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Submitted to: Dr. Marlon Era, Ph.D.
In partial fulfillment of the requirements in ABS679D:
Research Utilization and Policy Advocacy
July 15, 2015
Department of Political Science
College of Liberal Arts
DE LA SALLE UNIVERSITY
2401 Taft Avenue, Manila
Picture taken from www.inquirer.net
Alfredo M. Antonio, Ph.D. Development Studies
Challenges to the Filipino Family as Traditional Caregivers:
The Changing Landscape of Long Term Care Management
of the Filipino Elderly
Prospects for a Community-Based Communal Health Care
Challenges to the Filipino Family as Traditional Caregivers: The Changing Landscape of
Long Term Care Management of the Filipino Elderly
Prospects for a Community-Based Communal Health Care
A Paper Submitted to Dr. Marlon Era, Ph.D.
In partial fulfillment of the requirements in ABS679D:
Research Utilization and Policy Advocacy
Submitted by: Alfredo M. Antonio, Ph.D. Development Studies student
Department of Political Science, De La Salle University -Manila
A B S T R A C T
Filipino families are under pressure to maintain “ownership” of taking care of their respective el-
derly as globalization and international migration put pressure on the family as traditional caregivers .
Family members opt to leave the country or seek opportunities elsewhere in the country. The poorer
families are at risk of defaulting in this culturally ingrained task, and may have to pick the alternative
of sending their elderly to the home for the aged which is not customary for Filipinos. The current
policy regimes – provision of discount on food and medicines and the granting of a social pension to
underprivileged senior citizens 65 and above – are palliative at best, although they stretch the meager
incomes of these families that live below the poverty level. Other factors such as gaps in the targeting
system and operational capacity of the OSCAs to manage their tasks contribute to the misery of the
elderly. The Philippines may not be able to go the route of the welfare states in managing the long -
term care of the elderly; an alternative type of methodological care – one that expands the concept of
the family to include other community stakeholders that will also be operating under a voluntary sys-
tem of assistance – is therefore being proposed. This paper proposes the establishment of a broadened
community-based center for caring for the most indigent senior citizens in the barangay or municipal-
ity utilizing traditional cultural values such as pagtutulungan and bayanihan. In the process, efforts
and resources are hoped to be directed toward a broader community-based and multi-stakeholder
“attack” on caregiving for indigent senior citizens.
Keywords: senior citizens; family as caregiver; aging in the Philippines; methods in long -term
care of the elderly; RA 9994 implementation; cultural determinants in elderly care; commu-
nity-based residential facility; stakeholders participation in elderly care
Introduction
The Philippines has a young population. More than 6.8 percent of its 100.1 million population as of 2014 are
made up of people aged 60 and above.
While this is so, Philippine society has not yet reached the stage of being an aging population.
The United Nations defines a society to be aging if the percentage of the population 65 years and above
reaches 7 percent of the total. Factors that contribute to an aging population are declining fertility rates and
increasing life expectancy or declining mortality rates. These phenomena lead to “smaller proportions of
children and larger proportionate shares of older people in the population (UN Department of Economic and
Social Affairs, 2013). The Philippines’ fertility rate is still within the 3 percent range per annum but is ex-
pected to decrease within 1.73 to 2.31 in 2030-2040 (Philippine Daily Inquirer 2014) while life expectancy
is placed at 72.49 at present (Philippine Country Report 2014).
The current landscape of health care assistance to the Filipino elderly, mainly family-based and family-ori-
ented, is under threat. Globalization and international migration impact on traditional caregiving (Laguna
2013). As family members attempt to find work outside the country, the number of traditional caregivers
and their collective effort to care for the elderly dwindle.
Nonetheless, families struggle to retain their status as traditional caregivers. Even then the family as the
country’s traditional social security mechanism for the old maybe falling short of its duties and responsibili-
ties to the elderly (Cruz and Camhol, 2014). It is not surprising that a core strategy of the Philippines’ De-
partment of Social Welfare and Development is to extend assistance to families and other community care-
givers, to wit: As a result of urban and labor migration, the family as the “sole institution in which care for
the elderly is outsourced undergoes pressure” and therefore, “the institution of family as a cradle of care for
the elderly should be reinforced, the same with center and community -based program approaches which
will serve as alternatives” (Philippine Country Report 2014).
