The flow chart of themes and categories is illustrated in Fig. 1. The content analysis revealed five main themes: the circumstances of leaving home, life experiences before relocating to shelter homes, challenges to wellbeing before entering the care facility, coping with challenges, and decision to live in a shelter home.
Theme 1: The circumstances of leaving home
This theme emerged when the participants were inquired about the reasons and circumstances for their relocation in old age homes. Three main categories emerged under this theme: lack of support system, insensitive behaviour of children, and the impact of global change.
Category 1: Lack of support system
A wide majority of the participants were desperate to share their experiences of not being provided with the physical, emotional, and financial support from their children, as they were growing old and were dependent on them for food, shelter and clothing and activities of daily living. The elderlies also expressed that, despite fulfilling the responsibilities of educating, bringing them up until they were adults and settling them down, the children did not “pay back” in terms of meeting their parents’ expectations. The children were unwilling to care and deprived their parents from basic necessities of life. A participant cried while narrating his feelings:
She never gave me food…. At times I survived on an empty stomach for days… I stood up and told them after three days of staying on an empty stomach. They were eating chicken biryani (Eastern dish made of chicken and rice with spices). I told them to give me if there is some left after all have been fed. My granddaughter crawled towards me and offered me a piece of bread. Then my daughter-in-law said that, they will give me some if anything is left ….. Otherwise she told me to go to sleep (NB-14).
A depressed father who was very disappointed with his children reluctance to support him shared, “At this time, I do not have any family to support me and no roof to live under. I don’t know where I would have gone; whether I would have spent my life on a railway station or on a foot path. I didn’t know…” (MC-6).
The parents in South Asian culture especially focus on educating their male children, so that they can depend on them for financial support in difficult times and old age. They also expect to willingly fulfil their obligations and assist them financially when there is no source of earning. An upset father said, “I stayed here and took care of the family. I sent him abroad…So that he can support and assist us financially in times of need, when we get old. I have never requested him to support me and send the money…….He knows everything and is well aware about my condition” (JM-2). The participants also revealed challenges like arranging for finance when their spouse was sick and urgently required money. They were forced to live in misery and pain, and had to utilize their savings and assets to meet their financial needs. The participant explained, “My wife’s condition got so serious that I took her to a hospital where she was kept for a month…. I even had to sell my house for her operation” (AA – 1).
Category 2: Insensitive behavior of children
This category sheds light on the children’s insensitive behaviour towards their parents. The participants displayed nonverbal clues like taking long pauses, and getting into frequent crying spells when they were inquired about the behaviour of their immediate family members at home. Two of the participants requested to pause the recorder, so that they could cry out loud before continuing with the interview.
There was lack of acceptance in the role of father, mother, father-in-law, or mother-in-law by their children and their spouses. In eastern culture, these roles are the symbol of respect and deserve high esteem by the children and their families. They encountered profound resentment by the family, and were criticized on petty issues. The participant reported rude and harsh comment of his daughter in law, “When I told her that I am leaving, she said, “Who has stopped you from going… It was clear that she did not love me and did not want to keep me. So I left my home” (MR-12). The magnitude of resentment of a daughter for her father can be seen in this excerpt. “She abuses me, she calls me shameless [Woh gali galooch karti hai, baigairat bolti hai]. I am her real father and not a step one. She should not be so sharp and sarcastic while speaking” (MC - 6). The parents are the ones who bring up the children, teach moral and ethical values, and once they are in their ageing phase, the children neglect them. The children and their families considered the elderly members as burden and it was tough for them to tolerate their agonizing comments and severely insensitive behaviour. The participant recalled in a grief stricken state:
My daughter- in- law behaved badly with me. She used to say, who will take care of her if she falls sick? [yeh beemar par jayegi tau is ka kaun karay ga], who will give her a bedpan? [bedpan kaun deyga]. She taunted and asked me to die and return to God and misbehaved with me all the time [Jehan teri behan chali gai hai tu bhi wahan chali ja] (MR-6).
