Introduction

The care of elderly individuals in nursing homes is a critical issue that reflects a society’s values and commitment to human dignity. Reports of neglect, such as inadequate personal care, lack of mobility support, and insufficient nutrition, reveal systemic failures that can lead to severe emotional and physical harm. In extreme cases, neglect may contribute to premature death. This paper examines the issue of neglect in nursing homes, drawing on a specific case of severe neglect, and explores humane, cost-effective solutions to prevent such occurrences. It also compares care practices across cultures and religions to identify alternative models that prioritize dignity and minimize the burden on families.

Personal Experience

My mother was admitted to a nursing home at the age of 60. I’d rather not mention its name. I quickly realized there was severe neglect. Her wheelchair tires were never inflated, so she couldn’t get to the dining hall on her own. At times, she either got no food or was served garbage. Her hair wasn’t washed for months. She didn’t dare speak up, and with good reason. A few rooms down was Mr. X. I visited him often, and we’d sometimes grab a beer in the cafeteria. I got to know him well, and we grew close. The problem was that he loudly expressed his frustration about the nursing home from his room—you could hear it throughout the hallway. He was still physically fit. One day, my mother told me Mr. X had been taken to the hospital. “Why?” I asked. “I don’t know,” she said, but her face said it all. Suddenly, they brought Mr. X back to his room. I thought I’d visit him. When I walked in, I was horrified. There he was, completely cramped up, mouth wide open, trying to tell me something. I couldn’t understand him. The next day, Mr. X was dead. They took his life. My mother lived in absolute terror there for four years before she passed away.

The Problem of Neglect in Nursing Homes

Neglect in nursing homes can manifest in various forms, including inadequate personal hygiene, lack of mobility assistance, poor nutrition, and failure to address residents’ emotional and social needs. In the case described, a 60-year-old woman experienced significant neglect: her wheelchair’s tires were not maintained, preventing independent mobility; her hygiene was neglected for months; and she received inadequate or substandard food. Additionally, a fellow resident, referred to as Mr. X, suffered a rapid decline after voicing complaints, raising suspicions of mistreatment, and ultimately died under distressing circumstances. The woman lived in fear for four years, compounded by the facility’s apparent indifference, as evidenced by the director’s callous remark about unpaid debts and withholding personal belongings.

Such incidents are not isolated. In Belgium, studies have highlighted disparities in healthcare access, particularly for low-income elderly individuals, which can exacerbate neglect in underfunded facilities. The financial strain on municipalities and regional governments, with a consolidated debt of over €8.5 billion for Flemish municipalities and public welfare centers in 2023, limits resources for oversight and quality care. Moreover, systemic issues such as understaffing, lack of training, and weak regulatory enforcement contribute to neglect. The question arises: are care services, municipalities, and governments aware of these issues? Evidence suggests that while regulatory frameworks exist, enforcement is often inconsistent, and reports of neglect are not always adequately addressed.

Cross-Cultural and Religious Perspectives on Elderly Care

To develop effective solutions, it is valuable to examine how other cultures and religions approach elderly care, as these perspectives offer insights into humane and community-based models.

Eastern Traditions

• Confucian-Influenced Cultures (e.g., China, Japan, Korea): In Confucian societies, filial piety emphasizes the responsibility of younger generations to care for their elders. In traditional Chinese families, multi-generational households are common, with children and grandchildren providing care at home. This model reduces reliance on institutional care and fosters emotional bonds. However, urbanization and changing family structures have strained this system, leading to increased use of nursing homes in urban areas. Japan has implemented community-based care systems, such as day centers and home care services, which allow elderly individuals to remain in familiar environments while receiving professional support.
• Hindu and Sikh Traditions (India): In India, Hindu and Sikh communities historically emphasize respect for elders, often integrating them into family life. The concept of seva (selfless service) encourages family members to care for aging relatives. Community-based support, such as local religious organizations providing meals or companionship, supplements family efforts. These practices align with the principle of minimizing institutionalization and maintaining dignity.

