A comparative study on elderly care practice : Kyoto and Kathmandu

Abstract

This research compares the elderly care practice of Kyoto and Kathmandu. The selection of these two cities for comparative analysis is based on the principle of the “Most Dissimilar Systems” approach according to Dogan & Pelassy (1990). In combination with growing internationalization a shift has taken place in comparative research from emphasizing uniformity among variety to studying the preservation of differences and uniqueness in contrast to homogeneity and uniformity (Boje, 1996). The comparative study of elderly persons serves two purposes: the first is to develop a broader understanding of the social processes in question; and the second to learn about and develop new ways of responding to the interests and needs of older people. The researcher concerned here with both aspects. The social environment within which people grow older is rapidly changing. The size of families is decreasing, the role of extended families is diminishing, and perceptions of intergenerational support and caring for eldely are rapidly changing. The implications of these changes in family composition and living arrangements for support and care for elderly depend on the context. In developing countries such as Nepal, where elderly have limited access to formal mechanisms of social protection, they will need to rely on the family and the local community. However, these informal protection mechanisms have been under increasing stress recently, owing to the process of population ageing itself but also, in some contexts, to a growing participation of women in the labour force and to changing perceptions about caring for parents and elderly in general. Developed countries such as Japan, may need to expand the supply of formal long-term care for elderly, including institutional living, as well as to develop alternative services to allow elderly to age in their homes if they so desire. Family care in the world is changing, let there be no doubt. The traditional patterns of the past seem to be crumbling in the face of social, economic and demographic forces producing and resulting in changes in cultural values toward the elderly, in general, and family care to the elderly, in particular. In Japan, just a generation or two ago, adult children cared for the majority of the elderly in their own homes; as more women entered the workforce, families turned more to community home and other institutions to care for the elderly. In this context, the caring for the elderly is a challenge and can be overwhelming if not given proper consideration. Likewise, the global phenomenon of population aging also afflicts Nepal. Historical systems of care, living arrangements, and familial responsibilities that once centered around or within the family network are changing to look more like Western, individualistic systems (Eckerman and Brauner, 2007). Though the process of aging of Nepal’s population is still in its early phase, it is expected to gain momentum in the 21century and pose a major problem to the country. Apart from other important dimensions in the field of pensions and health care systems, ageing populations will also increase pressures on social and caring systems. Therefore care for frail elderly persons is an important component in this context (Jacobzone, 1999). The need for help can have enormous impact on the elderly and their families. Therefore, the health and social care for frail elderly persons is a serious concern for all sectors of society both in Japan and Nepal. Likewise, a comprehensible approach to including social care as a welfare dimension in the understanding of the welfare state and taking the aforementioned issues into account, it is necessary with a broadly encompassing understanding of care. The argument here is that it is the combination of formal and informal dimensions of care that constitutes the turning point for an understanding of the principles behind the social care system. The theoretical framework of this study is based largely on the concepts of Tronto’s theory of care (1993). Tronto considers 'care' to be an activity, a social practice. She insists that the activity of caring is largely defined culturally, and will vary among different cultures. Tronto distinguishes four analytically separate, but interconnected, phases in the caring process. These are caring about, taking care of, care-giving and care-receiving. In summary, finding efficient and effective ways to care for the elderly is always an important issue and it is an issue of growing importance both in super ageing society of Japan and growing aging population of Nepal. However, the magnitude of the problem varies significantly from one country to the next. Objectives The main objective of this study was to examine the family, community and state based care practices for elderly of both cities in a comparative perspective. Other objectives are as follows; a) To investigate the physical, mental, psychological, social, economic, housing condition living arrangements, employment as well as activity and entertainment status of the elderly. b) To analyze and find out the current situation and major issues faced by the elderly people of both cities. c) To inquire into the patterns of social support, both formal and informal. d) To gain a better understanding of adaptation of elderly care practices Methodology The mixed research design carried out for this study of both qualitative and quantitative. In other words, the research was descriptive and explorative. Mixed methods research resides in the middle of the continuum because it incorporates elements of both qualitative and quantitative approaches. Two different sources of information were consulted for this dissertation, namely primary and secondary. The former consisted of the experiences and views of governmental officials, policy makers, professionals, social workers, university teachers, medical doctor, staff nurses, and head of the elderly homes as well as elderly people by way of interview. The secondary information comprised research reports produced on the issues of aging and caring for the elderly by various types of national and international organizations as well as the published books, dissertations, journal, magazines by individual and scholars as well. A limited amount of information was obtained from the Internet. A carefully prepared, pre-tested and modified 95 item structured questionnaire (set A) for the elderly and 16 item mixed questionnaire (set B) for policy makers, professionals, social workers etc. was administered. This study was based on face to face interviews with elderly people aged 65 and over and also professionals, policy makers’ etc. from both cities. The study uses the data from the surveys done in Kyoto and Kathmandu, where the same sets of structured questionnaires were employed. I determined the sample size according to Cochran’s formula n= (t)2 *(p) (q) / (d)2 . Hence, the sample size of the Japanese survey was 66 elderly, and the one of the survey done in Kathmandu 100 elderly. Likewise, for qualitative information the equal numbers (ten from each city) of professional respondents were selected for interview. A purposeful sampling technique was investigated in this research. Purposeful sampling enabled the selection of subjects who best aided in achieving the research objective (Merriam, 1988). Campbell (1955) also states that both qualitative and quantitative sampling methods may be used when samples are chosen purposively. In this perspective, the researcher selected both types of samples from Kathmandu and Kyoto city. To collect quantitative data, the researcher visited to elderly people for face to face interview. The geographical coverage within which the information was collected includes all the 35 wards from