POV: Sent away as a child, I had no idea of 'home'. Now, I help seniors like me find their 'home'.

What does home mean to you?

Mothership | March 04, 2023, 09:15 AM

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PERSPECTIVE: What is home in an increasingly globalised world? And does its meaning change as we age?

In much of developed society, older people who require more care and support face the daunting prospect of being uprooted from their homes and transplanted elsewhere: their children's homes, a care facility, an assisted-living flat.

But there might be a case for allowing older people to grow old in their own homes, writes Mary Ann Tsao in her 2022 essay, "In Search of Home".

Tsao is chairwoman and founding director of the Tsao Ng Yu Shun Foundation, a Singapore-based nonprofit dedicated to the well-being of older people.

Sent away from home at the age of 12, she shares her firsthand struggle on finding a place to call home — and how, with age, it has become an increasingly tenuous concept. 

Tsao's essay was first published in The Birthday Book: Restart. Mothership and The Birthday Collective are in collaboration to share a selection of essays from the 2022 edition of The Birthday Book.

The Birthday Book (which you can buy here) is a collection of essays about Singapore by 57 authors from various walks of life. These essays reflect on the narratives of their lives, that define them as well as Singapore's collective future.

By Mary Ann Tsao

It was in the wee hours of the night when we finally arrived.

After a seemingly endless journey, through numerous airports and a two-hour drive, my brother and I reached California and the house of an aunt we had never met before.

“This looks like Dennis the Menace on TV!” my brother said, and indeed we saw a somewhat familiar single-storey house, neat square lawn, and station wagon in the driveway.

For a moment, I felt reassured. Inside, however, everything was unfamiliar; the sound, smell, air, people – all strange and foreign.

That night, I cried long into that alien darkness, as I finally realised that my life would never be the same again.

Leaving home at 12, never to return

With Hong Kong far behind, that was the first time I became acutely aware of the preciousness of home.

The year was 1967; I was twelve, my brother was fourteen, and we were put on the plane overnight to America because of political instability in Hong Kong.

Our refugee family from Shanghai was escaping Mao’s rule; my brother, the eldest, was sent away in case Hong Kong fell. I was sent along so he wouldn’t be alone.

With so much uncertainty, it was unclear when we might be able to return. Not understanding the situation, everything felt surreal to us until we arrived in San Francisco, when my uncle, a total stranger, fetched us at the airport.

The next morning, I steeled myself for what was to come until such time I could be home again.

That day never came.

Building a new home in New York City

Since that fateful night, I stopped thinking about home and what it meant.

Wherever I moved to for studies, training or work, home was just a place I lived and returned to for the night.

As much as I made those places comfortable and remember them fondly, I never really thought of any of them as home, nor did I ever desire to return – even for a visit – after I moved on to the next phase of my life, and the subsequent place of sojourn.

After many years, I finally settled in Manhattan, a city of endless offerings where I felt free, anonymous, and totally myself.

I acquired a house designed to raise my future family in, and was very much part of the neighbourhood fabric. I had relationships with the community – the families on my street, the newspaper man at the corner store, the Korean grocer with whom I shared Asian roots, the fishmonger who shared antidotes of life as much as the fish I was buying.

With a successful career, a house, a social network, and a partner who would later become my husband; I felt safe, secure, contented and at ease.

It was a city, community, and house where I felt I belonged. By then, travelling was easy; I was able to visit Hong Kong for the holidays with my family, but my attachment to it had changed and I never returned to live there.

For the first time after leaving Hong Kong as a child, I thought, this is it – New York City, my home.

As people leave, where is home now?

An enticing work opportunity brought me to Singapore, which was totally new to me; but one of the key attractions for relocating was a vague notion of returning to Asia and being closer to my family.

Life became busy with work, marriage, children and caregiving for my ageing parents. I grew older, and – one by one – the important people in my life started to pass away.

First was my grandmother, to whom I was very close and whose foundation was the reason I came to Singapore.

A few years later, my husband suddenly died, leaving me with our two young children and thwarting our plan to return to New York.

My parents followed, one after the other.

My youngest child is now about to go overseas, and facing an impending empty nest, I began to seriously ponder once again where home was for me – where I would grow old and feel content to live until my last day.

