ABSTRACT
The purpose of this study was to understand and compare elder's daily life in living in nursing homes in America and
Taiwan. Authors used a focused ethnography method for data collection and observation of the elderly's daily life in
nursing homes of Taiwan and another nursing home in America. Then, a cross-cultural comparison was presented. One
common theme that was revealed in the study was that "the nursing home is a place to be idle". There were four domains
under the major theme: surrounding environment, residents, recreation and privacy and autonomy. The environment
domain was categorized to two subcategories, internal environment and external environment. The external environment
of the two cultures' nursing homes is different, but the internal environment has similarities and dissimilarities. Recreations
for residents are very similar for both nursing homes, but nursing home residents in the U.S. have more space for
activities than nursing home residents in Taiwan. In addition, health care providers in both cultures try to respect residents'
privacy and residents have some autonomy, but American nursing home residents have more autonomy than residents in
nursing home of Taiwan. In sum, the findings contribute to knowledge of elders' daily life living in nursing homes by
demonstrating differences and similarities between American and Chinese elders in Taiwan. The study raises questions
about the effects of institutional, professional and cultural factors on the disposition to care for elders. (Tzu Chi Nursing
Journal, 2004; 3:2, 41-49.)
Key words: Nursing Home, Elder's Daily Life, Cross-Culture Comparison
The Elderly Living in Nursing Homes: Cross-Culture Comparison
Su-hsien Chang • Miao-chun Fang
Chung Hwa College of Medical Technology
Received: January 2, 2004 Revised: February 9, 2004 Accepted: April 8, 2004
Address correspondence to: Maio-chun Fang, No. 89 Wen-Hwa 1st lane, Jen-Te Hsien, 717 Tainan Hsien, Taiwan R. O. C.
Tel:(06) 2671214 ext. 563
Introduction
Becoming old is a universal phenomenon, but it seems
ironic that living independently into advanced old age often
means learning to accept help. In the United States,
about 12 million people need some assistance with their
daily living. Although only 9% of people aged 65 to 69
need help in performing activities of daily living (ADL)
such as bathing, dressing, and eating, 43% of elders aged
85 and over need such help. Also, some elders who have
!"#$ P O ! VP S
QO
fewer limitations in ADL still cannot manage their lives
independently because they are unable to keep track of
money, do minor housework, take medicine, and run
errands. As a result, they may need to move in to a longterm
care facility such as a nursing home. The nursing
home in the United States is designed to help people with
chronic conditions to compensate for limitations in their
abi1ity to function independently (United States General
Accounting Office, 1995)
On the other hand, placing adult parents in long term
care settings is considered as a violation of traditional filial
obligation among many Chinese in Taiwan, it has become
new caregiving alternative. After War World II, because
the living standard and quality of health and medical
care have improved in Taiwan, life expectancy has increased
from 53.38 years in 1951 to 72.60 years in 2000
for men, and from 56.33 years to 78.3 years for women.
Although the Chinese people in Taiwan have prolonged
their life span, their health status may not be satisfactory.
According to the Ministry of the Interior (MOI, 2001) in
Taiwan surveyed health status among 4067 people aged
20 or over. The result was that 79.3% of the people were
satisfied with their health status, only 19.7% were not
satisfied. Men were more satisfied with their health status
than women. Elders were less satisfied than young people
with their health status. Also, 27.9% of the elderly over 65
were not satisfied with their health status.