Kathmandu Metropolitan and 11 wards from Kyoto municipality. At least two elderly people from every wards of KMC and six elderly from Kyoty city were consulted for interview. Likewise, I analyzed the qualitative data manually and for quantitative by SPSS version-17. I analyzed the qualitative data manually and for quantitative analysis, I used chi-square test, t-test and used the simple statistical tools, such as frequency, distribution, average and percentages. The data were analyzed in a series of steps designed to allow sorting out, classification and description and as a final step, interpretation of the data. Information on the expressions and gestures of the respondents and also other salient points were written as field notes. The average interview length was around 42 minutes per individual. Major Findings The data revealed similarities as well as differences between the countries on the various dimensions that might reflect variations in family norms, patterns of behaviors and social policy traditions of the countries. Although both countries have bilateral kinship system, the typical images about Japanese and Nepalese families and elderly-care arrangements are contrasting. In Kyoto (Japan) the nuclear family is supposed to be predominant, among whom respect and care for the elderly persons is somehow lacking, because most elderly persons are cared for either in a home or in any community based homes and also institutions such as Hospitals, Nursing homes etc. The image about elderly care in Nepal is that joint family is predominant, strong family ties and respect for parents exists and elderly persons are supported within the family. The overall health status of the Kyoto (Japanese) elderly was found to be better than the one of the Nepalese. However, the increase in the elderly population, especially old elderly has raised many serious social and medical issues in Japan. The Nepalese society has more positive attitude towards elderly than the Japanese one. The results show that the social status and networks of the Nepalese are better than Japanese ones. The economic status of the Japanese elderly is better than the Nepalese one. The income level in Nepal is highly scattered but among the Kyoto (Japanese) elderly it is clustered more around US $ 2000. Almost all Nepalese elders' income lies below US$ 200 per month. The income level shows that the t-test is 10.252, which is significant at df=164, and P<0.001. Daughters-in law or daughters are the main care givers in both cities. In Nepal there is a tradition to keep a home servant who assists in caring for elderly as well as household’s chores. In Japan there has been an increase in the number of elderly people who are themselves caring for other elderly people. The biggest part of Nepalese elderly in need of care prefers to be cared for in their own homes rather than in community. For the Japanese elderly, buying food and social expenses are the main financial problems, whereas for the Nepalese elderly, paying medical expenses followed by buying food are the main problems. The life satisfaction and rating of life was seen betters than their Nepalese counterparts. Japanese respondents worried hardly ever about things they need in their daily life while Nepalese worried more. Qualitative and quantitative results show that the most of Japanese respondents expressed their view that community-based care practice might be a good way for caring for the elderly in an infirm old age. In other instances, the elderly have chosen to enter an institution to avoid becoming a burden to their families. On the other hand, Nepalese professionals and respondents have showed their opinion primarily in favor of home care and secondarily in community-based care practice as well. Even if governments major emphasis of caring for their super aged society in Japan, the public financing still remains insufficient to cover the whole costs. It may have strong repercussions on the health of elderly. This situation is more vulnerable for elderly people of Nepal. There has not been much attempt on the part of government to help and care for the elderly people in Nepal. The great advantage of using Tronto's concepts of care is that the results become comparable and lead to insights into care needs and care provisions as universal issues. The formal, professional care is something that is available to elderly persons in Kyoto, not to elderly persons same as in Kathmandu. These differences make it difficult to compare the two cities. Most of the houses of Japanese elderly are safety and elderly friendly than the Nepalese. However, Japanese houses are narrower than Nepalese, which being difficulty to live two or more generations in a same households. The provision of care is not a zero-sum activity and that neither is there a fixed quantum of care to be given nor is it divisible between public and private spheres. In Nepal there is complementarity rather than competition between formal and informal care. Conclusion and Discussions Aggravating society’s care problem is the fact that the average family’s ability to provide such care is decreasing, partly because of the ongoing transition from extended to nuclear family patterns. In response to these circumstances, care services need to be integrated between social and health services including reorganizing the welfare systems. They should be appropriately tailored to demand and balanced across institutions and care in the community (also at home). For that, all levels of government and all sectors of society will need to work in partnership to respond to the challenges of an aging society. Increased life expectancy is a positive achievement, yet population aging is often perceived as a burden, especially by governments concerned about costs of care and welfare service provision for elderly. A rapidly increasing population of elderly people and also frail elderly people, public policy concern with increased costs of providing care now encompasses care in, by and for the community system. In this context, an emerging new type of care model, the community care model seems a way out for caring the elderly people. The community care model is a combination of community service and home care. Elderly people could live in their own homes while enjoying certain level of community care. This is a modern way of caring for the elderly, extending one’s family to the community or taking the community as one’s home.’ The encouragement of true community care involves a broad approach and genuine joint strategies in social policy. A key aspect of social policy towards the care for the elderly must therefore be a positive partnership between family, the state, the market and other voluntary sectors as well. Elders play a vital role in providing a sense of structure and cultural identity that helps keep our families and communities emotionally and mentally healthy. It is therefore essential that we develop the services to support elders so they can remain with their families and communities. Keeping our Elders near their families also supports their own mental and emotional health, resulting in longer and happier lives. And, in an interrelated way, healthy families are able to provide a safer, more supportive environment for elder care. With the development of information resources and research, nationally and internationally, informed policies and plans for the care of the elderly can take place, ensuring successful coping by the elderly and their families of the ageing process, economically, mentally, emotionally and physically. So that elderly people are becoming a social stratum interesting to academics in the social and health care approach because they are needy, they are a group of specific size and in general, they are as yet unexploited as objects of genuine scientific investigation.