As discourse moves away from the family as the traditional channel of caregiving, it becomes an imperative
to find lasting solutions to this pressing concern. With this as background, I attempt to explore in this paper
the possibility of shifting the locus of caregiving to the community, one that will be ably supported by stake-
holders in the spirit of traditional Filipino values of bayanihan and pagtutulungan. Within the framework of
current debates and emerging practice as to which approach to caregiving may be applicable to the Philip-
pine setting, I am proposing to incorporate a cultural perspective to caring for the elderly in a community-
based setting. I deem this particularly significant when viewed within the context that indigent senior citi-
zens in the Philippines sorely lack in care assistance and are being marginalized from the mainstream of
adequate long-term support, care and assistance.
While Carlos (1999) had identified five main concerns of the Filipino elderly, this paper touches only on the
formal care of indigent senior citizens in homes for the aged – either already existing or in the process of
being developed. This particular concern was highlighted in the Philippine Country Report submitted during
the 5th ASEAN and Japan High Level Officials Meeting on Caring Societies in Tokyo, Japan in 2007, to wit:
Development and improvement of service infrastructure and management of centers and institutions in
an environment based on both traditional and modern institutions that will be able to meet present and
future needs of an aging citizenry (Philippine Country Report: 5).
Threats to traditional caregiving: requiring urgent solutions
Poverty incidence based on official government statistics is placed at 24.9 percent while subsistence inci-
dence – those living below the food threshold (P5,590 average per month) – is placed at 10.7 percent. Those
families who are in subsistence level are referred to as the poorest of the poor (Philippine Statistics Authority
as quoted in Philippine Star 2014). Labor migration is rampant. An estimated average of 6,000 Filipinos
leave the country each day to work as contract workers in the Middle East and elsewhere (Ibon Statisitcs
2015). This is not at all surprising due to the fact that the minimum wage as of 2015 is still pegged at P481
per day, not enough to cover the P8,022 target monthly poverty threshold to cover food and non -food ex-
penses for a family of five.
The government estimates the number of indigent senior citizens population aged 65 and above to be around
940,000 (DSWD 2015). Republic Act 9994, otherwise known as the Expanded Senior Citizens Act of 2010,
considers an indigent senior citizen as “any elderly who is frail, sickly, or with disability, and without pension
or regular source of income, compensation or financial assistance from his/her relatives to support his/her
basic needs, as determined by the Department of Social Welfare and Development (DSWD) in consultation
with the National Coordinating and Monitoring Board (NCMB).”
In the Philippine Longitudinal Study of Aging (PLSOA), 2007, older persons interviewed noted that they were
suffering from an average health level: not very good but not in a level that they are nearing death. Many
suffer from partial or permanent disabilities (poor eyesight and hearing and immobility and f rom certain
diseases). Some earn their livelihood from still working and pension (government and/or Social Security)
while a number do not have any source of income at all and rely solely on family members for support : one
in four elderly had a son or a daughter working abroad that sent them money on a regular basis. An unin-
tended consequence of such an arrangement is that older persons are also expected to assist in rearing the
grandchildren as the latter’s parents leave the house to work locally or abroad (Cruz 2014).
Filipinos take pride in their reverence for the elderly as this task has been enshrined in the Philippine Con-
stitution. Article 15, Section 4 of the Constitution states that “it is the duty of the family to take care of the
elderly members while the State may design programs of social security for them.” The value system of utang
na loob (debt of gratitude) is deeply ingrained in the Filipino psyche, that is why, it might be unthinkable for
Filipino families to commit the elderly to residential homes or institutions unless circumstances proved to
be extreme such that this phenomenon cannot be avoided.
How to best manage the long-term care of indigent senior citizens: discussing current methodological
debates
Scholarly articles have weighed on the advantages and disadvantages of approaches in the elderly’s long-
term care, that is, which among welfare state-sanctioned support regimes could prove to be cost-efficient
and cost-effective in the long run.
The purely biomedical approach, that is, treating the elderly patients in hospital or clinical settings, and
addressing aging from a biological or a scientific point of view may have lost its appeal and effectiveness.
Studies have found out that patients who have been recently treated in hospitals are prone to get sick again
a few weeks after their release from the hospital. Contributory factors include the absence of support mem-
bers during their recuperation phase and a disconnect between the place of treatment and the place where
the elderly patients come back to since more often than not, caregivers do not have an idea about the medi-
cation and process of healing of the patients. There is now the argument that there should be some form of
transition care from the hospital to the community where the elderly belongs (Rooney and Arbaje 2013).
