Comparative Study on Elder Care in Fredrikstad, Duluth, and Sefrou:
Reality for Elders Living in Three Small Urban Cultural Contexts
Stine Myrah
University of Minnesota - Duluth
Dr. David Syring
April 29, 2021
1Table of Contents
Acknowledgements 2
Abstract 3
Introduction 4
Review of Literature 6
Methodology 13
Results 19
Survey 22
Interviews 27
Discussion 60
Survey 61
Interviews 66
Conclusion 72
Next Questions for Study 74
Statement of Reflexivity: Subjective Response 76
Responses to Interviews/Surveys 77
Final Thoughts 77
Bibliography 79
Appendix 83
2Acknowledgements
This project would not have been possible without the guidance and support of many individuals,
of whom I am deeply grateful. Zina Deriche and Kathrine Myrah served as translators for my survey and
interview questions. Kathrine is also my mother and offered endless support throughout the research
process, including many late night chats. My tante (aunt) Heidi Mork helped share my survey and get
participants for interviews in Fredrikstad, Norway. Dr. Dana Lindaman sent countless emails to help
connect me with individuals in Morocco. Dr. Scott Vollum put in hours of work helping me create my
survey, guiding me through the quantitative data analysis, and creating several tables with the survey
results. Dr. David Syring served as my advisor for this project and I am sure I could not have found a
better mentor for this research. He offered constant support, wisdom, and guidance throughout the entire
process. To all the people above, as well as to those who took my survey, participated in interviews, and
engaged in meaningful conversations surrounding elder care, I am truly grateful.
The final acknowledgement I would like to make is to my inspiration and grandfather,
Edward G. Myrah. He passed away last fall, but it was through his caregiving that I discovered this area
of research. The challenges that my family encountered trying to provide the best quality of life for him in
his last years opened my eyes to the realities of elder care, and inspired me to work to create a better
world for all elderly persons. Caring for my grandfather was the greatest joy and most rewarding
experience of my life. Knowing that he was truly grateful made it even more fulfilling, and I feel blessed
to have had the opportunity to give back to this man that had given me so much. I hope to honor his
memory through this work.
Just as it took a team to care for my Grandpa Ed, it took a team to create the project you see
before you. As you read this presentation of research I ask that you acknowledge all the people that went
into making it a reality.
3Abstract
As the world population ages, the need for elder care continues to increase. Current
systems are struggling to keep up with the demand, and those providing care to the elderly are
often overworked and overstressed. In different cultures there are a variety of ways that elderly
are cared for. Through cross-cultural comparison of Fredrikstad (Norway), Sefrou (Morocco),
and Duluth (Minnesota, United States) this study highlights useful perspectives regarding the
holistic needs of the elderly and those who care for them. By interviewing both caregivers and
receivers, this project, by emphasizing first-hand experiences, highlights pros and cons of the
current models of care in each cultural setting. Surveys also revealed broader societal realities
surrounding both personal thoughts on elder care as well as the reality of elder roles within
society. Due to the extensive needs of the elderly it was highlighted cross-culturally that greater
support systems, both for family and institutional care facilities, are needed. Along with this, a
greater emphasis needs to be placed on the mental well-being of the elderly, specifically targeting
the issue of loneliness. Community amongst peers of similar cultural identity is key in
facilitating the flourishing of elder emotional health. It is also imperative that elder care systems
expand to account for the care of those who do not fit into the traditional systems in place.
Among other recommendations I will present in my conclusions, these three are most significant:
1) A future study could be on how capitalism has affected our sense of humanity, specifically by
engaging with elderly who live in capitalist based societies versus those who live in Indigenous
communities; 2) Study immigrant workers in nursing homes and other care centers to understand
how cultural differences affect those receiving care; 3) Further studies should be done
surrounding the broader implications of elder care, specifically the opportunities integrating
elderly into communities has for society as a whole.
4Introduction
In life there is one thing that will always be true and that is the fact that everyone will
eventually die. This may seem like a morbid way to introduce my research paper, but I think it is
key to understanding the need for my research. Death’s undeniable reality is accompanied by the
fact that every society around the world features an elderly population that requires care. As our
elderly populations continue to rise alongside increasing life expectancies, our elder care needs
are subsequently rising. Therefore, it is imperative that we reflect on our current systems in order
to improve the quality of life for everyone.
Elder care studies around the world focus on both the needs of the elderly as well as the
effects on caregivers. The needs of the elderly can be grouped into physical, medical, and
emotional categories. Caregiver effects1 focus on mental health issues related to stress,
depression, anxiety, guilt, and fear. These issues are found in both family caregiving as well as in
professional settings, such as in nursing homes. Current research also highlights cultural impacts
on elder care through detailing power dynamics and respect for the elderly within different
cultural settings. Cultural dynamics are also seen through research on elderly immigrant
populations. This research specifically focuses on how culture inhibits the elderly from getting
the resources they require due to cultural differences. Culturally focused studies on elder care
aim to highlight areas that need improvement within a specific cultural setting, but fail to identify
themes cross-culturally. What is lacking in the current research is the use of a cross-cultural
analysis in order to identify opportunities for improving elder care systems universally.
Identifying cultural differences will allow me to find universal truths about the elderly. I am
1 Scott R. Beach, Sara J. Czaja, et al. “Family Caregiving for Older Adults,” Annual Review of Psychology, 71,
(2020): 635-659 , https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev-psych-010419-050754
5specifically interested in understanding the role culture plays in developing community for the
elderly, and in which ways different systems of elder care promote and inhibit community
development. I am also looking at how the broader society is impacted through focusing on
caregiver experiences. To do this I conducted interviews with those giving and receiving elder
care in Fredrikstad (Norway), Sefrou (Morocco), and Duluth (Minnesota, United States). I also
conducted surveys within these communities to get a broader understanding of the realities of
elder care and elder respect cross-culturally.
My interest in focusing on elder care systems began after experiencing the realities of
elder care with my grandparents. My grandmother was diagnosed with cancer and was
subsequently in and out of hospitals, hospice centers, and eventually ended up at home for her
final weeks of life. I was too young to be heavily involved in her care, but I witnessed my
mother’s role in caring for my grandmother during that time. When my grandfather began
needing assistance I was much older and became heavily involved in his caregiving needs. For
the last five months of his life he lived at home with my family so that he could receive the care
that he both needed and wanted. Going through this experience was both extremely challenging
and incredibly rewarding, but above all it opened my eyes to some of the realities surrounding
end of life care. It was this experience that fostered my desire to study elder care, ultimately with
the hopes of improving the lives of those around me. Through my experience I have come to the
understanding that elder care is not just about the elderly and those that care for them, but it is
ultimately about society as a whole. Whether societies choose to recognize this impacts their
ability to realize their full potential. As Paul Wellstone, an influential senator from Minnesota,
once said, “We all do better when we all do better.” I believe this to be especially true in regards
to the impact elder care has on the rest of society.
6Review of Literature
As Buch says in Anthropology of Aging and Care, it is essential to study elder care
because “care in later life never exclusively impacts the lives of the old … (thus being) a critical
site for understanding the diverse ways that increased longevity is shaping the meanings,
experiences, and consequences of life itself”.2 To understand elder care, it is crucial to
understand the challenges faced by the elderly. These challenges can help identify issues with the
current system of care. Defining who should be taking care of the different needs of the elderly
becomes more challenging, and varies cross-culturally. Similarly, identifying where these
problems should be addressed can be difficult, and this varies greatly depending on resources and
cultural realities. Julia Alvarez’s chapter on the Dominican Republic, featured in Tout’s book
Elderly Care: A World Perspective, highlights multiple reasons why understanding elder care is
important. The first reason is that if elders are seen simply as a “burden” then the resources
elders offer will be wasted. In her chapter, she writes on the many positives elders offer societies,
such as “accumulated knowledge, skills, and experience”.3 This book features many different
cultures around the world, but it does not compare the experiences to each other, as I intend to do
with my research. It also has a large focus, as much elder research does, on elders that can care
for themselves. Using the existing literature as the basis for my research, I will work to
understand the holistic needs of the elderly and the roles of cultures in creating systems that
provide for these needs.
3 Ken Tout, Elderly Care: A World Perspective, (Malaysia: Springer Science + Business Media Dordrecht, 1993),
7-8.
2 Elana D. Buch, “Anthropology of Aging and Care,” Annual Review of Anthropology 44, (2015): 277,
https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev-anthro-102214-014254
7Problems Faced By Elderly
The elderly experience a wide variety of needs, including medical/physical and
emotional. There have been many studies focusing on the physical aspect of elder needs, but
there seems to be a “deficit in the quantitative literature” on “cognitive and emotional
components of successful aging”.4 Part of this may be due to the focus on using “cognitive health
… to rule out dementia or depression”.5 As Depp, Jeste, and Vahia point out in their article, it is
important to focus on emotional health of the elderly because “neurodegenerative illnesses are
less amenable to treatment than many other chronic physical illnesses”, “cognitive and emotional
processes mediate health behaviors that impact physical health”, and “although avoiding chronic
illness in life is probably not a feasible goal, cognitive and emotional adaptation to these illnesses
may well be attainable”.6 Just as emotional well-being influences physical health, physical
activity can positively influence emotional health. Other factors that are important when
considering mental health are diet, cognitive stimulation, meditation, and social activity.7
Cultural relationships to elder care needs can also be seen through examining elderly
immigrant experiences. Cela and Fokkema examine elderly mental health through studying
loneliness among Albanians and Morrocans living in Italy.8 Although the elderly that they
studied had meaningful relationships with family, the lack of relationships with other elderly
people, specifically “co-ethic peers”, drove their loneliness.9 Specific factors that led to this
loneliness also included “discrimination and lack of Italian language proficiency, free time,
9 Ibid. 1197
8 Eralba Cela & Tineke Fokkema, “Being lonely later in life: A qualitative study among Albanians and Moroccans
in Italy,” Ageing and Society 37, no. 76 (2017): 1197, DOI:10.1017/S0144686X16000209
7 Ibid. 540-542.
6 Ibid. 533.
5 Ibid. 532.
4 Colin Depp, Dilip Jeste, & Ipsit V. Vahia, “Successful Aging: Focus on Cognitive and Emotional Health,” Annual
Review of Clinical Psychology 6, (2010): 532,
https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev.clinpsy.121208.131449
8financial resources and nearby contact facilities”.10 Recognizing these social factors is important
for identifying the areas that can be improved to further improve the mental well being of the
elderly. Ahaddour, Branden, and Broeckaert studying with Morrocan and Turkish migrants in
Belgium found “several factors such as the language barrier, a low level of education, financial
barrier, a series of cultural and religious barriers, lack of knowledge of health care system and the
so-called return and care dilemmas” that inhibited elderly migrants from receiving the things
they needed.11 In another study on Turkish, Moroccan, and Moluccan elderly living in the
Netherlands, loneliness was found to have some of the greatest effects on quality of life.12 This
same population was further studied to highlight how “culturally sensitive services” are key to
creating accessible resources for elderly immigrant populations.13
Community is a necessary part of elder care, both for the elderly and those providing
care. Anthropologist Barbara Myerhoff wrote a book on her experience living in a Jewish elder
community in California. This specific community consisted of “a group of former migrants
from Eastern Europe”. 14 Community can be created indirectly through providing spaces for the
elderly to occupy within society. In Meyerhoff’s book she cites park benches as providing a
place for “intense sociability” to occur between elderly community members.15 This sense of
15 Ibid. 5.
14 Barbaraa Myerhoff, Number Our Days: A Triumph of Continuity and Culture Among Jewish Old People in an
Urban Ghetto, (New York: Touchstone, 1978), xiv.
13 Ilona Verhagen, Wynand J. Ros, Bas Steunenberg et al., “Culturally sensitive care for elderly immigrants through
ethnic community health workers: design and development of a community based intervention programme in the
Netherlands,” BMC Public Health 13, (2013): 22, DOI:10.1186/1471-2458-13-227.
12 Verhagen, Ilona, Ros, Wynand J., Steunenberg, Bas et al. “Ethnicity does not account for differences in the
health-related quality of life of Turkish, Moroccan, and Moluccan elderly in the Netherlands.” Health Qual Life
Outcomes 12, (2014): 138. DOI:10.1186/s12955-014-0138-8
11 Chaïma Ahaddour, Stef van den Branden, & Bert Broeckaert, “Institutional Elderly Care Services and Moroccan
and Turkish Migrants in Belgium: A Literature Review,” J Immigrant Minority Health 18, no. 5 (2016): 1226,
DOI:10.1007/s10903-015-0247-4
10 Ibid. 1197.
9belonging can prevent previously listed issues of loneliness and depression that are often
experienced by the elderly.
Issues With Current Care Systems
As the elderly population continues to increase it is important to take note of current
issues surrounding the broader systems of care in order to identify areas for improvement.
Through studying current designs of elderly Moroccan residencies, Bouaoudate et. al
have identified practical needs of the elderly. Most Moroccan elderly live in ordinary houses that
are not set up to provide for their physical needs, such as safety devices in bathrooms to prevent
falls, as they age. It is typical for multigenerational living to occur, but the homes are set up for
the nuclear family and do not account for the needs of the elderly.16 Of housing units directly
created for elderly residents it was concluded that top priority should be safety throughout the
home, adequate access to health care professionals, equipment for “preventative and curative
maintenance”, and several therapeutic options for increasing autonomy amongst the elderly.17 As
the Moroccan population continues to age it is important that new residencies built specifically
for the elderly cater to their many needs.
