“Honour thy father and thy mother”: the meaning of integrating migrant live-in caregivers for elderly in the Haredi society - challenges and barriers to culturally-sensitive interventions

ABSTRACT

Background and Purpose

This study seeks to examine the complexities of integrating migrant live-in caregivers for elderly in the Haredi society from the lens of elderly’s family members. The main research questions were – what is the meaning of integrating migrant live-in caregivers for elderly in the Haredi society, and what are the implications of these meanings for developing policies and interventions?

Materials and Methods

This phenomenological study included 15 adult family members of elderly people from the Haredi society who receive around-the-clock homecare from migrant caregivers. Data was collected through in-depth, semi-structured interviews.

Results

Three themes emerged from the interviews: The motives of family members to become the prime caregivers for their parents; The encounter between the values of the Haredi family and migrant live-in caregivers; The commandment to honour one’s parents, and whether the integration of a migrant caregiver is implementing this commandment.

Conclusions and Implications

Results shed light on family members’ attitudes, perceptions and interactions in a phenomenon not yet explored. The importance of these results is highlighted considering the potential conflict between the Haredi society as a faith-based community and migrant live-in caregivers. The results could help develop a culturally-sensitive social policy for faith-based societies.

KEYWORDS:

• Haredi society
• homecare
• migrant live-in caregivers
• phenomenological research
• value conflict

Introduction

Family members’ caring for their elderly parents has received broad theoretical and empirical research attention (Manning et al., 2019; Ris et al., 2019). One of the solutions for attending elderly’s needs nowadays is through integrating migrant live-in caregivers. This solution is accompanied by inter-generational and inter-cultural complexities and challenges (Shulyaev et al., 2020). In this study, we focus on this phenomenon within the Haredi society. This society is a distinct and closed community in the Israeli and global societies. However, in recent years, the Haredi society is undergoing significant changes, which appear in a variety of psycho-social contexts. One such change is the growing willingness to utilize welfare and health services offered by secular governmental and municipal authorities, such as social services departments and the National Insurance Institute (Band-Winterstein & Freund, 2015).

Further significant changes in recent years in the Haredi society are the growing population of elderly individuals, and the subsequent need to provide them with care (Maytles et al., 2021). The solution of integrating migrant live-in caregivers for elderly care in Haredi families is being examined and implemented as a culturally viable solution. On the one hand, this process is accompanied by cultural barriers (such as a possible resistance from community members); on the other hand, the scope of the cultural changes currently occurring within the Haredi society provides an opportunity to examine this change as well (Freund & Band-Winterstein, 2019).

For the Haredi society – as a faith-based society, which relies on a closed social system of unique attitudes, perceptions and values (Freund et al., 2019; Garrison, 2021) - this process creates a need to examine the experience of integrating migrant live-in caregivers, especially through the lens of the elderly’s family members, since they are obliged to set this arrangement for the sake of their aging parents. Hence, the aim of the current study is to offer an in-depth examination of the complexities involved in integrating migrant live-in caregivers for the elderly in the Haredi society. The study will explore its relevant implications from the lens of the elderly’s family members (i.e. children). Study’s results could also help develop suitable and culturally-sensitive social policies.

The Haredi society and aging

Faith-based communities are sub-cultures separated from the mainstream population, even though they do have a certain amount of relations with the surrounding environment (Wright & Davidson Mhonde, 2022). Faith-based communities encompasses all areas of the believers’ lives, while providing them with religious, educational, and social needs, from birth to death (Freund et al., 2019). These communities also have internal and separate means of support, communication, ideology and behavior (Ngin et al., 2020).

The Haredi community, as a faith-based community, is a differentiated group within the Jewish society in Israel and globally, characterized by extreme opinions in relation to religious belief and customs (Alfandari et al., 2021; Gemara et al., 2021). This society is given to community discipline, resulting from the community’s being subject to the authority of the Rabbinate, which encourages strong loyalty to the family, community and religious laws, and the strict obedience of behavioral codes (Baum, 2007). At the same time, this community is also characterized by a sophisticated network of mutual aid, based on Gemach (a Jewish free-loan fund), as a leading value (Klonover et al., 2022).

The Jewish tradition, upon which the Haredi society stands, tends to perceive the aging process as an important stage in life, and not necessarily as a period of physical and cognitive deterioration (Iecovich, 2013). In the Haredi society, elderly individuals are perceived as subjects of respect by the community, due to their rich life experience. longevity is also perceived by the Haredi community as a reward for a good deeds. Therefore, both the Haredi community and family are obliged to care for the elderly considering the respect they should receive. Moreover, in the Haredi society, the older men are, for the most part, the heads of multi-generational families and, in many cases, make the important decisions for the entire family (Yaffe, 2020).