Aging in place seems to be the most favored approach to taking care of the elderly as this allows for the
latter to take care of themselves or to be taken care of in areas where they lived as they can freely move there
and do the things that they have been accustomed to do. Often, it is difficult for the elderly to leave behind a
comfortable setting, familiar community and many memories (www.seniorresource.com). In the United
States, this practice is being maximized as the government subsidizes the cost of medicines and food of the
sick patients through Medicare.
Other types of caring for the elderly are the following:
1) Caring for the elderly in nursing homes or residential institutions: these are often private insti-
tutions staffed by medical practitioners who take care of the elderly in a setting that approximates
the house, except that the elderly live by themselves – not with their families.
2) Home care and community-based care: this is a little bit confusing as home care (and community-
based care) could also be synonymous with AIP. As defined by the Red Cross and Red Crescent Soci-
eties, this type of elderly care refers to a “help and support for older people who are in need of care
and/or nursing and who are living at home – alone or with family members.” Support can come from
informal carers (relatives, friends and neighbors).
Studies have argued against the benefits of taking care of the elderly in the places where they live as opposed
to institutions or residences (Chen 2012). Community care has been criticized in the United Kingdom as not
being cost-effective in the long run given the demands of “local” caregivers to be compensated for taking care
of their elderly. Part of this concern sprang from the fact that community care in the UK grew in the 1960’s
as the welfare system expanded; however, owing to the economic crisis in the 1970’s, social policy had to be
rethought in favor of what has been termed as welfare pluralism or sourcing of social and health welfare
assistance from a variety of service providers, not only from the government (Johnson as cited in Chen 2012).
From the point of view of Filipinos who take care of the elderly – and based on literature review – I observed
the following as evident:
1) The elderly, regardless of their health and mental condition, are taken care of at their respective
homes by family members. This is a cultural imperative and is firmly upheld by vir tue of cultural
beliefs. It is not common for children or other relatives of the frail and sickly elderly to commit them
to a public or government-owned residential institution or a “home for the aged” (Somera 1997).
2) Many senior citizens who lived in the homes for the aged were brought there by neighbors who could
no longer take care of them or social workers who found them in the streets wandering and nowhere
to go.
3) The elderly can opt to live alone but at some point, other family members would be looki ng after
them.
Current response: local strategies in addressing concerns of the elderly
Mandated government agency to oversee programs implementation
The DSWD is the officially mandated agency to advocate for the rights and interests of the senior citizens in
the Philippines. It is the lead oversight agency in the implementation of the components of the Philippine
Plan of Action for Senior Citizens (PPASC 2012-2016), along with other government agencies. It also chairs
the NCMB which is mandated to monitor the implementation of RA 9994.
Enactment and implementation of laws on senior citizens’ welfare
Two major laws were enacted to address elderly concerns, namely, RA 7876 or the Senior Center Law and
RA 9994. RA 7876 mandates the establishment of a senior center in all LGUs to address livelihood, and health
and general well-being concerns of the elderly while RA 9994 provides for a 20 percent discoun t on basic
food and medicine purchases. RA 9994 likewise mandates the establishment of an Office for Senior Citizens’
Affairs (OSCAs) under the office of the mayor with the primary task of facilitating the release of senior ID’s
which are required in availing of the discount. The OSCA is also mandated to provide avenues for the elderly
to engage in social and recreational activities.
RA 9994 provided for the granting of a social pension to indigent senior citizens, a feat that had been met
with initial with jubilation by local groups who had been clamoring for its passage (HelpAge International
2011). The pension is aimed at supplementing the elderly’s food and medicine expenses. As it stands, the
amount of the social pension is P500 per month and is rele ased to indigent senior citizen’s families on a
quarterly basis. In April 2015, the cut-off age for the social pension program was lowered from 77 to 65 with
an approved P5.962 billion budget, a 92 percent increase from last year’s P3.108B (Philippine Sta r 2015).
This figure is seen to benefit 939,609 senior citizens this year.
The OSCA has a big responsibility in updating the list of social pensioners in the localities: validation, enroll-
ment or replacement, and cancellation of members. Considering the p oor record of OSCA in attending to
senior citizen complaints and their lack of personnel and facilities, it may be too much to ask for this office
to put on the “added work called for in implementing the SP program” (Farolan 2011). To date, no formal
evaluation has been done to gauge the effectiveness of the OSCAs in handling their assigned tasks relative to
the social pension program.