The book Steps Toward a Planning Framework for Elder Care in the Arab World
highlights elder care issues related to cultural systems in Arab countries.18 It mentions the
depression felt by those living in care facilities, partially due to “feelings of shame related to
receiving elder care from non-family members”.19 Issues are also felt by caregivers of the elderly.
Caring for the elderly can be highly unpredictable and uncontrollable, leading to extreme stress
19 Ibid. 45.
18 William B. Ward & Mustafa Z Younis, Steps Toward a Planning Framework for Elder Care in the Arab World,
(New York: Springer Science + Business Media, B.V., 2013).
17 Ibid. 148.
16 M. Bouaoudate, Jaouad E. Harti, M. Maamar, & Redouane Abouqal. “Design of a typical residence for the elderly
in Morocco.” Journal of public health in Africa 9, no. 3 (2018): 146. DOI:10.4081/jphia.2018.835
10
in caregivers.20 In a study conducted in Morocco participants were found to have experienced
high levels of depression and anxiety, with 88.1% of participants experiencing depression and
79.3% experiencing depression-related anxiety.21 These participants were specifically family
caregivers because it is regarded as shameful to put family members in nursing homes in
Moroccan culture.22 In Arab regions women are traditionally expected to care for the elderly, and
rising care needs are adding intense stress to womens’ lives. As Hussein and Ismail highlight in
their conclusion studying this demographic, it is essential that the government step in and create
“formal care provision(s)” to support the growing elder needs.23
There has been extensive research done on the mental well-being of caregivers, as
discussed in Family Caregiving for Older Adults.24 As a large portion of caregiving worldwide is
done by family it is critical to understand the caregiver experience. Beach et. al further discuss
stress as being associated with the “unpredictable and often uncontrollable” reality of
caregiving.25 Due to the variety of individual care needs, there are also a wide range of effects
felt by caregivers. Stress from caregiving is proportional to the direct needs of the eldery, which
can vary from “assistance with daily activities … to navigating complex health care and social
service systems”.26 As families assist in navigating these complex issues the relationships
between the caregivers and care recipient changes. Often times these existing relationships are
26 Ibid. 639.
25 Ibid. 637.
24 Scott R. Beach, Sara J. Czaja, et al. “Family Caregiving for Older Adults,” Annual Review of Psychology, 71,
(2020): 637, https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev-psych-010419-050754
23 Shereen Hussein & Mohamed Ismail, “Ageing and Elderly Care in the Arab Region: Policy Challenges and
Opportunities,” Ageing Int 42, (2017): 285, DOI:10.1007/s12126-016-9244-8
22 Ibid. 347.
21 Sihame Lkhoyaali, Meryem A.E. Haj, Fadwa E. Omrani et al. “The burden among family caregivers of elderly
cancer patients: prospective study in a Moroccan population,” BMC Res Notes 8, (2015): 347,
DOI:10.1186/s13104-015-1307-5
20 Scott R. Beach, Sara J. Czaja, et al. “Family Caregiving for Older Adults,” Annual Review of Psychology, 71,
(2020): 637, https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev-psych-010419-050754
11
strained and negatively impacted due to the stress associated with caregiving.27 There are both
positive and negative impacts of caregiving, but the negative impacts are much more researched
due to their significant impacts.28 Further research is needed to understand the “drivers of
caregiver distress” beyond the “various functional disabilities” that have already been identified
through current research.29
Ideas for Elder Care Systems
Innovations in elder care will be needed to address current issues and prepare for the
large number of incoming elderly persons. A blog post by Maureen Bisognano describes the
ways in which Norwegian care systems have inspired her. One specific example is Norway’s
focus on home care. Bisognano describes a “re-ablement” program that offers rehabilitation for
elderly in their own homes, and focuses on creating independence.30 Toronto Star columnist Paul
Watson also writes about Norway’s effective elder care systems. Similarly, he highlights the
Norwegian policy to “stay home as long as possible”, focusing on keeping Norwegians out of
nursing homes.31 Watson also discusses Norway’s government funding towards supporting living
at home through assisting the elderly in purchasing technological devices.32 A lot of the push for
staying at home is due to the severe lack of workers to deal with the growing needs for elder care
in facilities. By 2060  “one out of every five Norwegians is expected to to be 70 years or
32 Ibid.
31 Paul Watson, “Why Norway is No. 1 for seniors,” Toronto Star,
https://www.thestar.com/news/world/2014/10/12/why_norway_is_no_1_for_seniors.html (accessed December 13,
2020).
30 Maureen Bisognano. “New Models for Elder Care: 3 Ways Norway Inspired Me,” Institute for Healthcare
Improvement, http://www.ihi.org/communities/blogs/new-models-for-elder-care-three-ways-norway-inspired-me
(accessed April 12, 2020).
29 Ibid. 652.
28 Ibid. 640.
27 Ibid. 642.
12
older”.33 The dramatic increase in population size is another reason why it is imperative to create
functioning elder care systems that can support the growing need.
Conclusion
My research will be able to connect the current knowledge of elder experience, specifically in
regards to elder care, with the research that has been done on caregiver experiences. As the
elderly become a much larger portion of the population it is important to review our current
systems of care for the elderly to not become a burden on society, and instead serve as a resource
of knowledge. I can use the research that has been done on elder care as a basis for further
research. Comparing the United States, Morocco, and Norway, in terms of elder care, is unique
to any current research that has been done because it focuses on care receivers and caregivers in
three regions that have not been directly compared previously. As Beach et. al state in their
conclusion, research should work to “educate and prepare all adults for caregiving” due to the
fact that everyone will eventually require care themselves.34 This point further affirms the need
for my research through recognizing the impending needs of all human beings. As our collective
societies continue to age the time to improve our elder care systems is now.
34 Scott R. Beach, Sara J. Czaja, et al. “Family Caregiving for Older Adults,” Annual Review of Psychology, 71,
(2020): 653, https://doi-org.libpdb.d.umn.edu:2443/10.1146/annurev-psych-010419-050754
33 Ibid.
13
Methodology
Study Design
This study compared public statistics on elders with survey results to understand elder
care experiences cross-culturally. I also conducted interviews to gain first-hand accounts of the
systems at play, and to highlight areas of success as well as areas for improvement in the
different cities included in this study (Fredrikstad, Sefrou, and Duluth). I received Institutional
Review Board approval to conduct this research (from the University of Minnesota Duluth).
Study Procedures
Interviews
I conducted virtual interviews using zoom as a means of collecting an initial rough
transcription. All participants were adults (18+). Those participating in interviews met the
following criteria: an elderly person (65+) who receives care OR a provider of care to the elderly.
All interview participants signed a consent form agreeing to the terms of the study, and I
recorded responses anonymously (pseudonyms will be given in the results/discussion/conclusion
sections to protect anonymity of participants). Elderly persons who were part of this research
were in full mental capacities and able to consent. I provided contact information for the Human
Research Protections Program, supervising advisor (Dr. Syring), and primary researcher (Stine
Myrah) in case of any concerns with the interview. IRB approved translators translated the
interview questions into Bokmål (Norwegian) and Darija (Arabic). A Norwegian translator
assisted and translated interviews.
14
Interview Questions
Care Receiver Care Provider
❖ Age?
➢ How old were you when you started
requiring care?
➢ What was the reason you started
requiring care?
❖ Do you have a partner/spouse?
❖ Do you have family? Describe?
➢ What does your relationship look like
with them?
❖ What does your current living situation look like?
❖ How satisfied are you with this situation?
❖ Expectations versus reality?
➢ Pros and cons of your situation
➢ What factors affected your decision to
live where you are?
■ Financial, availability of family
to care for you, etc.
➢ Would you change this decision based
on your experience?
❖ Emotional health: How has your care experience
increased/decreased your happiness?
❖ How would you say respect is for the elderly in
your community and what have you experienced?
❖ Why do you work with elders?
❖ What pros and cons have you found
working with this population?
❖ Is your work rewarding to you?
❖ What emotional experiences, if any, have
you had working with the elderly?
❖ Has your caregiving experience altered
your hopes for your personal care when
you are unable to care for yourself?
Of all elders that you are aware of in your
community, which options are most popularly used
for care? Examples:
➢ professional home care
➢ nursing home/assisted living
➢ move in with family/friends
➢ live at home with help from family/friends
Are elders respected in your community?
15
Of all elders that you are aware of in your community,
which options are most popularly used for care?
Examples:
➢ professional home care
➢ nursing home/assisted living
➢ move in with family/friends
➢ live at home with help from family/friends
*Additional questions/discussions came up during the interviews surrounding ideas for future
care systems and issues with current systems.
Survey
Any independent adult living in Fredrikstad (Norway), Sefrou (Morocco), or Duluth
(Minnesota, United States) was eligible to take part in the survey. The survey was created
through Qualtrics and all responses were anonymous. At the beginning of the survey there was
an outline for consent that included contact information for the Human Research Protections
Program, supervising advisor (Dr. Syring), and primary researcher (Stine Myrah) in case of any
concerns with the survey. IRB approved translators translated the survey questions into Bokmål
(Norwegian) and Darija (Arabic).
Survey Questions
Question Response Option(s)
Have you started thinking about your care plans for
when you are unable to care for yourself and are
elderly (65+)?
Yes/No
Do you have a plan in place? Yes/No
What are your expectations of who will take care of
you when you are unable to care for yourself?
Professional Home Care, Nursing
Home/Assisted Living, Moving in
16
with Family/Friends, Live at Home
with Help from Family/Friends,
Other (fill in the blank)
What is your preference? Professional Home Care, Nursing
Home/Assisted Living, Moving in
with Family/Friends, Live at Home
with Help from Family/Friends,
Other (fill in the blank)
How long do you plan to live at home? Until I can not care for myself, Until I require medical
care, For the rest of my life
In terms of your future elder care decisions, rate each
factor below on a scale of 1 (low importance) to 10
(high importance)
Finances, Family Opinion, Ability of Family to Care
for You, Medical Condition, Personal Opinion
Rate each statement below from 1 (I am able) to 5 (I
am unable).
Would it be feasible for you to move in with
family/friends considering finances and time?, Would
you be willing to live with family/friends if it was
offered to you?, Would you be able to care for someone
who is close to passing?, Are you able to help with
bills/mail/paperwork?
Do you know any homes with several generations
living together in your community?
Yes/No
Is it common for several generations to live in the same
household in your community?
Yes/No
How important is family to you? Extremely Important, Very Important, Moderately
Important, Slightly Important, Not at all Important
How important is living near family to you? Extremely Important, Very Important,
Moderately Important, Slightly
Important, Not at all Important
What have your family members (parents,
grandparents, great-grandparents, etc.) done for their
elder care once they have not been able to care for
themselves? (multiple choice)
Professional Home Care, Nursing Home/Assisted
Living, Moving in with Family/Friends, Live at Home
with Help from Family/Friends, N/A
➢ *If they responded to this question they were
also asked:
➢ At what age(s) did your family member(s)
require care? (multiple choice)
○ 65-74, 75-85, 86-95, 95+
➢ What factors were most important to them
once they required care? Rank most important
to least important.
○ Finances, Family Opinion, Ability of
Family to Provide Care, Medical
Condition
Of all elders that you are aware of in your community,
which options are most popularly used for care? Rank
Professional Home Care, Nursing
Home/Assisted Living, Moving in
17
most important to least important with Family/Friends, Live at Home
with Help from Family/Friends
Are elders respected in your community? Very much / above others, Same as others, Not at all
Would you be able/willing to care for an elderly family
member that requires assistance?
Scale 1-5: 1 (Very Likely) - 5 (Not Likely)
Please identify how each factor would influence your
decision:
Factors: Finances, Time, Personal Opinion, Elderly
Person’s Opinion, Medical Care Required, Closeness to
End of Life
Rate on a scale from 1 (Low/Minimal) to 10 (High)
Residence? Fredrikstad (Norway), Sefrou (Morocco), Duluth
(Minnesota, USA)
Age? Fill in the Blank
Gender Male, Female, Other
Are you currently caring for an elderly person? Yes/No
*If you said yes, what type of caregiving?
Family/Friend, Nursing Home, Assisted Living,
Professional Home Care, Hospice, Other (fill in the
blank)
Recruitment Process
For the surveys in each country 25-30 participants was the minimum goal. For the
interviews the goal wasa 5 individuals (for each country). Participants for interviews were
gathered through personal contacts and social media posts on Facebook. Social media posts on
Facebook were used to share the survey. All recruitment language used on Facebook was
translated into Bokmål (Norwegian) and Darija (Arabic) by IRB approved translators. Posts were
made on the researchers personal Facebook page as well as on several public/private Facebook
pages/groups (with consent of the administrators for each group). In Duluth the recruitment
materials were also shared by the Unitarian Universalist Congregation of Duluth’s email
newsletter. Professional health care providers were emailed directly from information found in
searching nursing homes online (both in Duluth and Fredrikstad).
18
Research Sites
The study activities were conducted “online,” in conformity with COVID-19 restrictions
on university research, which during the study period did not allow face-to-face collection of
research data. Participants were able to complete surveys and interviews from their home
environments.
19
Results
Study Context
As of 2015 the Global AgeWatch Index has ranked Norway #2, the United States #9, and
Morocco #84 in terms of top places to live as an elderly person.35 Rankings are based on several
factors, including income security, health status, capability, and enabling societies/environment.