Despite elderly’s higher status in the Haredi society, as they become older and older, they require more physical and social assistance to fulfil their basic needs, such as hygiene, accompaniment and supervision (Richardson et al., 2019; Serrano et al., 2019). In most cases, this assistance is performed by elderly’s children. Bear in mind that in the Haredi society, women tend to give birth in a relatively young age, and therefore most children of the elderly are grandparents of their own grandchildren. As a result, the daily care of the elderly is divided between several family members – children, grandchildren and more. This phenomenon is considered a “Mitzva” (a good deed) for family members who attend elderly’s needs. The caregiving of the elderly is vastly considered as an implication of one of the main moral commandment: “Honour Thy Father and Thy Mother” (or in Hebrew: Kibbud Av Va-Em), as represented in Blindstein’s (1976) seminal book that focused on the most enduring elements of the Jewish ethos. It is also important to state that in most cases, the elderly remains in their own homes and receive assistance from family members. In the Haredi society, it is very uncommon to place the elderly in a nursery home or other setting. Sometimes, when elderly’ functioning declines, they move into their children’s homes to be cared by them (Iecovich, 2013).

In recent years, there has been an increasing awareness that the multi-generational families in the Haredi society are experiencing overload, as most adults need to help not only their aging parents, but also their children and grandchildren (Arbel et al., 2022). This reality leads family members to examine alternative solutions for attending elderly’s basic needs. One such solution is the integration of a migrant live-in caregiver to provide this care.

Cultural sensitivity as a theoretical framework

Over the past years, Western society has undergone a transtitional change – from a homogenous society to a mutil-cultural, heterogenous society (Maddux et al., 2021). At the same time, we also understand that different communities have different needs. Professionals from different fields are required to recognize the fact that, when creating and implementing intervention programs, they must take into account the uniqueness of each individual (Greenberg et al., 2010). Furthermore, the currently-existing understanding is that early familiarity with the unique needs of different populations, and increased awareness and sensitivity to cultural, ethnic, and political contexts are critical steps for developing interventions in the areas of welfare and health, as it reflects the need for a multi-dimensional cultural approach.

Having stated that, it is important to understand that culturally-sensitive interventions do not embrace a homogeonous strategy. In other words, each individual intervention must be adapted to the specific culture, its values, worldviews, beliefs and perceptions (Baum, 2007; Itzhaki-Braun, 2021). Hence, it is important to address the “cultural knowledge”, which is the cultural background of the client. However, is is not enough to only know client’s cultural background, as it is also important that the professional understands the client, as well as his/her cultural heterogeneity, in order to propose the most suitable intervention in accordance with his/her specific culture (Russo-Netzer et al., 2021). In the next section, we will discuss the main issue of this study, which is – integrating migrant live-in caregivers for the elderly in the Haredi society.

Integrating migrant live-in caregivers for the elderly

As the lifespan becomes longer, there are more elderly individuals who experience limited functioning and chronic illness (Vinarski-Peretz & Halperin, 2022). As a result, it is necessary to develop and offer services that could support elderly’s care. Regarding the phenomenon being discussed in this study, homecare by migrant live-in caregivers serves as part of the elder care service package, as it allows the frail older adult to maintain his/her independence and to continue living at home in the community, instead of a nursery home.

In Israel, a total of 65,000 migrant live-in caregivers are currently employed. In the domestic care sector in Israel, the most common origin of the caregivers is from the Far East, mainly from the Philippines, India, Nepal, and Sri Lanka (Cohen-Mansfield & Golander, 2021; Talit et al., 2020), while other caregivers originated from Wastern European countries from the Former Soviet Union, such as Moldova and Ukraine (Kushnirovich & Raijman, 2022). By the year 2030, this number is expected to rise to 114,000 caregivers (Sabar et al., 2022). The relationshp between the older adult and the migrant live-in caregiver is highly significant (Cleland et al., 2021), since the migrant live-in caregiver is often perceived by the older adult and his family as a part of the family, which makes it possible to receive intimate assistance and emotional support.

This unique work environment creates a shared reality, which blurs the borders between work and the caregiver’s concern for the care-recipient (the older adult), and enables expressions of fondness and closeness, which go beyond the caregiver’s formal role and responsibilities. In addition, defining the caregiver’s area of responsibility and decision-making regarding the older adult and his home are not always clear (Ayalon, 2009). Therefore, it is important to explore this phenomenon as it ever growing.

