As an Arab living in the Netherlands, I see the question of how we care for older people across cultures as more than an academic discussion. Over the past decade, Europe has welcomed substantial numbers of migrants from Arab countries. As these communities age, European health and social-care systems will increasingly encounter older people whose expectations of family, dignity, religion and caregiving may differ from those embedded in mainstream long-term-care models.
For ENIEC, understanding these differences is essential. The challenge is not simply to provide care, but to develop long-term-care approaches that are culturally responsive while protecting the wellbeing and autonomy of both older people and their caregivers.
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The Family-Based Care Model
Across many Arab societies, the family has traditionally been the cornerstone of old-age support. This is more than an individual preference: it is a deeply structured social arrangement in which responsibility for older relatives is distributed across generations.
Intergenerational solidarity can involve co-residence, financial assistance, household support, childcare, emotional support and direct caregiving. Older people are not necessarily passive recipients; they may continue to contribute to household finances, domestic work and childcare. As Sibai and Yamout argue, family-based care has historically allowed many older people to remain within their communities with limited reliance on formal state services.
Religious and cultural values reinforce these arrangements. Within Islamic traditions, respect for parents, filial responsibility and caring for vulnerable family members are important moral obligations. Care for ageing parents can therefore be understood simultaneously as a family responsibility, a religious duty and a form of communal accountability (Sibai & Yamout, 2012; Kronfol, Rizk & Sibai, 2015).
This cultural foundation remains important for Arab families living in Europe. However, it should not be interpreted as meaning that every older Arab person prefers family care or rejects professional services. Cultural values influence expectations, but individual preferences, family circumstances and migration experiences also matter.
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Gendered Dimensions and Structural Inequalities
The family-care model also contains an important gender dimension. Women have traditionally carried much of the practical caregiving burden, often combining responsibilities as daughters, daughters-in-law, wives and mothers. Men, by contrast, have more commonly been positioned as economic providers.
This division becomes increasingly difficult to sustain when women participate more extensively in education and paid employment. Arab women living in Europe may simultaneously face expectations to succeed in the labour market, care for children and support ageing parents. Without a corresponding redistribution of caregiving responsibilities, these overlapping expectations can create significant role conflict.
Hussein and Ismail (2017) highlight an important consequence: a substantial proportion of family-based elderly care is effectively unpaid and largely invisible labour. Its costs may appear in women’s reduced employment opportunities, financial security, health and social participation.
Supporting family care must therefore not mean simply asking families, and disproportionately women, to do more. A culturally sensitive system must also recognize and support the people who provide that care.
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Emerging Pressures and Quality Concerns
The sustainability of family-based care is becoming more uncertain as demographic and epidemiological conditions change. Increasing life expectancy means more people survive into advanced old age, while chronic diseases, dementia and complex care needs can require specialized and continuous support.
Kronfol et al. (2015) and Hussein and Ismail (2017) both highlight the growing pressure placed on families as demographic structures change, fertility declines, migration separates family members and women’s employment increases.
Informal care also has inherent limitations. Family members may lack medical training, experience caregiver burnout or become socially isolated themselves. Older people may receive highly variable care depending on family resources, geographical proximity and caregiver availability. As care becomes more complex, the absence of professional assessment, training and oversight may become increasingly problematic. This does not make family care inherently inadequate. Rather, it suggests that family care alone may no longer be sufficient for every situation.
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The Central Question: Support, Replace or Complement?
Moving toward formal or institutionalized care can be culturally sensitive. For some families, residential care may raise concerns about dignity, religious practice, family responsibility and even family honour. Yet the alternative, expecting families to absorb increasingly complex care needs without adequate support, is also problematic.
The strategic question for ENIEC should therefore not be whether family care or formal care is “better.” Instead, we should ask:
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How can the family-care model be professionally supported rather than simply replaced?
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How can the often-invisible contribution and needs of women caregivers be recognised without dismantling valued family structures?
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Under what conditions can residential and community-based services be presented as complementary to family obligations rather than contradictory to them?
The recent scoping review by Alhaizan and du Toit adds an important perspective: culturally appropriate care should not be reduced to a checklist of language, food or religious requirements. It should be person-centred, allowing older people to define what family involvement, cultural identity, meaningful activity and dignity mean to them.
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Moving Forward
ENIEC can help advance this agenda by:
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Strengthening research on how older people of Arab background and their families actually negotiate home care, professional care and residential care in Europe.
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Developing culturally responsive training for healthcare and long-term-care professionals, with particular attention to family involvement, religion, communication, gender and individual preferences.
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Creating policy dialogue between European care providers, Arab communities, researchers and policymakers to develop models that combine family solidarity with professional support and caregiver protection.
The future of intercultural elderly care should not require a choice between cultural values and professional standards. The goal should be to build systems in which family solidarity is supported rather than exploited, cultural identity is respected rather than stereotyped, and the wellbeing of both older people and caregivers remains central.
Sources
Alhaizan, R., & du Toit, S. H. J. (2025). Scoping review: Culturally appropriate care for Arab elders in long-term care settings. Journal of Applied Gerontology. https://doi.org/10.1177/15394492251360231
Hussein, S., & Ismail, M. (2017). Ageing and elderly care in the Arab region: Policy challenges and opportunities. Ageing International, 42, 274–289. https://doi.org/10.1007/s12126-016-9244-8
Kronfol, N. M., Rizk, A., & Sibai, A. M. (2015). Ageing and intergenerational family ties in Arab countries. Eastern Mediterranean Health Journal, 21(11), 835–843. https://doi.org/10.26719/2015.21.11.835
Sibai, A. M., & Yamout, R. (2012). Family-based old-age care in Arab countries: Between tradition and modernity. In J. S. Chen & A. Powell (Eds.), Aging in the Arab world (pp. 75–90). Springer. https://doi.org/10.1007/978-3-642-27881-5_5