This category also reflected that the male children of the family were often torn between filial obligations and with their new family commitments and responsibilities after marriage. In order to meet the expectations of parents and spouse, the son of the family gets under spousal pressure and consequently, misbehaves with the elderly parents, who raised them up. The participant recounted, “He has bent himself in front of his wife’s command. [Uss nay apnay aap ko jhuka diya hai]. He feels embarrassed [Woh sharminda hai]. My elder son now regrets a lot [Mera bara beta bohat pachtata hai], that despite having a son his father is living in an old home” (JS-11).
Category 3: Impact of global change
This category presents the findings related to how globalization has transformed and influenced the younger generations. The impact was evident as the children migrated to the western countries for pursuing higher education and better earning prospects, leaving the elderly parents without support. An informant explicated,
He lived in Pakistan for four months. He tried to search for jobs, so that if he could find an appropriate job he could stay here and take care of his mother as well. He did not get the required one. But there, he is earning more. (RS-13).
The findings also underlined a significant impact of globalization in eastern families, which was seen as a shift in caregiving role of a women, from a traditional house hold role to an empowered and self – reliant role. Work life left no time for women to perform the usual and expected care for the elderly at home.
Theme 2: Life experiences before relocating to shelter home
This theme emerged when the participants were asked to describe their life experiences which led them to relocate into shelter homes. The negative experiences emerged significantly however, few positive experiences were also shared by the participants. The rich life experiences which emerged were feelings of loneliness and helplessness, psychological consequences and some positive experiences.
Category 1: Feelings of loneliness and helplessness
In this category, majority of the participants reported their feelings of isolation, which were resulting from terminal illnesses of spouse, death of spouse or children, and marriage of their daughters. They needed someone to talk and share their concerns and stressors. The participant explained in these words, “I need people around me. Like, when I and my husband lived together, he was there with me. After his death, I need someone with me; I don’t like to live alone” (FR-5).
A few of the informants reported feelings of isolation at their parting with their daughters, at the time of their marriage. Marriage is a cultural custom in Pakistan, where a girl becomes a part of husband’s family after the wedding. Besides, a few of the participant’s reported extreme loneliness on the death of their children. An elderly mother, who had lost her two sons, reported sadly, “My first boy died in 1999 and my second boy died in 2009, exactly after ten years. The deaths of my children left me all alone in this world” (MR-7).
This category also revealed that, cultural constraint, fear of society’s criticism of residing with their married daughters and merciless behaviour of children were the reportable reasons of the elderly participants in a helpless state. A helpless father stated his views by saying,
She will take me, but I do not want to go. The reason is that she is my daughter and in our society it is not considered appropriate if a father lives in his daughter’s house after her marriage [humaray muasharay main acha nahi samjha jata kay baap beti kay ghar ja kaar rahay]. I do not want to be a burden on them [Main unpar jaa kar bojh banoo, yeh nahi chata], or may be in future I do not want them to say that I am a burden for them. I don’t want her husband to taunt her because of me [Main nahi chata kay meri beti ko iska khavind taanay maaray]. (AK-10).
The informants’ conveyed that their lives were made miserable by their children and their spouses, leaving them in a more vulnerable state. A participant narrated his emotions, as he did not want to leave the house because of his intense attachment with his grandchildren and his own physical disability. He said, “I became homeless after the death of my son, there was no place to live….[ Meray betay ki death kay baad main baighar ho gaya]. My daughter-in-law told me to make some arrangement for myself at some place. We cannot keep you…That day I cried a lot [Us waqt meri bahu nay kharay ho kar kaha kay papa, aap apna kahin aur bandobast karlo hum aap ko nahi rakh sakti…Uss din main bohat roya]” (NB-14).
Few participants reported their helplessness, as they were physically and financially dependent on their children, and were also willing to work and earn in old age but could not find a job. A helpless participant said, “At this age, people don’t employ us, we don’t find jobs. I don’t have money. I am unable to find any employment at this age. I was trying to hunt for work but couldn’t find a job….” (MC-6).