Hong Kong and New York – my childhood home and my chosen one – are now distant memories. While I still miss those places, I increasingly feel that – as time passes – I don’t quite fit there anymore.

But having lived in Singapore for three decades, somehow Singapore doesn’t quite feel like home either.

A new concept of home, as we age

A recent conversation with a life coach on the subject of home was revealing.

He has been working on a book about identity; his theory is that one’s identity is a major determinant of where one feels at home, and one’s identity is informed by one’s parents; the generational history forming the family’s values and mindsets; significant relationships like those with one’s spouse, siblings and children, authority figures that played important roles in one’s life; culture, and one’s own life experiences.

A clear understanding of the above allows one to answer the following questions: 1) who am I?, 2) why am I here?, 3) who do I trust? and very importantly, 4) where do I fit in?.

Doing so gives one a better sense of where home is. Instead of ready answers, though, the conversation gave me further pause and food for thought.

Perhaps inquiring about the meaning of home becomes more significant as we age.

The tragedy of leaving home

If so, what does this imply for older people who had to leave their homes?

Having worked with many seniors through my grandmother’s foundation, I have come to deeply appreciate how much home means to older people regardless of its physical condition.

Almost universally, older people report high preference for living in their own homes.

Yet this is also a major challenge for older people as their health and functions begin to fail, and they require more care and support.

Older people also spend most of their time inside their home, so where they live matters greatly to their well-being.

Older people nonetheless do move for various reasons. In some instances, older parents move into their children’s home at their behest, especially when they become widowed.

Others have to move as old housing stock is renewed. Still others need residential care because they cannot continue living independently in their own homes.

In my experience, most surrender to relocation because they feel they don’t have a choice.

A widow once told me that her son asked her to live with him after her husband passed away, so she was selling her flat, giving the money to her son to buy a larger one and moving in with him, knowing that she will then have neither home nor money but be a guest in her daughter-in-law’s house.

Though reluctant and concerned about the risk and consequences, she nonetheless felt she must proceed. Fearing that if not, her son might be unwilling to take her in later on because of her earlier rejection.

Furthermore, how can a mother reject a son’s good intention?

As it turns out, this is a common story among older people accepting nursing home placements without complaint.

They do not want to burden their children, even if the move goes against their wishes.

With older people, familiarity is key

While research on the concept of home is plentiful, studies on home for older people tend to focus primarily on the physical dimensions of safety, access and usability of care accommodation – and much less so on their mental wellbeing.

But there is growing interest in understanding the socio-emotional aspects of what home means, as more and more older people are dislocated from their own homes, especially into longterm care institutions.

In addition to preference, living at home helps to provide a familiar and stable environment during a time when they are likely to face challenges and lifestyle changes that accompany older age.

It also enables them to retain a semblance of control and autonomy at a time when their lives feel increasingly out of control due to illness, functional decline, as well as the loss of spouses and friends.

By understanding the key factors that make a home important to older people, policies and practice can provide better support to enable ageing-in-place, be it in people’s own homes, or adapting to a new place if a move is inevitable.

Recent studies showed that a happy home for older people has four key attributes: Comfort, Connectedness, Freedom, and Sense of Self.

Home brings comfort because it has all the things they need, where they need them. Familiarity provides them with peace of mind, stability as well as the competence to move around in their home easily; even as they lose vision and mobility.

Being connected with family, friends and community is also important. Remaining in the same community in old age allows them to maintain relationships within the vicinity, and creates a platform for them to participate in activities, make new friends, be supported by and contribute to the wellbeing of others, especially in times of need.

Being independent and having control over their lives is also a source of pride, as the typical view of older people involves dependency and helplessness.

Maintaining their own home gives them purpose, anchoring them with a daily structure and reason to be busy in living their lives.

Finally, home also holds good memories that are triggered by mementos; it is a place for relaxation and restoration, where they can be themselves.

The loss of liberties in institutional care

Adults generally take these fundamental liberties for granted, but things are different for older people in institutional care.

While comfort is one dimension of home that can be negotiated with relocation by having familiar things with them, many institutional homes do not allow residents to bring any of their personal belongings, including their own clothes.