All persons over 65 in Norway receive a pension, and as of 2015 only 1.8% of people over 60
had “an income of less than half the country’s median income”.36 The life expectancy of
someone at 60 is 24 more years, and the healthy life expectancy at 60 is 17.4 years.37 In terms of
civic freedom, 96% of people over 50 are satisfied with the “freedom of choice in their life”.38
The United States provides a pension for 92.5% of people over 65, and 18.8% of people over 60
had “an income of less than half the country’s median income”.39 Similar to Norway the life
expectancy after 60 is 23 years, and healthy life expectancy after 60 is 17.5 years.40 The
satisfaction with civic freedom is lower among people over 50, coming in at 84%.41 In Morocco
only 39.8% of people over 65 have pension coverage, but the poverty rate of people over 60 is
better than than the United States at 9.8%.42 Life expectancy at 60 is 18 years, and healthy life
42 Global AgeWatch Index 2015, “Age Watch Report Card: 84th Morocco,”
https://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Morocco (accessed
February 9, 2021).
41 Ibid
40 Ibid.
39 Global AgeWatch Index 2015, “Age Watch Report Card: 9th United States of America,”
https://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=United+States+of+
America (accessed February 9, 2021).
38 Ibid.
37 Ibid.
36 Global AgeWatch Index 2015, “Age Watch Report Card: 2nd Norway,”
https://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Norway (accessed
February 9, 2021).
35 Global AgeWatch Index 2015, “Global Rankings Table,”
https://www.helpage.org/global-agewatch/population-ageing-data/global-rankings-table/ (accessed February 9,
2021).
20
expectancy at 60 is 14.4 years.43 Morocco has the lowest satisfaction with civic freedom of
people over 50, with only 50% feeling content with the “freedom of choice in their life”.44 It is
important to consider these factors when reflecting on the current elder care systems.
The cities I have chosen to study within these countries are Sefrou (Morocco),
Fredrikstad (Norway), and Duluth (Minnesota, United States). I chose these studies due to their
similar population sizes. Sefrou’s population is roughly 92,965 with the elderly population (65+)
being 4.23% of the total population (roughly 3,933).45 Median age in Sefrou is 27.5 years overall,
with women having a median age of 28.4 years, and men 26.6 years.46 Through searching on the
internet and consulting with Moroccan’s from nearby cities I could not find any care facilities in
Sefrou specifically for the elderly. As stated in the review of literature above, elder care is an
expectation of the family, therefore not being able to find care facilities online was not
surprising. The nearby city of Feś does have some facilities that would potentially provide for the
limited professional needs from Sefrou.
In Fredrikstad the elderly population comprises 18.90%, or 15,675, of the total population
(82,936).47 The average living time at nursing homes is 1.59 years, and nationally it is 1.3
years.48 Average death after 1 month in a nursing home is 8.2%, and nationally 7.3%; the average
death after 6 months is 29%, and nationally is 28%.49 For men the mean death rate is 7.43 for all
49 Ibid.
48 SAMDATA Kommune, “Botid i sykehjem og varighet av tjenester til hjemmeboende,”
https://www.helsedirektoratet.no/rapporter/botid-i-sykehjem-og-varighet-av-tjenester-til-hjemmeboende/2017-02%2
0Botid%20i%20sykehjem%20og%20varighet%20av%20tjenester%20til%20hjemmeboende.pdf/_/attachment/inline
/9f8fa68c-5969-4147-95d1-2177464084de:8a6b1b6e741b917894778a5ef81610764635ea4c/2017-02%20Botid%20i
%20sykehjem%20og%20varighet%20av%20tjenester%20til%20hjemmeboende.pdf (accessed February 20, 2021).
47 Statistisk sentralbyrå, “Kommunefakta Fredrikstad,” https://www.ssb.no/kommunefakta/fredrikstad (accessed
December 13, 2020).
46 Ibid.
45 City-Facts, “Sefrou,” https://www.city-facts.com/ورفص-ورفص (accessed December 15, 2020).
44 Ibid.
43 Ibid.
21
of Fredrikstad, while it was 5.28 for women, per 1000 of the population.50 According to my aunt,
who lives in Fredrikstad, and in consultation with online research, Fredrikstad has roughly 11
sykehjem (nursing homes), 1 korttidssenter (short term facility), 1 avlsstningssenter (place to go
so caretaker can take a break), 1 eldresenter (care facility), 1 omsorgssenter og 1 dagsenter (day
center).
In Duluth the elderly represent 15.88% (13,655) of the total population (86,004). 51 The
poverty total in Duluth is roughly 15.5 k or 19.3% of the population, while the poverty amongst
the elderly represent 1,182 individuals (496 male, 686 female).52 The life expectancy is about
83.96 years old.53 Average age at death by long term living at a nursing home is 87, which is the
same as the national average.54 Duluth has over 20 different elder care facility/residence options,
including nursing homes, assisted livings, senior care centers, retirement communities, and
senior apartment centers according to what I could find online.
Care options in each city appear to align with their respective types of typical elder care:
Sefrou being home care by family, Fredrikstad being professional home care with some nursing
homes, and Duluth relying heavily on senior care facilities.
54 Essentia Health, “Working Together for a Healthy Duluth: 2020–2022 Community Health Needs Assessment,”
https://www.essentiahealth.org/app/files/public/e40ecfeb-23b6-4a37-a436-f6fe8e5625e4/duluth-chna-2020-2022.pdf
(accessed December 13, 2020).
53 Ibid.
52 Ibid.
51 Data USA, “Duluth, MN,” https://datausa.io/profile/geo/duluth-mn/#about (accessed December 13, 2020).
50 Fredrikstad Kommune, “Levekårsrapporten 2016,”
https://www.fredrikstad.kommune.no/globalassets/dokumenter/planer/helse-velferd/levekaarskartlegging-rapport-20
16-web.pdf (accessed February 20, 2021).
22
Survey
There were 98 total surveys attempted, 43 of which were either empty or lacked a
response to the location question. Between the different cities 32 surveys were completed from
Duluth, 17 from Fredrikstad, and 6 from Morocco. Due to the low number of responses...
Survey results were analyzed through consultation with Dr. Scott Vollum (Associate Professor of
Criminology & Sociology and Department Head of the Department of Anthropology, Sociology,
& Criminology at the University of Minnesota - Duluth). Dr. Vollum is a specialist in
quantitative research and analysis and used SPSS to analyze the data. He created the following
tables based on discussions with the researcher:
23
Cross-Cultural Comparison
Table 1 highlights the cultural differences in care preferences as well as the ability of the
general population to care for their elderly outside of professional facilities. It is interesting to
note that the preferences in Fredrikstad and Duluth do not necessarily align with their current
elder care realities.
24
Table 2 defines the realities of elder care within each city. These realities directly contrast
the preferences of the general population, as highlighted in Table 1.
25
Care-Giver vs. Non-Caregiver
Table 6 identifies the difference between caregiver responses and non-caregiver
responses. As shown below, there is a significant difference in factors including finances, family
opinion, and ability of family to care for you. This difference can be attributed to a deeper
understanding of care realities through caregiving experience.
26
Age Breakdown
Table 7 highlights the generational difference between care preferences as well as
thoughts on elder care. The younger groups tend to prefer home care and want to live at home.
Interestingly the percentage of  those who have thought about care plans and those with a plan in
place is not significantly correlated with age.
27
Interviews
I conducted 12 interviews with care receivers/givers from both Fredrikstad and Duluth.
Difficulties with getting interviews from Sefrou will be discussed in a later section. It should also
be noted that all participants were women.
Recordings of each of the interview sessions were made so that transcriptions of the
interviews could be used for data analysis. The software program MAXQDA was used to code
the resulting transcriptions.
Interviewee Background
From Fredrikstad there were five respondents, all of whom are caregivers. The interviews
in Norway included a legal guardian (Veronika), home care nurse (Marit), nursing home
professional (Reine), and two persons who had cared for their mothers (Brit and Tonje). Veronika
had worked as a legal guardian for over 10 years, and was currently serving as legal guardian for
between 5-10 elderly persons. Marit was relatively new to the field and had 20+ patients. Reine
was an immigrant from northern Africa and had been living and working in nursing homes in
Fredrikstad for over nine years. Brit cared for her mother for roughly 4 years before her mother
needed to enter a nursing home. Tonje was currently caring for her mother, who was in her late
80s, while also working a full-time job.
In Duluth there were seven respondents (five caregivers and two care receivers). Of the
care providers three worked in nursing homes/assisted living (Gabby, Sophia, and Willow), one
provided care for her mother (Victoria), and one assisted her elderly neighbor (Taylor). Gabby
was in her early 20s, but had worked in nursing homes since high school. Sophia had also
worked in nursing homes/assisted living facilities since she could remember, having 15+ years of
28
experience. Willow worked as a social worker in a facility for almost five years, but also had
over 20 years of experience working as a nurse. Victoria was currently caring for her mother
while also working full time and being a single parent of a young child. Taylor was caring for her
elderly neighbor, but had served in several other professional and volunteer care positions for
elderly throughout her life. Care receivers included Roxy and Idai, who were both residents in a
long term care facility. Roxy was a transplant from the east coast and had lived in Duluth since
the early 2000s. She had been in a facility for a little over a year and was in her early 80s. Idai
was originally from western Africa, but moved to the United States as a young girl. She has been
in several care centers for the past 5 years and was in her early 70s.
Resulting Data
The interview data will be presented as a running dialogue between the various people
that I interviewed, both caregivers and care receivers. Each section will begin by identifying the
specific topic/question that will be discussed by participants. I decided to present the data in this
way because I think it displays the richness of the perspectives of real people, and honors their
lived experiences. This section is truly the heart of my research and I believe offers the best
insight into how we can work to improve our elder care systems. The names below are
pseudonyms to protect the interviewees identity.
Why do you work with the elderly?
This section highlights relationships as the central reason for being involved in elder care.
Educational opportunities in the medical field by working with the elderly is the other important
take away. Note that the letter (F) indicates the speaker was from Fredrikstad while a (D)
indicates the speaker was from Duluth.
29
SOPHIA(F): It’s actually kind of like my motto, I say “gerry’s are my thing” like geriatrics… I
have been in long term care ever since I can remember… I love my job.
MARIT (F): I love home nursing care... I want to learn as much as possible to be the best nurse I
can be for my patients and their next of kin, that’s really important to me.
REINE (F): It’s work that I enjoyed when I was a child, but I had no opportunity for an
education… so I came to Norway and had the opportunity to get schooling… I also learned a lot
of different things on how I can help people outside of Norway… I call people at home… about
the illnesses I’m learning about here… when I first came I learned a lot about dementia.
WILLOW (D): I sort of accidentally tripped into this business, and I just don’t see myself doing
anything different. Even though it can be taxing, you do form relationships with these people,
they become your family members... you want to go to work everyday… it sort of gets in your
blood and I can’t imagine doing anything different.
BRIT (F): She [my elderly mother] wanted to live... in her apartment... and then I also wanted, of
course, wanted to keep her there… as her only child… I had a responsibility [to care for her]
VICTORIA (F): I take care of my mom because really there is no one else to take care of her and
it seems like it makes sense
VICTORIA (F): I know she’s getting a level of care that I approve of and that she approves, she’s
able to stay at home while, I’m caring for her.
TAYLOR (D): I did it because I love them [my grandparents] and I wanted to help them, so part
of it is realizing the relationship that you can have with an elder person, and how important it
is… maybe not all people see that as valuable, but it is to me and the value is the long term
friendship, it’s not about getting money, or, there’s more to it than that.
30
What are the best parts of caregiving?
This section also centers personal relationships as a reward of caregiving. Storytelling
was brought up again and again by caregivers as a favorite part of working specifically with the
elderly.
SOPHIA (D): It’s fulfilling.
SOPHIA (D): I can’t tell you about any other satisfaction that I’ve had… I’ve worked in MED
surg, ER, ICU, I’ve done it all right? Nothing fills you up more than walking down the hall and
seeing a resident and you’re like “Hey Jerry” and he’s like “How you doing sunshine?”
SOPHIA (D): No matter if you’re having a bad day, they just wipe it all away… you don’t get
fulfilled anywhere else with any other population.
WILLOW (D): You come to work in the morning, you’d have four or five residents say “good
morning”... never a day went by where you didn’t laugh [before Covid]... you’d always here
songs… there’s always activity with family coming and going… it was really just one huge
family.
GABBY (D): I take them out to get ice cream, I take them out shopping. I take them when their
families can’t, or they don’t have families, I become that family. We also become very close with
the family members, because our residents... live a long time here, they actually thrive here.
MARIT (F): I love my job because I never get bored. You get a lot of experience with a lot of
different diagnoses.
GABBY (D): You have the most hands on experience.
MARIT (F): You can learn something from the elderly population, because we live in different
times so they usually have experiences that I don’t, so I think I learned a lot from them in that
way.
31
REINE (F): Family stories, private life, they share everything.
GABBY (D): Their stories, their wit, how they carry themselves; I think they always have the
most interesting things to say.
GABBY (D): It’s cool [working] in Duluth because I’m not originally from Duluth, I’m here for
college, but they [elderly in care facility] make me feel like a local does with what they talk
about. I feel like I know things that the average Duluthian might not.
REINE (F): I can’t think of any negatives, it’s only positive.
What difficulties come with caring for a loved one?
The stress of caring for loved ones is often due to the overwhelming responsibility that
comes with caregiving. Changing relationship dynamics often create a sense of obligation.
TONJE (F): It takes a lot of time and gives a lot of thoughts that are stressing.
TONJE (F): To admit to myself that I can't be there more than I am – because it takes too much
energy to stay and listen – and to care for someone you HAVE to care for.
VICTORIA (D): Sometimes I feel like my mother daughter relationship is a, it’s a weird dynamic
when you take care of the person you love and it becomes an obligation sorta.
VICTORIA (D): I gotta go over to moms because I gotta do stuff, not because I am going to go
over and visit with my mom.
