'Why do people put their parents in nursing homes when there are so many problems in them?'

"Why do people put their parents in nursing homes when there are so many problems in them?"

It was not the first time my mom had asked this question. 

This time, it came after yet another report of an elderly woman's death in a nursing home. The story ended with the largest jury verdict payout related to Florida assisted living homes, with the total reaching $12.5 million. The family had accused the home of negligence and causing preventable bedsores, which eventually resulted in her death.

Nursing homes are scary, my mom said, because the elderly often cannot speak for themselves, and understaffing may lead to mistakes and fatal oversights. 

Many nursing homes are, of course, compassionate and responsibly run. Many families depend on these facilities to care for loved ones with cognitive issues requiring more supervision than families can provide at home. But herein was a deep fault line of cultural difference: Many of my mom's notions are based on stigmas rooted in a number of Asian countries. 

Putting a parent in a home is often interpreted as a sign of abandonment. It can be a source of deep shame. Though we know this may not be the case, traditional thinking can be difficult to shake. My mom noted that other countries approached elderly care differently and wondered why Americans can’t do the same. 

And that set me down a path, looking for the answer. 

I'm an anchor at KESQ, the ABC/CBS stations in Palm Springs, California. I'm the daughter of Taiwanese immigrants and a supporter of solutions journalism, in which we not only highlight problems across society but also offer potential solutions based on what other places are doing. This particular story came at the tail end of the coronavirus pandemic, when the slower-moving impacts of the pandemic were beginning to surface. And it was especially important to our audience in the Palm Springs and greater Coachella Valley area, which is largely known as a retirement community. In some cities, more than half the population is 60 years or older.

How we treat our elderly tells us a lot about ourselves. And how we treat our elderly can be traced back through our social structures as well as our culture. I knew I wanted to do a story on why care for our aging population is so lacking compared to other countries. I also knew we had to frame it through the lens of the pandemic. 

But how utterly depressing this report would have been if the takeaway was simply: If you get old in America, you're on your own. Too bad! It was important to me to look for potential solutions, or at the very least, show how other countries may care for their elderly and succeed in ways the U.S. does not. With support from the Center for Health Journalism 2023 California Health Equity Fellowship, I took the following steps to tell my story: 

Step 1: Identify the problem. 

This came after several versions of the same conversation with my mother. Caregiving for elders has always been a fascinating topic. Why is life expectancy shorter in the U.S.? Why is our social net significantly weaker for the elderly, compared to other countries? The topical inroad here was the coronavirus pandemic and how it had severely worsened health outcomes for older people and caregivers.

What makes this country strong also makes it weak. Our ruthless individualism and worship of self-achievement has led to extraordinary entrepreneurship, creating some of the world's biggest tech empires, which in turn, shape the world. It allows for sky-high dreams, even though we know our systems are not equitable and don't always allow everyone to achieve their dreams because of systemic discrimination. Big dreams and the perception of individual exceptionalism define the United States.

At the same time, our individualism can make us selfish. It creates a society in which many look out only for themselves. This was apparent during the COVID-19 pandemic when people across the U.S. refused to wear masks to protect themselves and other people —- a refusal that confounded much of Asia, where people have masked up for decades to prevent contagious diseases. Branching from the mentality of individualism is the idea that once someone turns 18, the person is on their own, another idea that baffles many people in other nations. 

When they turn 18, my mother asked, do they stop being your child?

Step 2: Identify who else is dealing with this problem and who may handle it better. 

It wasn’t hard to find other countries with stronger social nets. But the tougher question to answer was what allows them to handle the challenges better. I started domestically, by looking at local and national reports on caregiving and how the pandemic had affected rates of depression, anxiety, burnout and more. I checked a variety of organizations and sources, including the Alzheimer's Association, Caring Across Generations, Frontiers in Psychiatry and federal reports on social program funding for the elderly. I also spoke to people about the cultural differences that allowed different modes of elderly care to thrive in other countries. I found that U.S. history, political attitudes, and socioeconomic individualism are firm blockades to achieving what other countries have. 

All of this leads to the differing concepts of family and the expectation surrounding family. For Americans who negotiate the idea of self-sufficiency and obligation to family, it can be tough. What do you owe the parents who raised you? What do you owe yourself? How much of your own desires do you sacrifice for your family? For many Asian countries, it's an expectation that aging family members live with the eldest child until they die. 

Step 3. Follow the money. Always.

Money tells stories. This is true across nearly every piece of journalism.

Every country has old, sick people. But stark differences in cultural attitudes and approaches toward the elderly are revealed in how countries support programs to assist them. My focus was on caregivers and how lives can pivot in a moment because a loved one has a devastating diagnosis. I found that several European and Asian nations invested much more in caring for their elderly than we do. In Finland and Taiwan, for example, government funding guarantees care for elderly citizens, with recipients given the option to receive care at home or in a facility. These countries see long-term elderly care as a social imperative. 

While Medicare and Medicaid offer either coverage with long waitlists or limited coverage for people who qualify, the U.S. has no federal long-term care program that works for everyone. If you need care in old age and you don't qualify for Medicaid, you are primarily on your own. 

Step 4. Humanize the issue.

Advocates argue that caregiving in the U.S., for the old or young, is not a funding priority because it has been undervalued. This attitude has roots in historically racist and patriarchal structures reaching back to the nation's founding, when caregiving was the work of Black enslaved women, according to Sade Dozan of Caring Across Generations, an advocacy nonprofit. Today, paid care is done largely by Black and brown workers, many of them undocumented immigrant women. The work is underpaid and not valued or respected because of the way we have marginalized these groups.

For all the statistics and cultural analyses — which certainly contextualize why we are where we are — the humanity of the crisis is how you get people to care. Through Alzheimer’s Association we found our main character, Davette Robinson. She put a face to the crisis and gave us access to her heartbreaking situation. 

After the story aired, we created a local resource list for people across Coachella Valley. Viewers emailed, thanking us for bringing the caregiver struggle to light and offering resources specific to our valley.