Local government response
The LGUs run the OSCAs as the lead local unit to deal with DSWD offices in planning and imple menting ac-
tivities for the elderly. In provincial and city governments, these entities are mandated by RA 7160 or the
Local Government Code of 1991 to establish an Office of Social Welfare and Development that is tasked to
oversee planning and implementation of service delivery projects to cater to various sectors within the LGU.
The LGUs through the provincial or city or municipal councils enact ordinances that supplement the man-
dated laws. Allocating a small portion of their Internal Revenue Allotment (IRA), a number of LGUs initiated
projects that allow for the elderly to receive other cash grants and health assistance (free or discounted
check-ups, laboratory exams, medicines, etc.) Some LGUs have a burial plan for the elderly – to cover the
expenses. Often cited cases, as they are deemed to be exemplary models for others are Makati and Marikina.
Makati is rather known for the cakes delivered to the houses of the elderly on their birthdays.
Focus on the public homes for the aged
The DSWD runs the following homes for the aged nationwide:
1) Haven for the Elderly, formerly known as the Golden Acres Home for the Aged (Tanay, Rizal)
2) Golden Reception and Action for the Elderly and Other Special Cases (Graces), located in Bago Bantay,
Quezon City
3) Homes for the Aged (Zamboanga City and Tagum City)
The Golden Acres Home for the Aged
1
, formerly located at the back of SM North EDSA which transferred to a
bigger facility in Tanay, Rizal in 2010. The new facility, now called Haven for the Elderly, boasts of new
residential homes and a full-time staffing composed of doctors, nurses, social workers and other aides. The
facility housed 213 residents in 2014 and “promotes balanced lifestyle by fostering independence and
providing social care.” (DSWD 2014).
DSWD published stories of how residents of Haven for the Elderly were thankful that “they found a new
home” or that “they were given opportunities to grow old peacefully.” Since no external evaluation has been
done to assess the effectiveness of government-run homes for the aged in managing the multi-faceted re-
quirements of the elderly, these may be regarded as self-serving at best.
The City of Manila runs the Liwayway ng Maynila, an institution for homeless and sick elderly from Manila,
located within the Boys and Girls Town Complex in Marikina. I visited this facility in 2006, and upon talking
with the center management, I learned the center had to contend with a meager budget for food of the el-
derly; supplies such as diapers, soap and clean blankets often run out being that the care for the sick and
dying elderly becomes intensive and the demand for washing and drying the beddings increases as the “res-
idents” near their death-bed.
Cases of abuse against the elderly in such homes are being talked about but si nce abuses rarely figured in
police reports, they tended to be anecdotal at best (Carlos 1999). To date, there is no formal study conducted
by the DSWD to determine the extent of violence or abuse committed against the elderly in public or privately
run nursing homes.
Zooming in on existing approaches: some critique and observations
The discount on food and medicine purchases indeed is helpful in stretching the budget of families that have
senior members that take maintenance medicines or those that undergo expensive treatments such as peri-
toneal dialysis. And while the government noted some violations in the implementation of RA 9994 – Rep.
Rufus Rodriguez and his brother from ABAMIN Party List filed House Re solution 1892 to seek clarification
from selected restaurants as regards the non-extension of the full 20 percent discount to senior citizens
(House of Representatives 2015) – the law is being followed to a greater extent.
1
Somera (1997) famously described this as the Home in his seminal publication (Bordered aging: Ethnography of daily
life in a Filipino home for the aged. Manila: De La Salle University Press). Somera noted that bureaucratic procedures
hampered the provision of adequate care to the elderly in the Home. He coined the term “bureaucratization of death”
to describe the delay in the release of the dead to the partner funeral parlor and subsequent burial in identified ceme-
teries due to forms that had to be filled up and unsystematic arrangements pertinent to these.
The social pension program as it is being implemented is another “stretching” move to support the needs of
the indigent senior citizens. Even the government does not harbor any illusions that the P500 per month
release to the beneficiaries could do wonders for the senior citizens themselves or their families. Without a
regular source of income or if income is barely enough to meet the needs of five member, families will find
that such a response remains palliative.
