Elder care, old-age security and social change in rural Yogyakarta, Indonesia = De zorg voor en bestaanszekerheid van ouderen tegen de achtergrond van sociale veranderingen in ruraal Yogyakarta, Indonesië

I.N. Keasberry

Research output: Thesisinternal PhD, WU


<p>This thesis describes the significance of the living conditions and care arrangements of older persons for their old-age security in the villages of Kebonagung (regency of Bantul) and Giriwungu (regency of Gunung Kidul) in the Special Region of Yogyakarta, Indonesia.</p><p>The world population is ageing. The United Nations designated the year 1999 as 'The Year of the Older Person', thereby recognising and reaffirming that the global population is ageing at an unprecedented rate. This is also the case for the population of Indonesia. In 1996, the Indonesian archipelago counted about 206.3 million people of which two-thirds live on the island of Java. The proportion of older people is still small compared to that of Western countries, but is increasing at a remarkably high rate. The elderly population was projected to increase by 191 percent between 1996 and 2025. The Special Region of Yogyakarta, a province in the central part of Java, is a front-runner in the ageing process.</p><p>In combination with demographic change, the processes of social and economic change are affecting the Indonesian society. Traditionally, Javanese children are obligated to take care of their parents, especially when their parents have stopped working. When Javanese people became old and were no longer heads of complete households, no longer had young children, and were no longer economically productive, they used to live with their children or siblings' children or grandchildren. In practice this often meant that the youngest child, preferably a daughter, stayed behind in the parental house and co-resided with the parents after marriage. The intergenerational relationships guaranteed the parents' care and support in their old age. However, we expect that these kinds of living arrangements are changing as a consequence of processes of social change and that this will also affect the elder care practices. Households and families that have always provided the support and care for the large majority of elderly people in Indonesia are becoming smaller. Members of families are living further apart as a consequence of increased mobility and migration. It is no longer self-evident that women are working at home or around the house, since the participation of women in paid labour is increasing. In the context of rapid social and economic change, traditional support mechanisms can no longer be fully relied upon for the care of older people. In the near future, Indonesian people will be less certain that their children will care for them in their old age.</p><p>Older persons in Indonesia are as yet little studied and there is a lack of theoretical conceptualization on (elder) care in developing countries. To enable formulation of appropriate policies, it is, however, necessary to understand how elder care and support are arranged. The amount of literature on older persons in Indonesia is limited. Most of the studies use the decennial national censuses and intercensal surveys of the Indonesian Central Bureau of Statistics ( <em>Biro Pusat Statistik</em> ) and are not based on actual data collection, especially of qualitative data. The majority of the studies are about Java or the whole of Indonesia. They studied the subjects of demographic ageing, socio-economic conditions and well-being of older persons, nutritional health and institutional care. There are no comprehensive studies available that focus on older persons' living conditions, care arrangements and old-age security in rural Indonesia.</p><p>The present study is part of the 'Household and family care for the elderly in an ageing society' project. The research project focuses on the issues of the socio-economic position of older people, the amount and kind of care and support needed by older people, the role of households, families and significant others in providing elder care, now and in the immediate future. The research project was set up with a comparative perspective towards rural and urban Yogyakarta on the one hand and rural Indonesia and a rural area in the Netherlands on the other hand. The different study areas share the common problem of the societal consequences of the ageing process. However, it was assumed that given the different demographic and socio-economic contexts, patterns of household and family care for older people as well as the socio-economic position of older people would differ.</p><p>Developing countries in Asia offer a wide variety of cultural practices regarding care for and intergenerational relationships of older people. The Javanese have a bilateral kinship system that is generally characterised by the values of showing respect ( <em>hormat</em> ) and maintaining harmonious social appearances ( <em>rukun</em> ) towards older and senior relatives. The majority of the population adheres to Islam, a religion that emphasises intergenerational concern, kindness and mutual obligations, especially in matters of subsistence and general care.</p><p>In Indonesia, rapid population growth is placing great strain on the government. However, the government provides limited special services for particular groups of older persons, and relies on private and charitable groups to assist in providing for the needy. Social security programmes are typically limited to government-employed individuals with complementary special welfare programmes for the impoverished and the impaired. To be able to anticipate future needs of older persons and to formulate appropriate policies, it is important to know more about the living conditions of older persons and their care arrangements with household members, kin, friends and neighbours. The former government of Suharto (1966-1998) acknowledged the problem of the 'low priority' given to ageing and having 'inadequate information' about older persons and the problems they experience.