VICTORIA (D): It’s [also] really difficult having roles reversed, you know, the elders in your life
are normally the caretakers and the ones that, you know, look out for you, and then the role gets
reversed and it’s weird.
TONJE (F): [To me it] feels more like “duty” than rewarding.
32
Describe your emotional experiences:
The emotional experience of caregivers can best be described as an “emotional
rollercoaster”, and below caregivers describe the wide variety of experiences.
MARIT (F): I really enjoy hearing stories about their lives, how much they have lived before,
that makes me happy if they have had a great life. Of course, you have a lot of elderly who
doesn’t have a good life now and that’s sad to see for me. So I guess it goes up and down; it’s an
emotional rollercoaster sometimes.
GABBY (D): It’s very complex feelings, to be honest, like even talking about it’s like almost like
an adrenaline rush because there’s so many emotions that are just pulsating through your body
at once. I would say, probably honestly any emotion in the book that you can even think of I
guarantee you I’ve experienced it at work.
VICTORIA (D): I’m on the roller coaster on the spectrum of feeling [as well]… on one hand my
heart is not ready for her to be gone and then my head is like “she will be so much happier”... I
ride the roller coaster of emotions, I feel, almost on a daily probably.
WILLOW (D): [I feel] love and connection… I feel responsible, sometimes for, especially those
residents who don’t have families in the area. I’m sometimes the only person that offers to take
them out to get their glasses [for example].
MARIT (F): The loneliness, if they’re lonely that’s hard to see and look at, and sometimes they
can get depressed and feel like they have no one… they just want to talk and they want to talk a
lot but I don’t have time, that hurts.
TONJE (F): It gives me the feeling that I am not enough, not giving enough care. It hurts to leave
a lady to loneliness and emptiness and pain.
33
GABBY (D): I feel really, really sad a lot. When they pass away… I have happy tears because I
know whatever they’re doing it’s better than them having to lay in a bed.
BRIT (F): When she was in her last days, at the end she laid in her bed all the time and I was
sitting with her… I sometimes tried to move her a little bit on one side in the bed and I sat beside
her in the bed. When the nurse came in “Oh my are you sitting in the bed?” I didn’t think that
was very normal to  see that, but I know it was fine for me just to sit beside her in the bed, lay
beside her and then I think that’s a nice way to [crying].
VICTORIA (D): It makes it hard to watch her, I’m not going to get emotional, makes it hard to
watch her basically dying [tearing up].
WILLOW (D): When you lose somebody that you’ve watched over for a number of years and
you love them and they pass away, yeah I feel grief… we’ve had a lot of deaths this last year, so
it’s been a hard year.
SOPHIA (D): You’re making an impact on them, and they leave an impact on you too.
SOPHIA (D): The shock sometimes when it’s not expected that they’re going to be lost. If you
lose people too frequently, like, you know it builds up and you can’t process it, so that’s I think
the biggest thing is there’s a lot of emotions in this industry.
SOPHIA (D): Lot’s of heartache, anger, sometimes you get angry with the families.
VERONIKA (F): I have an old lady living in the nursing home and one of her relatives are so
disillusioned, she tells things that don’t exist… she just confused this old lady a lot and it’s
hurting to see.
VERONIKA (F): When I see a person is embezzled it’s difficult and sometimes that can be the
nearest relative.
34
How is caregiving rewarding for you?
The rewarding part of caregiving, as defined below, all connects back to the honor that
comes with caring for another human during the end of their life and knowing that they are
getting what they need.
GABBY (D): To say it’s rewarding is really an understatement.
MARIT (F): To help people [is the most rewarding part of my job].
GABBY (D): I love all the people I work with in the care centers.
SOPHIA (D): I [also] love my seniors, wouldn’t trade it for the world.
WILLOW (D): Having a resident say I love you is hugely rewarding… even though sometimes it
bugs me having a resident call me 10 times on my phone just to see what I’m doing, it’s sort of
rewarding you know?
SOPHIA (D): I have the one resident who still calls me little sister, and she’s at another facility
now and she still calls my cell phone. I have another resident… and she’ll call downstairs and
leave me yodeling voicemails.
GABBY (D): Having such depth and personality and wit and just stories and such a life is just
super rewarding to get to work with every day.
GABBY (D): Just to hear their journey through life is really, really rewarding for me just to have
the opportunity to even work with these people, because they’re pretty remarkable of what
they’ve accomplished in their lives.
GABBY (D): It’s so rewarding, those residents mean so much to me… I’m honored enough to be
with them [in their final years].
BRIT (F): Of course, to be there, both to give her [my mother] help and also she giving me help,
it was sort of meant to be. To get the opportunity to follow my mother to the very end… I feel
35
grateful. I can’t say I have any sorrow, I can’t say that I didn’t tell her or I didn’t say… I have
nothing to regret.
GABBY (D): I’ve gone to so many funerals of the residents that I’ve had in the care center
because that meant so much to me.
BRIT (F): Oh, I’m almost crying again... Those moments that I really know that I suddenly came
up to her and gave her something I really knew she would appreciate, that was really happiness.
VICTORIA (D): When I can like see on her face that you know she appreciates me, [that is
rewarding].
TAYLOR (D): This is something I do to help them [the elderly] and in a way it kind of helps
me… in my heart I know what I’m doing is good. My satisfaction is in the fact that I know that
they’re okay.
Has your experience caregiving altered your hopes for your future care?
This section highlights the individual nature of care hopes, further providing evidence
supporting the need for dynamic care systems. You can also see concerns that arise based on
experience with the current system.
VICTORIA (D): You better believe I want to stay home… I don’t want to lose my sense of self by
going to a facility… I hope my baby loves me just as much [as I love my mother] when I get
older [by taking care of me].
TAYLOR (D): I am concerned about me… I hope I don’t ever enter into a nursing home or
assisted living.
BRIT (F): I’m sure I will be taken care of in one way or another if I needed to be taken care of…
I don’t give it a thought.
36
TAYLOR (D): I just hope… that the help I’m going to get is sincere, you know, and they want to
be there, not just for the paycheck.
SOPHIA (D): I know when I’m older I can’t afford a private room… that’s what scares me are
those kinds of things.
WILLOW (D): I think about money.
TONJE (F): It would be nice [to be in] homes for old, not very sick people. We did have them
before, now there is only homes for very sick, old people. And a lot of old people sit alone in
their homes. That is not healthy for anybody. Not your body - and not your mind.
VICTORIA (D): I [just] hope that there’s a better system in place by the time I’m old enough to
need these services so that it’s easier on my kids.
What does elder care look like in your community?
This section is crucial for understanding the reality of care from the people directly
involved in each cultural care setting. It also highlights areas that need adjustment.
VERONIKA (F): Most common [in Norway] is you apply for help at home and then you get
someone that comes to your house to take care of you. You used to have something called home
help, they would come and do things in your house, but that’s rarely even existing anymore.
Maybe you get help cleaning two times a month.
BRIT (F): The politics is that people should live as long as possible in their homes and they do
all they can to give help in their homes.
REINE (F): Home healthcare first and some are prioritized faster to get to a nursing home. The
dementia patients have first priority. The healthier older people stay at home as long as they can.
BRIT (F): Some daughters or sons experience that the system is demanding too much and they
don't feel free and they have to take care of their old parents… maybe that's because their
37
[parents] became, they got those needs earlier in life. I had such a good experience, because, as I
told you, she [my elderly mother] was 94 be before she needed help.
BRIT (F): It was possible to get an appointment that when I was away so she could have a
couple of weeks at a nursing home and then come back [home] again so that was also a sort of
preparing stadium for both her and me.
GABBY (D): I think they do as much as they can in their own home until it becomes dire enough
where the family just can’t spend all of their days passing their medications and monitoring them
[elderly]... and sometimes the family just doesn’t have the funds to house them. Usually at that
point the families are like ‘we’re going to have to move you into a nursing home, not because we
don’t love you but because we fiscally can’t afford to just be taking care of you’.
BRIT (F): We [me and nursing home staff] understood that she [elderly mother] couldn’t stay at
home anymore… they told me the next time she have periods of nursing home, they just let her
stay and try to explain to her that she could stay a little bit more, a little bit more, and that
functioned very well.
GABBY (D): I can think of a few residents that started out at their family’s house, but then it was
a pretty quick turnaround time out of the family’s house and then back to the nursing home. I
think families understand how short staffed nursing homes can be, and they think their family
member is a very important person, which they are (all the residents really are), but the family’s
expectations of the care that we give the resident and the care that can happen in a nursing home
sometimes don’t equal.
IDAI (D): I think it should be the nursing home or if they’re still able to the Assisted Living
situation, because sometimes it’s not very easy for families to take care of some situations… they
38
can’t handle the frustration that comes to see their relative declining, almost on the verge of
death… that makes them put their family in a nursing home.
SOPHIA (D): They’re keeping some of these [elderly] people at home excessively too long
because there’s this push for aging in place and it’s almost like decompensating in place. You
should do it to a certain point, as long as you’re able to thrive.
What are your concerns with the current system(s)?
The concerns of elder care below are broadly connected with the educational component
that is missing in elder care. These issues lead to gaps where elders are not receiving the care
they need.
SOPHIA (D): It’s a confusing system that’s a messy system… If there was a way that we could
level the playing field a little bit and make it to where it was the same for everyone, then you
know, I think I would be a lot more comfortable, but I think it’s not there yet.
TAYLOR (D): You want them [the elderly] to be safe and have a good quality of life, not just
living on the edge, and I think there are a lot of seniors who are living on the edge (Taylor),
There are still seniors out there that don’t have access to care.
SOPHIA (D): It’s not having education, not knowing what to do, not knowing what you need,
not knowing what people are eligible for… people don’t know what’s here, that’s a big issue.
SOPHIA (D): There's this thing called senior linkage line for our area from Minnesota. The
senior linkage line is supposed to be the senior reference right you call this phone number they're
supposed to be someone on the other end that gives you everything you need to know. If the
senior linkage line would just give people what I told you… this basic education or referring to
those people, but what happens is, by the time they call in there, so confused they don't even
know what they need. If there was something as simple handout that they could send people that
39
was guided and graphic and easy to understand [saying] ‘this is where you are, this is where you
could go’ but there's nothing.
TAYLOR (D): I think the first thing they do is they have to somehow get connected with social
services .
VICTORIA (D): I could use some help but I wouldn’t have it any other way.
SOPHIA (D): The elderly have been kind of left out in this [navigating the system] right, there is
nothing. They [the state] just expect families to figure it out, because they've managed to all this
time… That’s the problem with not having that education in the community.
What are cultural issues you have found with elder care?
Issues relating to broad realities in care systems are shown in this section. Food is also an
important cultural factor within nursing homes that is mentioned by both care receivers.
GABBY (D): All these [nursing homes] what do they have centered in them: the Holy Spirit. I
worry… by the time that [the younger population] is in nursing homes… what is there going to be
for people that don’t identify as like a Christian faith? Are there going to be nondenominational
nursing homes eventually?
ROXY (D): It's a different culture, the food, a lot of the food is different and some of the food I
like you can't get here.
IDAI (D): I would have been satisfied being at home with somebody helping me because, then I
can cook my own meals I love to cook and I couldn't cook my own meals and eat whatever I like
to eat but I've been satisfied being here, because the meal choices are pretty much okay.
VERONIKA (F): We have established a system in Norway so you have to be very very ill or
incapable before you get a place in a nursing home. I think that is a negative. There are lots of
people living at home that should be in a nursing home.
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VERONIKA (F): We have over the last several years had a change when it comes to consent
competence. Even if you are assisting people and doing things that would harm them you have to
allow them to make their own choices. It takes a lot before someone can be deemed incapable of
making their own decisions, and often people are allowed to put themselves in danger. They are
allowed to make their own choices and it has to be extremely bad before someone is allowed to
interfere.
How do monetary issues affect elder care?
Both in Duluth and Fredrikstad monetary issues were major factors in elder care systems,
and served as major concerns for future care needs.
WILLOW (D): I butt heads with the administrators who think about money all the time, so that’s
probably the toughest part for me.
SOPHIA (D): I know healthcare is a profit game [because of government programs allowing
higher prices for private rooms]... you walk into some facilities and it’s like only 5 out of the 30
rooms on a unit are eligible for any type of medical assistance, I think ‘why do you think that
many people have that much money that they can afford that’.
SOPHIA (D): The way it works out is that when they [elderly] run out of money… they have to
go down to the medical assistance rooms… so you have to go from a private room to sharing. If
you have all the money in the world… you can afford a private room forever, but not everyone
can.
WILLOW (D): In this business money talks, so if somebody can’t pay their bill, they can’t stay.
WILLOW (D): This huge baby Boomer influx is coming, everybody's predicting it, and there's
lots of people who are going to get rich off it. But we have to adjust on our end... we truly
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believe, though, that our mission is always to provide good loving care to the poor and the
elderly… most people cannot sustain $8,000 a month rent.
SOPHIA (D): You’ve got these buildings popping up to absorb some of this increase of this aging
population, but… there’s going to be a lot more of us that can’t afford these places… Are we just
going to keep churning out , getting broke in those places and then getting pumped out into
others and then at home and have nowhere else to go?
SOPHIA (D): There’s no regulation on pharmaceutical supplies… nursing homes have to be
regulated, hospitals have to be regulated, but not pharmaceutical supplies… [it can be] tripple,
quadruple [the price] just because you bought it for a facility. There is no regulatory control
[but] that cost has to go somewhere, right, so meds and supply costs and all of that is going to
cost of care.
SOPHIA (D): Healthcare five cent bandaid, that’s now $1.
