Nursing Homes and the Fifth Commandment

John M. Frame

 [Christian Culture (Aug., 2002), 2]

But if anyone does not provide for his relatives, and especially for members of his household, he has denied the faith and is worse than an unbeliever (1 Tim. 5:8).

Providing for our elders is love, but it is also justice. When we were young, we were helpless. Then our parents provided for all our needs.² When our parents become helpless, the roles must be reversed. We must provide everything for them, to the extent of their needs.

Those needs are more than financial. Older people often find themselves alone, without friends or family. They need companionship, mental stimulation, compassionate understanding, indeed love. So often the ideal place for them, when they can no longer live independently, is in the home of an adult child. Such home care enables the child more easily to meet the needs of his parent, and it gives the parent a real home, with loved ones and the support that only families can give.

In a fallen world, however, no situation is perfectly ideal. Home care for elderly relatives is often a difficult situation, both for the older person and for the younger family. So the younger adults often seek alternatives; but they often feel a sense of guilt about the prospect of sending their parents to live somewhere other than their family home.

Nursing homes, particularly, have developed bad reputations over recent decades. Studies have revealed deplorable care in many such institutions, as well as the tendency for younger relatives to abandon the nursing home residents. Many of those residents experience extreme loneliness and neglect. So Christians sometimes ask, is it ever legitimate to put an aged relative in a nursing home? Is such a decision ever in keeping with the fifth commandment?

There are several principles that bear on this issue:

1. It is not wrong in itself for parents to live apart from their children. Indeed, the original ordinance of marriage in Gen. 2:24 describes a man “leaving” his father and mother in order to “hold fast to his wife.” This principle does not rule out multi-generational living arrangements, but it does mean that marriage creates a new authority relationship that normally is expressed by the couple living apart from their parents. As long as a parent is able to live independently, such separation is desirable, though there are certainly advantages for parents and children living fairly close to one another.

2. Even when parents are ill or infirm, we should value their independence. If they can afford and obtain the care they need while living independently, and they prefer to do that, nobody ought to object. Children, of course, should monitor such situations closely, with a willingness to step in when needed.

3. There are some medical needs that preclude either independent living or living in a family home. These are becoming more common, as people live longer and medicine becomes more sophisticated. Sometimes these needs can best be met through a long-term nursing facility. We should be thankful to God that such institutions exist.

4. Of course, there are wide disparities in the quality and cost of nursing home care. One responsibility of children is to help their parents make wise decisions among alternatives.

5. Children should never abandon parents who have been institutionalized, but should visit often, providing prayer and emotional support.

6. When a nursing home patient has recovered to the point that such care is no longer needed or advantageous, the children should take responsibility to make other arrangements for their parents.

In short, nursing homes can play an important role in the life of Christian families. But children must take responsibility for determining how to use them in an overall context of love and care. Nursing homes should never be dumpsters for people nobody wants to have around. Rather, they should serve to supplement, when needed, a broad relationship of family care, motivated by love and honor.