Category 2: Psychological consequences
In this category, majority of the participants reported various psychological concerns such as development of fear, anxiety and depression on being lonely and helpless. One of them voiced her anxiety by gesturing towards her chest and heart. She expressed, “After the death of my husband, I get too anxious and worried because of loneliness [Akaylay pan say bohat ghabraahat hoti thi]” (FR-5). Many of the elderly articulated about depression after the loss of loved ones as there was no one to care and hear from them. An elderly lady reflected, “I was very upset and went into depression after my daughter went. I felt as if I lost something precious [Meri beti chali gai tau mujhay bhari para, depression ho gaya. Mujhay lagta tha kay meri koi qeemti cheez kho gai ho]” (RS-13).
Category 3: Positive experiences
This study also unveiled positive feelings shared by few elderly informants about their family and children. The children were concerned for their parents but were helpless and had to leave their parents alone with a heavy heart. A few participants stated their close bonding and caring attitude with all the family members. One of the participant reported,
My daughter-in-law didn’t want me to leave but I preferred to stay separately. You see, now she is a widow. She is young and she may be wanting to have some friends; if I am there she would hesitate to call any friends so that’s why I said: No, I think I will go and stay in a shelter home but we will meet each other frequently (MR-7).
Theme 3: Challenges to well-being before entering care facility
This theme surfaced, when the informants were asked about the reasons and circumstances which brought them to live in old age homes. The significant challenges encountered by the elderly people have been categorized into poverty and family disputes.
Category 1: Poverty
Majority of the participants belonged to a low socio economic group and had faced extreme financial challenges in their lives. Because of unemployment and illiteracy they were unable to educate themselves and their children and find reasonably paying jobs. Additionally, because of lack of money, it was challenging for them to manage domestic expenses, health, education, and other costs of living, and were in a complete helpless state. A participant reflected, “At this age, people don’t employ us. We don’t find jobs. I was trying to hunt for work but could not find work to manage my household living” (MC-6).
Category 2: Family disputes
Family dispute was another challenge that emerged from this study. The conflicts usually stemmed from issues of children’s marriage, parenting, unwilling to keep elderly parents at home and caring for them, and non-provision of food and shelter, etc. The elderlies considered these conflicts as the reason of distancing of family members and loss of family bonding and harmony between elderly’s and family. The participant’s disclosed feelings of frustration which were arising because of family disputes and vice versa. The participants were annoyed with children and family member’s behaviour, and had no choice but to live in an old age home. An irritated elderly father narrated his feelings for his daughter-in-law. He said, “My daughter in law challenged me that she will not let me live here in this house. She said that she will destroy my marital life or her own” (JS-11).
Theme 4: Coping with challenges
This theme emerged when the participants were asked to describe how they managed with the challenges and stressful life situations. Almost every elderly participant reported praying in tough times and considered it as a source of spiritual support and relaxation. Apart from the regular offering of prayers, recitations of verses from holy books, like “The Quran” and “The Bible”, “Tasbeehats”(reciting the rosary), and “reading of religious books” provided them inner peace and serenity and assisted them during the times of stress. The richness found in their genuine expression has been categorized into faith in God/Allah and coping techniques in tough times.
Category1: Faith on God/Allah
Majority of the participants had an immense faith in religion, and this conviction was a major source of strength when they were battling with their life stressors. A participant expressed his blind faith on religion, “I just know that Allah is the one who assists you every second and He will respond too because He is always with you [Bas main yeh jaanta hoon woh har paal saath dainay wala hai]” (QM-3). Another participant expressed her feelings of satisfaction in the following words, “I opened up the BIBLE and it was written that your brothers and sisters will leave you but I will not. I got immense satisfaction after this and prayed to God and thanked Him” (MR-12).
