Caring has traditionally fallen to women: caring for babies and children, invalids, the elderly and infirm. It still does.

But massive generational shifts are rewriting the context in which that care happens.

Women of the baby boomer generation who cared for elderly parents likely did so after their children had left home. Many were not engaged in full-time work outside the home.

Their kids are caught in a new squeeze. Gen X are more likely to be single parents and working mothers, to be raising teenagers while in their 40s and 50s and to have kids in their 20s who haven't left home or achieved financial independence.


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Add to that disappearing jobs (especially of the full-time, permanent, meaningful kind) and housing their kids can't afford. No other generation has had to juggle caring for infirm parents with so many other responsibilities and pressures. No wonder retirement villages and rest homes are booming.

There's persistent talk of beastly, ungrateful children but reality is always more complex. Often older people don't want to live with their kids, for any number of understandable reasons.

Saddened by news of yet another rest home closure in Whanganui, I've been reflecting on how these trends have expressed themselves in my own family.

My mother is now 77 ("very old", she tells me frequently). As a teen, her widower grandfather lived with her family, which she remembers fondly.

Both mum's parents lived into their 90s. My gran ended her days in Whanganui rest homes, moving here to be close to mum after several bad falls ended independent living. Gran settled surprisingly well into a small, family-owned rest home on St John's Hill.

But she was devastated when the home was sold and she had to move.

Her decline was sudden after that. Mum kept doggedly visiting every day, even as gran shut out the world, refusing to talk or respond. Mum, at a loss of what else to do, would shout in her ear about the events of the day and leave disheartened.


Unsurprisingly, given that experience, my mum isn't very keen on rest homes. She was forced to spend several months at Whanganui's Nazareth rest home in 2013 while she recovered from a fractured hip.

I appreciated the new wing (quiet and warm thanks to double-glazing and modern insulation, equipped with en suites), the expansive views and beauty of the surrounds - and Helen, the patient and capable nurse manager. I was grateful mum was being well fed and cared for.

Things have moved quickly since the March 14 announcement that Nazareth would close. Only a handful of residents remain now.

The number of staff who have found new positions is steadily increasing but some of those jobs are outside of Whanganui. Some former residents have also moved out of town.

Reflecting sadly on all this has sent me back to Atul Gawande's masterful book, Being Mortal: Illness, Medicine and What Matters in the End.

This American cancer surgeon is a gifted writer and he fearlessly raises the big issues of suffering, mortality and the meaning of life.

We've all heard the horror stories that periodically emerge about badly run rest homes - filth, neglect, deprivation, restraints, abuse. But even a clean and safe facility can be bleak and breed despair.

For instance, Gawande points out that the families of elderly people generally rate safety as a paramount concern, and so do the institutions that provide for them. Falls for instance must be documented, investigated and reported as a means to reducing their occurrence.

But old people, themselves, typically value autonomy and independence more than safety ... there are worse things than dying.

My gran was survived by the youngest of her four siblings, who in turn lived into her 90s. I saw Kit not long before she died. She had had to leave the small rest home in the city suburb where she had lived her whole adult life. There, she had been rooted in place, connected to places and people that mattered to her. She attended her local church and met for lunch with lifelong friends.

As she became more frail, she needed hospital-level care and that forced a move to a larger rest home, a flash one far away that was favoured by her children.

Kit was dislocated from almost everything familiar and she was frustrated and unhappy.

I saw her one morning after she had overbalanced again. A carer told her if it happened again, she would be confined to bed. It felt like a threat to Kit, the last contraction of the edges of her world.

I was even sadder because - thanks to Gawande - I had already learned about a growing movement that has revitalised elder care in some parts of the United States. It could have been different for Kit.

Gawande tells the story of Bill Thomas, a maverick doctor who turned things upside down at an New York nursing home in the 90s. In came pets and pot plants in every room, and a hundred parakeets. All at once.

There was chaos, there was tension with staff ... and, in among it all, the residents began to thrive. Formerly withdrawn residents began to talk and laugh or offer to take the dogs for a walk. Prescriptions dropped and, with it, the drugs bill; death rates fell.

There were three plagues of nursing home existence, according to Thomas: Boredom, loneliness and helplessness. To counter them everywhere, he and his wife founded an "elder-directed model of care" known as The Eden Alternative.

Happily, it has made its way to New Zealand and it's noteworthy that Kowhainui Home, right here in Whanganui, is one of just seven fully registered Eden Alternative rest homes in New Zealand.

Our country's largest retirement villages and rest homes are corporations run by chief executives who must account for profits to their directors and shareholders. Glossy marketing shows off their impressive buildings and facilities, populated by laughing, active seniors.

Is a larger room and an ensuite bathroom nice to have? Yes, it is.

But ask those who work in the sector and they'll tell you what my family came to know - more important than the infrastructure are the people who work there. Care, continuity, connection and community - those things never stop being important.

■Being Mortal is available at the Davis Library.
■Rachel Rose is a Whanganui-based writer and daughter. More information, plus sources, can be found at