Family members’ experiences of integrating migrant live-in caregivers

The literature shows that differences in cultural and ethnic background between migrant live-in caregivers and older adults and their families from specific cultures may lead to conflicts, tensions, and misunderstandings. Therefore, in order to create a beneficial encounter, both the migrant live-in caregiver and the elderly’s family members must become familiar with one another’s culture, in order to create a shared reality (Nielsen et al., 2015). Alternatively, it was found that sharing a similar culture – in the context of ethnicity, religion, and language – improves the quality of care and serves as a foundation for good relations between the older adult and the migrant live-in caregiver. An important result emphasizes that this cultural understanding is not the mere responsibility of one party, but is the outcome of mutual and shared interaction (Freund & Band-Winterstein, 2019; Llorente & Valverde, 2019).

Overcoming inter-cultural gaps and barriers in order to develop a shared reality requires cultural sensitivity, including a wide variety of communication skills, the ability to interpret body language, technical skills related to household management, and inter-relational skills (Iecovich, 2016). In the Haredi society, these types of cultural-ethnic-religious differences may be more extreme, and are even more important in the inter-relationship between the migrant live-in caregiver, the older adult and his/her family members (Ayalon et al., 2013). This issue will be further discussed in detail below.

Integrating migrant live-in caregiver into the homes of elderly in the Haredi society

Integrating migrant live-in caregivers to provide elder care is one of the alternatives for elderly care in the Haredi society, but it is still considered a controversial issue considering the inherent conservatism of this society. Ayalon (2011) stated that family members and professionals from the Haredi society tend to search other alternatives, before eventually integrating a migrant live-in caregiver. Therefore, this integration is considered the last resort when other alternatives did not apply. Ron (2020) also indicated a complex reality, in which the very idea of integrating migrant live-in caregivers for elderly care in the Haredi society resulted from constraints related to the reality of the multi-generational family in the Haredi society, which found it very difficult to care for their elderly parents, along with their children and grandchildren (Braun Lewensohn & Kalagy, 2019; Edelstein et al., 2018).

Even the Rabbis, as relevant authority figures, are now more willing to authorize assistance from migrant live-in caregivers, which has led to a change and new openness regarding the integration of migrant live-in caregivers in the the homes of elderly from the Haredi society (Band-Winterstein & Freund, 2015). We now address the two research questions: What is the meaning of integrating migrant live-in caregivers for elderly in the Haredi society (from the lens of family members), and what are the implications of these meanings for developing policies and interventions?

Materials and methods

The research method of this study was the qualitative-phenomenological method, whose aim is to provide deeper knowledge of the subjective meanings of integrating migrant live-in caregivers in elderly’s homes in the Haredi society, from the lens of their family members (sons and daughters). This theoretical, inductive, and interpretive approach illuminates the researched phenomenon and tries to explain it by relating to the “lived experience” of all involved parties (Smith et al., 2009).

Participants and sample

The unit of analysis in this research was one of the frail older adult’s sons or daughters, who served as the main caregiver for their older parent. The interviewees were performed through purposive sampling, among those who turned to social services departments, health clinics, and other agencies that provide nursing assistance services. The objective of this type of sample was to include participants who can provide variety and uniqueness regarding the phenomenon under study (Maxwell, 1996).

The sampling method used was criterion sampling (Patton, 2002). The following sampling criteria were included: adult children (sons or daughters) who serve as the main caregivers for their elderly parent (according to the National Insurance Institute’s definition: a man aged 67 and above, and a woman aged 62 and above) who is frail and requires a migrant live-in caregiver.

In the current sample, 15 family members were interviewed, 11 (73%) of which were women, and the rest were men (n = 4, 27%). Their mean age was 57 years of age (SD = 12.97), they had 7 children in average (SD = 2.45), and 4.67 siblings (SD = 2.42). Seven interviewees lived in Jerusalem (47% of the sample), four (27%) lived in Modi’in-Illit, and rest lived in Mevo Horon, Bnei Brak, and Tel Aviv. Regarding their religious affiliation, two interviewees (13%) were affiliated with the Haredi-nationalist community. This community represents Religious Zionists who pay high attention to observing Mitzvot, especially in the area of modesty, religious conservatism, considering the Torah as a supreme value and gender segregation in educational institutions (Lazar & Cohen, 2022). Further two interviewees (13%) were from the Hasidic community. This community splits into different factions. Each of the Hasidic communities has a leader (An “admor”, which a role that is often passed down through permanent family dynasties of rabbis). The major Hasidic communities are Gur, Vizhnitz, Satmar, Breslev, Belz, and Chabad (Bilu, 2020; Newman, 2022). Four interviewees (27%) were derived from the Lithuanian Haredi community. This community represents Haredi Ashkenazi Jews who do not belong to the Hasidic movement and even oppose it (Braun Lewensohn & Kalagy, 2019). The rest were Sepharadic and Ba’alei Tshuva. The Sepharadic community includes Jewish people originated from Islamic countries, the Iberian Peninsula (Spain and Portugal) and the Balkans. Finally, the Ba’alei Tshuva community, which is also called “repetants”, were previously secular, and made a decision to strengthen their religious belief by becoming ultra-Orthodox\Haredi (Newman, 2022).