</p><p>The present research seeks to address both the issue of inadequate information and knowledge, and the absence of theoretical conceptualization. Therefore, the research objective has a descriptive and a theoretical component. This research aims to:</p><OL><p><LI>Gain insight into the lives of older persons, particularly regarding the care they provide themselves and receive from others at the micro-level (household-kin-community). Moreover, it aims to identify the transitions in elder care to be better able to anticipate the needs for elder care in Indonesia in the future.</LI></p><p><LI>Develop a theoretical framework for care that will be applicable in Indonesia and countries of similar socio-economic and cultural setting. The theoretical framework starts from the assumptions and concepts found in the literature, which are adapted to and tested in the local situation.</LI></p></OL><p>This thesis has a societal and practical relevance for policymakers, who are expected to develop programmes and social services to accommodate the problems of old age and improve the lives of older people in rural Indonesia. It has a scientific and theoretical relevance for researchers, who want to study older persons and elder care in developing countries from a comparative perspective.</p><p>The central question of the research is as follows:</p><DIR><DIR><DIR><p>How does social change affect older persons' lives, and what is the significance of care arrangements and support relations for old-age security?</p></DIR></DIR></DIR><p><A NAME="_Toc9867275"><A NAME="_Toc10088908"><A NAME="_Toc11222878"><A NAME="_Toc11227236"><A NAME="_Toc11770612"><A NAME="_Toc11770691">This question is broken down into a number of subsidiary questions, which will be dealt with in the following sections. Each research question will be answered by summarising the results of the research bearing on that point.</p><p> </p><strong><em><p>Characteristics of older person's lives</A></A></A></A></A></A></p></strong></em><p>There is a need to know more about the living conditions of older persons, to know more about the socio-demographic, health and economic characteristics of the lives of older persons. The first research question was, therefore, more generally phrased as:</p><OL><OL><p><LI>How can the lives of older persons be characterised?</LI></p><p>Chapter 6 describes the socio-demographic status of persons aged fifty-five years and older, who live in the Javanese villages of Kebonagung and Giriwungu in the Special Region Yogyakarta, Indonesia. The age distribution of the sample shows a slightly irregular pattern with relatively few people under 60 years old and more than could be expected above the age of 75. The sex distribution is skewed with more women than men in each age group, except the age group of 70-74. The older persons are 69 years old on average and they have more female than male peers. Most older persons say that they are Muslim. However, in practice they combine Islam with animistic and Hinduistic elements in a syncretic belief system in which the <em>slametan</em> plays a central part. The majority of the older persons did not receive any schooling, because there was no school in the village when they were young, and schooling was a privilege for the happy few. Almost two-thirds of the older persons are married and one-third are widowed. Their marriages were often arranged by the parents on the basis of practical reasons. The majority of the older persons live with their spouse and/or others, who usually are child(ren), a child-in-law and/or grandchildren. In general, an elderly household consists of nearly five persons and is a three-generation household. Most older persons have three children still alive of whom at least one lives with them or in the same village.</p><p>Chapter 7 describes the health characteristics of older persons. We measured the relatively objective health situation with scales for nutritional health and ability to perform the personal/instrumental activities of daily life. Most respondents have a moderate nutritional health and are usually able to perform the personal and instrumental activities of daily life. However, older persons could improve their health by adding more nutritional value and variation to their diet. Subjective health was measured by self-reports of physical and mental well-being, capacity of the senses, minor and chronic illnesses. In general, older persons are in good health, although they suffer from at least one minor illness and half of them suffer from a chronic illness. Most respondents can use all their sense organs; problems are mostly related to seeing and hearing.</p><p>We only found a few cases of demented, bedridden or destitute persons. Although mental well-being is difficult to assess, we hypothesised possible reasons for the low prevalence of dementia. Indonesian people seldom reach the ages characterised by dependency and dementia. Besides, older persons continue to be useful around the house and farm, and, therefore, may retain the capability to perform (instrumental) activities. They gradually reduce their activities and do not abruptly stop working. People generally stay in their own houses and are mentally involved with (grand) children, which may prevent them from becoming estranged from their environment as would occur if they moved to an institution.</p><p>Chapter 8 describes the resources and assets that determine the livelihood of older persons. Resources are the immediate means necessary for livelihood generation. Access to work, individual income, household income, food crops, (fruit) trees, and water sources are important for the satisfaction of older person's daily needs. About half of the older respondents spend most of their time on work from which they earn an income in cash or in kind. A quarter spent most of their time on household activities, and another quarter performed other activities at home. These people could be called retired. Here retirement stands for not spending most of the time on income-generating activities. We found that people retire at the average age of 64 years while the life expectancy at birth is 65 years. Hence, we may say that in the rural areas of the Special Region Yogyakarta older people tend to work until they die.