BEIRUT: When Mohammad Hamza suffered his third stroke in 1998, he took matters into his remaining functional hand. Half-paralyzed, he decided he would not be a burden on his daughters. He checked himself into Dar al-Ajaza al-Islamia, a hospital and shelter for the old and disabled founded in 1952 near Beirut’s Sports City.
Hamza, 66 from Baalbek, was spending a recent Friday morning in the center’s courtyard, reading a book of translated Russian poetry. He loves reading philosophy, and greatly admires Socrates, because he chose to drink hemlock (poison) rather than break the law.
“Idleness is the poison of the mind,” he said, explaining why he spends his time reading. He kept the book pinned between his hip and paralyzed arm as he slowly shuffled across the courtyard.
Following the stroke, his doctor told him the treatment would be long and costly, and advised him to go to the nursing home.
“I have seven daughters and no boys,” he said. “My in-laws will bear with me for a month, two, three, a year, and then what?”
Hamza’s family visits him regularly. He also ventures back home to visit his wife, who has back problems and cannot come to the center. He wakes up every day for the dawn prayers, then morning coffee and breakfast. After that, he does physiotherapy, listens to music, and reads.
“You must continue with life,” Hamza said.
He is one of 275 elderly patients being cared for in the hospital, many of whom suffer from illnesses brought on by the onset of old age, such as Alzheimer’s. The center provides them with housing, medical and psychiatric treatment, nursing, social services and entertainment.
Care for th elderly care is a growing concern as medical advances extend the human life span, often while enduring chronic illnesses. People who are over 65 now make up nearly 10 percent of the Lebanese population, according to the Social Affairs Ministry, and their share of the population is expected to rise in the next few years, blunting the famed Arab youth bulge.
“There were a lot of illnesses that cause death and now have treatments,” said Azzam Houri, Dar al-Ajaza’s general director.
Houri estimates the number of old people in nursing homes in Lebanon to be about 1 percent of the total number of people over 65, in 52 institutions in the country, about 3,500 in total.
The issue of elderly homes is emotionally charged.
The family unit is paramount in most Arab societies, and sons and daughters who send their parents to an elderly home risk being stigmatized and labeled as ungrateful children.
“Unfortunately, a large percentage of families stop visiting,” he said, blaming changing values. “We are becoming a more materialistic society.”
But keeping an elderly loved one at home is not always in his or her best interest, Houri said, especially when he or she needs specialized treatment.
Houri beams as he tours the facilities of the hospital – from specialty clinics, X-ray machines, small elevators for patients, a medical lab and pharmacy, even carpentry and steel workshops, and an oxygen plant.
Some of the rooms are lined with mosaics and collage artwork made using threads and small rocks by patients – an attempt to engage them and work their minds in a persistent battle with ennui and mental entropy.
“The point is to keep pushing them toward independence,” he continued.
The hallways where the elderly live are bustling with life and noise, some lying down to relax on leather chairs while others play cards or take a smoke break by the window.
There are currently no specialties in geriatric or elderly care in Lebanese nursing schools, but nurses in the field pick up the experience by working with patients. Some schools offer occasional lectures or activities focusing on the subject.
Marina Adra is a clinical assistant professor at the Rafik Hariri School of Nursing in AUB and a member of the Lebanese Center for Studies on Aging, which encourages academicians to study aging and students to specialize in the field.
Adra, who spent time observing two nursing homes in Lebanon as part of her doctorate, which was published this summer on the website of the University of Manchester, said she grew concerned because of a sense of “powerlessness and helplessness” that she sensed among patients.
Adra said that there was a lack of legislation for elderly care, a need that is growing more urgent as families face economic pressures and travel abroad to work outside the country, leaving behind older family members.
Government pension schemes don’t cover treatment in nursing homes, though Dar al-Ajaza, which is a non-profit organization, is funded partially through government contributions and partially through donations, but funding is an issue.
Adra said there had been an increase in residents of nursing homes despite the stigma.
“It is against our cultural tradition to send parents to the nursing home but it is changing because more women are working nowadays and there is nobody to take care of the older person,” she said.
According to her research, one of the main problems facing elderly care in Lebanon is a lack of specialists, both among physicians and nurses. A paper in 2012 said there were just seven geriatricians in Lebanon, and the field is not particularly appealing to graduates of medical schools.
“They probably think that this is an older person who is 80 or 85 years old and he’s eventually going to die,” Adra added. “Aging was not considered as a priority.”
On the family side, she stressed the need for older people to have good relations with their families and staff to reduce their anxiety and distress.
Another problem that Adra identified is the gap between what older people expect their life would be like, and how it actually is. While in the West the elderly are expected to continue contributing to society, in Lebanon they are often seen as incapacitated.
“[He or] she should be considered an active member of the community, visited by the family, allowed to have some autonomy and privacy,” she said.