Data collection

Data collection was carried out using semi-structured, in-depth interviews, whose objective was to allow participants to discuss the subjective significance of behaviors, feelings, attitudes, and worldviews about integrating migrant live-in caregivers for the elderly in the Haredi society. The interview guide was comprised of the content worlds developed in the research literature, and based on the authors’ prior familiarity with the research subject (McLeod, 2001; Patton, 2002).

One should also bear in mind that the current study was conducted within the framework of a closed faith-based community that protects its privacy and exhibits a relatively higher amount of suspicion towards the secular establishment. Therefore, in order to create trust, the interviewers themselves were two grad students from the Haredi society. One of them was male and the second was female in order to comply with participants’ religious and traditional values. All interviews were same-gender, as the male interviewer conducted the interviews with male participants, and the female interviewer conducted the interviews with female participants.

In addition to the abovementioned measures, full confidentiality and anonymity were also promised. All data regarding participants’ personal identification were obscured in order to prevent any type of identification. In regard to the environmental conditions of the interviews, bearting in mind the sensitivity of the participants-interviewers interaction in the Haredi society, all interviewers were asked to locate the interview in a quiet and comfortable place, preferably at the participants’ homes in which they can rest assure that their messages will be carefully listened to.

Data analysis

The first stage of the data analysis included relating to the individual perspective from within the family. In accordance with the phenomenological-interpretive approach (Smith et al., 2009), this stage requires identifying the “unit of meaning” in the interviews with each one of the interviewees, in order to find common themes (Patton, 2002). In the next stage, these themes were investigated and thoroughly analyzed; each theme was examined in the personal context, from the interviewee’s point of view. At this stage, the researchers examined the differences and similarities that emerged from the interviews – a process which generated a flood of new information about family dynamics and ecology, in the context of what it means to inegrate migrant live-in caregivers for the elderly in the Haredi society.

Procedure

The study received authorization from the Helsinki Committee of the University of Haifa’s faculty of Social Welfare and Health Sciences. After receiving this authorization, we addressed the managers of the various services, and requested their assistance in locating and accessing the study population. After contacting the participants and receiving their verbal consent, they were interviewed by Haredi interviewers, who specialize in qualitative research and are experienced in conducting in-depth interviews. All interviews were conducted in Hebrew. There were no interviews in the Yiddish language.

The researchers explained the study’s significance, the expected length of time of each interview, and received the interviewees’ formal agreement to participate in the study. During the recruitment process, the participants received general information about the research question, with an emphasis on transparency. The one-hour interviews were conducted, for the most part, at the homes of the interviewees. Each interviewee signed a consent form to participate in the study, and was told that s/he could stop the interview, and withdraw from the study at any time, without incurring any damages. The interviews were recorded verbatim for analysis purposes, in order to express the subjective experience in the interviewees’ own personal voice and language.

Limitations

The current study had some limitations, most of these derived from its qualitative nature. First, the study had a relatively small sample (fifteen family members in total). While reaching a theoretical saturation, it is still possible that expanding the sample range could have resulted in exploring new perspectives and insights. Second, the interview team was comprised from interviewers from the Haredi society. There is certain possibility of a cultural bias considering the similar opinions that could emerge between interviewers and intervieweers.

We anticipated these two limitations, and decided to proceed with our research plan, since the studies that related to the described phenomenon is still scant, and therefore it is important to explore it, and to shed light on an expanding phenomenon in the Haredi society and in faith-based communities in general. Regarding the possible cultural bias of the interviewers, each worked according to a pre-prepared interview guide, and while conducting and concluding the review – each reviewer was asked to add a reflection section in which he or she reflects on their own values and beliefs while conducting the review process.

Results

In this section, we will present the themes that deal with integrating a migrant live-in caregivers into the Haredi home setting, from the perspective of family members. The results included experiences, attitudes, and perceptions about the subject. In this analysis, three central themes were revealed. The first theme related to the question of “What causes a family member to initially become a main caregiver?”, The second theme relates to the significance of the encounter between the Haredi family and the migrant live-in caregiver. This theme embraces personal, cultural and religious aspects from the family’s perspective. The third theme focused on performing the commandment to honor one’s parents, and the ways in which this commandement is interpreted in the context of integrating a migrant live-in caregiver into the Haredi home setting in order to provide elder care.