VERONIKA (F): The county takes 85% of their [elderly who live in nursing homes] social
security so it’s quite expensive and for some of them there’s not much money left… they are
having to sell their houses, the things that they own… If the state administrator says no [to the
elderly that want to sell their houses] some of them almost don’t have enough money to pay for
electricity and taxes and everything for the house.
Where is there a lack of support?
Support for both caregivers and receivers is important because elder care is very
complex. Without support issues of loneliness are prevalent in both caregivers and receivers.
VICTORIA (D): [I think] Does anyone understand what I’m going through? It gets lonely
occasionally.
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TAYLOR (D): She’s [elderly woman] more needy and I can’t be there for her all the time,
because I also need to work to pay my bills .
VICTORIA (D): I’m a mom and I have a toddler and I work and it’s difficult to take care of [my
mother] all the time and it’s stressful because it’s appointments and medicine and groceries and
cleaning and socializing and trying to have a life at the same time and it makes things stressful.
VICTORIA (D): The other thing that makes things really difficult is being in a position of only
being able to do so much, I can’t do everything, and wanting to give her everything she needs.
VERONIKA (F): Maybe you get help cleaning two times a month. There’s an issue because you
can’t keep a house clean by having help just two times a month.
ROXY (D): It’s unfortunate that even had I not ruptured my leg I was looking for Assisted Living
just because it was getting harder and harder when you live alone to do everything and it was
nice to have the woman to come and clean and do the laundry, but that was sporadic that was
temporary with one woman that I had to get another woman, and it was harder.
TONJE (F): I wish she could be in a home for old sick people, where she could see and talk to
others.
MARIT (F): When the elderly doesn’t have any next of kin, and that’s a problem because the
health care in Norway, we don’t have a lot of time for each patient usually. So if the person
doesn’t have any next of kins maybe the care is a little less good. We [home care nurses] usually
are only filling the physical needs and the procedures, and the communication gets sometimes a
little bit lost because we don’t have any time, and that’s sad.
MARIT (F): You can have one next of kin, for example, a daughter, who visits all the time and
then you can have 10 children and almost no one visits you so it's a variety.
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What are staffing issues that you have noticed?
Short staffing has had a ripple effect on elder care, and created systems that are so
desperate for workers that they will accept people that are lacking in the essential role of
caregiving that includes working from the heart.
BRIT (F): It’s very hard to, all the time have new people [home care nurses] around you, not
knowing what’s best for you. You have told it 1234 or five times, maybe, and it’s a new one (Brit),
Sometimes I was a bit worried because I knew that not all of them [home care nurses] have my
total trust.
VERONIKA (F): We’re supposed to take less regards to each individual… it’s more of a
conveyor belt approach, something I don’t enjoy at all.
GABBY (D): A CNA has 50,000 things to do during the shirt, they ask way too much out of us,
but that’s on short staffing>
GABBY (D): Some of my coworkers are just doing it for a paycheck… and it kills me because…
people miss the point way too often of like why they’re in this profession.
GABBY (D): The turnover rate in Duluth, like Duluth has such a high turnover rate… because
we’re always short staffed.
GABBY (D): [At a nursing home in a different city] if it’s short staffed they will give me a call
and they’ll say ‘hey if you pick up this shift it’s an extra $7.50 an hour and it’s $100 cash bonus if
you come in right now’ and I’ll be in the car [because] I feel valued. But in Duluth, short staffed
and I don’t get anything. The thing is I love these residents, but I also have to think about my
spine and I’m [young] and I don’t want to throw it out. They’re so close, they give us gift cards
and little fun little treats and snacks as a thank you… instead of giving me a waterbottle… how
about you give me a cash bonus? I don’t need a water bottle, I need to pay for my house.
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GABBY (D): I wish the hiring committee would kind of like get a grip and just hire people that
actually were worth working in a care center and weren’t just there for a paycheck. [How many
people do you think are there for a paycheck?] 75%.
VERONIKA (F): I have an older mother in law, and she has just been first in hospital and so in
a short term care rehab place. And she was physically very very ill. She hardly ate so she was
like a little bird but she was strong willed. To hear here tell from this place how awful it
functioned, it scares me. She was so furious. She was probably the patient from hell, but she said
she thought the people that worked there were picked off the street.
IDAI (D): They do get some [staff] that are not good enough and they try to tolerate them, but
sometimes those people leave. [Care facilities] have a short staff and that becomes very hard on
the staff that works here.
ROXY (D): It could be somebody that’s terrific [helping me with the shower/bathroom], or it
could be somebody brand new that doesn’t quite know what’s happening.
TAYLOR (D): I worked with different agencies before it just wasn't fulfilling because they would
put you with somebody and what if that person is like, doesn't like you or doesn't fit, I've had that
happen.
TAYLOR (D): Home and State and different agencies that that you just come in and they
schedule you and you go in and do your job, and you leave and there's like really no strings
attached.
ROXY (D): The people they get from the agencies, that may not be so good, in fact I had a
dangerous experience here, I would say about four weeks ago… the woman who was from an
agency took me [to the bathroom]... she yelled at me ‘don’t tell me my job’, really nasty she was
unpleasant to begin with, she says ‘if you know so much why don’t you get back to your room’.
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She left me… with nothing around me but the sink and the floor. If I weren’t as strong as I am I
could have fallen and cracked my skull… They [care facility] listened to my things, the head of
the nurses came up and they let her go because she was dangerous. I don’t know if they handle it
that way, every place because they say something to the effect of ‘well we're very short staffed,
we have to just take anybody’.
ROXY (D): Oh, and nobody wants to really work in this kind of thing. You got to take people to
the bathroom, people throw up, you got to go in for training, and some people start off training
as a CNA. They start off training, but they don't finish it because the salary may not be that
great, it's, you know they might make as much working at McDonald's.
WILLOW (D): Social worker paychecks aren’t very rewarding.
SOPHIA (D): I can’t afford it [another person on staff] because of their staffing models. The way
they’re cutting hours and the way their staffing, I can’t afford to do it.
Can you highlight bureaucracy within care systems?
The government regulations and rules surrounding elder care are important to protect the
elderly from harm, but some of the regulations seem to be unnecessary and proving more
harmful than helpful.
WILLOW (D): The one thing I dislike the most… very strong regulations [I understand why we
have them] but they demand so much paperwork to be done, and so much documentation to be
done, and sometimes silly things that don’t mean much… if I had to quantify the time every day I
spend making sure I have everything documented, so the state of Minnesota is satisfied, that’s
25% of my day, that’s my least favorite.
VERONIKA (F): I didn’t go into caring for people because I am an economist and want to run
their money.
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VICTORIA (D): The process should be made easier to get resources… we’re currently looking
into getting my mom a caretaker… we went to the doctor and the doctor said he would make a
referral and now we’re playing a waiting game… like we need the help now.
VICTORIA (D): For somebody trying to take care of their parents or their family members
trying to navigate this with somebody who also doesn’t know how to navigate, my mom has
never, you know, navigated this system.
SOPHIA (D): If they [the family of the elderly person] apply for the caddy waiver and they’re
eligible then they’re automatically eligible for medical assistance… but not all facilities accept
both… they [the family] go and they start applying [a caddy waiver] and the nursing home finds
out [they only have a caddy waver] instead of saying to the family ‘hey go to the county and
reapply for medical assistance’ they just deny them .
VERONIKA (F): The framework I have work within has become narrower and narrower. I think
that the role I have you have to fulfill certain terms to become a guardian. Specifically when it
comes to diagnoses it isn’t enough that you can’t take care of your own life, you have to be
diagnosed that gives a reason for why you need a legal guardian, such as a mental issue, drug
abuse, gambling addiction, or major disabilities such as dementia. I think the framework is too
narrow and it’s becoming more split up who is doing what instead of one person going in and
helping the person wholly. For example, there are deep health questions a legal guardian should
not have to worry about but at the same time I have to ensure that my person gets the healthcare
they need so I have to get involved.
VERONIKA (F): In this setting when people die suddenly and unexpectedly and the minute they
draw their last breath my role is done. I’m not supposed to follow up on anything. It’s really a
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hole in the system because everyone expects that the legal guardian should follow up but it’s just
a sudden stop.
VERONIKA (F): I have a colleague who had a man without any relatives. That guardian went to
the funeral and she probably did things she wasn't supposed to do. There were three people at
the funeral. There is a big gap. There should be some kind of a transition between when someone
dies and following up with everything. The family then takes care of the funerals and everything.
She feels like she should be able to follow up especially with those that don’t have family.
What’s working with the system?
When proper support is provided to caregivers and the social programs created for the
elderly are actually utilized, elder care can be successful through providing for both
medical/physical and emotional needs of the elderly.
IDAI (D): I used to wonder why people have to go into nursing homes, but I can see more clearly
now why families don’t keep their relatives at home and take care of them, the job is immense.
They [elderly] need several components and the CNA’s account for that and the nurses have their
own input and you can see a doctor or two anytime you want to, and there’s a nurse practitioner
on site, and activities on site.
ROXY (D): I feel I really feel blessed to be here. I really do, I was very, very lucky to be able to
get into [this facility] and the people are very nice to all of us.
VERONIKA (F): What we have [in Norway] which is good and that's for both elderly is a copay
for pharmacy, necessary medications, doctoring, psychologists, rehab, so it’s one card with one
amount. Around 2,500 kr is your copay and everything beyond that is free (per year).
REINE (F): The culture of elder care is very good in Norway. People show respect when you’re
working. Not only showing respect, but people want to help patients to keep the functions that
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they have from before. They’re not only there to help, but also there to help patients keep
functions. Some of the patients help me, they clean off the tables. They are actively living. They
are doing the work they would do if they were at their own homes. They will help fold towels just
like they would do at home, and put them away. Daily chores.
BRIT (F): ‘We [home care nurses] are taking care of all the practical things about your mother,
you should be the one giving her the social connection, giving her the things that you know she
likes from you’. That functioned really, really well.
BRIT (F): I was very calm and very satisfied that she got what she needed from other persons
than me; I was not totally responsible for her help.
What are the most important things for your care?
Finding care that provides for the specific needs of each individual is key in ensuring
their safety and well-being. Hosting opportunities for elderly to give feedback on their care is
also crucial for improving care systems.
IDAI (D): I get all the help I need, from the person dispensing the medication, from the aids,
from everybody.
IDAI (D): I have everything in fact just before our session my nurse practitioner was here. She's
on site, so if I need anything medically taken care of she'll take care of it right away… and the
nurses are top notch.
IDAI (D): My room at [a different facility] was much bigger, but I gave it up. I looked at the
situation... it was a beautiful room facing the lake. I could just sit down in my room and just gaze
and wander off on the lake but I gave it up for peace of mind.
IDAI (D): The independence that you got and feeling comfortable and feeling safe is a really big
priority and why you decided to come to the facility itself.
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IDAI (D): Personal care plays a lot [in my happiness]. I need to be clean… I don’t want to wake
up in the morning and be in my urine… I pride myself on being clean.
ROXY (D): He [my son] said to get an attorney out here that would take me from medicare to
medicaid and tell me what I needed to do and so on, and I did that… and you know everything is
covered basically. My care is covered totally which is wonderful. Transportation if I have to go to
the doctor or dentist is covered.
ROXY (D): I have physical therapy to help me to stand and walk… so that when things are
better [Covid-19 restrictions] I can get out and go to my synagogue.
ROXY (D): We also have every month, a meeting of the residents to air our problems air any
difficulties and see what we could do to you know alleviate these things, which is very nice that
everybody has that.
ROXY (D): As far as this place [care facility] they try really hard for the patient.
What role does community play in your care?
Having a sense of belonging to a community is one of the top needs of the elderly, and
can also help to combat the large issues of loneliness that come with the inability of society to
recognize their elders.
ROXY (D): I took classes at UMD using stride [bus] and I became active in the lighthouse
because of my eyes… I joined the temple out here… after my husband passed away I needed to
be part of the community… I wasn’t part of the community and so I became part of it.
ROXY (D): There's always somebody to talk to [in the care facility]... it's a community.
ROXY (D): I’m kind of happy here, to be honest happier than living alone… I could live with my
son and daughter in law, but the living conditions weren’t suitable, everything is stairs where
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they are… I didn’t want to go back to [the east coast]... I don’t have anybody left there and I like
it here, I have a lot of friends here.
ROXY (D): I was alone for the first few years [after my husband died], it was very bad. It got
better as time goes but coming here [to the care facility] I’m not depressed or sad or anything… I
feel so much better being here, it’s so different, there is always someone around… I think for a lot
of other older people it's a blessing [coming to a care facility]. I'm psychologically and
emotionally much happier here. I used to cry a lot at home, it was very sad, I was very sad.
ROXY (D): Humans are, you know, we like people and friends. We're not loaners, for the most
part, you know.
ROXY (D): One lady I am a legal guardian for she pays she's kind of in a daycare where she
visits during the day. It's a very nice thing it's something paid directly to a facility, and especially
for younger people with dementia. And, and they live in a small house on a farm.
VERONIKA (F): And they do different things like making jam, making their own food, going on
walks, very nice thing and then she pay for the food to stay there… they're planning to start
something like that in Fredrikstad, they just bought a farm.
How does a support system work?
Great elder care relies on the support of family/friends, healthcare professionals, and
society at large to provide a good quality of life.
MARIT (F): If you have many next of kins that is actively in your life then you also have more
resources for a good life… next of kins they are like the source of something good in
healthcare… in the Norwegina healthcare the next of kin are usually very good to help and
without them it would be very difficult.
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TONJE (F): I am glad that the elderycare (Hjemmesykepleien) visit her [elderly mother] every
morning and that she gets help to wash and dress.