Granted that the government could not go the so-called welfare route of the more developed countries, much
needs to be done in planning and implementing programs and projects for the elde rly. For one, the system
of identifying and enrolling the most indigent among the senior citizens needs to improve: those that need
the assistance most should be participating in this program. The National Household Targeting System
(NHTS) or Listahanan as it is being conducted by the DSWD is primarily aimed at identifying and listing poor
households to make them eligible for the 4Ps or the Pantawid Pamilyang Pilipino Program. In other words,
the subject of the survey is not the elderly per se but poor households where the elderly can be found. Con-
comitant with this is the need to facilitate the data-gathering process to make sure that indigent senior citi-
zens are immediately enrolled in the SPP since they literally do not have much time in terms of availing the
P500 monthly allowance.
The technical capacity of the OSCAs to handle their respective tasks related to the abovementioned serves as
as an obstacle in ensuring that the current programs work to benefit the elderly.
As it is, the Philippines does not have a holistic approach to addressing the long-term requirements of the
country’s senior citizens. There seems to be a major disconnect as to what the situation or context requires
and the solutions being put forward. What is needed is to ensure that the sick and frail elderly are taken
care of where they are situated, that is, in communities where they live side by side with people that they
know personally or with groups or individuals that will be in a position to take care of them twenty-four-
seven (24/7).
Areas for improvement or why is it noteworthy to factor in cultural perspectives in managi ng indi-
gent senior citizen’s long term care
Cultural determinants of aging are well documented in various studies.
Studies have accounted for perception about personal health care and subsequent aging as somehow influ-
enced by culture. Asians, in particular, Japanese, who now have the highest life expectancy in the world at
80 years, tend to emphasize collectivism and community processes (living with the support of families and
neighbors) more than the Americans’ preponderance for individualism and liberalism (living alone) as they
age in communities (Karasawa, Kitayama, et al 2011).
Cultural factors also influence perspectives in health policy in Asia. A 2013 study in Hong Kong revealed that
nearly half of residents in the former British colony thought that younger people should be prioritized in
terms of health care support more than the elderly (Mak, Woo et al 2013). This is not to say that the Chinese
population in HK does not regard the elderly highly; on the contrary, they do, except that the vie w to rank it
as a priority for the government to address springs from the fact that “death still remains a taboo subject in
this country” (Ibid). In Latin America, treatment of elderly patients is seen as becoming entirely successful
and should thus push through if it is done with the full consent of immediate family members (Gutierrez
1998 as cited in Rooney and Arbajo 2013).
Nonetheless, various literatures do not necessarily agree on what constitutes successful aging. Cultural var-
iables often factor in the equation (Lockenhoff, De Fruyt, Terraciano, A., et al 2009).
As it is not customary for Filipinos to commit the elderly to nursing homes or homes for the aged, the goal
for families is to take care them at the household level, if not look for external carers – relatives or neighbors
– that will take care of them while the breadwinners go out (sometimes out of the country) to work. I view
this as an emerging concept of caregiving. If the sick and frail elderly could not be taken care of by their own
families, then the concept of the traditional family as it is needs to evolve to include other people – stake-
holders – in the community. Families who have above average incomes could hire the paid services of rela-
tives or neighbors to take care of their respective elderly but for families who are poor, an alternative is to
entrust their sick and frail elderly to a residential facility that they can visit on a regular basis and whose
carers may be in a position to work together – as volunteers and as committed community stakeholders.
Current homes for the aged could only accommodate a limited number of “transient” clientele. Moreover,
the Haven for the Elderly is located far from where Metro Manila urban poor resides. It is also a generalist
residence, so to speak, since any homeless and family-less senior citizen could be welcomed, regardless of
their health and mental status. However, support centers that will allow for frail and sickly elderly to be
taken care of in areas where they can be found (in barangays or central towns in municipalities) to alleviate
poor families’ onus of tending to them in their respective houses do not exist at the moment. Given current
realities being faced by families, I am firm in my analysis that the need for such a “locally grown” institution
must be concretized, whether the elderly is a social pensioner or not
2
.
