The Limits of Aging Services in Turkey

All societies have their perceptions of evaluating a particular social phenomenon despite their desires for a common ground to benefit from the universal human experience. This doesn`t mean need need to create a monotype or unique societal understanding by eliminating diversity. By contrast, the sharing of experiences among various societies helps them to understand each other while enjoying their differences. In Turkey, for example, there is still a kind of stereotype in benefiting from experiences of “other” societies. One might argue that the reason might lie on a long history of staying in an imperial position, leading many societies, but the historical records shows us that the Ottoman background of Turkey was based on reciprocal relationship with various local cultures and foreign societies. So the reason can be associated to the mournful effects of the collapse of the Ottoman Empire and the growth of the nationalist movement accusing some local cultures and foreign societies or countries as main providers of the collapse. Therefore, this work is important for examining the limits of the aging services for the elderly persons and why nursing home, for example, is still not a well adopted phenomenon in Turkey.


Introduction
The perception of aging service models differs from society to society, but the reality is the same by showing its strong impacts on the older adult population. Some societies were introduced by this concept earlier and thereby they have showed a progress in developing aging services and even their alternatives, but some societies like Turkey resist in accepting the reality although they have a strong background to build their futures on. This is nothing than benefiting from a universal human experience. Interestingly, there is still a fear of benefiting from some other experiences and learning from mistakes of other societies in Turkey. Without a doubt, there are several reasons behind the logic of developing of this fear. The primary reason can be related to the dramatic effects of the collapse of the Ottoman Empire. In particular, the remnants of old empires have an interesting behavior in accepting "the reality" and learning to adopt universal human experiences. That is because their futures are ridden by the past and they look all concepts retrospectively.