VERONIKA (F): The main thing is to try to get other people to do things because I shouldn't be
the one that's actively doing things. I am trying to get others to do their part in things such as
healthcare, it can be in regards to housing situations, I take care of their finances. Right now
we’re dealing with their taxes that has to be correct for everyone. I am sort of a watchdog and
someone that ensures that things are done and speak up if things aren’t getting done.
What is needed to work with the elderly?
Caring for someone at the end of their life comes with great responsibility, and a need for
basic respect of human life. Above all interviewees said care needs to come from the heart.
SOPHIA (D): Dealing with this population there's a lot of a loss right, so you have a little look
at what you're doing how you're doing it. You know what I mean? And making the last years of
their lives, the best years of their lives and making sure that you're making an impact on them in
that way.
GABBY (D): Some stuff that you do is pretty like cut and dry and like you know black and white,
and you have to like be okay, with it, and you have to be good at it, because it's like pretty
serious stuff.
GABBY (D): You have to also kind of be a perfectionist to a T in some sort of ways, because
when I'm working with a resident and they've just passed away and I'm doing death cares on that
resident, I want to make sure that I do not mess anything up. Because… if I passed away and
somebody was just like so like rude with like my body and tossing me around just being
disrespectful [that would be terrible]... I just make sure that, like everything that I do is as good
as I can do.
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IDAI (D): They [caregivers] give due respect to the elderly.
IDAI (D): I think empathy is needed… Some of the people that took care of the elderly just look
at it as a job, but it's a job that comes with a lot of caring and empathy and if they don't have that
they just treat the person like an old person that doesn't have any feelings or any use in society…
Empathy can not be taught.
REINE (F): There’s some stories you have to take in a realistic way. You know they have
dementia. Some will tell you they want to go home to their mother, she’ll tell me how she helps
her mother cleaning and housework. You have to believe what they tell you. You have to find a
way to show that you understand what she’s telling you. You have to have good dialog. You can’t
just say “your mom’s dead”. You have to think about how they would feel.
REINE (F): You have to be very patient and you have to like your job. You can’t work with joy if
you don’t like your job.
SOPHIA (D): It's really important that any of us that work in the industry participate in in
advocating for that population.
TAYLOR (D): You try to live for their wishes and that is a very simple thing. It doesn't
necessarily have to be a written will, but like if you know that they don't want to be hooked up to
like a respirator to live, then you should respect that.
REINE (F): You have to have good relationships with your patients because they tell you a lot of
things and there’s lots you have to observe. Observation of your patients is very important.
VERONIKA (F): Of course they [caregivers] have to be educated, but I think even more
important is they work both with their heart and their head. If it’s only the head it isn’t good
enough.
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BRIT (F): We are not only the physical arms and legs, we have energies outside us and those
energies and those fields are really nursing, we are nursing each other with those fields… [we
need to care] from the heart.
What are caregiver needs?
Providing care for another person is a big task that requires the ability to process
emotions and create boundaries in order to maintain a healthy mind.
SOPHIA (D): It gets really hard. You have to be able to learn how to process emotions
appropriately and when to process them.
BRIT (F): It's also a very important part, just to be aware of what I need, and not only be aware
of what she needs.
TAYLOR (D): Part of it is like connecting them with services and making them understand that
it is okay to ask for help from other services or other agencies.
TAYLOR (D): You have to figure out how you're going to balance it.
What are other struggles typically faced by the elderly?
Families often override the wishes of the elderly, and sometimes that can even be the
people providing care. Loneliness is another big issue that is common among elderly, and in this
section Willow uses the pandemics effects to highlight how significant loneliness is in ability to
thrive.
SOPHIA (D): It's not usually about what's best for the residents usually about what's best with
family.
SOPHIA (D): I can't even tell you... residents can be begging to die, in pain, like, I just want to
see my wife again I'm just going into my husband again, Oh i'm getting so, all I can do these
bones anymore, and I can't I can't wait for the day you know I see my Lord again, you know you
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hear them saying things. And then oh I just I just wish I close my eyes and not wake up and you
do everything, everything, everything you can to try to turn them around. They slowly stop eating
me slowly start drinking, you know they're showing you everything, they're trying to tell you, ‘let
me go’, and then the families refuse hospice. Hospice is the one that comes in and helps… they
help them with anxiety and pain and depression and everything… but the people that have
trouble with it are the family, the family doesn't want it, ‘I don't want it to them, I can't let them
go’.
SOPHIA (D): Not everyone stands up for residents decision because you know the one the
squeaky wheel gets the attention, so the one that's hollering and yelling the most is going to get
the decision.
SOPHIA (D): You can be as clear and as concise as you want to be but your family is going to
override you every step of the way.
SOPHIA (D): Families do it all the time, they override their loved ones wishes all the time, and
they find a way to do it legally.
SOPHIA (D): We had a resident discharge his mother to take her to a lower cost assisted living
that is basically a crap hole… and the reason that he moved her…. he was expecting her to die
and she was eating up all of his inheritance.
WILLOW (D): We’ve lost a lot of residents [during Covid-19] just from failure to thrive... People
need people, people need hugs, people that are elderly, maybe with some dementia, need
routine… [during Covid-19] our residents didn’t leave the room for nothing for months upon
months, so we stopped seeing people being strong, so we had more falls… some of our dementia
people used to be in the dining room and they watch other people, maybe, eat a sandwich. Then
they would know, ‘remember to eat the sandwich’. Most people didn’t have those cues anymore.
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Families couldn’t come in the building, so I think there’s that internal sense of the will to live
when you feel like you’re being provided for and your needs are met, including psychological
and physical touch. You know we were never supposed to be hugging our residents, but I made
sure I wore masks, face shields, gloves, gowns, everything I could to make sure our residents got
hugs, but I couldn’t get to every resident either. You can feed them [elderly], but that’s only one
area... for somebody’s heart [to thrive] they need physical touch.
WILLOW (D): I remember seeing prisoner of war movies or even movies about people in jail
having to go to solitary… that’s isolation, you’re removing them from the community, right? So
day after day, really, that’s what they [the elderly in the care facility] were in, they were in
solitary confinement.
What does respect for the elderly look like?
The term “respect” was a big topic of discussion during the interviews. There were many
different examples of both respect and disrespect, and further discussion should be had on the
generational and cultural understanding of what constitutes true “respect”.
MARIT (F): Some people in the health care that doesn't listen as closely, maybe doesn't take
them [the elderly] seriously because maybe because of their age or if they have bad hearing and
can't speak properly, then it's difficult to communicate, so you [some caregivers] don't give them
the time to explain themselves and that's not as respectful… I think that happens a lot.
SOPHIA (D): There seems to be two subgroups: there’s the group of people that elders are
important and are part of our community, and then there’s the subgroup of Duluth that the
elderly don’t exist. It’s almost like when they see a senior citizen walk through the door they don’t
see them at all. They can look through them, they’re not there.
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TAYLOR (D): I think people forget [about the elderly], and they are they don't want to be
reminded.
VICTORIA (D): Duluth experiences a variety of living situation, like the elderly homeless
demographic, no respect, none. I would say they get the least amount. The folks at Assisted
Living, I would hope that they get that [respect]. And then you know, like my mom lives at [an
apartment complex] where it used to be elderly people only and then they switched management
and things like that, and then they started accepting people on housing, anybody on housing. And
the demographic inside the building changed to where it's a lot more younger people coming in
and out, and I will say, as far as it goes [I don’t] feel a lot of respect… I don't think many people
are very respectful these days in a general sense, it's really hard to find.
WILLOW (D): ‘Help the little old lady across the street’, I don't see that very often, and maybe
I'm not looking for it, but you know I think I think our elderly outside [facilities] have become a
little more invisible because we are so busy working. We are this busy doo doo doo doo world
you know, hurry up get started, hurry up get home, cook, separate and wash clothes, go to bed
and get up and go to work to do it all over again, and when we’re living in that way we get
tunnel vision. We don’t see really anything on the outside, right?
WILLOW (D): If they’re [elderly] invisible it’s a little disrespectful.
TONJE (F): I do think that we are less respectful now than before to our elders, and seem to
think that the official healthcare have the main responsibility for their wellfare. Not we as family
members. They also struggle to be heard in matter of politics. We don’t listen to old and wise
people any more. I think the problem is the huge gap between their lives and the life that they
have lived, and the life younger people are living now. My mother can’t do the crossword
anymore, not only because she is old - but she doesn’t know or understand all the new words.
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They don’t understand what we say anymore. And young people don’t understand that they don’t
understand… The world is running away from the elders. Soon running away from me too. I am
60 - and my life-experience is soon of no use in the modern world. It’s another world... and that
world need to make it’s new and own experiences. I work with culture for elders - and I see that
they struggle - and see that they need to be seen and heard. It is very sad that they feel that they
are not seen or heard - and one day a wise, nice and very intelligent lady said to me: I just feel
invisible.
BRIT (F): Unfortunately, I think I have to say [the elderly] have less [respect], and I don’t like to
say it, and that’s because I’m very envious of different Native People’s who really honor their
elders and honor them and honor their wisdom, they could transfer to the next generation and
younger people… I think our society is really in quite a bad condition and we don’t honor
wisdom at all. It’s too much attention to the material world, and that’s a pity.
IDAI (D): I think there’s respect for the elderly, but sometimes the young ones don’t exercise that.
VICTORIA (D): We [my mom and I] were leaving [her apartment] one day, and she’s kind of a
stickler for the rules that our building you’re not supposed to let people in that you don’t know…
it was a younger group… and they got all mouthy with her, and I mean my mom was like an
overweight white lady with a walker, like how are you going to be mean to her? And they got
right in her face.
REINE (F): You can come onto the bus and see an older person standing and lots of young
people sitting. Generally you know how young people are, they don’t have as much respect. They
are in their own world. They’re too busy with technology. Young people walk past older people
laying on the ground. It’s sad but if there’s a grownup that comes by they would help. It’s not
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their problem. They don’t know what to do so they keep walking. It’s not all the young, just some
that don’t care. It’s more typical for the younger not to care.
GABBY (D): [The] ‘respect your elders’ thing, I think that's kind of going on the wayside, I
think people look at like, geriatrics in a kind of way where it's like… I respect you respect me
type thing. The ‘respect your elders’ thing I understand that, but that's like the same energy as
like saying, Mr. and Mrs.. I think it's a mutual respect. I can think of one resident in particular
that got mad at me that I wasn't like kissing her feet and she was and then she was like she was
like you need to learn to respect your elders and I wanted to be like ‘ma'am I respect you if you
give me respect back’, and so I think that's where there's a disconnect in the community, because
I think the older generation, at least part of it… They have like this complex... I think they were
told from being young ‘respect your elders, respect your elders’, and I was told growing up ‘treat
people how you would want to be treated’ on equal playing field.
ROXY (D): Yes indeed [I feel respect], I have to tell you, a tremendous amount. You couldn't find
this respect [on the east coast]. Your walk through a door and you're slow and someone says
‘come on lady move it up’, that’s [the east coast], here you have so much respect and a lot of
kindness. If you’re old, I told my friend, come to Duluth because the old are sick, we have the
best medical here in the whole United States, the best medical is in Minnesota, and Duluth,
wonderful people, kind, a lot of respect… the young people that work here show a lot of love for
the patients and I found respect everywhere in Duluth.
ROXY (D): A lot of respect and really nice, I wouldn’t want to live anywhere else as an older
person.
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What are your ideas for new systems of care?
Interviewees provided lots of ideas for new elder care systems that center around the
wishes of the elderly and building community intergenerationally.
WILLOW (D): We could maybe be suited for going back to that original model… of board care
home. It wouldn’t cost you very much money per month to live here but you'd have help from
each other and maybe some cooks and maybe some nursing assistants.
GABBY (D): A lot of my coworkers think that nursing homes are going to go away. A lot of
people think that there's just going to be home health aides for our generation that like people
are pages come to our house.
TAYLOR (D): College students like living with elderly people [would be a great idea], like I did
my first my second year of college... I lived with an 88 year old lady.
VERONIKA (F): It was planned [in Oslo] that, I think it was, five or six young students should
move in and live together as a whole group with the elderly. Because of Corona it wasn't possible
but they did things. They came and one of the old men at this place, he had in his younger days
at a large collection of records. These young students donated a bunch of vinyls to him. There
was also an older lady that would lower a basket and they would fill it with wine and candy.
They didn’t have skype but they were still able to communicate with them.
VERONIKA (F): To have the choice to decide when to die… there was an organization in the
USA for helping the one or two persons to die. This one lady in the program, she wasn’t that old,
she was in the 60s, but she was losing things she had done before she could no longer know how
to put on makeup, she forgot things. She had been a widower and she thought to stay in a nursing
home and it would be so expensive so she couldn’t afford it so she decided she should die, and
she died.
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Discussion
Limitations
Survey
Since surveys were taken on a volunteer basis, this could affect the results that were
found. In future surveys it would also be good to be able to follow up with participants to ask
why they took the survey as well as to be able to ask questions on why they answered different
questions on the survey. Low response rates also limit the effectiveness of conclusions drawn.
A specific issue with the survey, highlighted by a participant, was the response options
for gender. These were limited to female, male, and other. The limited options were created so as
not to deter Moroccan participants from participating, but was not inclusive for all participants of
the survey. Future surveys could utilize the fill in the blank option or search for other alternatives
(that are both inclusive and culturally sensitive).