</p><p>The individual income of older persons is lower than the officially set mean value of basic daily needs. The elderly household income is higher than the official minimum wage for a standardised household of two adults and two children. However, the research data and formal standards are difficult to compare due to measurement differences concerning rural and urban environments, informal and formal work, income in cash and in kind, and household composition. Nevertheless, for three-quarter of the older persons in the research the individual income is sufficient for their daily needs. For one-quarter it is not sufficient because they have an uncertain income or many needs to fulfil.</p><p>Assets consist of a wide range of tangible and intangible stores of values or claims to assistance that can be converted into money if necessary. Ownership of a house made of durable building materials, household items, fertile farmland, and livestock is important for meeting basic needs, and for additional resources in times of need. In Kebonagung the houses in which older persons live are made of better materials and have better facilities than in Giriwungu. More than half of the elderly households do not have access to enough farmland (corrected for type of irrigation) to meet their basic needs. Almost ten percent of the households are considered landless, and most of these are in Kebonagung. People in Kebonagung more often have income from sources other than agricultural production than in Giriwungu.</p><p> </p><strong><em><p><A NAME="_Toc9867276"><A NAME="_Toc10088909"><A NAME="_Toc11222879"><A NAME="_Toc11227237"><A NAME="_Toc11770613"><A NAME="_Toc11770692">Patterns of elder care</A></A></A></A></A></A></p></strong></em><p>We are primarily interested in the care arrangements and support network relations of older persons; specifically the care activities that older persons provide for themselves, that people in their personal network can provide for them, and the care they can provide for others. The care arrangement is defined as the totality of all settlements about the care and support activities between an older person and others. The support network relations are narrowed down to the supporting ties of the older person with household members, other kin, neighbours and friends, social organisations and neighbourhood groups. The individual care arrangements and support relations of older persons result in patterns of elder care. Hence, the second research question was phrased as:</p><p><LI>What patterns of elder care can be distinguished?</LI></p><p>Chapter 9 describes the living arrangements and daily care practices within elderly households. The availability, coresidence and proximity of children together make up the living arrangements of older persons. It does not mean that care and support is automatically provided to an older person when s/he lives with a child or has children living nearby. However, living with children indicates a possible source of care and support, and it influences the perspective and expectations of older persons with regard to support. Very few people have no children, but the majority of these childless people live with other relatives. The childless people who live alone are all women and, given the absence of a social security scheme, they are probably most vulnerable when they are in need of support. Most older persons live with or close to (some of) their children and hence apply for support from them. However, a large majority does not need help with the personal or instrumental activities of daily life, because they can still perform them without difficulty. The few persons who need help with the personal or instrumental activities, are mainly supported by a coresiding daughter. Although other studies report a preference of older parents for coresidence with a daughter, we only found a weakly significant confirmation of this hypothesis. We found that older mothers seem to prefer living together with a son. The distance at which children live from their parents does not seem to have implications for the daily care that parents receive. Most care is still provided by children, who live with the parents or live in the same village. However, we found some indication that respondents who have nobody near who can help, are reluctant to confess that they need help.</p><p>Chapter 10 describes the relations of material, emotional and social support in and beyond the elderly household. Material support consists of money and material goods. Less than half of the older persons receives monetary support and only a quarter receive support in kind such as food or clothes. In general material support is received regularly: monetary support every three weeks and support in kind every ten days approximately. The main sources of financial support are sons. It is common practice that financial responsibilities and power are gradually transferred from the older persons to the younger persons in the extended household. We have hypothesised that migrated children would support their parents more by sending money home. Indeed, the proximity of children has implications for the financial care that parents receive. Parents with children living at a larger distance receive significantly higher yearly amounts of money than parents with children living nearby.