Islamic Perspectives

In Islamic cultures, caring for the elderly is a religious duty rooted in Quranic teachings that emphasize respect for parents (e.g., Surah Al-Isra 17:23-24). The Charter of Medina, attributed to the Prophet Muhammad, promoted coexistence and mutual support among diverse communities, a principle that can extend to elderly care. In many Muslim-majority countries, such as those in the Middle East, extended families live together, and elderly individuals are cared for at home. Community mosques often organize welfare programs, including visits to the elderly, to ensure social inclusion.

Indigenous and Non-Western Approaches

Indigenous communities, such as those in Africa and the Americas, often prioritize communal care. For example, in many African cultures, elders are revered as sources of wisdom, and care is distributed across the community rather than centralized in institutions. This model reduces costs and fosters social cohesion, though it requires strong community networks.

Western Secular Models

In contrast, Western societies, including Belgium, often rely on institutionalized care due to smaller family units and higher workforce participation. However, countries like the Netherlands have pioneered “dementia villages,” where residents live in small, home-like settings with trained caregivers, promoting autonomy and dignity. These models, while more expensive than traditional nursing homes, demonstrate that innovative institutional care can prioritize residents’ well-being.

Religious Perspectives on Dignity and Care

Religious frameworks emphasize the inherent dignity of every individual, which can guide solutions to neglect. Christianity, prevalent in Belgium, teaches compassion and care for the vulnerable (e.g., Matthew 25:40). The Catholic Church, a significant influence in Belgium, has historically supported charitable care initiatives, though institutional care often falls short of these ideals. Buddhism, though not yet officially recognized in Belgium, emphasizes compassion and mindfulness, which could inspire caregiver training focused on empathy. These religious principles align with the need for humane care that respects the elderly as individuals with inherent worth.

Proposed Solutions

To address neglect in nursing homes and prevent tragedies like those described, the following solutions are proposed. These are designed to be cost-effective, humane, and minimally burdensome for families, drawing on cross-cultural and religious insights.

1. Community-Based Care Networks

• Description: Establish community-based care networks where volunteers, trained professionals, and family members collaborate to support elderly individuals. These networks can include home visits, meal delivery, and social activities, reducing reliance on institutional care.
• Implementation: Municipalities can partner with local organizations, such as religious institutions or NGOs, to coordinate volunteers. In Belgium, the Catholic Church and Islamic communities could leverage their networks to provide companionship and basic care, inspired by the seva model from Hindu traditions.
• Cost-Effectiveness: Volunteers reduce labor costs, and existing community infrastructure (e.g., churches, mosques) minimizes the need for new facilities.
• Impact: Enhances social inclusion, reduces isolation, and allows elderly individuals to remain in their homes, aligning with Confucian and Islamic emphasis on family and community care.

2. Enhanced Regulatory Oversight and Whistleblower Protections

• Description: Strengthen oversight of nursing homes through unannounced inspections and mandatory reporting mechanisms. Establish anonymous whistleblower systems for residents, families, and staff to report neglect without fear of retaliation.
• Implementation: The Flemish government’s Zorg en Gezondheid agency could expand its inspection protocols, as outlined in existing regulations, to include resident and family feedback. Legal protections for whistleblowers can be modeled on Belgium’s asylum procedures, which emphasize human rights.
• Cost-Effectiveness: Leverages existing regulatory frameworks, requiring minimal additional funding for enforcement.
• Impact: Deters neglect by holding facilities accountable and empowers residents and families, addressing the fear experienced by the woman in the case study.