Theme 1: what causes a family member to become a main caregiver?

The results show that three main factors lead family members to take on the main caregiver role in Haredi society: Personality traits, the nature and quality of the relationship with the parent, and family members’ life circumstances.

The first factor: personality traits

Several prominent personality traits had led the interviewees to become the family member serving as the main caregiver to their elderly parents. The first personality trait is the tendency to take responsibility and “take charge”. As N. explains: “I was always the responsible one. The one who takes charge, and care about my parents, in contrast to other [family members] who aren’t involved”. H. says: “Basically, I’m the type of person who takes responsibility, also at work. I am a take-charge sort of person; I just pay more attention, in general”. As is clear from these interviews, the traits of taking responsibility, concern for others, and a “take-charge” personality are mentioned among those family members who became their eldery parents’ main caregivers.

Another personality trait that came up in the interviews was emotional intelligence or the emotional ability expressed by attentiveness, the skill of containment, the ability to make others feel safe, and the ability to love. Y. says:

“Maybe I radiate a sense of confidence, something internal that I’m unaware of. I also have the ability to listen to others … I see it not only in regards to Mother. If someone has trouble with the family, he calls me. Not for money, because I have no money to give him”.

Y.’s comments show that his ability to listen, together with the way he inspires trust, make people feel they can lean on him.

The second factor: the nature and quality of one’s relationship with his parents

The quality of the relationship between the family member and his\her eldery parent was a significant factor in the very representation as the main caregiver. Some of the interviewees said that their relationship with their parent had already been significant before the need for assistance arose, and that this relationship played a role in their decision to take responsibility as a caregiver. E. explains: “All my life, my mother cared for me and protected me, and gave me everything. Everything I am today, and my whole life, I owe to her”. And A. added: “My relationship with my mother was always excellent, as a beloved and only daughter … even before we immigrated to Israel, we lived near her”.

This theme depicts the quality of the relationship with the parent before the need for assistance arose, as an additional factor expressed by both sons and daughters – a unique relationship, which serves as a motivating factor to become the main caregiver.

The third factor: life circumstances

The third factor that emerged from the interviews in relation to taking on the role of main caregiver to an elderly parent was various life circumstances, such as gender, birth order, geographic proximity, and extent of availability. Regarding the gender component, some claimed that daughters naturally take care of elderly parents more frequently than sons. As A. said: “I think it’s because I’m his [the elderly] daughter. In my opinion, sons take less responsibility in these situations”. In contrast, D. claims that Haredi men have more availability and freedom of choice when it comes to taking care of elderly parents: “It’s true that I have an older sister, but she must comply with her husband’s wishes, so it’s not so easy for her to always be available”.

Geographic proximity is also an important factor in determining which family member becomes the main caregiver of an elderly parent. The geographic proximity to the parent’s home makes care provision easier and more accessible. Therefore, many times, the family member who lives closest often becomes the main caregiver. As A. notes: “The fact that I live right here is also a significant factor – the geographical factor”.

Along these lines, it is worth noting the interview with E., which included several of those traits mentioned above, the total effect of which seemingly led to her becoming her mother’s main caregiver:

“My mother lives in an assisted living facility … which is close to where we live in Jerusalem. My other brother lives far away … I am simply the one who lives closest to her from a physical standpoint. And, being a woman, I’m the one who, in the end, takes care of most things that concern her”.

This theme explains and describes the characteristics that caused the son/daughter to become the main caregiver of an elderly frail parent. It is clear that various personality-related factors – including emotional intelligence, cognitive abilities such as the ability to understand and the skill of containment; the quality of the relationship with the parent before he/she became frail and in need of assistance; life circumstances such as geographic proximity to the parent, birth order, gender, and the stage at which the son or daughter’s nuclear family is (children’s age, number of married children, etc.) – all have a significant influence on deciding to initially become the main caregiver to an elderly parent, and carrying out this role. The next theme describes the experience of the encounter between the Haredi family and the migrant live-in caregiver, from the perspective of the main caregivers.

Theme 2: the nature of the encounter between the Haredi family and the migrant live-in caregiver

Integrating a migrant live-in caregiver into the home of a Haredi family may raise issues related to Halacha (Jewish law), culture, and perspectives, which force both the family and the migrant live-in worker to learn and adapt. Subjects such as Kashrut (Jewish dietary laws), keeping the Shabbat, Bishul Israel (directions of cooking and preparing food), modesty, and more – which are all significant to the Haredi family’s lifestyle – may seem strange and unfamiliar to the world of the migrant live-in caregiver.