</p><p>Emotional support was operationalised as advice, trust and social contact exchanged outside the household. It was difficult to ask questions about advice and trust, because Javanese people do not easily talk about private matters. The responses to questions about social contact were easier to obtain. The majority of the older persons talked with neighbours and friends every other day. The different words for small talk ( <em>omong-omong</em> ), visiting for pleasure ( <em>main, dolan</em> ) and visiting a sick person ( <em>besuk</em> ) have different connotations and uses. We observed that children who live far away from their parents do not visit them regularly. Not even when the children live in Yogyakarta, which is only fifteen to twenty-five kilometres away from the study areas. They don't even return home at <em>Lebaran</em> at the end of the Fasting month ( <em>Idul Fitri</em> ), when children are expected to show respect to older persons and are expected to visit and bring presents to their parents.</p><p>The social activities in which an older person participates constitute a social network and create a potential source of support. The social activities, which are most popular among older persons, are organised by the neighbourhood. The social networks of <em>gotong royong</em> (mutual assistance group), <em>arisan dan simpan pinjam</em> (saving and credit group), <em>ronda</em> (nights patrol group), <em>Dasa Wisma</em> (women's information group), <em>pengajian</em> (Koran recitation group) and <em>lingkungan</em> (social circle of direct neighbours) provide financial or labour support in a direct and reciprocal way. However, a person is only assured of support from these networks as long as at least one household member participates. Therefore, these social activities are not beneficial for the oldest people, who cannot participate anymore and who do not live together with a participating household member. Older persons who live alone, do not live with a child, or only have children living at a large distance are the most vulnerable to a lack of emotional and social support.</p><p> </p><strong><em><p><A NAME="_Toc9867277"><A NAME="_Toc10088910"><A NAME="_Toc11222880"><A NAME="_Toc11227238"><A NAME="_Toc11770614"><A NAME="_Toc11770693">Old-age security and livelihood strategies</A></A></A></A></A></A></p></strong></em><p>To be able to assess, act on and prevent problems with care for older persons, it is useful to have indicators for old-age security. Old-age security is defined as the relative state of security of older persons, which refers to their food security, health security, physical security, economic security and emotional security. We are interested in how secure older persons feel and what factors influence this security. Hence, the third research question was formulated as follows:</p><p><LI>What factors affect old-age security?</LI></p><p>Chapter 11 describes how we developed the old-age security scale, as an indicator of the older person's subjective feelings of security. We hypothesised that older women, female widows and the oldest persons will be more vulnerable to insecurity, but this was not confirmed. Gender, age or marital status have no effect on perceived old-age security. We also hypothesised that older persons will be less secure in Giriwungu than in Kebonagung. However, we found that it was just the other way around. This study shows that economic factors are less important than social factors for feelings of security of older persons. The main indicators proved to be the ability to perform the (instrumental) activities of daily life (IADL) and health. Besides, the economic asset of farmland acreage is a determinant of perceived old-age security.</p><p>We assume that persons have strategies to provide for a secure and quiet old age. A livelihood strategy is defined as the ability to maintain and improve (old age) security while maintaining or enhancing the assets and resources on which households depend. The fourth research question was formulated as follows:</p><p><LI>What livelihood strategies secure old age?</LI></p><p>Chapter 11 describes the strategies of care arrangement, remarriage, moving house, support mobilisation and delayed property transfer. The care arrangement strategy of having many children to provide for a secure old age seems to have an effect on the perceived old-age security. However, the effect cannot be explained by the coresidence of the children. The effect can partly be explained by the care received for personal activities of daily life, which is usually provided within the elderly household or by non-coresiding children. We could not demonstrate the existence of a strategy of remarriage, house move or delayed property transfer. The strategy of mobilising monetary support or support in kind has no effect on perceived old-age security. Only the mobilisation of material support from other kin, and talks with non-coresiding children or neighbours/friends have an effect. These indicators seem more important than several objective indicators for the perceived old-age security. Older persons feel more secure when they live with an adult child, who can take care of them personally within the household and when they can talk frequently to children who live outside the household.</p><p> </p><strong><em><p><A NAME="_Toc9867278"><A NAME="_Toc10088911"><A NAME="_Toc11222881"><A NAME="_Toc11227239"><A NAME="_Toc11770615"><A NAME="_Toc11770694">Effects of social change</A></A></A></A></A></A></p></strong></em><p>It is assumed that care arrangements and support relations change under the influence of social change. When care arrangements and support relations of older persons change, this will affect the old-age security. As discussed in Chapter 2, social change is defined as a complex of interrelated natural, cultural, societal and individual transitions. Of all processes of social change, we assume that migration and longevity will have a major impact on familial elder care in rural areas. When young persons leave the village to seek work and a livelihood in a city, older persons stay behind without children who traditionally provided care in old age. When older persons live longer, they will generally need more care in the final stage of their lives. The last research question was, therefore, phrased as follows:</p><p><LI>How do processes of social change affect elder care and old-age security?