Filipino families are extended, with sometimes three generations sharing one roof. There are innumerable branches of cousins, nieces, nephews, tito (uncle), and tita (aunt) that surface during family reunions occasioned usually by births and deaths.

The convolutions of Filipino family life are rationalized by the irredeemable realities of ageing, sickness, and death cushioned by an unlimited army of relatives caring for their elderly in their twilight years.

Yet, many Filipinos pity a couple without children, as well as the only child who singlehandedly faces the burden of caring for both parents.

For other realities have seeped into and altered the Filipino version of life insurance: the family takes care of its own from birth to death.

The economy dislocates Filipino families through poverty, women’s full-time employment, overseas work, and migration.

In families where the elderly is perceived to present unwanted burdens on their relatives’ time, resources, and even space in drastically reduced mass housing units, the practice is to hire a kasambahay or helper to care for elderly members.

A professional caregiver, such as a trained caregiver, midwife or private nurse, was once thought to be an extravagance afforded only by the wealthy.

Yet, many nurses are leaving the Philippines for overseas to seek better compensation and working conditions. Hospital nurses manage as many as 20 patients instead of the Department of Health standard of 12 patients for every nurse in the ward.

With overworked nurses, many Filipinos feel the need to engage a caregiver for admitted relatives, especially the elderly needing maintenance medical procedures, like hemodialysis and chemotherapy, or limited in their mobility and capacity for self-care.

Many families embrace helpers and caregivers as members of their households for the essential roles they play, especially during the coronavirus disease (Covid-19) pandemic and community lockdowns.

Yet, there are risks involved in completely delegating all responsibilities of caring for the elderly to helpers and caregivers. The rates of elder abuse increased during the Covid-19 pandemic, as monitored by the World Health Organization (WHO).

The abuse of older people can be a single act or repeated acts carried out in a relationship with an older person that should involve trust and confidence but results in the harm or distress of the elderly.

Neglect or lack of appropriate action preventing the elder’s access to basic services or fulfillment of basic needs also falls under elder abuse.

The WHO considers elder abuse as a “type of violence (that) constitutes a violation of human rights.”

Elder abuse involves “physical, sexual, psychological, and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.”

A medical doctor recalled the shock of seeing the bruises and old wounds covering the arms, legs, and back of the neck of her mother after hospice staff informed the family that her mother, a hospice resident, died from cardiac arrest.

Tied down by work and family, the doctor hired two helpers to accompany her mother at the hospice, which was located above the emergency room of the hospital where the doctor worked.

While the helpers were pleasant and professional during the doctor’s infrequent visits, hospice staff reported the helpers focused on their smart phones and abandoned the elderly woman slouched in her wheelchair or left out in the midday sun.

On hindsight, the doctor admitted she should have listened to her mother’s complaints and replaced the helpers. What cuts her up is the realization that her late mother endured months of abuse from strangers.

However, neglect and apathy from the family of the deceased was part of the tragedy of elder abuse.