The dietary laws are an important part in the life of the Haredi family. A food that does not comply with all of the dietary law requirements cannot be eaten, and any kitchenware whose handling violates these laws must be thrown away or undergo the Koshering process.

Therefore, many complex issues arose around this subject in the encounter with the migrant live-in worker, who is often required to prepare food for the elderly according to the Jewish dietary laws. R. explains that in the beginning, there were problems around this issue, but the family overcame them in a creative manner: “Then, one day, [the migrant live-in caregiver] made a mistake … she told me: ‘I did this. Is it alright?’ I said: ‘Okay, this frying pan – it’s yours now’. I gave her the frying pan, to cook for herself”. R. used the mistakes made by the migrant live-in caregiver to teach her about Kashrut. In addition, she gave the caregiver the frying pan as a present, as a way to avoid the embarrassment associated with throwing away the pan. Hence, R. describes the caregivers’ quick adoption of the rules. She explained how, at first, small mistakes were made, and small things were forgotten, but as time went on, the migrant caregiver learned how to fully observe the rules of Jewish law.

N. also believes that the migrant caregiver is well versed regarding the Jewish laws relating to Kashrut and Shabbat:

“She comes, she knows everything. Every Friday, she checks with me about when it’s time to light the Shabbat’s candles, and makes sure everything is prepared in time. She takes Mother to light the candles, she’s prepared, and helps her with the blessing. She also knows about Kosher products and she knows about keeping meat and dairy separate – she knows everything. A water heater for Shabbat, she cooks, and makes sure that everything is as it should be”.

Many times, the family must also adapt to the cultural changes the migrant live-in caregiver brings with her, such as the use of Technology and Internet. In this case, an initial conflict may occur between the needs of the caregiver and those of the family, after which both sides reach an agreement. D. relates to her experience and says: “She asked for Internet here at home, so I inquired and they [the Rabbis] said yes. In the 20^th century, they give them Internet, so I allowed it”.

Modesty (Tzni’ut) is a cornerstone in the worldview of the Haredi family. The migrant live-in caregiver, naturally comes from a culture where the dresscode has a different meaning. Therefore, the encounter between the ultra-Orthodox Haredi culture and the migrant live-in caregiver’s culture may cause various conflicts and complexities, which usually resolve themselves in a positive manner, as can be seen by D.‘s quote: “In the beginning, [the migrant live-in caregiver] hung her laundry in the window, also her underwear. I said: ‘you can’t do that here. There are boys outside’. How was she to know? She doesn’t know about such things. Why should she?”

Another subject that came up in the interviews dealt with the migrant live-in caregiver’s encounter with religious customs, not just Jewish law (such as attending synagogue and accompanying the elderly outside of the home). The religious encounter often serves as a unique link, connecting the migrant live-in caregiver and the family, as it provides subjects for discussion and similarities between the different religions and cultures. These links help create a better and closer relationship. R. explains that she feels the caregiver is a “spiritual” person, and has a special connection with her regarding prayer and the connection to God: “She is very respectful, she also prays and says ‘Thank God’ all the time … she likes going to the Western Wall to pray”.

M. also describes a good experience in the religious context and notes that the reality in which the migrant live-in caregiver also comes from a religious background – makes it easier to understand and take religious needs into consideration:

“Because she herself is religious, she can understand and respect it. She loves Judaism, she makes sure they have candles for Shabbat and she never touches the wine. She knows it is forbidden for her to turn on the stove and cook. She is fine with the fact that we are religious, because we respect her beliefs and don’t interfere”.

In this theme, the family members described the interest the migrant live-in caregiver shows in the encounter with life in a religious society. The family members relate the positive experiences resulting from the migrant live-in caregiver’s encounter with religious subjects, the connection between the two religions (Judaism and Christianity or Buddhism), a desire to learn more about Judaism, and the appreciation of various customs. In addition, it seems that some of the ways of life among the Haredi society are perceived by the migrant live-in caregiver as an advantage, such as the separation of kitchens because of Kashrut and more. The next theme also relates to performing Mitzvot (commandments) – specifically, the subject of honoring one’s parents.

Theme 3: how is the commandement to honor one’s parents perceived in relation to integrate a migrant live-in caregiver?

From the interviews conducted with the family members who serve as main caregivers, it emerged that Haredi family members focus on the subject of honoring one’s parents, and discuss among themselves the question of whether integrating a migrant live-in caregiver goes against this commandment or helps uphold it. The interviews show that, in most cases, the family members perceive the migrant live-in caregiver’s provision of physical needs as an act that maintains the parent’s dignity – a significant good deed in relation to performing the commandment to honor one’s parent. For example, A. said:

“Maybe it strengthens the commandment to honor one’s parent, for example, the adult diaper. I don’t know how comfortable my mother would be about her daughter changing her diaper and helping her in the bathroom … it’s more respectful when the migrant live-in caregiver does these things. that seems to me to be the best way to honor one’s parents”.

