Advanced age is marked by physiological, psychological, and social changes (Leslie & Hankey, 2015). Physically, it leads to loss of muscle mass, increased body fat, physical weakness, limited physical activity, and a reduced resting metabolism (McLean & Kiel, 2015). Elderly people are more vulnerable to injury than other age groups, and therefore require assistance and care in their everyday activities. Every elderly person requires physical, psychological, spiritual, and social service as well as guidance. The means by which these needs are fulfilled are determined both socially and culturally. In other words, various responses to aging, including elderly care, are part of a society's sociocultural choices. However, each country and culture has specific indicators that define old age. In the context of this study, people over 60 years of age are referred to as “elderly” based on Law No. 13 of 1998 concerning Elderly Welfare (Bappenas RI, 2020).

Anne Leonara Blaakilde (2001) has shown how the misery narrative has colored debate over the elderly and elderly care, even though there is significant evidence that the elderly can have happy lives as they prepare to transition to the afterlife. Such narratives also fail to illustrate the unique subjectivities of women in their individual and social preparations for the afterlife. Based on this assumption, it is necessary to understand the basis for transformations in elderly care, the connections between the elderly and their families and communities, and their autonomy in decision-making.

Researchers have found that dementia is a significant factor in determining the placement of the elderly in care homes, noting that 80% of adults aged 65 years and older have at least one chronic health problem (Andel et al., 2007). This fact influences life and care patterns within families. In this context, it is necessary to consider which environments are appropriate to the needs, desires, and habits of the elderly to ensure their quality of life (Hansen & Gottschalk, 2006). Where standards of care at home are lacking, elderly care homes are considered a solution. In these care facilities, for example, the nutritional needs of the elderly can be met (Buckinx et al., 2017), thereby avoiding the common problem of malnutrition.

As individuals enter advanced age, their families remain their basic social unit and help them satisfy their needs, both physical needs such as food and shelter and social needs such as love and acceptance (Huitt, 2004). Families can help improve the psychological welfare of the elderly and reduce their stress levels.

Frequently, the elderly are seen as nurturers of their grandchildren, and through them, other family members may also find love and nurture (Giang et al., 2019). Simultaneously, the elderly seek to give meaning to themselves through their children and grandchildren. Many studies have found that filial piety, including family values, influences how the elderly live. Orientation toward family values can be seen through families' allocation of love, the lack of which may be why many individuals do not feel at home in elderly care homes (Saarnio, Boström, Hedman, Gustavsson, & Öhlén, 2017). Family bonds may therefore significantly influence the treatment the elderly receive from their families.

Psychological issues, such as depression, are quite common among the elderly and influence how they live. Adjustments are essential for client comfort in elderly care homes. Wreksoatmodjo (2013) found that visits to such homes can significantly influence mental health, as visits from family members and friends provide the elderly with significant emotional support, separation from family being a common fear among those in nursing homes. However, at the same time, it is also common for the elderly to consciously choose to live apart from their families to ensure greater privacy and peace.

Community and social bonds are essential factors that influence the quality of life enjoyed by the elderly. In other words, social relationships and interactions within a specific community determine its continued survival (Rapaport Lurie, Cohen, Lahadeg, & Limor Aharonson, 2018). In this context, elderly care homes may be seen as communities in which members support and help each other during the remainder of their lives. Existing studies have emphasized the need to understand such homes as families or communities that include specific emotional bonds. Simultaneously, these care homes offer specific environments, including appropriate food, that may improve quality of life. Shared understanding and individual and community perceptions can create a sense of trust, provide a collective identity, and improve sharing (Abrams & Hogg, 2001), because of such considerations, clients and their families may consciously choose elderly care homes.

Women play an important role in the social and cultural structure of the Minangkabau ethnic community in Western Sumatra, Indonesia. The Minangkabau are one of the few ethnic groups in the world that adhere to a matrilineal system in which women determine their lineage and have the power to be reckoned with in society. Women are also owners of the rights to large family inheritances, including land and houses, so they can expect a proper place and support from their family in their old age. However, over the last 20 years, this has changed. Many women are no longer accorded a position in the family in their old age, as they are considered a burden and are neglected. This has led to an increased demand for nursing homes in Western Sumatra as institutions that can assist these elderly women.

The change in care for the elderly from families to nursing homes has not been caused by a breakdown of the matrilineal system in Minangkabau. However, there have been some changes in that system, notably a weakening of extended family ties, and especially so among families that place their elderly family members in nursing homes. Ideally, in Minangkabau culture, living in an extended family system is the core of a matrilineal family (Hartati, Minza, & Yuniarti, 2021).

Every woman, including the elderly, is subordinated to being part of a family that lives in a communal and collective spirit supported by shared ownership such as the rumah gadang, the clan's inheritance, and the penghulu kaum (chief of lineage) as the clan leader. However, traditional elements have changed, and this includes the concept of family, which has shifted from an extended to a nuclear family.

