INTRODUCTION
In many Asian societies, caring for aging parents is viewed as a social expectation and a sacred moral duty rooted in filial piety and religious belief [1,2]. In Indonesia, this value is reinforced by Islamic teachings that emphasize birrul walidain, which means the virtue of honoring and caring for one’s parents in their old age. Within such a moral framework, entrusting older adults to institutional elder care is often perceived as a taboo, associated with shame, abandonment, and moral failure [3]. Families that choose to send their parents to a nursing home may face social judgment and internal conflict, even when the decision arises from economic necessity or caregiver exhaustion.
However, demographic shifts, migration, and the pressures of modern urban life have complicated traditional caregiving norms. As younger generations pursue employment in distant cities, family-based care arrangements become difficult to sustain. Older adults left behind frequently face isolation, health decline, and emotional distress [4]. For some families, institutional elder care emerges as the only viable option, though it remains morally contested. This tension between filial devotion and practical necessity reflects a broader crisis in the moral economy of care in contemporary Indonesia.
Research on aging in Indonesia has mostly addressed physical and social well-being, but limited attention has been given to the lived moral and spiritual experiences of both residents and caregivers in institutional settings. Studies in other Asian contexts, such as South Korea and Japan, have documented similar tensions between enduring family-based values and changing eldercare arrangements. In South Korea, filial piety has historically emphasized family responsibility for older parents, while the development of long-term care services has contributed to changes in how eldercare responsibilities are organized [5]. In Japan, traditional expectations of family caregiving have likewise evolved alongside the expansion of formal and institutional long-term care services [6]. In Indonesia, however, the topic remains ethically sensitive and socially stigmatized.
The experience of institutionalized older adults cannot be understood solely through abandonment. Faith often becomes a source of endurance and a moral framework through which they interpret suffering, loss, and hope. Religious practices such as sholat (prayer), dhikr (remembrance of God), and sholawat (sending blessings upon the Prophet Muhammad) provide spiritual anchors and meaning amid feelings of loneliness or betrayal. Sholawat, in particular, carries important spiritual significance in Muslim communities and may serve as a religious practice through which individuals seek emotional calm and spiritual well-being [7]. [7]. Within the nursing home context, these religious practices become an everyday form of coping and resistance.
Equally important are the moral and economic dilemmas experienced by caregivers (pramurukti). Many caregivers work under financially constrained conditions, with minimal training and limited institutional support. Some express empathy and devotion in caring for the older residents “as their own parents,” but others struggle with emotional fatigue, disgust, or moral conflict. This contradiction reveals that care work is physically demanding and ethically charged [8]. The act of touching, feeding, and cleaning the frail body of an older person becomes an intimate and a moral act, shaped by compassion and obligation.
Beyond individual relationships, systemic issues further shape the moral landscape of eldercare. Most Indonesian nursing homes operate with inadequate resources, insufficient medical facilities, and minimal governmental support [4]. Managers face continuous financial strain and bureaucratic neglect and rely heavily on community donations to sustain operations. These structural challenges reveal the broader invisibility of aging populations within Indonesia’s social welfare policies.
This study aims to explore the lived meanings of aging, faith, and moral dilemmas among older adult residents, caregivers, and managerial informants in an Indonesian nursing home. Through an examination of their narratives, the research seeks to understand how moral and spiritual values are negotiated within the intersection of familial love, religious faith, and institutional elder care. Understanding these sensitivities is essential for developing gerontological nursing models grounded in cultural and faith-based values that honor human dignity and moral complexity [9].
This interpretive qualitative study conducted in a nursing home in Indonesia offers an explanation of how older adults and caregivers make sense of their everyday lives amid loss, endurance, and systemic scarcity. This study argues that aging, within this context, is not simply a biological process or social condition but a deeply moral and spiritual journey shaped by faith, abandonment, and the struggle to preserve dignity in the face of limited care resources.