N. also elaborates about the way he receives feedback from the environment about his mother’s improved quality of life, and he perceives this as honoring one’s parents:

“I do perform the commandment of honoring one’s parent better. Even if I’m less present, the result is far better and more worthwhile, in relation to my parents, but also as regards my own life. People who have known my mother for many years think her situation has improved greatly since she has the migrant live-in caregiver, and this is also a way to honor one’s parents”.

However, there is still a certain sense of ambivalence that continues to accompany the family members, as can be seen in the following quote of E.:

“Maybe I would have gained more from performing the commandment to honor one’s parents, but maybe I would had gone crazy, and that would have made it less of a good deed … or not a good deed at all. I also wouldn’t have done it with all my heart, and that’s even worse, and my mother would have felt it, and that’s really not the way to do things”.

Another important aspect that emerged from the interviews is that one of the main ways to perform the commandment to “Honour Thy Father And Thy Mother” is by giving parents the possibility of staying in their home and their familiar environment. R. for example, says: “I think that the most respectful thing is for her to stay in her home, with all of her furniture from abroad. She’s got a lot of furniture that she’s really attached to”.

This theme relates to the various aspects of honoring one’s parents in the context of integrating migrant live-in caregiver. The interviewees’ responses show that integrating a migrant live-in caregiver is perceived by those family members who serve as their parents’ main caregivers as fulfilling the commandment to honor one’s parents, rather than denigrating it. Nevertheless, there remains a certain sense of ambivalence regarding the question of whether the care they provide their parents with is enough, whether they are available enough, or whether the the presence of the migrant live-in caregiver reduces their own presence.

There are several subjects which the interviewees mentioned regarding the commandment to honor one’s parents: Maintaining the parent’s dignity by providing assistance, emotional appeals to the parent, independence, continued living at home, and more. Almost all of the interviewees experienced integrating a migrant live-in caregiver as improving the frail parent’s situation – seemingly the most important factor – Meaning that integrating migrant live-in caregiver increases the respect shown to one’s parents, rather reducing it.

Discussion

Some very interesting results emerged from the analysis of the interviews. The current study’s research questions were: What is the meaning of integrating migrant live-in caregivers for elderly in the Haredi society, and what are the implications of these meanings for developing policies and interventions? The rationale for dealing with this subject derives from the sensitive issue of integrating migrant live-in caregiver in the context of a faith-based society, which has received very little and partial research attention to date.

With the increase in the elderly Haredi population in Israel (Ben Ami, 2022), there is a growing need to add the integration of migrant live-in caregivers to provide elderly care in the Haredi society, as a possible solution regarding aging-in-place policies for this society. The separatist nature and collectivist and faith-based lifestyle of the Haredi society make the need to integrate migrant live-in caregivers into the home setting particularly challenging and unique (Freund & Band-Winterstein, 2019). Moreover, the migrant live-in caregiver herself brings her own cultural world, as this process involves three parties: the frail elderly, his/her family members, and the migrant live-in caregiver. This brings the discussion to the importance of understanding the network of attitudes, perceptions, and interactions among these three parties in order to ensure a harmonious and beneficial integration process.

One of the topics that came up repeatedly in the interviews with family members focused on the inter-cultural and inter-religious encounter in the framework of the care relationship between the migrant live-in caregivers and the older adults. The interviewees related to the challenges that were present at the beginning of the process, mainly in relation to dress, food, Bishul Israel, and the separation between men and women. Family members mentioned that, at first, the migrant live-in caregivers did not understand where are they, or the unique rules governing the Haredi society. Nonetheless, most interviewees said that the migrant live-in caregivers’ learning curve was very quick, and that they rapidly internalized the customs and laws of the Haredi society. In addition, the interviewees also mentioned, in a positive light, the migrant live-in caregivers’ spiritual world as an element that formed a unique connection between them and the elderly they care for.

Another important issue dealt with the complexity involved in making the decision to integrate a migrant live-in caregiver to provide care for the elderly in the Haredi society as a different population with unique needs. This is an ethical and moral dilemma of the first degree. Therefore, there is a conflict between one of the ten commandments: “Honour Thy Father and Thy Mother” and the realistic constraints of life. Some family members related to how they themselves are grandparents, and find themselves having to care for their grandchildren, an especially important endeavor, as Haredi women are expected to work and provide for the family (Fuchs, 2018). In the Haredi society, men are expected to focus on studying Torah (Sharabi & Kay, 2021), while some combine religious studies with paid-jobs (May-Yazdi & Ben David-Hadar, 2018).