Painting broad strokes: how this community-based communal residence for the aged could look like
I reckon the following to be broad guidelines and principles in conceptualizing and establishing working
community-based facilities for indigent senior citizens:
a) The facility will be under the auspices of the LGU (barangay or municipal level) and must be located
in a town center or in a barangay that has a significant number of indigent senior citizens. It should
not be confused with a hospital wing for dying senior citizens: those who need serious medical con-
sideration should be confined in a hospital setting.
b) The facility must subscribe to elderly-friendly construction standards to secure the indigent senior
citizens’ general well-being.
c) The facility will make full use of rotational volunteers from community stakeholders such as church
organizations, volunteer societies, nearby Nursing schools and similar academic institutions, and
other groups (possibly students who are enrolled in the National Service Training Program).
d) Systems, policies and procedures that would ensure a smooth functioning of the latter will have to
be devised using a participatory methodological approach as it is a general community undertaking
I have identified core requirements to make the idea operational:
a) Site identification and land titling. It should be constructed in a government land. The facility must
be spacious enough for the elderly to be able to walk or to more around or just plainly “enjoy the
view”.
b) Funding sources: Construction funds may be sourced out from international donor agencies. Regular
donations from the community, including from the relatives of the indigent senior citizens, will be
needed to fund programs and projects for the residence.
c) Core of carers/caregivers: Initially, a few full-time health personnel (a doctor, a nurse and a social
worker) may be needed; however, since the facility would make full use of community support, the
need to keep volunteer work going may be difficult and may not be sustained in the long run for
carers may have to ask for some volunteer allowance.
d) The process of firming up the plan must be done in a participatory way and planners must come from
a multi-disciplinary background (social sciences; engineering; social work and community develop-
ment; health sciences; psychology; environmental sciences; spiritual and religious background; etc.).
e) Ethics and goals of the center must be clearly shared with the volunteers – all stakeholders must
understand the principles of volunteerism, working together and respecting the rights and dignity of
the elderly. The full values of pakikipagtulungan (cooperation) and bayanihan (volunteerism) will
be explored.
2
The senior center at present does not address this but in some LGUs that alrady have such a facility, it may be wise to
reconfigure use and budget sources.
f) Documentation and monitoring and evaluation will be incorporated as main requirements in resi-
dential management and administration. The facility’s management will report regularly to the
NCMB about the progress of administration and support services.
Expected benefits and results
Participatory research will be able to identify the neediest among the senior citizens in identified locali-
ties.
Those who will be taken care of in the community residence will be afforded a sense of belongingness
and a feeling of having a “super extended” family.
The team of carers can learn from a cooperative process of living out traditional values of pakikipagtulun-
gan and bayanihan.
Participating families – those who would choose to “drop” their elderly in the facility could have more
time to do productive work.
The project will expand the “territory” of DSWD and the government as part and parcel of a long-term
decentralization plan.
Conclusion
There is a saying that desperate times call for desperate measures. Indigent senior citizens are experiencing
the brunt of changes in the traditional family caregiving setting. The situation in the households necessitates
that family members work, either locally or overseas, to provide for their respective families and the elderly
parents or relatives. The indigent Filipino elderly, left with no tangible source of income, are likely to suffer
more in their twilight years. They are predisposed to “age in place” without Medicare or an adequate social
pension being afforded their counterparts in developed countries.
Interestingly, while a social pension program and a discount on food and medicine purchases policy are being
implemented by the government, these are not enough to sustain the health and other requirements of indi-
gent senior citizens. The number of enrolled in the SPP is still limited and the amount as it currently stands
is just meant to augment whatever income accrues to the elderly at the moment. The process of enlisting
indigent elderly in the Listahanan with the assistance of the OSCAs should be foolproof that all deserving
participants could be included in the SPP, and that the implementation of the social pension program itself
would be sped up given the limited “availability” of the frail elderly.
Even as changes have been noted in the management of the homes for the aged – with the transfer of the
Golden Acres to the new location in Tanay – it would take some time for Filipino families to even consider
the idea of having the elderly pass their remaining time on earth in such a facility. The issue of abuse in
residential homes for the aged is not even discussed here.
It is within this aforementioned context that the probity of having a localized and an accessible residential
facility for the indigent senior citizens based in the barangay or a central area in a municipality should thus
be examined and considered. At the core of such a concept would be the practice of full volunteerism and
community stakeholder assistance from planning to implementation to monitoring and evaluation in an at-
tempt to stretch the definition of family.
In a way, actualizing this concept of a localized residential facility for indigent senior citizens is in anticipation
of the eventual aging of Philippine society which should take place within the foreseeable future, considering
the foreseen decrease in fertility rates about 15 years from now and an increase in life expectancy among
Filipinos. Whether such an idea could prosper in the intermediate future will depend on the determination
and assertiveness of LGUs in realizing the Filipino’s deep reverence for the older generations. In the mean-
time, informal and exploratory talks with interested LGUs within Metro Manila can be done and the possibil-
ity of conducting a technical study to assess its feasibility could be discussed.
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