METHODS
Ethic statement: This study received ethical approval from the Institutional Review Board (IRB) of Universitas Brawijaya (IRB No. 36/EC/KEPK-S1-PD/02/2022). Prior to data collection, the purpose, procedures, and voluntary nature of participation were clearly explained to all participants. Interviews were scheduled after participants provided written informed consent.
1. Study Design
This study used an interpretive qualitative design to explore the lived meanings of aging, faith, and moral dilemmas among older adult residents, caregivers, and managerial informants in a faith-oriented nursing home. This approach was selected to support an in-depth examination of how individuals construct meaning from their experiences within specific sociocultural and institutional contexts. Experiences related to eldercare, spirituality, and family obligation are deeply embedded within cultural and moral frameworks, particularly in collectivist societies where caregiving is guided by social expectations and ethical norms [10,11].
The study adopted an interpretivist paradigm, which assumes that experiences and meanings related to aging and caregiving are socially constructed and shaped through interpersonal and cultural interactions. Data were analyzed using thematic analysis based on Braun and Clarke’s six-phase framework [12]. This analytic approach was used as a flexible and rigorous analytic method aligned with interpretive qualitative inquiry. This approach allowed identification of patterns of shared meaning while preserving the depth and complexity of participants’ narratives.
Although the study was conducted within a single nursing home, the setting served as a contextual environment for exploring participants’ lived meanings within a specific sociocultural and institutional context. The analytic focus was directed toward participants’ experiences, rather than the institution itself.
The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) to ensure methodological transparency, reflexivity, and rigor in qualitative reporting.
2. Research Setting
The study was conducted at a private, faith-oriented residential care facility located in Gresik, East Java, Indonesia. The facility served as a sociocultural context within which participants constructed and interpreted their experiences of aging, spirituality, and caregiving relationships. The institution accommodates approximately 30 older adults, most of whom were women aged between 60 and 85 years. The nursing home was founded by a retired nurse who sought to deliver compassionate care grounded in religious and cultural values. Daily activities in the home include communal prayers, light physical exercise, and religious study sessions led by visiting volunteers. The environment reflects an integration of professional care routines and community-based spirituality. This combination created a meaningful context for examining how moral values and faith-based understandings of aging were expressed in daily life.
At the time of data collection, Indonesia had limited formal systems of long-term elder care, and many families continued to view nursing homes as a final option when home-based care was no longer possible. Within this cultural backdrop, institutional elder care is often stigmatized as an act of family neglect. This sociocultural background was essential for understanding participants’ narratives and interpretations. These contextual characteristics should be considered when interpreting the applicability of findings to other long-term care environments.
3. Participants and Recruitment
Purposive sampling was used to recruit 15 participants who represented three stakeholder groups in caregiving interactions. These groups included six older adult residents, six caregivers (pramurukti), and three managerial informants (the nursing home owner and two administrative staff members). Selection criteria for residents were (a) age 60 years or older, (b) cognitive ability to communicate, (c) residence in the facility for at least three months, and (d) voluntary willingness to participate. The older adult participants were aged between 60 and 85 years and commonly lived with chronic conditions such as hypertension, diabetes mellitus, mobility limitations, and visual impairment. Most residents required varying levels of assistance for activities of daily living but remained cognitively capable of participating in interviews. Caregivers were required to have at least 6 months of caregiving experience and familiarity with residents’ daily routines. The caregiver participants were mostly female between 25 and 45 years of age and had caregiving experience ranging from 6 months to 8 years. Their responsibilities included assisting residents with personal hygiene, feeding, medication reminders, and emotional support. Managerial informants were included to provide insights into institutional philosophy, operational management, and moral reasoning that shaped caregiving practices within the nursing home.
Participants were informed that participation was entirely voluntary and that declining or withdrawing from the study would not affect the care they received or their residence in the nursing home. Interviews were scheduled after participants provided written informed consent.
All individuals who were invited agreed to participate in the study, which reflected a strong willingness among residents and staff to share their experiences and viewpoints.