All of the above leads to the situation where the adult children find themselves over-burdened, and unable to simultaneously manage their own lives: Help their children by taking care of their grandchildren; and also provide adequate care for their aging parents (Edelstein et al., 2018). Thus, the solution of integrating a migrant live-in caregiver is significant, as it can help families manage their lives and bear the burden of their multiple responsibilities, and allows them to fulfill the commandement “Honour Thy Father and Thy Mother”.

Another interesting theme that emerged from the family members’ interviews, is apparently open to interpretation. Some of the family members said that they must carry out this commandement by actually caring for the parents with their own hands. In contrast, others said they must take care of the parent’s needs, which may also mean integrating migrant live-in caregivers to care for the parent’s physical needs (sanitary needs, bathing, etc.). Those who supported the latter interpretation expressed the opinion that in carrying out these intimate needs for their parents – it would impinge their parents’ dignity, and that it is better that someone else, from outside the family, should provide this type of care. The family members, of course, remain an active part of the picture, but more in regard to organizational aspects rather than the actual provision of care. Hence, the commandment “Honour Thy Father and Thy Mother” is open to interpretation.

Along the chronological continuum of caring for elderly individuals in the Haredi society, and in light of the interpretation of the commandment to honor one’s parents, the initial stage was making a decision regarding the actual integration of a migrant live-in caregiver for the elderly. Regarding this stage, multiple and various opinions were voiced. Some of the interviewees said that the older adults had an integral part in the decision-making process to integrate a migrant live-in caregiver, while others indicated that the older adult was not capable of being involved in the decision. In most cases, wherein the older adult was not involved in the decision-making process, it was attributed to his/her acute medical (physical or cognitive) decline.

Regardless, most of the interviewees stated that the decision to integrate migrant live-in caregiver was made out of a feeling of having no other choice. In other words, the decision was made only after checking into (and rejecting) other options, such as the elderly parent moving in with one of their adult children, etc. It should be noted that these possibilities created unique difficulties of their own among the family relationships. For example, among siblings regarding the division of responsibility and care of the elderly parent. In light of this, it is understood that the decision to integrate a migrant live-in caregiver was made only after considering every other possible option.

The general impression from the analysis of the interviews is that there is a difference between past perceptions about elder care and those that exist today. In the past, it was clear that in the Haredi society, it is the grown children who care for their parents (or, to be more precise – the daughters), with some assistance from the surrounding community (Freund & Band-Winterstein, 2019). Today, the grown children have more of a “management” role, and provide less of the actual hands-on care. In other words, the children utilize the various services they are qualified to receive, to best suit the needs of their parents, such as health and nursing care benefits, contact with health services and with social services departments, contact with private agencies that employ migrant live-in caregivers, and more. The care itself is in the hands of others, such as dedicated professionals associated with different services, mostly migrant live-in caregivers regarding ever aspect of personal care.

Implications

This change in the family’s organization around the subject of elder care in the Haredi society clearly reflects important social changes that have been taking place in the Haredi society for the past several decades, including increased openness to the mainstram society and government institutions, such as the Ministry of Health and Welfare, and the National Insurance Institute (Keren-Kratz, 2016). As part of the far-reaching and comprehensive social changes occurring in the Haredi society – also expressed by changes in occupational and economic patterns of behavior in Haredi society – there seems to be an increased willingeness to utilize services from the general (secular) system. In the past, the Haredi society tended towards separatism and maintained the status of a closed community, caring for widows, orphans, injured, and elderly in an independent manner. Today, in light of the rising needs of the elderly population, the Haredi community can no longer do this alone, and is therefore in need of help from the government.

The way in which the Haredi society relates to government authorities continues to be rather ambivalent. On the one hand, there is a still an inherent sense of suspicion towards utilizing government services, for fear of government interference in the Haredi society, and an enormous influence on its behavioral patterns (which actually occurs, to a certain extent). On the other hand, in light of the Haredi society’s ever-increasing needs – there is an understanding and recognition that it is possible, and even desirable, to receive help by utilizing the resources and services offered by the government. In other words, the results of the present study, along with those of other recent studies conducted among the Haredi community, indicate that the Haredi society is ready to participate, to a certain extent, in the mainstream Israeli society. However, only if given the possibility to maintain the restrictions imposed by Jewish law, as dictated by the Chief Rabbinate of Israel.

Disclosure statement

No potential conflict of interest was reported by the author(s).