In addition, industrialization and urbanization not only
change the family structure in Taiwan, but also the value
of filial duty and elders' living arrangement. According to
the National Statistics of Taiwan, ROC (2001), the family
composition was 55.8% nuclear families and 22.3% threegeneration
families. Elderly aged 65 and over living with
children and grandchildren were 30.9%; living with spouse,
24.0%, and living alone; 1.4%. In 2000, living arrangements
for the elderly aged 65 and over were 58.1% with
three-generation families; 17.4% with spouse; 6.7% with
relatives; and 16% alone. Although, most elderly like to
live with and be taken care of by their children, they may
not able to do so because of physical or mental limitations
and the need for other's assistance. In the past few decades,
nursing scholars in Taiwan have been studying about which
people are more likely to be admitted to long term care
facilities. They found that nursing home entry is associated
with advanced age, gender, educational level, and independency
levels of elders (Chiu, Shyu, Liu & Wang,
Chang, 2001; Liu & Tinker, 2001; Shyu & Lee, 2002; Wu,
Li & Chang, 1997). For instance, Liu and Tinker (2001)
indicated that the average age of people in nursing homes
was greater than in the community. More women than
men resided in nursing homes compared with their counterparts
in the community. There were more widows or
widowers lived in the nursing homes. People who received
higher education were more likely to live in nursing homes
when they are aging. Also, elderly people in nursing homes
were severely dependent. Specific medical problems such
as cardiovascular, neurological, and skeletal muscular diseases
were major contribution for nursing homes admission
in Taiwan.
The result of increasing aging population and people
who need assistance with basic activity of daily living such
as feeding, bathing, dressing, washing face, brushing teeth,
toileting, and bowel and bladder care, transferring, ambulating
and stair climbing, the needs for nursing homes are
increasing. According to the MOI in Taiwan (2004), in
1996, the number of nursing homes was 16 that could provide
1200 beds for senior adults, and 70.3% of the beds
were occupied. But in 2003, this number increased to 738
that were 24,882 available beds, and 72.02% of the beds
were occupied. Although, some elders have positive perceptions
of living in nursing homes, most elders perceive
living in nursing homes negatively (Lee, 1997a, 1997b ;
Yeh, Shey & Lin, 2002). Unfortunately, the elderly living
in nursing homes in Taiwan may not be aware that their
negative perceptions become stressful events. They only
know that they are not happy living in nursing homes.
Conse quently, their perceptions of quality of life decreases.
Owing to culture is formed through history, human
beings as individuals are determined not only genetically,
but also culturally. That is why each person has his/her
unique characteristics. To understand a human being, culture
entities and the culture history of society should be
considered (Shin, 2001). As we know Chinese people are
very proud of their history, which is more than five thousands
years old. The way of Chinese living and thinking
are influenced by the Chinese cultural heritage, which are
ABSTRACTThe purpose of this study was to understand and compare elder's daily life in living in nursing homes in America andTaiwan. Authors used a focused ethnography method for data collection and observation of the elderly's daily life innursing homes of Taiwan and another nursing home in America. Then, a cross-cultural comparison was presented. Onecommon theme that was revealed in the study was that "the nursing home is a place to be idle". There were four domainsunder the major theme: surrounding environment, residents, recreation and privacy and autonomy. The environmentdomain was categorized to two subcategories, internal environment and external environment. The external environmentof the two cultures' nursing homes is different, but the internal environment has similarities and dissimilarities. Recreationsfor residents are very similar for both nursing homes, but nursing home residents in the U.S. have more space foractivities than nursing home residents in Taiwan. In addition, health care providers in both cultures try to respect residents'privacy and residents have some autonomy, but American nursing home residents have more autonomy than residents innursing home of Taiwan. In sum, the findings contribute to knowledge of elders' daily life living in nursing homes bydemonstrating differences and similarities between American and Chinese elders in Taiwan. The study raises questionsabout the effects of institutional, professional and cultural factors on the disposition to care for elders. (Tzu Chi NursingJournal, 2004; 3:2, 41-49.)Key words: Nursing Home, Elder's Daily Life, Cross-Culture ComparisonThe Elderly Living in Nursing Homes: Cross-Culture ComparisonSu-hsien Chang • Miao-chun FangChung Hwa College of Medical TechnologyReceived: January 2, 2004 Revised: February 9, 2004 Accepted: April 8, 2004Address correspondence to: Maio-chun Fang, No. 89 Wen-Hwa 1st lane, Jen-Te Hsien, 717 Tainan Hsien, Taiwan R. O. C.Tel:(06) 2671214 ext. 563IntroductionBecoming old is a universal phenomenon, but it seemsironic that living independently into advanced old age oftenmeans learning to accept help. In the United States,about 12 million people need some assistance with theirdaily living. Although only 9% of people aged 65 to 69need help in performing activities of daily living (ADL)such as bathing, dressing, and eating, 43% of elders aged85 and over need such help. Also, some elders who have !"