Interviews
Most of the interviews were conducted with caregivers, and the care receivers that
participated required help in setting up the virtual interview. This barrier made it more difficult to
engage with the elderly. Out of the 12 interviews two of them were with elderly individuals
requiring care, and they were both from Duluth. It would have been better to get elderly
participants from all cities involved. Not having any interviews from Morocco also greatly limits
the ability to fully compare Sefrou with the other cities in the study. The ability to conduct
interviews was also limited by not having access to an interpreter for Darija (Arabic). The time
difference also made it difficult to schedule interviews with participants in Norway, specifically
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for those who needed a translator (due to the fact that the interpreter works full time during the
week).
Overall
Recruitment for the survey and interviews proved to be much more challenging than
anticipated. Issues with not having a direct contact in Sefrou greatly inhibited getting participants
and the ability to truly compare elder care structures with Fredrikstad and Duluth. Having a
marketing partner to help create tactics for sharing my survey would have been ideal to increase
response rates, as well as for recruiting participants to sign up for an interview.
More broadly time and funding was a great limitation in this study. To get a
holistic understanding of elder care systems in Fredrikstad, Sefrou, and Duluth I should have
spent months living in each city and directly engaging with the respective elderly populations.
However, this would have posed additional language barriers.
Survey
Cross-Cultural Comparison
Understanding care preferences across cultures highlights interesting realities. In
Fredrikstad the preference for future care ranked nursing homes over home care (see Table 1).
This is particularly interesting considering the national push away from nursing homes and
towards home care. Duluth marked high for living at home with help from family/friends, which
goes against the system designed for nursing homes (see Table 1). Part of this could be due to the
negative media surrounding nursing homes, as highlighted by Sophia in the interviews. Idai
reinforces this misrepresentation through her interview where she highlighted that she did not
know why anyone would want to live in a nursing home until she moved into one, and now she
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is happier than ever. In Sefrou participants ranked living at home as top preference, which is not
surprising given the cultural value of keeping elderly at home (see Table 1). Similarly no one
marked nursing homes as a preference (see Table 1). In terms of the realities of what
respondents' families have done for care Duluth marked nursing homes highly and Fredrikstad
marked professional home care as number one (see Table 2). The social structures put in place,
specifically in Fredrikstad and Duluth, do not seem to align with the preferences of the general
population, highlighting a disconnect between the policies and realities surrounding the future of
elder care.
Questions regarding family and multigenerational living proved interesting as well. In
Sefrou living with family is feasible, while in Fredrikstad and Duluth it is maybe feasible (see
Table 1). At the same time Duluth marked high for wanting to live with family. In both
Fredrikstad and Duluth roughly 50% of participants marked that they know multigenerational
households, but also marked that it is not common (see Table 2). This data highlights that the
realities of several generations living together might be more common than generally thought by
the public. In regards to how important it is for family to live near you, Fredrisktad marked
higher importance than Duluth, even though Duluthians are hoping to live/get help from family
when they are elderly (see Table 3). Overall, all three cities marked the ability of family to
provide care as average importance, even though the preference for wanting family support is
ranked much higher (see Table 3). This shows a disconnect in understanding the reality of family
care systems.
Cross-culturally the respondents are primarily female, aligning with women’s traditional
roles as caregivers (placed on them by society). This can also be seen in the interviews, where all
participants are female. This could be part of the larger issue surrounding the support gaps in
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elder care systems. It is also important to consider gender in terms of the policy makers who are
creating legislation surrounding professional care requirements.
In terms of respect for the elderly, both Fredrikstad and Duluth marked overwhelmingly
“same as others” in society (see Table 2). This is in direct contrast to the results of the interviews
that highlighted a strong lack of respect for the elderly. Sefrou marked high respect for the
elderly, which is in correlation with their expectation of family to care for the elderly (see Table
2). While keeping the elderly at home shows respect within Moroccan culture, it also comes with
issues surrounding the lack of support given to home caregivers.
Caregiver vs. Non-Caregiver
Comparing the survey responses from caregivers to non-caregivers also helps to show
knowledge gaps among the general population. In analyzing the section for rating each factor on
importance there was a distinction between caregiver results and non-caregiver results.
Caregivers reported a medium to medium/high importance on finances, while
non-caregivers rated finances medium/high to high importance (see Table 6). In interviews
professional caregivers mentioned the services provided for the elderly, but stressed the lack of
education for how to obtain those services, including financial resources. In cross-cultural
comparison of these factors Norway rated finances as high importance, similar to the US, even
though Norway has lots of social programs to provide help to the eldelry (see Table 3). These
results show a significant issue in communication of services to those that need them.
Family opinion was another factor rated differently by caregivers and non-caregivers.
Similarly caregivers ranked the ability of family to care for you highly in terms of importance
compared to non-caregivers (see Table 6). The higher importance rating by caregivers shows
their understanding of the importance of a support system and specifically the role family plays
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in elder care. Cross-culturally Fredrikstad rated family opinion higher than Duluth. This supports
the results from the interview that mention family obligation towards elderly in Norway. Overall,
it seems there is a lack of social responsibility surrounding caring for elderly family members.
Personal opinion was ranked high across the board in terms of elder care (see Table 6). In
the interviews, the  professional caregivers  highlighted several issues with family overriding the
wishes of the elderly. It seems ironic that individuals place high importance on personal opinion
when there is such a large amount of lack of respect for the personal opinions of the elderly. In
contrast, Norway has a high standard for allowing the elderly to make their own decisions, which
in the interviews was pointed out as dangerous due to the fact that elderly are allowed to make
decisions past the point when they should be able to based on the interviewees experience.
Caregiver insight is crucial in understanding the current elder care systems and social
changes that need to be made in order to improve the lives of the elderly.
Age Dynamics
Examining the survey results by age category also provided interesting insights into the
understanding of elder care systems and hopes for future elder care.
The mean age for persons that responded saying they had a plan in place was younger
than the mean age of persons who did not have a plan in place (see Table 7). This result could
have been due to the types of respondents filling out the survey. A respondent between 45-60
said “I have no plan and wake up at night worried”, signifying the importance of thinking about
needs before they occur. There were several respondents who were caregivers and younger. their
exposure to caregiving systems may have prompted their preparation in thinking about their
future elder care needs. This example highlights an area of opportunity surrounding preparing the
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general public for thinking about their elder care needs by exposing youth to the realities that
come with aging.
The younger respondents tended to prefer to live with family or get help from family
whereas older respondents tended to prefer a nursing home or professional help for their elder
care needs (see Table 7). There was a middle section of 45 to 60 year old respondents who did
not want to go to a nursing home (see Table 7). These results could be correlated with the
understanding of elder care and realities that comes with age and also highlights the need for
discussing elder care with use. A potential opportunity could be including elder care discussions
in public education systems.
In regard to the factors affecting elder care the younger respondents did not see finances
as being a major factor (see Table 9). Younger respondents also tended to think the ability of
family to care for you was very important, going along with their preference for receiving care
from family versus a professional facility (see Table 9). Also, the ability to move in with family
is less important amongst respondents in correlation to increasing age (see Table 7). In other
words, the older the respondents, the less likely they were to want to live with family. These
factors highlight, again, the general lack of Education surrounding the realities of elder care.
Between age groups, every category had a 50/50 amount of respondents who knew
multi-generational homes, in Duluth and Fredrikstad (see Table 2). Similarly across age groups it
was recorded as uncommon, in the same cities (see Table 8). This is an even greater indicator
that there is a misunderstanding of the realities of multi-generational living within these cities.
In regards to family importance the trend of respondents highlighted an increase in family
importance directly correlated with an increase in age (see Table 9). An exception was found
among the 25 to 44 year-old respondents, who marked the importance of family high above all
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other age groups (see Table 9). This could potentially be due to this age group starting families of
their own. Further research is necessary to examine this possibility. The increased importance of
family correlated with age could also signify an understanding of the important  role family plays
in elder care. These  same results were found in regards to the importance placed on family
living near you (see Table 9). Is confusing to notice younger respondents lack of importance on
family and family living nearby when that same age group placed a heavy importance on
wanting to live with family and receive family support for their elder care.
The younger respondents tended to think that the elderly received higher amounts of
respect than older respondents (see Table 8). In the interviews most of the concern surrounding
lack of respect for the elderly was in connection with the younger members of society. This
disconnect could also be due to the type of respondents that filled out the survey. Similar to
misunderstanding elder care needs, the youth seem to have a misconception of the respect elderly
receive in the community.
The survey results provided multiple opportunities for analyzing and understanding
cultural realities and conceptions around elder care and the role of elderly in society.
Interviews
Having such a variety of caregivers and care receivers was very beneficial in the
interviews. There was a mix of people caring both voluntarily and professionally, as well as a
wide variety among the professionals. One of the care providers in Norway was originally from
northern Africa, which also offered insight on immigrant workers. Interestingly enough one of
the other care providers in Norway mentioned her great concern for immigrant workers due to
their lack of cultural and language understanding. This was highlighted to me partially through
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the interview process, where Reine was struggling to understand some of the basic questions.
The translator, my mother, also noted that she seemed to refuse to say anything negative about
her job, possibly due to fear. It is also possible that she truly believed the Norwegian care system
is incredible; based on her description of the care provided for elderly in her home country in
Africa, specifically regarding dementia patients, that could be completely possible. Both care
receivers were originally from different places as well, one even from a completely different
continent, so they both offered insights that may not have come from a local resident. Food was
one of the things that both care receivers mentioned in their interviews. They said it was pretty
good, but they both wished they could cook their specific cultural foods.
Roxy also talked about the topic of respect for the elderly in a very unique way from all
the other interviewees. She was the only one that truly believed there was great respect for the
elderly, and went so far as to say she would recommend Minnesota as the best place to live as an
elderly person. Lots of her thoughts on respect in Duluth were contrasted by her experience on
the east coast of the US. This really highlights to me part of my research that maybe needs
further definition, and that is the term “respect”. Roxy’s cultural standard from the east coast
allowed her to appreciate the level of respect in Duluth, even though the other care receiver and
all other Duluth interviews reported negatively in terms of respect for the elderly in Duluth. The
interview with Gabby also highlighted a generational difference in thinking about respect. She
compared the “respect your elders” culture of the older generation with the “treat others how you
want to be treated” culture of younger generations. This also plays into the severe issue of young
people lacking respect that was highlighted in interviews cross-culturally, often specifically
related to issues with changing technology and “youthful” beauty standards.
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Beyond basic respect, a recurring theme in the interviews was a sense of invisibility felt
by the elderly in the broader community. This was connected to the fast paced world we live in,
with Willow talking about how we get “tunnel vision” because we are so busy. This issue seems
to be broader than just affecting the elderly, but is an important idea to understand due to its
broader connections to capitalism.
Another effect from the capitalist society are the monetary issues aligned with the current
care systems. It was highlighted by Willow and Sophia extensively that healthcare is a profit
game. Because facilities can make more money on private rooms they are limiting the
availability of much needed government funded rooms. There also needs to be restrictions placed
on pharmaceutical companies in order to create affordable care options for the incoming group of
senior citizens.
This leads to the larger issue at hand which is a lack of education surrounding the public
resources available for elder care, both monetary and social services. Sophia gave a very detailed
explanation of the current support systems in Minnesota, and defined the lack of accessibility of
resources is due largely to miscommunication and education within the community. By the time
people realize they need help they are often confused as to what they need and where to get it.
The education really needs to go beyond talking about the services, and start with helping
families and the elderly identify what their actual needs are.
On top of education of the current resources, there is also a need for greater support
systems. Brit shared her positive experience caring for her mother, and this was largely due to the
fact that she had lots of support with her mother’s medical/physical needs so she had enough
time to provide emotional support. Lots of caregivers mentioned the issue of being overly
stressed because they spend all of their time providing for the medical/physical needs of the
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elderly and do not have time to also address their emotional needs. This leads to feelings of not
being enough and makes it very difficult to care for someone. Not only do personal caregivers
need support, but facilities also benefit greatly from family input. Marit mentioned the key role
family plays in providing emotional care for the elderly, while also pointing out issues of
loneliness that occur if a family does not provide support. A larger support network is needed to
help in caring for the elderly, both to support elderly emotional needs as well as caregiver mental
health.
Some of the issues with having a support network can also be found in the short staffing
dilemmas that facilities are facing. There are not enough people to fill all of the positions needed,
and not enough money to properly pay workers. This leads to facilities hiring inadequate workers
and creates a work environment where up to 75% (according to Gabby) of workers are there
mainly for the paycheck. Even more broadly there is an issue with workers not feeling
appreciated for the work they are doing. Gabby compared different facilities incentive programs
for getting workers to cover extra shifts, due to short staffing, and pointed out a couple important
takeaways. One is that when she is given rewards for doing extra work she feels appreciated and
is happy to help out. Another was how she “(does not) need a water bottle, I need to pay for my
house”, which was a reflection on the types of bonuses she’s received at different facilities. I
think this is especially important for facilities to keep in mind when giving bonuses to their
employees. Showing appreciation to workers is great, but the administration needs to understand
the needs of their employees.
Similar to administration needing to understand their employees needs, it is important
that the needs of the elderly are taken into consideration when creating care systems. Through
the interviews it seemed like there is a large disconnect between care realities and the systems
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being put in place. In Norway, for example, there is a huge push for home care, but the
interviewees all highlighted the need for more nursing homes, with Tonje noting “we did have
[nursing homes] before, now there is only homes for very sick, old people, and a lot of old
people sit alone in their homes. That is not health for anybody, not your body and not your
mind”. Along the same lines, there is a broader issue of generalizing care systems that are not
providing for those who are outliers in the care systems. In Veronika’s interview I learned about
the bureaucracy that comes with her job, and how elders without family often do not have
anyone to take care of arranging a funeral. Veronika was very upset because part of her position
requires that after a patient dies she is supposed to be completely done with the case, but she
feels a human connection and wants to be part of specifically helping those who do not have
families.