Changes in the matrilineal system in Minangkabau society have occurred evolutionarily as a consequence of the culture of merantau (migrating) and the latent impact of modernization and globalization. Interaction with knowledge from foreign cultures has changed the Minangkabau generation understanding of local cultural values, such as the principles of kinship, collectivity, and responsibility. This includes responsibility for elderly care, which was previously the full responsibility of the family but is now starting to shift to nursing homes. This shows that the shift in the institutions of care for the elderly from extended families to nursing homes in some Minangkabau communities is a form of flexibility in the Minangkabau culture to modify and adapt to various external influences coming from outside.

Elderly care homes in West Sumatra were established using a top-down approach implemented by the Department of Social Affairs in the 1980s. The increasing number of nursing homes in the Minangkabau community is based on the growing needs of the community due to the number of elderly requiring care outside their families. In the early years of their founding, they were not readily accepted by community leaders, who perceived them negatively. However, despite this, nursing homes have survived and developed significantly. Today, opposition to and negative perceptions of elderly care homes are rarely heard, and they appear to have been accepted by Minangkabau society. The head of the Sabai Nan Aluih Nursing Home stated:

From my recent observations, since 2000, the strong reaction of community leaders regarding the reason for bringing in their elderly family members to be cared for in elderly care homes has become feeble, and they consider it a matter and decision for the respective families. (Interview, July 15, 2022).

This statement is in line with the view of the mayor of the Padang Pariaman Regency:

The community is becoming more realistic; we from the Nagari government can only allow it if there is a request for a letter of recommendation to receive support at elderly care homes. Many elderly people living in villages have been neglected. There was no one to care for or provide for their needs. Family members from more distant relatives are already busy with their affairs, and their average standard of living is also poor. (Interview, July 23, 2022).

These statements show that the shift in the pattern of elderly care in the Minangkabau community occurred because of the need to ensure the welfare of the elderly where it was being neglected by the family. This can be observed in the data gathered from the elderly and presented in Table 1.

Table 1 gives information about the circumstances of the elderly women interviewed in this study, including their relatively low level of education and their economic dependence on productive-aged family members. Their marital histories indicate that while some never married, the majority are widows. This suggests that most respondents lived independently and relied on assistance from their children and other family members.

Most interviewees stated that they had sought care in a nursing home because circumstances forced them. The desire to avoid burdening their families was the dominant reason, and was linked to their families' limited financial capacity (see Table 2). Family poverty is not only a factor that may drive elderly women to seek nursing home care, it is also a criterion for entering government-run homes. This is illustrated by Mrs. RSM, an elderly woman living in the nursing home. According to her:

“I entered this elderly care home because of these circumstances. Previously, I lived with a daughter with five children whose husband worked as an elementary school caretaker. We lived together in cramped and uncomfortable elementary school caretaker’s accommodation. When my daughter or her husband scolded their children, I felt like I was being scolded by them myself. When I received information about elderly care at the nursing home, I secretly looked for a way to move there (Interview on August 12, 2022)

Other factors that could potentially drive women to seek elderly care outside their family home include dilapidated residences, limited receipt of care at home (i.e., required to wash their clothes), and violence/disrespect by family members. Almost half of the respondents presently receiving elderly care at exceptional homes had previously lived in their own houses.

Although economic factors and negligence are among the causes of changes in the care of elderly women and the increasing use of nursing homes, they are not the only factors. Other key factors relate to the transformation of the cultural system of Minangkabau matrilineal society. The shift in the family system from the extended to the nuclear family, the impact of the culture of merantau, and changes in ownership patterns of communal land and the move from rumah gadang to smaller houses have led to a decline in the power of Minangkabau women. This change has affected the responsibility of caring for the elderly, which has shifted from the extended to the immediate family. This becomes a problem for elderly people who do not have children or elderly people who are neglected in their nuclear families.

The transition of care for elderly women in Minangkabau from a rumah gadang to a nursing home is an indicator of the waning economic power of Minangkabau women. The rumah gadang and other family possessions are central to their power and if jurisdiction over them is lost, Minangkabau women would lose control and this could impel elderly women to seek care elsewhere (see Table 2).

The practice of asking their families rather than the penghulu kaum (chief of lineage) for permission to live in an elderly care home also indicates the decreased role of the kaum (extended family) as the main foundation of the matrilineal system. The decision to seek a place in a home is made through discussions with family members, both nuclear and extended. The need for such discussions indicates limited social cohesion within families.

Interviewees indicated that they were happy to live in an elderly care home and most suggested that they no longer wanted to live with their families. Most also preferred to be buried at their care homes, indicating the extent of the distance that has been created between themselves and their past, despite being part of matrilineal families.