#$ P O ! VP S QO fewer limitations in ADL still cannot manage their livesindependently because they are unable to keep track ofmoney, do minor housework, take medicine, and runerrands. As a result, they may need to move in to a longtermcare facility such as a nursing home. The nursinghome in the United States is designed to help people withchronic conditions to compensate for limitations in theirabi1ity to function independently (United States GeneralAccounting Office, 1995)On the other hand, placing adult parents in long termcare settings is considered as a violation of traditional filialobligation among many Chinese in Taiwan, it has becomenew caregiving alternative. After War World II, becausethe living standard and quality of health and medicalcare have improved in Taiwan, life expectancy has increasedfrom 53.38 years in 1951 to 72.60 years in 2000for men, and from 56.33 years to 78.3 years for women.Although the Chinese people in Taiwan have prolongedtheir life span, their health status may not be satisfactory.According to the Ministry of the Interior (MOI, 2001) inTaiwan surveyed health status among 4067 people aged20 or over. The result was that 79.3% of the people weresatisfied with their health status, only 19.7% were notsatisfied. Men were more satisfied with their health statusthan women. Elders were less satisfied than young peoplewith their health status. Also, 27.9% of the elderly over 65were not satisfied with their health status.In addition, industrialization and urbanization not onlychange the family structure in Taiwan, but also the valueof filial duty and elders' living arrangement. According tothe National Statistics of Taiwan, ROC (2001), the familycomposition was 55.8% nuclear families and 22.3% threegenerationfamilies. Elderly aged 65 and over living withchildren and grandchildren were 30.9%; living with spouse,24.0%, and living alone; 1.4%. In 2000, living arrangementsfor the elderly aged 65 and over were 58.1% withthree-generation families; 17.4% with spouse; 6.7% withrelatives; and 16% alone. Although, most elderly like tolive with and be taken care of by their children, they maynot able to do so because of physical or mental limitationsand the need for other's assistance. In the past few decades,nursing scholars in Taiwan have been studying about whichpeople are more likely to be admitted to long term carefacilities. They found that nursing home entry is associatedwith advanced age, gender, educational level, and independencylevels of elders (Chiu, Shyu, Liu & Wang,Chang, 2001; Liu & Tinker, 2001; Shyu & Lee, 2002; Wu,Li & Chang, 1997). For instance, Liu and Tinker (2001)indicated that the average age of people in nursing homeswas greater than in the community. More women thanmen resided in nursing homes compared with their counterpartsin the community. There were more widows orwidowers lived in the nursing homes. People who receivedhigher education were more likely to live in nursing homeswhen they are aging. Also, elderly people in nursing homeswere severely dependent. Specific medical problems suchas cardiovascular, neurological, and skeletal muscular diseaseswere major contribution for nursing homes admissionin Taiwan.The result of increasing aging population and peoplewho need assistance with basic activity of daily living suchas feeding, bathing, dressing, washing face, brushing teeth,toileting, and bowel and bladder care, transferring, ambulatingand stair climbing, the needs for nursing homes areincreasing. According to the MOI in Taiwan (2004), in1996, the number of nursing homes was 16 that could provide1200 beds for senior adults, and 70.3% of the bedswere occupied. But in 2003, this number increased to 738that were 24,882 available beds, and 72.02% of the bedswere occupied. Although, some elders have positive perceptionsof living in nursing homes, most elders perceiveliving in nursing homes negatively (Lee, 1997a, 1997b ;Yeh, Shey & Lin, 2002). Unfortunately, the elderly livingin nursing homes in Taiwan may not be aware that theirnegative perceptions become stressful events. They onlyknow that they are not happy living in nursing homes.Conse quently, their perceptions of quality of life decreases.Owing to culture is formed through history, humanbeings as individuals are determined not only genetically,but also culturally. That is why each person has his/herunique characteristics. To understand a human being, cultureentities and the culture history of society should beconsidered (Shin, 2001). As we know Chinese people arevery proud of their history, which is more than five thousandsyears old. The way of Chinese living and thinking
are influenced by the Chinese cultural heritage, which are
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