can tell that he really likes to share with you, about history or just whatever knowledge he has. He really likes interactions.”

And of all the conversations I have had with the seniors, the one thing that all of them have said, albeit not ad verbatim, is “we’re old already, what else can we do?”

To them, it is just better to lead a happy life and enjoy the simple things when you are already at that stage of life.

Also read: People Leave, But You Don’t Have To Be The One Left Behind.

“Secretly, I was ashamed of how I was living. I couldn’t even go out or face relatives during Chinese New Year because I [think that they would] think of me as a leech, a parasite.” Having been made fun of in school for her background and the way she spoke, Andrea* started becoming wary of people. She kept them at arm’s length and although that prevented her from forming any close friendships, it was to protect herself. At least, that was how it began. “I developed a paranoia that people would laugh at or pity my pathetic lack of friends.” As she grew out of adolescence, this fear of social situations manifested into an extreme level of social isolation. Can you imagine yourself being cooped up at home for months on end? Never heading out for lunch with friends, not going to work or school and just idling away in bed? For people like Andrea, that’s their life as hikikomori. Image Credit: <a href="

WHAT'S HIKIKOMORI?

For the uninitiated, hikikomori is a term used to describe those who rarely leave their house, and seek extreme degrees of isolation. Some never set foot outside their homes. Others occasionally do, heading out to buy food or even to the cinemas for the latest blockbuster, but all of them are completely, socially isolated. They would even limit their interaction with their own family members. Although this social phenomenon is predominantly widespread in Japan, I recently stumbled upon a Reddit thread that tells me that we too, have our share of social recluses hidden in their rooms somewhere, unseen by society. Through a local forum, I stumbled upon Andrea’s story. Back then, Andrea cooped herself up at home for eight consecutive months. Waking up at five every morning, she spends her time browsing Reddit, reading and binging on TV series, only leaving her room for lunch and dinner, which her parents would prepare for her. At around 11 pm, she will head to bed and the same routine repeats for months, and in those months, she did not step out of her house once.

Her home had become a place of solace for her, a fortress she can’t bear to leave.

Likewise, this is the case for the many hikikomori in Singapore, who have taken to forums to pour the feelings that they have hidden away from their friends and family.

WHY DO THEY ADOPT THE HIKIKOMORI LIFESTYLE?

Hailing from a ‘financially comfortable’ background, Andrea is aware that she is more fortunate than most, as she could afford the option of not having to work or fend for herself. But because of that, she feels more pressured to pay her parents back for all that they have done for her. The low self-esteem, crippling social anxiety, and negative outlook on life that came from her being bullied in school when she was younger kept her imprisoned. The self-imposed pressure and the expectations about the future stressed her out and caused her to feel even more helpless. When she finally entered the workforce, work became her life. All she did was wake up, go to work, head home to have dinner with her parents, and repeat. Due to her micromanaging boss, she grew to resent work. Even so, she continued working for some years to save up a sum of money before eventually resigning, dampened by the rat race. “So after that, I didn’t really have a plan. I just stayed home. Months quickly turned into years. And because I was used to a solitary lifestyle of just reading and watching drama and anime, I just shut myself off from society and basically became hikikomori, just living off my parents and my savings.”

ONLY FOR THE PRIVILEGED?

Of course, not everyone is privileged enough to be able to just drop everything and withdraw from society in the first place — most of us are not as financially blessed. Through r/hikikomori, I was able to speak to another Singaporean hikikomori, 24-year-old Josh*, who shared how he was once a hikikomori. Like Andrea, Josh comes from a financially stable family.

“Maybe we were too sheltered. Maybe we were too spoiled and everything comes to us easy and without any barriers. Back then, I felt that no matter how useless I was, I would still be able to live comfortably, or still be able to live somehow.”

An avid fan of Disney’s classics, Josh had a grandiose dream of being a 2D Animator for Disney. When news broke that Disney closed down their 2D animation company, his hopes and dreams were dashed. Dejected, he let himself waste away, passing the days by gaming and watching anime at home.

WHAT'S THE CAUSE FOR THIS?

For many of us, such behaviour is aberrant and tough to comprehend, much less empathise with. It’s not surprising for us to jump on the conclusion that hikikomori chose to stay cooped up at home because they are just “lazy” and “spoiled”. “We all have problems, so why can’t they just do something about their problems?” But unlike what we think, the hikikomori syndrome is not another convenient excuse to be idle.