4. Data Collection
Data were collected from April to August 2022 through in-depth semi-structured interviews and non-participant observation. Interviews were conducted in Indonesian by the first author, a nursing faculty member experienced in qualitative research and gerontology. Each interview lasted between 45 and 90 minutes. The duration depended on the participant’s comfort and willingness to elaborate. Interviews were conducted in private but familiar areas of the facility, such as residents’ rooms or the prayer hall. These locations were selected to promote a sense of safety and openness during the interview process.
The interview guide covered three thematic areas. These areas included (1) experiences of being cared for or left in a nursing home, (2) interpretations of faith, destiny, and filial duty, and (3) reflections on moral dilemmas in caregiving relationships. To enhance methodological transparency, guiding questions were tailored according to participant roles.
For older adult residents, sample questions included:
• “How do you interpret your family’s decision to bring you here?”
• “What does faith mean to you as you grow older?”
• “In what ways do you feel cared for or neglected in this place?”
For caregivers (pramurukti), sample questions included:
• “What motivated you to work as a caregiver in this nursing home?”
• “What challenges do you experience when caring for older residents?”
• “How do moral or spiritual values influence your caregiving practices?”
For managerial staff, sample questions included:
• “How do you interpret the mission and values guiding care in this institution?”
• “What challenges does the institution face in providing care for older adults?”
• “How do financial and organizational factors influence caregiving practices?”
Probing questions were used to elicit deeper emotional and moral reflections. The interviewer practiced empathetic listening and allowed sufficient time for participants to pause, reflect, and clarify their responses. All interviews were audio-recorded after participants granted permission. Extensive field notes captured non-verbal expressions, environmental conditions, and spontaneous interactions observed during daily routines.
Non-participant observation was conducted over multiple visits to allow immersion in the setting. The researcher observed mealtimes, caregiving activities, and prayer sessions to contextualize the verbal narratives. Observational data supported the identification of contradictions between spoken beliefs and embodied practices, which strengthened the interpretive depth of the analysis. Data collection was discontinued when thematic saturation was reached, indicated by the absence of new themes or substantive insights from additional interviews[13].
5. Data Analysis
All interviews were transcribed verbatim in Indonesian and subsequently translated into English by a professional translation service. The translated transcripts and participant quotations were reviewed through a professional proofreading process to improve language accuracy. Culturally nuanced and idiomatic expressions were carefully adapted during translation to preserve their intended meanings in the English version. Data were analyzed using thematic analysis following Braun and Clarke’s six-phase framework [12]: (1) familiarization with the data, (2) generating initial codes, (3) searching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. Two researchers independently coded all interview transcripts to strengthen analytic credibility. Codes were compared and refined through iterative discussions, and discrepancies were resolved through consensus. NVivo 12 software (Lumivero) was used to facilitate data organization and retrieval.
Initial codes were clustered into subthemes that represented shared meanings, such as experiences of family separation, faith-based coping practices, caregiving ambivalence, and structural care constraints. These subthemes were subsequently synthesized into five overarching themes that represented participants’ lived experiences of institutional elder care. These themes were (1) family deception and prejudice leading to loss of belonging; (2) praying and working as strategies for emotional endurance; (3) waiting for family with persistent hope amid sorrow; (4) caregivers’ moral and economic tensions in care practices; and (5) systemic scarcity and managerial constraints in institutional elder care. Analytical memos were maintained throughout the analytic process to document emerging interpretations, reflexive insights, and decisions related to theme development.
6. Trustworthiness and Rigor
Several strategies were implemented to ensure credibility, dependability, confirmability, and transferability of the findings. These strategies followed established qualitative rigor frameworks [14,15].
• Credibility was strengthened through prolonged engagement in the field, triangulation of interviews and observations, and member checking with three participants who confirmed the accuracy of preliminary interpretations.
• Dependability was ensured by maintaining an audit trail documenting methodological decisions, data management steps, and analytical processes.