Bureaucracy was a key topic in discussing elder care, specifically among interviewees
working in professional care facilities. Willow commented on some of the necessary and
unnecessary paperwork that occupies roughly 25% of her time, while she would rather be using
that time to connect with patients, who are her favorite part of the job. Veronika also focused on
bureaucracy, saying that she is upset with the “conveyor belt” approach that has become the
reality of her job. She said she did not get involved in this career to “be an economist” either, and
that she wants to spend time helping people with less focus on paperwork.
Beyond the logistics and technical aspects of elder care, the most important things that
were highlighted in the interviews were empathy, patience, and working with the heart. Both
Taylor and Roxy spoke specifically on the issues with agency caregivers lacking these qualities.
Roxy offered a specific example of a woman that left her in a dangerous situation, but more
broadly focused on the overall concerns she has with people from agencies. Taylor talked about
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her personal experience working for an agency and how she was very frustrated with the work
structure that ignored the need to pair workers with patients versus randomly assigning patients,
which completely ignores the need for personal connection between caregiver and care receiver.
The issues highlighted with both the agencies and agency employees seemed to all connect to a
sense of missing humanity. Veronika commented on caregivers broadly saying “of course they
have to be educated, but I think it even more important is they work both with their heart and
their head”. This concept gets at the core of elder care, which goes beyond a “conveyor belt”
approach and focuses on the individual.
As a whole, the interviews featured the central ideas of family and love in elder care. I
heard story after story about the deep relationships and connections that were developed through
providing care, both through professional and volunteer care methods. This is at the heart of
elder care itself, and when dreaming of ideal systems for elder care it is important to put
humanity at the center of care. Outside of elder care “systems”, the benefits of multi-generational
interaction have greater opportunities for benefiting society as a whole. The “emotional
rollercoaster” several interviewees described sounded to me like an opportunity to fully
experience being human. Through integrating elderly into society as a whole we can improve the
lives of the elderly, and they can improve the lives of those they touch with their wisdom and
stories. This idea of integration also aligns with several of the ideas for a new system that were
proposed by the interviewees, including an interesting idea proposed by Willow and Taylor on
having college students live with elderly people in special communities. It also connects to the
thought of treating the elderly as equally important members of society, and not treating them
“like an old person that doesn’t have any feelings or use in society” (Idai).
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Conclusion
Elder care is extremely complex, and just as it “takes a village” to raise a child, so, too,
does it take an entire community to care for the elderly. As highlighted above, the task is
stressful and often overwhelming. Families are often unable to provide for emotional needs
because they are too busy fulfilling the basic physical and medical needs of their elderly family.
Following current data, caregiving has been shown to impact relationships between family
members, but the negative impacts are greatly reduced with a proper support network.
Professional caregivers and facilities are filling the physical and emotional needs, but
family/friends are needed to fill the emotional needs of the elderly due to understaffing and lack
of extra time of professional caregivers to provide adequate emotional support to the elderly.
Beyond family/friends and caregivers, society at large has a duty to be engaged in elder
care. This group has largely ignored its responsibility to recognize the elderly in their community
and is an area of opportunity for increasing elder well being. This starts with educating our youth
on elder care in public schools. It also includes creating accessibility within public spaces
including stores, museums, schools, and more. Along with creating accessibility, continued
efforts to invite the elderly into social systems can be made.
When creating policies and future elder care systems, it is important to understand
cultural realities and societal wishes. Culture can provide for certain aspects of elder needs as
humans, but social programs need to recognize the areas in which they need to provide support.
In Morocco respect is shown to the elderly through family providing care, but the  families need
further support from the government to properly provide for the physical and medical needs of
the elderly. Norway is pushing away from nursing homes and towards staying aging in place, but
there is an issue with lack of community for the elderly who remain in their homes. In Duluth,
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people want to stay at home, but don't have adequate resources to make this a reality. Through
understanding cultural wishes societies can  work to provide the resources and education needed
to create functioning elder care systems.
Community for the elderly needs to be a top priority when adjusting current systems.
Family support is needed, but spaces for similarly aged and culturally relatable elderly
populations is key in elder well being. We have seen how isolation reduces ability to thrive in
nursing homes during Covid-19, and in the literature review we also saw issues with elderly
immigrant populations not finding community with culturally similar populations, beyond their
family members. I believe this starts with creating spaces for older people to live together before
they need full time care. Building apartments and communities specifically for older individuals
creates a space for blended living, and also makes it much easier for homecare nurses, reducing
their travel time between patients. By acknowledging age we can prepare for impending needs,
instead of reacting once they become a reality.
A greater effort could also be made to celebrate aging at all stages of life. Brit’s mother
received a letter from the King, visit from the mayor, and a community celebration for her 100th
birthday. This is a perfect example of how the community can engage in the celebration of age.
More broadly this can be extended to celebrating birthdays at any age, and relinquishing the idea
of being ashamed of growing old. This is also tied up in the beauty standards we uphold
surrounding youthfulness.
Our lives are too fast, we do not talk about death, we do not talk about grief, it seems our
lives are too fast to even experience true human emotion. If people were more aware of their
impending death and the fact that we all die someday, maybe they would live more fully. Maybe
old people are seen as “sassy” or “rudely honest” because they accept that they are going to die
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soon, so they chose to feel their emotions fully. Knowledge and respect for the elderly improves
the lives of the elderly as well as our own lives, and brings us in touch with the reality of our
impending death, therefore inspiring us to live more fulfilling lives
In our current society we are so alienated from reality, we do not talk about death, grief,
sadness, our lives are too fast to have the time to deal with that. We do not have the time, but the
thing is we are filling our lives and moving so quickly. Reflecting on our lives is important and if
we do not have time to reflect what's the point? “The unexamined life is not worth living”
-Socrates.
We need to focus on elder care because we will need elder care. The cycle of birth, aging,
growing old and needing care includes those in the “middle” who might not need help with
physical needs, but who can benefit from the wonder and wisdom of the elderly, whom the
“middle” people should be taking care of at some point in their lives. Everyone should seek the
opportunity to care for an elderly person, if they are able. It is an experience that changes the
lives of all who get a chance to help care for the elderly. Caring develops an appreciation for life
that is necessary to be truly grateful, to be able to slow down and truly experience every part of
being human. Having a caring experience also prepares you for the realities that come with
growing old. This helps ease the shock of not being able to do everything you were once able to
do as you age.
Next Questions for Study
❖ Look at death rates in nursing homes (not including death due to contracting Covid-19)
during the pandemic compared to before/after to see how loneliness affects ability to
thrive among residents. This can be more broadly applied to studying loneliness rates of
elderly living at home.
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❖ Study immigrant workers in nursing homes and other care centers to understand how
cultural differences affect those receiving care.
❖ Understanding culturally what “human needs” are provided for, and which need to be
provided for by government / social programs, and how reliable are cultures at providing
these programs is another avenue for further research. What ways can we work to create
society that naturally and reliably takes over the roles that need to be temporarily by
social programs (because culture/societal norms take longer to change than creating
policies or programs to supply these needs). Social programs need to be temporary and
paired with societal norms shifting to fulfilling those needs, otherwise programs / policies
burn out and there aren’t enough funds to support them (especially with the rising elderly
population).
❖ Through my interviews a lot of people describe the “emotional rollercoaster” working
with elderly. I would argue that feeling our full emotions are suppressed within the “fast
paced” world. A future study could be on how capitalism has affected our sense of
humanity, specifically by engaging with elderly who live in capitalist based societies
versus those who live in Indigenous communities to get their reflection based on their
experiences in contrasting realities.
❖ More research could be done to define “respect” cross-culturally as well as
generationally, to get a better understanding of expectations and how to create
communication on this issue.
❖ Finally, further studies should be done surrounding the broader implications of elder
care, specifically the opportunities integrating elderly into communities has for society
as a whole.
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Statement of Reflexivity: Subjective Response
This research was so incredibly personal. I was crying through almost all of the
interviews. I was sobbing on the phone to my mom several times, both happy and sad tears. I
was tearing up reading Barbara Meyerhoff’s book. This research felt like an emotional release
and connection with the depression I experienced around my grandparents death because nobody
ever talked about it with me. My grandmother's cancer was hidden until she died and when I told
my best friend she was completely shocked, even though my grandma had cancer for over a year.
Even while writing my research paper I felt like I connected with my Grandpa Ed. I spent
endless hours writing most of my paper from the old “grandpa” recliner I have in my apartment,
and my legs got sore. While my grandfather was passing he spent a little over a week almost
completely confined to his “grandpa” recliner. I remember waking up throughout the night just to
bed his legs and readjust them because he would get uncomfortable. After reclining for hours on
end while writing my paper I found myself constantly moving and adjusting my legs, and at one
point it seemed like they would never be comfortable unless they were constantly moving.
I really do tend to operate like an older person in general. I need bigger signs with large
text, I always require seating, and if you ask any of my friends they will tell you about my
“hearing issues”. During this research I became even more aware of these specific issues that the
elderly experience in their everyday lives. At Farm & Fleet I was concerned with the lack of
seating in the auto department, only to realize that the chairs were put over in the corner. Once I
found the seating and I sat down and ended up having a conversation with an older gentleman.
He told me he was retired, but he used to be the head of an ER in Duluth. The conversation we
had that afternoon left us both in tears, wishing each other a good life, and him telling me if he
77
could go back and do it all over again he would be an anthropologist. He thought the work I was
doing, and the broader idea of understanding humans, sounded fascinating.
It feels as though I am searching for the meaning of life through this research, and it
seems to me that there are many “right” answers, just like there’s many “right” ways to be
human.
Responses to Interviews:
❖ Could you talk about your emotional health and how you think it has changed coming
into this facility versus how you felt living alone before? Roxy: “Oh that's a wonderful
question that's probably the best question you could ask me.”
❖ Willow: “Thank you for doing this type of research, you know what happens is that you
won't forget it, you will be that generation who changes, how we look at old people.”
❖ Has your caregiving experience altered your hopes for your personal care when you are
unable to care for yourself? Gabby: “Yes, oh my gosh, that is a wonderful question!”
❖ Brit: “The most rewarding that must be... very interesting to be asked these questions
because they give me an opportunity to reflect and that's very important.”
Responses to Surveys:
❖ “I honestly appreciated the questions! I found the questions really thought provoking, and
appreciate what you’re doing.”
Final Thoughts
Going into this research project I was thinking “how do I fix this with anthropology”,
now I am thinking “how do I work with other people to improve these systems”. It is ridiculous
to think that there is ever just one answer to a problem, and absurd to think a system can ever be
fully “fixed”.  I thought there would be one clear answer, but I found that there are instead many
78
opportunities for improvement that look different in each cultural setting, though there are many
ideas that could potentially work cross-culturally. I feel honored to have had the opportunity to
interview so many wonderful individuals and look forward to continuing to push for
improvement to our elder care systems. Our elderly populations are about to become
overwhelming, and it is imperative that we work to ensure that they will be taken care of.
Before I began this research I thought there was no way I would ever want to go into a
nursing home, but now I hope when I am elderly I can find a community as beautiful as the ones
that are created within these care facilities.
79
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Appendix
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Additional Cultural Stories from Interviews:
This section highlights broader connections to elder care systems, and specifically notes
interviewee knowledge of cultural connections to elder care.
BRIT: [When my mother turned 100] she got the visit me the from the mayor of the town, the
biggest flower bouquet, and she got a congratulation letter from King Harold.
ROXY: Where my mother was and, from what I gather my oldest son's mother in law, was they
[nursing home staff] were indifferent to whether you were in pain or not… whatever medication
people needed probably they gave it to them, but everything was very cold and indifferent… day
and night from my experience… my older son at one point said, because he and his wife are still
[on the east coast], he said I’d live in a box rather than go into an assisted living there.
SOPHIA: The Caucasian culture that I've grown up with versus the Hispanic culture that I've
grown up with, there's a very stark contrast difference in the way that they treat their elderly. It's
cute, it's like white folks we put our people in nursing homes, Hispanic people they're going to
put them in their spare bedroom as long as humanly possible, and that means, even if I have to
quit my job, I don’t care what it takes… I am not gonna let nobody take her [grandmother] out of
this house.
SOPHIA: If you pull up census and demographic information and you look at what the spread is
[of people in nursing homes] it’s going to be primarily Caucasian, and if you look then the next
is going to be African American. The last is going to be Spanish.
TAYLOR:, Over in Finland, I have extended family over in Finland, and it's sort of expected that
you help the families out as they get older, and my daughters from China, it's for sure expected
you take care of your mom and dad as they get older.
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TAYLOR: We don't have that same expectation, but we've probably had nursing homes around
for a lot longer.
WILLOW: Because we work so much in this country [the United States], we have to rely on
other people to help us [care for our elderly].
VERONIKA: We have people in Oslo, I know there is a group who whenever you have a death
announcement. If it says on behalf of friends on the bottom of the obituary it typically means they
didn’t have family and it's a volunteer group that goes in and takes care of the funeral.
VERONIKA: There is a woman in Sweden that has stores in Sweden in Norway and is selling
clothes. She has used very mature models. One of the models is probably well into her 70s. She’s
a beautiful woman.
REINE: [In northern Africa] elders can’t carry water (on their head). I’m the one expected to
help fetch the water. I help other people that I don’t know carry their water. I can help with all
kinds of things as a volunteer basis. Everyone helps elders. I’ve been gone for so long so I’m
assuming that has changed. In the old days [when I moved 9 years ago] in Norway there was
respect for the elders, but now they’re so busy on their devices.