3. Caregiver Training and Support

• Description: Implement mandatory training programs for nursing home staff, focusing on empathy, dignity, and practical skills like mobility assistance and hygiene care. Provide mental health support for caregivers to prevent burnout.
• Implementation: Training can incorporate Buddhist principles of mindfulness and compassion, as well as Christian teachings on caring for the vulnerable. Programs can be funded through public-private partnerships, with universities like KU Leuven offering expertise.
• Cost-Effectiveness: Online training modules reduce costs, and improved staff well-being decreases turnover, saving recruitment expenses.
• Impact: Ensures residents receive dignified care, addressing issues like unwashed hair and inadequate mobility support.

4. Family and Community Involvement Programs

• Description: Encourage family involvement through structured programs, such as regular family-caregiver meetings and subsidized home care services. Offer tax incentives for families who care for elderly relatives at home.
• Implementation: Modelled on Japan’s community care systems, these programs can be supported by local OCMWs (Public Centers for Social Welfare), which already provide social services. Tax incentives can be integrated into existing frameworks for elderly support.
• Cost-Effectiveness: Shifts some care responsibilities to families and communities, reducing institutional costs.
• Impact: Strengthens family bonds and reduces the terror and isolation experienced by residents like the woman in the case study.

5. Technology-Enabled Care

• Description: Use affordable technology, such as wearable health monitors and automated mobility aids, to enhance care quality. For example, smart wheelchairs with pressure sensors can alert staff to maintenance needs.
• Implementation: Partner with tech companies to pilot low-cost solutions in nursing homes, with government subsidies to offset initial costs. This aligns with Belgium’s push for innovative healthcare solutions.
• Cost-Effectiveness: Technology reduces the need for constant staff supervision, lowering labor costs over time.
• Impact: Prevents neglect like the unmaintained wheelchair and ensures timely interventions for health issues, potentially saving lives like Mr. X’s.

6. Cultural and Religious Sensitivity Training

• Description: Train caregivers to respect diverse cultural and religious needs, ensuring that care aligns with residents’ values. For example, dietary preferences (e.g., halal or vegetarian) and spiritual practices should be accommodated.
• Implementation: Draw on Belgium’s tradition of religious tolerance, as enshrined in the Constitution, to develop training modules. Collaborate with organizations like the Boeddhistische Unie van België to include non-traditional perspectives.
• Cost-Effectiveness: Integrates into existing training programs, requiring minimal additional resources.
• Impact: Enhances residents’ dignity and reduces feelings of alienation, addressing the emotional toll of neglect.

Addressing Systemic Issues

The case highlights systemic issues, including financial pressures on nursing homes and inadequate government oversight. Belgium’s high public debt and budget deficits limit funding for care improvements. However, reallocating existing resources—such as redirecting funds from administrative overhead to direct care—can enhance quality without increasing costs. Municipalities should prioritize audits of nursing homes with poor track records and enforce penalties for neglect, as suggested by the Vlaamse Ouderenraad’s findings on healthcare disparities.

Conclusion

Neglect in nursing homes, as exemplified by the harrowing experiences of a woman and Mr. X, is a profound violation of human dignity that demands urgent action. By drawing on cross-cultural and religious perspectives, Belgium can adopt humane, cost-effective solutions that prioritize community involvement, robust oversight, empathetic training, family support, and technology. These measures align with global traditions of respect for the elderly, from Confucian filial piety to Islamic communal care, and Belgium’s own constitutional commitment to human rights. Governments, municipalities, and care services must collaborate to ensure that no elderly individual lives in fear or neglect. By implementing these solutions, we can honor the memory of those who suffered and build a future where every elder is treated with the dignity they deserve.

References

• Belgische Grondwet, Godsdienstvrijheid
• Vlaamse Ouderenraad, Ongelijke toegang tot Belgische gezondheidszorg
• Zorg en Gezondheid, Geestelijke gezondheidszorg
• Naar een gezond België, Zorg voor ouderen
• Senate.be, Wet van 15 december 1980
• Belgium.be, Gewaarborgde inkomens
• Vlaanderen.be, Geconsolideerde schuld lokale overheden
• Degroof Petercam, Hoe houdbaar is de Belgische staatsschuld?