In fact, most, if not all, hikikomori hate the plight that they put themselves in, and they are ashamed of it.

“When I was hikikomori, I lost all desire for wants. Normal things like going to movies or buying expensive new things don’t interest me anymore. I don’t know why I exist, to be honest. Sometimes I can feel my parents’ disappointment in me and I don’t feel good too,” shares Andrea. They have confined themselves to their homes, but most hikikomori actually want to return to society. However, the fear and anxiety of how society may react to them. Even if they manage to take the first step out of their homes, they are plagued by this constant fear that they are being judged by those around them, afraid that the world wouldn’t come to accept them because of their past. Maika Elan, a Photographer exploring the topic of hikikomori, shared on National Geographic that “Over time, hikikomori lose whatever self-esteem and confidence they had, and the prospect of leaving home becomes ever more terrifying. Locking themselves in their room makes them feel ‘safe’.” Similarly, Andrea admitted that the very paranoia of being judged for being a hikikomori is the toughest obstacle she had to overcome. She would often slip back into isolation because of it. Thanks to volunteer work at a church, Andrea was able to break out of the hikikomori syndrome. She eventually managed to land herself a job through one of the other volunteers. As for Josh, he stumbled upon the animes Re:Zero and Konosuba, which shifted his perspective on life. Both shows feature male protagonists who were hikikomori and Josh was able to relate to them strongly. “In Re:Zero, it tells us that no matter where you are, nothing’s going to change if you don’t put in any effort to take charge and improve yourself.” Witnessing his friends’ success also pushed him to eventually change his lifestyle.

“What gives them the drive to keep doing what they do? Why are they set on improving themselves and going out there to find jobs and socialise, and to be proactive with their lives?”

These were the questions that Josh posed to himself, and subsequently embarked on a quest to uncover. “Sometimes it’s hard, but you just have to remember that there are other people out there who are struggling and still trying their best as well.” Today, he works as a Digital Designer, which is not too far off from his initial dream. Although, there are others who struggle to break out. “It all started after he finished his degree overseas and came back. He didn’t find work and just stayed at home gaming and surfing the net. We’d ask him to come out for coffee or meals but he’d always turn us down.” Tim*, a male in his 30s, shares with me about his friend who has been a hikikomori for over 10 years. “I’ve a feeling that the shame of being long unemployed while everyone else is working just drives him to become a hikikomori. I guess his parents still buy him food or give him spending money so he doesn’t need to force himself to get a job.”

A VICIOUS CYCLE OF FEAR AND PARANOIA

Although hikikomori is a social condition that has not been widely recognised as a mental illness, many of them do require mental health care. Some turn to this reclusive lifestyle due to a lack of purpose or existential crisis while others do so as a form of rebellion to cope with trauma such as childhood abuse or bullying. While hikikomori wish to recover, they are so ashamed of their past that it freezes them up, causing them to retreat back into their shelter. However, the longer they isolate themselves from society, the harder it will be to integrate back into it. It’s a vicious cycle that they are dealing with. For such people who haven’t interacted with anyone nor formed any ‘proper’ relationships, it could be tougher for them to reintegrate into society as they grow older, especially if their family members (like their parents) are no longer around to support them. In Japan, this has become a real problem. These days, it’s an absolute nightmare if we were to be void of our handphones, computers, and the internet. While technology is not the root cause of the hikikomori syndrome, it provides a gateway to endless virtual worlds that we can immerse ourselves in. Nat*, another Redditor, says he usually spends an average of 10 hours on his computer and does not see the need to leave his home. Whether it’s food or entertainment, technology has made that conveniently accessible and available for us. There are even avenues to learn and work ‘virtually’, with online classes and freelance jobs. All of these make it even easier for one to slip into the hikikomori lifestyle. With that said, however, completely isolating oneself from society is not healthy, and should not be normalised. Regardless, Josh hopes that hikikomori will have it in them to realise that they are responsible for themselves, and find the strength in them to overcome it, just like he did.

“There’s only so much that others can help you with. Only you can change yourself. Even if it’s for your parents or yourself, I hope you will find it in you to want to get better.”

“We all are living for a reason. We need to reflect on that more often, to put our lives into perspective. Once things are in perspective, it will all make sense in the end.” “After all, life exists and thrives beyond these four walls, but it’s up to us whether or not we want to open the door to live.” *Names have been changed to protect the identity of the individuals. Also read: It’s The 21st Century, Why Do We Still Treat Maids Like Slaves? (Header Image Credit: Unsplash)