• Confirmability was reinforced through peer debriefing with two independent qualitative researchers from the same institution, who reviewed the themes for coherence and bias reduction.
• Transferability was supported through detailed descriptions of participants, institutional characteristics, and cultural context. The study was conducted within a faith-oriented nursing home in Indonesia, where family-based elder care is culturally expected and institutional placement may carry moral stigma. Rather than aiming for statistical generalization, the findings offer interpretive insights that may resonate with similar collectivist and spiritually grounded care environments. Readers are encouraged to consider contextual similarities when applying these findings to other gerontological nursing settings [15].
The findings are likely to hold relevance for other faith-based care institutions and for collectivist societies where caregiving practices are strongly shaped by cultural expectations of filial responsibility and religious values. In such contexts, the interaction between moral obligation, spirituality, and institutional elder care may resonate with similar patterns observed in this study.
However, the transferability of these findings may be limited in more individualistic or secular care settings, where family obligations and religious practices are less central to caregiving experiences. These contextual differences require careful consideration when interpreting and applying the findings to other settings.
7. Researcher Reflexivity
The first author, a nursing academic, had previous clinical and teaching experience related to gerontological care, which supported her empathetic engagement with participants. However, she remained aware of potential biases arising from personal beliefs about filial piety and faith-based care. Reflexive journaling was maintained throughout data collection and analysis to document emotional reactions and evolving interpretations [16]. These reflexive practices helped sustain a balance between empathy and analytical distance, which supported the authenticity of participants’ voices.
RESULTS
Through thematic analysis, five major themes emerged that reflect the lived meanings of aging, faith, and moral dilemmas among older adult residents, caregivers, and managerial informants in the nursing home. The findings suggest that institutional elder care in collectivist societies cannot be understood solely as a healthcare phenomenon but should be interpreted as a relational, spiritual, and structural process. Each theme represents interwoven narratives of pain, endurance, faith, and resilience that show how aging in an institutional context redefines the meaning of home, care, and devotion. Direct quotations are included to illustrate the depth of participants’ experiences, under pseudonyms to ensure confidentiality.
1. Theme 1: Family Deception and Prejudice Leading to Loss of Belonging
This theme emerged primarily from narratives of older adult residents and reflected their experiences of relocation to the nursing home as a disruption to their sense of belonging and family connection. Several participants described being brought to the facility under misleading explanations from family members. One participant recalled, “I didn’t know I was being sent here. My son just told me we were going to an apartment. He lied to me.” Another participant shared, “They said I would stay here for 2 weeks to treat my eyes, but it’s been months, and no one has come to take me home.”
Participants frequently described feelings of confusion and emotional pain when reflecting on these experiences. Some residents attempted to explain their children’s actions by referring to illness-related fears or misunderstandings. One participant stated, “My son thought I had a contagious disease, something in my womb,” expressing both uncertainty and sadness.
Residents also described the relocation process as emotionally distressing. One participant illustrated her loneliness by saying, “I feel like an owl, silent on my bed. When people talk to me, I answer. When no one does, I stay quiet.” Participants described losing not only their previous living spaces but also their sense of familial connection and emotional security.
Several participants expressed difficulty reconciling their continued emotional attachment to family members with their experiences of being placed in institutional elder care. Their narratives reflected ongoing efforts to understand and accept changes in their family relationships.
2. Theme 2: Praying and Working as Strategies for Emotional Endurance
This theme was derived primarily from older residents’ accounts that described how daily activities and religious practices supported emotional coping and personal strength. Residents spoke about routine tasks as purposeful actions for managing loneliness and sadness. One participant explained, “I work all the time, here, there, and everywhere, so I won’t think about my sadness.”
Some residents described changes in eating patterns that they associated with emotional experiences. One participant shared, “Sometimes I don’t eat during the day, maybe just one or two spoons at night. When I feel hungry, I forget for a while that my child doesn’t remember me.” Other residents described maintaining independence in daily self-care activities despite physical limitations. One resident stated, “Since I came here, I do everything by myself. I don’t want to be spoiled,” while describing her efforts to bathe independently despite visual impairment.