Category 2: Coping techniques in tough times
This category revealed various coping strategies, which a majority of the participants turned to during the difficult times of their lives. What topped the list amongst the strategies was prayers; others included crying, and positive thinking. These strategies gave them strength, inner peace and tranquillity. Prayers were recited as a religious norm and to stay away from worldly stressors. A participant remarked, “Whenever I get afraid, I recite my prayers [tasbeehs]” (DL-4). Many of the participants narrated their close connection with God/Allah particularly in tough times of their lives. Another remarked, “I remain connected with God and holy sayings. When I am sitting, even at that time I recite God name internally” (AK-10). Some of them also voiced about the reading of religious books and holy verses during stressful times and he stated, “When I am in difficulties and problems, I read religious books [mazhabi kitabain]. It guides you to a solution of the problem” (QM-3). Additionally, positive thinking and sole belief on God/Allah supported them in handling their life stressors however, few of the residents considered crying as a technique to cope, and they felt strengthened after giving a vent to their feelings. One of the elderly stated in a hopeful voice, “I have never been down. I have always been optimistic and always look at the bright side of things. I never thought that something bad will happen tomorrow because God is there and He is looking after me…” (MR-7).
Theme 5: Decision to live in a shelter home
The final theme emerged, when the participants were asked to express their feelings when they made the decision to move to a shelter home, whether voluntarily or against their wishes. They were also asked about how they felt about living and adjusting in a new environment, away from their families and their loved ones. Their genuine experiences have been categorized into: decision choice: (voluntary or forced) and adaptation with new environment.
Category 1: Decision choice: (voluntary or forced)
Majority of the participants shared that, it was their choice to leave their homes and none of the family members forced them to opt for a sheltered home. Nevertheless, there was no other choice left for them when their children did not want to keep them and take care for them. Hence, they felt it was better to leave their homes and dwell in substitute shelters. These participants had experienced a lot of loneliness, neglect, and rejection, and what they construed as insensitive behaviour of their children. As one of the elderly described, “Nobody forced me. I came on my own. I was left like an unwanted person. I don’t want to live in that house” (JS-11). Another expressed freedom from long standing family issues. She narrated, “I have worked like a donkey for my family …. I was fed up and was feeling miserable. How much could I do? I am happy that I came here” (JD-8). Additionally, few of the participants expressed that they were forced to leave their homes by their immediate family members. The father painfully expressed these words, “Many times, my daughter bluntly told me to get out of the house along with my belongings [Kitni baar kaha niklo ghar say, iska samaan nikalo baahir]” (MC-6).
Category 2: Adaptation with the new environment
This category presents adjustment concerns when relocated into shelter homes. These elderly people were emotionally attached with their home where they lived their entire life. Though, the participants had left their homes, the memories of their home and family were still fresh in their minds and they got distressed and emotional when they reminisced about their past experiences. One of the participants sobbed and verbalized, “I left that house with a heavy heart. I have lived my life there. [sad] [crying]” (FR-5). Another participant disclosed mixed feelings while leaving her home and stated,
I was feeling very sad. I had lived in that house for thirty three years but at the same time, while I was there my daughter got married my son got married my other son got married and then I lost my two boys all in the same house. So there were good memories and sad memories. (MR-7).
These elderly participants also encountered difficulty in adjusting with the old age home environment. The new surroundings, changed physical location, different daily routine and pattern affected their comfort and adjustment level. Almost all the informants communicated difficulty in accepting the new environment; however with the lapse of time, they adapted the routines as part of living there. An informant narrated “Here people live according to a proper plan of meals and sleeping and waking up routine; I did not like it. The environment, way of living, and time plans of meals of the day were different….. but then gradually I got adjusted to the routines”(AA-1).
The participants also expressed their satisfaction as they tried to familiarise in a new atmosphere along with the availability of basic necessities of life such as food, clean water, shelter etc. An informant reflected in these words, “For me this place is as precious as gold. It is God’s blessing for me… If there were no senior citizen homes for old people, we would have to sleep on roads and from where would we have arranged for food” (JM-2). Besides this many of the residents expressed their contentment as they were the victims of loneliness, and were now surrounded by a gathering of people. One of the informants explicated, “There are many people around me in this home. The comfort and peace which I found in this home cannot be compared with anything” (FR-5).