The aim of this study was to gain an overview of the experiences of older people living in an elderly residential home (Panti Sosial Tresna Werdha [PSTW]).
MethodThe study used qualitative method with the descriptive phenomenology approach. The participants consisted of six older people who live in institutions. Data were collected through in-depth interviews in accordance with the purpose of the research, and an analysis of the data from the interviews was performed using the analysis stage by Collaizi.
ResultsThree themes emerged from this study, namely independent living needs and support systems as a reason for staying at PSTW, the adaptive response to life in PSTW, and family support as a contributing factor to remaining at PSTW.
ConclusionsMost of the elderly’s support came from their children or nephews and nieces. Receiving full emotional support from relatives through family visits was deemed necessary for the elderly, as it made them feel happy to continue the rest of their lives in the elderly care home.
The older population in Indonesia is ranked the fourth largest in the world after China, India and the United States1. In 2008, 2009 and 2012, the number of aging people reached 7%.According to the Indonesian Health Ministry, this figure put Indonesia into the category of countries with aging populations. The thinking is that, the older the population, the more successful the country is in achieving its goal2.
Older people are regarded as the most vulnerable group when it comes to experiencing the decline of their functional ability as well as some changes in their physical conditions, such as their cognitive, social and psychological functions. Older people’s happiness and well-being are generally based on their having nearby family members who can contribute to their lives significantly, even though they may live in care homes. Their prior life experiences and their levels of self-resilience have a huge impact on their abilities to adjust changes of residence and to the loss of people close to them. It is important that they receive respect and appreciation so that they not feel marginalized.
Many older people who live in care homes experience some notable changes in their lives, such as role changes and not being respected or considered, which causes them to feel lonely. They must have adaptive capabilities in their new environments to successfully interact with their surroundings. Nuryanti’s et al. research3 revealed that 52.9% of elderly people living in care homes can experience positive role changes with the functional roles of relatives, the economy and social status in society. Meanwhile, 47.1% have negative role changes due to lesser interpersonal and social relations.
Elderly residential care is an institution providing service and nursing care to the elderly. The government provides such facilities to preserve society life. Elderly socialization in the care home environment was determined to be better than allowing the elderly to live alone and marginalized society. Family support can help them in the process of adaptation so that they do not feel marginalized by their families. This enables them to engage in their daily activities with confidence. Haddock suggested that dignity makes others precious4.
MethodThis study used the qualitative method and the descriptive phenomenology approach. This research study was aimed at exploring their experiences while living in residential home in their old age. The selection of the participants in this research study was performed using the purposive sampling method, that is, the selected sample was oriented to the aim of the research. There were six participants involved in this study. The data collection process was terminated when data saturation was reached.
This research was conducted after ethical clearance was obtained from the commission of ethics of the Faculty of Nursing Science, University of Indonesia. This was done to protect the dignity and safety of the participants as research subjects. The researchers followed the principles of ethics, that is, informed and involuntary consent, autonomy, confidentiality, beneficence and reciprocity or the presence of a mutual relationship5. The data collection process in this qualitative research study was performed via in-depth interviews using an interview guide featuring open-ended questions6.
ResultsThe interview results along with field data from the participants were analyzed by using the process of data analysis according to Colaizzi7. Three themes emerged in this study.
The need to be independent and the availability of a support systemPersonal desire, the loneliness condition and the need for serenity and life comfort in elderly were seen in the expressions of the participants as follows: “I feel serene here…my friends are indeed already single again, it’s better here with them who are like me…” (B). “What I can do here...is to spend my life, I don’t think about anything else here…” (C).
The desire to live independently and not to be a life burden on their relatives was the most common reason for the participants to choose to stay in the elderly care home for the rest of their lives. In addition, supporting factors such as religious activity and service and other types of activities were considered to be meaningful to them during their stays in the elderly care home.
Adaptive response to life in the residential homeThe response to life adaptation in the care home involved two subthemes, that is, experiences in stressing factor and the factor of the comfort felt during a participant’s stay in the care home. A caregiver’s rough attitude and growls might create sadness for care home residents, as the participants expressed in the following statements: “When CG growled at me, I felt hurt, I wanted to weep….” (D). “There was a nurse growling…” (B).
The discomfort that the administrator’s ill-mannered attitude caused could also be found in this research. Statements from two participants describing the discomfort they had experienced were: “We had suggested them but nothing changed…” (B). “The administrator was like that, when a problem arose, never be settled…” (D).
Although the participants might have felt discomfort, they were able to enjoy life in a regular way, as they said the care home was a convenient place. This feeling can be found in the following expression: “I like being here. I have a regular life with some activities…” (A, B, C, D, E, F).