Religious practices were frequently described as sources of comfort and emotional support. Participants mentioned prayer, dhikr, and sholawat as daily practices that helped them cope during moments of distress. One participant said, “Instead of being sad, I pray, recite dhikr, and do sholawat.” In residents’ narratives, these religious activities were associated with feelings of calmness and a sense of acceptance toward their circumstances.
Residents described praying and engaging in daily work as part of their routine efforts to manage emotional challenges and maintain a sense of personal dignity within institutional life.
3. Theme 3: Waiting for Family With Persistent Hope Amid Sorrow
This theme also emerged mainly from residents’ narratives and reflected their emotional experiences of longing, sadness, and persistent hope for reunion with their families. Living in the nursing home was often described as a painful separation; however, many participants continued to hope that their children would eventually remember them and bring them home. The coexistence of sorrow and hope shaped how residents understood their daily lives and gave meaning to their waiting.
One participant recalled a moment that revealed emotional distance and concern and said, “My child was so happy when I started eating here because at home I refused to eat.” Another participant said tearfully, “I’m still waiting for my child to pick me up. My family hasn’t contacted me at all, and that makes me so confused.” For some residents, physical decline intensified the emotional suffering. One participant shared, “I want to see my children and grandchildren, but now I can’t see anymore. I feel trapped here. Sometimes, when I lose awareness, I pray for death,” and she cried while speaking.
Prayer was frequently described as inseparable from the experience of waiting. One resident stated, “I pray every night during tahajjud, surrendering myself to God and asking to go home.” Another participant expressed hope that prayer might soften their children’s hearts and said, “May Allah make it easier for my child to contact me, remember me, and take me home.”
Residents described waiting as an emotionally complex experience characterized by longing, uncertainty, and continued hope for family reconnection.
4. Theme 4: Caregivers’ Moral and Economic Tensions in Care Practices
This theme was primarily derived from caregivers’ narratives and was complemented by residents’ perspectives that illustrated the ethical, emotional, and economic complexities of caregiving roles. Caregivers (pramurukti) described their work as strongly influenced by financial necessity, emotional challenges, and personal values. Several caregivers explained that economic needs initially motivated them to accept the job. One caregiver stated, “At first, I just needed the money to support my family. Then I thought, maybe I can do this with the intention of caring for parents.”
Residents occasionally described dissatisfaction with caregiving interactions. One resident commented, “The facilities here are good, but the staff don’t really care about us.” Another resident shared, “Sometimes the caregivers don’t want to help, even when asked. I don’t know why, maybe they don’t know how, or maybe they just don’t want to.”
Caregivers reported mixed emotional responses toward their caregiving responsibilities. One caregiver acknowledged feelings of discomfort and strain and said, “Sometimes it’s disgusting to take care of old people, but what else can we do?” In contrast, another caregiver expressed emotional attachment, stating, “I’m happy to take care of them. It feels like caring for my own parents. I don’t have parents anymore, so I treat them like mine.”
Heavy workloads and limited employment opportunities influenced caregivers’ experiences. One caregiver explained, “Finding work elsewhere is difficult. Here, at least, I just have to look after the older adults.” These narratives illustrate how caregivers continuously negotiated emotional labor, practical responsibilities, and economic survival within their caregiving roles.
5. Theme 5: Systemic Scarcity and Managerial Constraints in Institutional Elder Care
This theme emerged from caregivers’ and managerial staff narratives and reflected structural and organizational conditions that shaped everyday care delivery. Caregivers reported that some residents required specialized attention due to depression or physical frailty, but available staffing and facilities were limited. One caregiver explained that “Some older adult residents need special attention, but the nurses and facilities here are not sufficient, and the family no longer wants to take care of them.”