The Reasons for Late Advent of Aging Services in Turkey
There are many reasons for late advent of aging services for the older adults in Turkey. Perhaps the primary reason is related to a political point of view stating any adopted technology and institutions cannot be separated from their cultural components.
For this reason, how to adopt them either with minimum cultural influence or without cultural influence was a major concern of the Ottoman-Turkish scholars [1]. The active role of religious affiliated groups and the reluctance of Ottoman-Turkish society in opening nursing homes before 1900 show the level of a hesitation in adopting nursing home, a Western oriented facility, to the Ottoman-Turkish society. For instance, religious affiliated groups (Christians and Jews) had built five nursing homes before 1900 and a nursing home in 1937, whereas Turkish people started to build nursing homes in 1950. One can only see a rise in number of nursing homes in 1970 and a dramatic increase after 1980 [2].
However, Darülaceze (almhouse) is an exception that needs to be mentioned. It was built up by Ottoman Sultan Abdülhamid II in 1895 to show the Sultan also had something to do for his subjects. There are two main academic trends in evaluation of Darülaceze. One of these trends tends to completely disregard the nursing home aspect of Darülaceze. By doing that, it is believed that the reality of religious affiliated nursing homes will be out of vision by not seeing one of their counterparts. The other trend accepts the nursing home aspect of Darülaceze by showing it more than a nursing home. Especially, in Turkish literature the concept of müessese (institution) is being used for this facility. Although this facility has http://www.ijSciences.com Volume 5 -February 2016 (02) 60 a part of the same story with poorhouses transformation into public old age home in American society in terms of including all paupers, it is hard to argue that the keeping other age groups in its separate parts makes it an institution more than a nursing home [3]. This is because the main focus of facility is older adults-not to mention how this population is diverse in itself.
Filial responsibility is another reason for late advent of aging services for the older adults in Turkey. One of the family members, especially elder son is responsible for taking care of his aged parents even though the burden of work is on the shoulder of his wife, the daughter-in-law. Although the rapid urbanization and active participation of women in the public space paved the way for alternative solutions for the aging services, traditional form of service was able to reproduce itself in significant part of society. For example, elder pension is supposed to contribute a relatively more independence to older adults, but it has become one of the main factors for keeping older adults in the family setting, especially during the fiscal crisis. In a similar vein, inability of married couples to pay the expenses of kindergarten for their children helps aged parents to stay at home for looking after their grandchildren [4]. This reciprocal relationship may contribute family and help older adults to "age in place." Nevertheless, the flip side of this condition prolongs the lifetime of the problems of older adults in the family setting and closes main borders for any possible external interventions. That is to say, individual freedom becomes family freedom and personal privacy turns into family privacy. Therefore, the external intervention faces with family resistance although the issue is about a particular life of a family member. Thus, any decision about the placement of older adults, for example, in an institutional setting is required the permission of family members and even belonging community.
On the other hand, although the birth rate has begun to decrease in the recent years, the youths or children are evaluated as future of the country. It is interesting to note that in the rural areas of Turkey a child means "social security" for the aged parents since they don`t have deserving pensions due to lacks of formal or governmental works. Furthermore, the high number of children means the unpaid or cheap labor and social power for the family in the rural areas. Such an inclination has a strong relationship with the borders of development of aging services for the older adults in the rural areas of Turkey. That is to say, any regulations for improvement of older adults situation can be seen a part of conspiracy theory of reducing the birth rate in Turkey. For instance, nationalists believe that if people know their future can be guaranteed by the state providing nursing home service for example, they would not have more children.
The negative image of nursing home is another reason for less improvement of aging services for the older adults in Turkey. Even the perception of nursing home in the USA is as follows: But nursing home is another world entirely, an alien and forbidding environment. It is a part of the health care system with which most of us have little contact. The truth is that nursing homes have no visible or positive place in our social landscape. There are no soap operas about life in a nursing home as there are television dramas set in hospitals. Most Americans have a distaste of nursing homes and would just as soon forget about them, except when scandals momentarily capture the public attention. At those moments of ritualized public horror, we are likely to insist, with high moral fervor, "There must be a better way." [5]. (Moody, 1992: 4-5).
This perception has been formed through many unfortunate incidents occurring in the nursing homes in Turkey, too. For example, after releasing of some elder abuse scenes in a nursing home in Beyaz Melek (White Angel) movie, people started to question what is going on in the nursing homes. The unfortunate incidents covering the pages of newspapers show this is not just about a movie dramatizing a particular incident. Conversely, it shows a tip of iceberg about elder abuse and domestic violence.
It is not hard to predict that the residents who do not have children and relatives mostly face abuse. The statistics of about the residents of nursing homes provides a hint for elder abuse incidents. 81% of nursing home residents don`t have a living relatives. Furthermore, the picture is almost the same today whether or not people have started to name the situation as loneliness [6].
As seen, the reasons for inability of development of aging services for the older adults is not only due to political choices and strong family or community relations, but it is also owing to inadequacy of present services. As it is well known, American society developed a "better way" by Eden Alternative and Green House to break the stereotypes about aging services. Who knows Turkish society well then might accept that there is a lot to learn from these universal experiences.

Rethinking "Total Institution"
"Total institution" displays the problem of institutional setting in terms of aging services [7]. However, whether or not the nursing home is a "total institution" raises question. That is because nursing home is different from "total institutions" such as the prison and mental asylum because the residents of nursing home are not stigmatized as being done for inmates of prison and mental asylum. Also, the inhabitants of total institutions are seen as threat to society and danger to the social order [8]. On the other hand, discipline and punish are main characters of modern institutions and there is a power realizing itself by staying out of vision. In the metaphor of Foucault's panopticon, all inmates feel they are being observed by the power due to inserted camera system in the panoptic prison model [9].
After this short theoretical background, one can easily argue that it is hard to either separate nursing homes from total institutions or see them completely as total institutions. Turkish nursing homes show the character of total institutions in that there are strict rules and regulations restraining the autonomy of the residents. There is only a difference in the exercising of power in the Turkish nursing homes that as opposed to Faucault`s panoptic power metaphor well equipped with high technology, the power needs to demonstrate itself instead of dominating the resident from the back of the stage. Turkish nursing home system is different from total institutions because the residents are not stigmatized as threat to society and supposed to be tamed for obeying social rules and regulations.
Whether or not Turkish nursing home system is total institution, it is evident that with its present condition it doesn`t provide a good example for providing services for the older adults in Turkey. For this reason, one needs to humanize this institutional setting by giving more autonomy to the residents. Moreover, their active participation in decision making process in the nursing home is crucial. That is because this can be a way to break system of rules and regulations imposed from above by the power.