The participants’ experiences with conflicts or with stressful situations during their stays in the residential home did not change the closeness they felt with their friends or with the caregivers of the care home. They simply tried to solve the problems they faced in the best ways they could. They accepted the facility and the living conditions therein.
Relatives’ support as contributing factor continuing to stay in the elderly care homeMaterial support was seen the form of attention that the participants received from their relatives, which made the participants happy. The following are statements from two participants: “[…] my child bought a big fridge for me in my room…”(C). “[…] food supply sent to me once a month” (A).
The support that the participants received from their families made them feel appreciated and not marginalized. As a result, they experienced mental happiness. The participants decided on their own to remain in residential care for the rest of their lives.
DiscussionThe personal desire to live independently and the need to be involved in group activities were among the strongest reasons for the participants to live in the care home. This is in accordance with Robinson et al.8 who suggested that, for elderly people, living independently had a strong relationship with being actively involved in community activities, such as arts, handcrafts and sports, and with enjoying interaction with friends without needing much assistance from others during the activities. The need for activities was considered a supporting system. The activities mentioned above were ones that could be completed in the care home as part of a daily routine, such as exercise, arts, skill building, and religious service. Research has suggested that independence is closely related to activity fulfillment at a level of trust of 95%9. This means that the more independent they were, the better their levels of elderly activity fulfillment. Other suggestions were also made. Jones stated that 99% of the elderly wanted to live independently in safe and healthy places until they gave up their last breaths10.
Religious service activity could not be separated from the elderly’s lives. As Taylor et al.11 suggested, spiritual services play an important role in their lives. Their religious beliefs could help them to accept the deaths of their loved ones as events that could not be avoided. Other research conducted by Santika et al.1 also suggested that religion and spirituality make great contributions to the welfare of the elderly.
Another expression that became an underlying reason for the elderly to stay in the care home was that they did not want to be burdens on their families. This was in accordance with what Jafar12 suggested that the elderly’s decision to stay in the care home was to seek independence and not be tied up with family matters.
This research was also supported by the opinion of Subekti13, where he suggested that living in the care home was valuable to the participants and that one of the reasons for this was that they did not want to be burdens on their families or make their children’s lives busy because of them. The response to life adaptation in the residential home was a common theme of the research based on participants ‘stressful or uncomfortable situations and their comfortable situations during their home stays. The discomfort to which the researcher alluded was based on participants’ statements in which they expressed the presence of the ill-mannered attitudes of their caregivers, conflict with friends, and a misbehaving administrator. To make matters worse, they felt that the manner in which their menu was processed was inconvenient.
A research study by Nurhayati stated that the conflicts that arose in the care home were interpersonal in nature among the elderly, where they did not want to lose their arguments3. Conflict stemmed from unconfirmed news or issues among the residents, with the residents defending themselves and asserting that they were absolutely right. Expressions about ill-mannered caregivers were mainly due to the poor service that the participants felt they received. For instance, the caregivers were accused of being in patient. These expressions caused insecurity and caused the residents to receive less service. Another opinion was given by Unwin et al.14 expressed that the caregiver could assist and fulfill the daily needs of the elderly so that they are able to adapt to their prevailing conditions. Skirbekk and James15 found that 11% of the elderly had experienced at least one kind of abuse: 5.3% physically, 10.2% verbally, 5.4% financially, 6% in terms of appreciation and 5.2% due to ignorance.
The handling method for the adaptation of the elderly played an important role in dealing with the inconvenience they felt. The responses regarding the convenience of the home suggested that the elderly felt that the care home was like their own homes. According to them, this was a place where they could enjoy life, strengthen their spirits and experience feelings of happiness. The experience of feeling comfortable was closely related to the use of handling method in facing the arousal of inconvenience. Research by Najjah suggested that feeling comfortable was a satisfactory experience for individuals11.
Family support as identified in this research came in the form of material and emotional support. Family is the main support system for the elderly. Even the smallest form of attention can be extremely meaningful to them. The participants clearly stated that the gifts, family visits and financial support they received were among the acceptable forms of attention to them. This research also found that not all elderly obtained support from their core family members but that they also received support from relatives or neighboring friends. This fact was supported by the research of Setiti16, who also suggested that close family or relatives can provide support for the elderly. Koren and Lowenstein17 also suggested that the elderly require some support to discover the meaning of life, which could make them happy.
This research revealed the fact that most of the elderly’s support came from their children or nephews and nieces. The child was the most important supporter. This suggestion was supported by the research of Supraba18, who suggested that the life quality of the elderly is closely related to an elderly individual’s social activity and interaction as well as his or her family function. Receiving full emotional support from relatives through family visits was deemed necessary for the elderly, as it made them feel happy to continue the rest of their lives in the elderly care home.
The study was financed by the Directorate Research and Community Service (DRPM) University of Indonesia.