</LI></p></OL></OL><p>To investigate the effects of social change older persons' lives, elder care and old-age security, a comparative element was included in the study design by the selection of two villages. The village of Kebonagung with low or no out-migration is more prosperous, but still has its main employment in agriculture along with other paid jobs. The village of Giriwungu with high emigration is poor and, because of its less fertile soils, has limited agricultural possibilities. We assumed that the impact of social change would be most noticeable in Giriwungu. Hence, we assumed that in Giriwungu the lives of older persons would be more negatively affected, older persons would be without traditional care providers and less secure in old age. However, the following results do not support the assumption that Giriwungu is the village experiencing a higher rate of emigration of younger persons than Kebonagung. In Kebonagung, older persons have smaller households, more often live alone, have no coresiding children and less often have a child living in the same village.</p><p>In Giriwungu more older persons are still working. They are usually farmer, who gradually reduce their activities without having to stop working. In Kebonagung the activities of older persons are more evenly distributed between farm and other work. In Giriwungu elderly households cultivate a larger variation of crops and have more different types of livestock. In Kebonagung people have specialised in wet-rice cultivation and there are more landless people. Landless people who are dependent on cash income are more at risk when they become older and can no longer earn an income and provide for their own subsistence. In Giriwungu elderly households appear to invest more in agricultural stores of value, such as livestock and hardwood trees. In Kebonagung elderly households appear to invest in household items and housing quality. Although the household income in cash and in kind in Giriwungu is about half that of Kebonagung, farmland ownership (corrected for irrigation facilities) in Giriwungu is five times that of Kebonagung. Cassava is an important crop in Giriwungu. Although it has low monetary value, it is a buffer crop that is kept in the field and can always be eaten, which makes people in Giriwungu more food secure.</p><p>We hypothesised that older persons would feel more secure in Kebonagung, because their children would not need to leave the village and, therefore, could still take care of their parents. Our hypothesis was mainly based on economic assumptions. However, contrary to our hypothesis, older persons in Giriwungu feel more secure because they live with at least one child, have children living in the same village and own more farmland. These factors are more important to the perceived old-age security than the negative factors of having a poor IADL capacity, more often needing IADL support and having to work hard as a farmer. These effects could not be ascribed to the impact of social change.</p><p> </p><strong><em><p><A NAME="_Toc9867291"><A NAME="_Toc10088918"><A NAME="_Toc11222892"><A NAME="_Toc11227250"><A NAME="_Toc11770626"><A NAME="_Toc11770705">A theoretical framework of</A></A>elder care</A></A></A></A></p></strong></em><p>The theoretical framework of this study is based on concepts known in literature, in particular Tronto's theory of care (1993). The theory starts from a broad definition of care: "On the most general level, we suggest that caring be viewed as a <em>species activity that includes everything that we do to maintain, continue, and repair our 'world' so that we can live in it as well as possible</em> . That world includes our bodies, our selves, and our environment, all of which we seek to interweave in a complex, life-sustaining web". Tronto distinguishes four analytically separate, but interconnected, phases in the caring process. These are caring about, taking care of, care-giving and care-receiving. These concepts are all verbs, to emphasise that care is an activity, a social practice. Tronto insists that the activity of caring is largely defined culturally, and will vary among different cultures.</p><p>To enable the assessment of Tronto's theory of care in Indonesia and to study the issues of care in the field, we developed an analytical framework that consists of the older person's individual attributes, care arrangements, support relations, old-age security and livelihood strategies. The specific caring activities are operationalised by the personal activities of daily life (ADL), instrumental activities of daily life (IADL), monetary support, material support, emotional support and social support. These concepts of care activities are not culturally specific and therefore, applicable in any country. However, what is involved in the activity of caring, for example in instrumental care, has to be investigated empirically. The individual attributes affect old-age security directly and indirectly through the livelihood strategies that an older person has. Investing in relationships and building up care arrangements is a life-long practice, which will result in the provision of 'good care' and a secure old age. As such, it is a strategy that will enhance the chances of enjoying a supported old age.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Wageningen University
  • Niehof, A., Promotor
Award date15 Nov 2002
Place of PublicationS.l.
Print ISBNs9789058087249
Publication statusPublished - 2002


  • elderly
  • old age
  • home care
  • health care
  • social security
  • social change
  • rural areas
  • indonesia

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