The Borders of Aging Services in the U.S. and Turkey
As aforementioned, one can easily see how Turkish society is reluctant to develop aging services for the aged. On the contrary, aging services were promoted by "aging enterprise" in the U.S. For example, I visited Good Samaritan Denton Village and had ten hours service in addition to have a depth interview with Director of Resource Development Katrina McPherson and wellness coordinator Becky N. Proctor and some residents. As they said and mentioned in Good Samaritan Society-Denton Village`s Resident Handbook, The Evangelical Lutherian Good Samaritan Society is the nation`s largest not-for-profit provider of long -term care and senior services. It was built in 1922 at Arthur, North Dakota. Now it serves 27,000 residents in more than 240 locations within the U.S.
As seen, it might be unfair to compare 300 million over populated country with 79 million less populated state, but the 240 facilities of Good Samaritan shows that the perception of the U.S. toward the aging services is completely different. It is impossible to have this big network without the promotion of the state.

Filial Responsibility, Duty-Laden Practices, and Autonomy of Older Adults
While comparing the development of aging services in Turkey and the U.S., the structure of the family comes to mind as well. For example, since Turkey is still mostly a traditional society, filial responsibility is strong there. For example, elder son is supposed to take care of his parents although the most of the burden is on the shoulders of the daughter-in-law. It is interesting to note that although with the modernity women entered public space more and don`t have much time to take care of the aged, the elderly are still under the umbrella of the family. However, during my depth interview with older adults I realized that they were not quite happy about informal family care. For example, one of the male older adults stated that he had to stay with one of his son, whereas his wife had to live with other one due to conflict between mother-in-law and daughter-inlaw. Another senior citizen complained about nonprofessional help. She stated that none of the family members can even use injector. She used an interesting word I would like to mention here: "araf (limbo)" She said, "We are living in araf and we don`t know whether we will go paradise or hell." To me, it explains all story of the aged not having enough services.
The exaggerated focus of duties as opposed to rights shows how the older adults were left as passive in Turkey instead of being active. In other words, there is not a balance between rights and duties. For instance, nursing homes are based on duty-laden rules and regulations. For being integrated to welfare state idea they are required to set a platform for their residents to put their rights in practice. For this reason, the active participation of residents in decision making process gains much importance. However, this decision should be collective and be made through consensus.
While looking Good Samaritan Denton Village, I observed that there is a relatively more autonomy of residents and the nursing homes specialists. For instance, the administrative building is not separated from the complex in the Good Samaritan Denton Village, whereas it is separate in Darülaceze. For this reason, the residents or their families can reach the administrators more easy to fix their problems. That is why one can say institutional setting is more humanized and the level of participation in decision making process is higher in the U.S. although the nursing homes are not quite welcomed by the U.S. citizens as opposed to independent livings.
In any cases, when you pay for something you have more rights to speak and use rights for what you paid for. In Turkey, most of the older adults don`t pay for their any expenses for aging services. As a result, their hands become weak to object any rules and regulations bestowed upon them. In the U.S., the aged pay plenty of money for the provided services. For this reason, they feel themselves free to object to the rules and regulations. Also, older adults have many alternatives in the U.S., but in Turkey they don`t have much alternatives. While interviewing one of the older adults about any other alternatives to the family care, she told me that the only alternative is the street.

Conclusion
Although the idea of aging services is the same in every society, the practices show great differences. For example, while looking the history of aging services in the U.S. and Turkey I faced with the same reality, but different practices. For example, there is a traditional perception of aging evading older adults from using their rights. Not only does it put aside the rights of older adults but it also exaggerates the enforcement of their duties. So it has become very hard to balance rights and obligations, but it is imperative that state should take more responsibility for well-being of their senior citizens. This is one of the basic requirements for being an apparatus of modern welfare state which is supposed to provide a platform to its citizens for enjoying their rights, especially social rights.
It is incongruous with nature of rights to be bestowed upon power in deserving way. For this reason, while talking about rights of older adults in an institutional setting, their active participation in decision making process gains more importance. However, such a decision should be a "collective decision" and made through consensus. Otherwise, it will be difficult to help people to get rid of institutional fear enriched by inadequate nursing homes in Turkey.