Single rooms are available only in private homes at a high cost, and occupying one bed among several with strangers with whom they have no previous connections provides little, if any, comfort.

Residents are also not at liberty to move about freely or do something outside the usual schedule.

For many provider-driven efficiency reasons, longterm care institutions like nursing homes have strict regimens, even for the most basic of daily functions, such as when to eat, bathe and sleep.

Residents have no role in running their own lives and depend on others to provide everything for them.

Finally, being removed from their neighbourhood and freedom to move about, they are largely cut off from friends and community.

Making ageing in-place the norm

The home forms an integral part of one’s identity; and the longer one lives in one’s home, the harder it is to leave it, especially at times of significant change, such as the death of a spouse.

Deeper are the memories, connections, attachments, and how they see themselves through the mementos and the way the house is arranged.

As one older person said, “Home represents our past, present and future”. Home is an extension of themselves, and leaving their home, where their lives have been entrenched, is like leaving a part of themselves behind and losing some of their sense of self.

Ageing-in-place is a philosophy that my grandmother’s foundation has advocated since 1993.

It is increasingly adopted in Singapore and elsewhere because the cost of building and operating more and more nursing homes is unsustainable, and the relocation of older persons tends to be dislocating.

The foundation has pioneered services to enable older people to continue living in their own homes and community. We can make seniors’ lives better by avoiding relocation, and if necessary, by aiming to address the issues of comfort, connectedness, freedom and sense of self as much as possible both in their own homes as well as in a new care home, should it be necessary to move.

It seems so obvious, yet we have not paid much attention to it.

A different meaning of home

As I write this piece, my notion of home has begun taking a different shape.

For many older people, home is about attachments – to physical space, memories, relationships, communities – and sense of self, so it’s often heart-wrenching to have to leave a much beloved home.

While I aim to enable older people to age comfortably in their own homes, the refugee in me counsels me that there is no guarantee that I can remain in my home for as long as I wish.

On reflection, perhaps I don't feel rooted because subconsciously, I do not wish to feel the disappointment of being uprooted again, like I did in Hong Kong and New York.

The trade-off, however, is the unsettling and disturbing sense of not knowing where I belong.

How can I feel secure in my emotional roots, and avoid the fear of loss and dislocation in case I need to move once more – not at all an unlikely scenario as the possibility of me developing frailty and disability in my later life is quite real.

Is it possible to enjoy the attachments of home and yet have the resilience to avoid or manage the sense of loss and grief in case of a necessary move? As I wrestle with my own notion of home, I suddenly realise that all this anxiety is making me hold back unnecessarily.

The future in many ways is for us to create; so it is when it comes to my search for home.

In view of my preference for and the well-researched benefits of ageing-in-place, I can do all I can right now to avoid a future move.

I can work on developing my emotional resilience so I won’t fear change. I can mindfully keep myself healthy and fit to avoid disease and disability. This reduces my future needs and risk of dependency on others for daily care or needing nursing home placement.

I can create a home with minimal structural barriers (such as stairs), where I can function even with increasing frailty.

As I do that, I ought to also consider if my current home will be optimal; if it isn’t, then I should choose to move sooner than later to a place of my choice, rather than being forced to move to a less desirable place down the line because I am unprepared.

To prevent an ever-shrinking social network, as friends and relatives leave me because of death or relocation, I will take to heart the sound advice of an older aunt, to continue making new friends, especially with younger people.

Having a strong social network would allow me to be better supported, and with online communication platforms, I will be connected to family and friends no matter where I am, if I need to move.

All these I can begin considering and doing, though of course, it is easier said than done...

Home is where the heart is

Yet I am convinced that I should stop depriving myself of the joy of home because I fear losing it.

I might still have to move one day, but as long as I build my community and locate my sense of self not just in my physical home but in the relationships I continuously build – both far and near – I can start to embrace the wise adage, “Home is where the heart is”.

It will be effortful to create that future and I may not be able to achieve it, but I must give it a good shot.

I will embrace the thought that my home is where I stand. Starting now.

“I live my life in widening circles that reach out across the world. I may not complete this last one, but I will give myself to it.” – Rainer Maria Rilke

Top image from John T/Unsplash and courtesy of Tsao Foundation.