Participants also described overcrowding and shortages of supplies. One resident noted that “Three to four people share one small table,” which reflected spatial constraints during daily activities. Caregivers described ongoing difficulties in securing essential items such as adult diapers, which created additional strain during routine care provision.
Management staff described financial constraints in maintaining daily operations. Government assistance was described as inconsistent, and the facility relied heavily on charitable donations and financial contributions from residents and their families. One staff member explained, “For residents from poor families, I let them pay whatever they can.”
These descriptions illustrate the operational challenges faced by the institution in sustaining daily care services for older residents.
Together, these five themes illustrate an interconnected moral, spiritual, and structural framework of institutional elder care. Experiences of family separation shaped residents’ emotional vulnerability and influenced how they understood abandonment, hope, and belonging. Residents negotiated these experiences through spiritual practices and routines that supported emotional endurance. Simultaneously, caregivers managed moral obligations within economic and institutional constraints, while systemic scarcity influenced care delivery and residents’ lived experiences. This integrative perspective suggests that institutional elder care in collectivist societies cannot be understood solely as a healthcare phenomenon but must be examined as a relational, spiritual, and structural process.
DISCUSSION
This study explored the lived meanings of aging, faith, and caregiving dilemmas among residents, caregivers, and administrators in an Indonesian faith-based nursing home. The findings reveal that institutional elder care in this context cannot be understood only as a system of service delivery. Instead, it operates as a site of ongoing moral negotiation shaped by family relationships, spiritual commitments, and structural limitations. These findings show that aging within collectivist and religious societies is deeply embedded in relational and moral expectations, rather than solely biomedical or functional dimensions of care.
The findings demonstrate that admission to a nursing home often signifies a moral rupture within family relationships. Participants described relocation experiences that involved indirect explanations or misleading information, which reflects the persistent social stigma attached to institutional elder care in Indonesia. Within collectivist societies, filial piety remains a dominant moral framework that assigns primary caregiving responsibility to children [1,3]. Consistent with studies in other Asian contexts, institutional placement often generates moral tension and guilt among family members, which may lead to avoidance or indirect communication [10]. At the same time, these experiences should also be understood within broader demographic and socioeconomic transitions, including migration and employment demands that limit families’ capacity to provide direct care [4].
The coexistence of grief and hope among residents extends existing gerontological research. Despite experiences of abandonment, residents maintained emotional attachment to their families, and waiting for reunification functioned both as a source of emotional burden and coping strategy. Similar results have been observed in other collectivist settings, where hope and longing serve as relational survival mechanisms that enable older adults to maintain a sense of belonging [9]. These findings support the interpretation that waiting represents an active process of meaning-making that preserves relational identity rather than a passive state of acceptance.
Spirituality emerged as a central mechanism through which residents constructed meaning and maintained emotional resilience. Practices such as prayer, dhikr, and sholawat functioned not only as expressions of religious devotion but also as embodied coping strategies that supported emotional regulation and acceptance of suffering. These findings align with previous studies that identify spirituality as a protective factor for psychological well-being among older adults [17]. Importantly, faith-based practices in this study did not indicate passive resignation; instead, they enabled residents to preserve dignity, agency, and emotional stability despite experiences of social displacement.
The study also emphasizes the moral and emotional complexity of caregiving within resource-limited institutional settings. Caregivers described ambivalent experiences shaped by empathy, fatigue, and financial necessity, which reflects the dual nature of caregiving as both relational labor and a means of economic survival. These findings are consistent with existing literature on caregiving in long-term care settings, where emotional engagement and moral stress coexist [16]. Limited training and heavy workloads further intensified these pressures and indicate the need for structured educational and emotional support programs for caregivers [8].
At the institutional level, the findings reveal persistent structural constraints, including inadequate staffing, limited funding, and reliance on charitable support. These conditions reflect broader systemic gaps in gerontological care infrastructure, particularly in low- and middle-income contexts [13]. The concept of the moral economy of care is extended in this study by demonstrating how faith-based institutions function as informal social safety nets. These institutions compensate for limited governmental support while placing additional moral and operational burdens on caregivers and administrators.