When women seek care in nursing homes, it can be surmised that the power of their traditional culture has been eroded. Extended families can no longer guarantee their members safety and security. The rumah gadang, a symbol of the extended family, is seen as inefficient and requiring too much upkeep. Communal land (tanahulayat) is similarly no longer able to maintain the bonds within extended families, and the penghulu kaum can no longer protect family members (Ikhwan, Barlian, & Syah, 2023). Kinship relations are built based on a mutual understanding of the family’s actual conditions, as stated by a more distant relative of the informant, Mrs. RSM:

Relationships within the extended family are mutually understandable because family life is, on average, difficult. If there is a celebration, we will help as much as possible, and if there is no material, we can only use our energy and thoughts. (Interview on August 12, 2022)

However, receiving care in an elderly care home does not mean that women forget their families; some women may return to their family homes either temporarily or permanently, perhaps for fear of contracting a communicable disease or simply because they feel like doing to. However, women are rarely invited by their children to return to their family home, even though, during visits, administrators frequently urge family members to bring their relative home with them.

In this regard, some families firmly state their unwillingness to have the elderly live in their homes (again), viewing it as most beneficial for them to live in an elderly care home. This indicates that members cannot provide the necessary care or may be unwilling to have their comfort disturbed because of the need to provide care. Other reasons for families not bringing the elderly home include the following: (1) living in an elderly care home is what the woman desires, and thus she does not need to return home; (2) the woman appears comfortable living in an elderly care home and thus should not be brought home to a small, crowded house; and (3) nobody at home could care for the woman. This third reason indicates a perception of elderly women as an undesirable burden.

Families may or may not be willing to accept such women into their homes; however, they are generally not sure that the women would be ready to join them. The main reason they want to stay in the elderly care homes is that they already feel “distant” from their previous life within their family, as stated by YM:

Why would I expect to live outside the elderly care home again? I used to live with the family of my adopted child, who we raised at a young age. While living with them, Mother felt lonely. In this elderly care home, Mother has many friends of the same fate, the mosque is also close by for worship, and the elderly care home manager provides food. Let Mother wait for death to pick her up at this elderly care home. (Interview on June 4, 2022)

Some walinagari (village heads) who disapprove of elderly care homes cite a normative understanding that families are the ideal elderly caregivers. They do not recognize societal changes and argue that religious and customary teachings do not provide for such a care regimen. They believe that all matters can be resolved through traditional mechanisms and discussions. Meanwhile, other walinagari focus more on what is best for elderly individuals themselves rather than on normative values. Some approve of elderly care homes, but with some caveats, including the situation of the elderly themselves. If an elderly individual lives alone, seemingly abandoned by family, it is best for that person to enter an elderly care home. This reflects the tendency of the Minangkabau people to find normative and practical solutions.

The shift in elderly care from extended families to government-run homes can be seen as part of the dynamic of Minangkabau society, including its social acceptance of the change. On the one hand, shifts in elderly care may be seen as deviating from ideal behavioral patterns; on the other, this shift may be seen as a consequence of long-term transformations in Minangkabau society.

Over time, women, including those with family problems, have come to perceive elderly care as desirable. However, many elderly women in these homes rarely receive visits from their families, including their children, and some have never received any visits since becoming residents. In such cases, their presence in elderly care homes appears to be a means of relieving the burden on their families. One common reason elderly women are placed in care homes is the limited financial capacity of their children.

While receiving care, some women are actively involved, refusing to be treated as passive objects. These women take care of themselves and may even have chosen to enter a care home without previous discussions with their extended families or the penghulu kaum. As cultural actors, these women can distance themselves from the cultural expectations of collective decision-making. By entering elderly care homes, they can redefine their social positions and reject the traditions that dictate how they live. Such facts prove that the social solidarity of the Minangkabau people has begun to shift and concern for the welfare of elderly family members has decreased.

The position for men differs somewhat in this respect, as in the matrilineal Minangkabau society they occupy a vulnerable position; this is particularly true for widowers, who are expected to remain within their matrilineal family structure and live in a surau (prayer hall). This vulnerability is worst when men have no daughters. If they have no children at all and their wives have died, men must make a difficult decision: will they return to their extended families, remarry (although this may not resolve the situation), or live alone and face psychological isolation (Endrizal, 2006). Living in a surau after becoming a widower is similar to living in an elderly care home. Indeed, this institution may be viewed as a prototypical care facility within the Minangkabau social system. This differs significantly from the situation experienced by women, whose lives and security are supposedly guaranteed within the matrilineal system owing to their control of their extended family’s inheritance and rumah gadang (Reenen, 1996).

It is essential to consider the growth in elderly care homes within the context of the social transformations occurring in Minangkabau society. They have become “magnets” for change in elderly care. Initially, they were poorly understood by the communities. Over time, they have become known as alternative places where elderly women with social problems can receive care. These women feel more comfortable and safe in these facilities, and their food, shelter, and healthcare needs are guaranteed. At elderly care homes, they can pray solemnly and interact with other elderly individuals. This is one reason why many elderly women are happy to live in care homes and, conversely, unwilling to live with their families.

Over time, elderly care homes have come to be perceived in West Sumatra as an alternative for women with difficulties within their families and communities. They have positioned themselves as, “actors” capable of making conscious choices and undertaking actions to abandon the matrilineal structure and create new chapters in their lives. When the social and kinship system limits their individual freedom, women can gather new information and become more aware of how these facilities can meet their needs.