From a gerontological nursing perspective, these findings support the need for holistic care approaches that integrate emotional, relational, and spiritual dimensions of aging. Nursing interventions should include faith-sensitive communication, facilitate opportunities for spiritual expression, and support strategies to maintain family connection [18]. At the policy level, strengthening caregiver training, improving workforce conditions, and expanding governmental involvement in long-term care are essential to enhance care quality and sustainability [19].
The findings are particularly relevant to other faith-based care institutions and collectivist societies where caregiving is shaped by strong cultural and religious expectations. In such backgrounds, the interaction between moral obligation, spirituality, and institutional elder care may resonate with similar patterns identified in this study. However, the transferability of these findings may be limited in more individualistic or secular care settings, where family obligations and religious practices play a less central role. These contextual differences should be considered when interpreting and applying the findings to other settings.
These findings should also be understood within Indonesia’s socioreligious context, where Islamic values and collectivist norms strongly influence perceptions of aging and care. Although the data were collected in 2022, recent national reports indicate that family-based care remains an important feature of eldercare in Indonesia, while formal aged-care and long-term care services continue to develop [4].
This study contributes to gerontological nursing literature in several important ways. First, it strengthens existing evidence that spirituality functions as a key coping mechanism among older adults in institutional settings, particularly within religious communities. Second, it extends current understanding by demonstrating how spiritual practices operate not only as sources of comfort but also as embodied strategies that sustain dignity, agency, and emotional resilience in contexts of social displacement. Third, the findings conceptualize institutional elder care as a site of moral negotiation shaped by the interaction of filial expectations, economic pressures, and structural limitations. This perspective offers a more integrated understanding of aging in collectivist societies by situating caregiving within a relational and moral framework rather than an individual level.
CONCLUSION
This study explored the lived meanings of aging, faith, and caregiving dilemmas within an Indonesian nursing home and revealed a complex interplay among cultural expectations, emotional endurance, spiritual coping, and structural constraints. The findings demonstrate that institutional eldercare within this faith-oriented Indonesian nursing home context is shaped not only by healthcare needs but also by moral, relational, and socioeconomic dynamics. Residents managed experiences of separation and uncertainty through spiritual practices and daily routines, whereas caregivers balanced professional responsibilities alongside moral reflection and economic pressures.
The study contributes to gerontological nursing knowledge by offering culturally grounded insights into how faith and moral reasoning influence caregiving relationships and residents’ emotional adaptation within institutional environments. These findings underline the importance of integrating spiritual sensitivity, emotional support, and context-aware training into caregiving practices, particularly in resource-limited settings where institutional elder care remains socially and morally complex.
However, the findings should be interpreted within the scope of a single faith-oriented nursing home and therefore represent context-specific insights rather than broadly generalizable conclusions. Despite this limitation, the study provides conceptual and practical perspectives that may inform future multi-site research, caregiver education programs, and culturally responsive eldercare approaches in similar sociocultural contexts. Strengthening collaboration between institutional elder care providers, communities, and policymakers remains essential for improving the dignity, sustainability, and equity of eldercare services in aging societies.
1. Implications for Practice
The findings of the study emphasize the need to strengthen caregivers’ emotional, ethical, and caregiving competencies in nursing homes, particularly in resource-limited care systems. Care practices should be grounded not only in clinical competence but also in empathy, compassion, and spiritual sensitivity to maintain residents’ dignity and psychological well-being. Structured reflective programs, including faith-based coping strategies and emotional support sessions, may help caregivers manage moral distress and occupational fatigue.
At the institutional level, policy development should prioritize workforce support, adequate resource allocation, and culturally appropriate care frameworks. Strengthening partnerships among nursing homes, community religious organizations, and local governments may reduce systemic scarcity and improve access to equitable elder care services across socioeconomic groups.
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