Filial duty for adult children to care for aging parents

Filial duty for adult children to care for aging parents is presented in Elena Knows as a demand made tangible by progressive illness, intimate labor, and unequal power. Dr Benegas frames Rita’s responsibility as repayment for the care Elena once gave her, but the scenes around that appeal show no simple exchange: Elena needs increasing assistance, Rita is already exhausted, and neither can make the future promised by the doctor feel fair or manageable.

The Duty Stated

When tests establish that Elena has Parkinson-Plus syndrome, Dr Benegas explains that the disease is expected to advance faster than previously predicted. Elena may soon be unable to get out of bed, feed herself, or use the bathroom without help; she may be limited to liquids or soft foods, lose the ability to read, become difficult to understand, and experience memory loss or dementia. He tells Rita to consider hiring someone to care for her mother while Rita is at work, and stresses that time is short. The prognosis turns filial care from a general expectation into an imminent practical requirement.

Dr Benegas then gives that requirement a moral and familial rationale: there comes a time for children to give back what their parents gave them, and Rita must become her mother’s mother because Elena will become like a baby. The language casts care as reciprocal repayment and role reversal. Yet Rita rejects the comparison. A baby develops new abilities; Elena, by contrast, is losing control of her body. Rita describes the worsening in terms of sphincters, speech, posture, and bodily dependence, and says she does not think she can become the mother the doctor asks her to be. The duty is asserted, but the scene refuses to make its fulfillment seem emotionally or physically effortless.

Care as Daily Labor

The novel makes the obligation legible through repeated acts of assistance. Rita helps Elena out of bed, prepares her for the day, and eats with her while managing the visible effects of illness. At night she brings water for Elena’s dentures, removes and replaces them, takes her to the bathroom, helps with her underwear, seats her on the bidet, hands her a towel, and settles her back into bed. Elena may call her back to adjust her feet, sheet, or pillow after Rita has tried to leave. These tasks recur across the day and night; care has no clean boundary between a completed duty and the caregiver’s own time.

Rita’s account also makes clear that physical assistance carries sensory and emotional strain. She describes drool mixed with food, the smell of urine that persists despite washing, and the repeated sight of Elena’s expressionless face and dentures. Her complaint does not cancel the care she provides; it shows the cost of providing it. The narrative places tenderness, dependence, disgust, resentment, and continued attention within the same relationship rather than reducing caregiving to either selfless devotion or rejection.

Care also shapes decisions that can look like ordinary arrangements until their purpose is made clear. Rita schedules Elena’s visit to a beauty salon around her Levodopa so her mother’s body will not go without medication. The appointment includes washing and styling Elena’s hair as well as a manicure, pedicure, and waxing. Rita says she has to look at her mother every day and that Elena’s appearance affects the person doing the looking. The intervention is therefore not simply a makeover: it emerges from the strain of sustained proximity, while also revealing how caregiving can give a daughter practical control over her mother’s body and presentation.

Reciprocity, Autonomy, and Its Limits

The doctor’s appeal to repayment meets a different claim from Elena. She wants to remain in her own house and says she can manage there; when she misunderstands Rita’s distress as a wish to put her in a home, she asks instead to be left in her own home. Rita clarifies that this is not what she means. Their exchange exposes the gap between a general demand that a daughter provide care and the particular question of where and how an ill parent wishes to live. The duty does not erase Elena’s preference, even as her increasing dependence makes that preference harder to sustain without assistance.

Rita, for her part, names her own limit rather than simply refusing responsibility. When she asks what more can be demanded of her, she distinguishes her mother’s wish to live from her own fear that she cannot endure further demands. Dr Benegas answers that she will have to manage for her mother’s sake; he offers help and support for both women. Rita cries, but does not take the pamphlets he holds out. Elena accepts them instead, then reaches for her daughter’s help to stand. The gesture leaves the conflict unresolved: the doctor’s instruction remains, support is offered, and the two women leave still bound by the immediate fact of Elena’s physical dependence.

Institutional Conditions and the Meaning of Care

The novel places private caregiving inside a public and insurance system that makes assistance difficult to secure. As Elena’s needs and costs increase, Rita contests the health insurer’s limits on therapy, medication coverage, and reimbursement. Staff tell her that a disability certificate would remove a cap on treatments and speed authorization, but obtaining it requires a separate appointment with the National Services for Rehabilitation and Promotion of Disabled Persons. Rita objects that Elena’s condition is already unmistakable and that the medical chart and doctor’s letter should be enough. The office still requires the certificate; when Rita asks for an appointment, she is told the wait is fourteen months. By the time it arrives, Roberto Almada has to arrange time off and a car to take the women there.

That delay gives filial duty a material setting. Rita is expected to coordinate treatment, challenge denials, arrange transport, and care for Elena while navigating rules that consume time and require further proof of disability. Their reluctance to seek help from the PAMI public medical service is also grounded in an earlier failure: an ambulance took more than an hour to reach Antonio during his heart attack and arrived five minutes after he died. The family’s experience of care therefore includes not only the work Rita performs at home, but also the limits and remembered failures of the systems meant to assist them.

The pamphlets Dr Benegas offers name Rita as Elena’s caregiver and recommend relaxation, breathing exercises, and shared activities. Elena reads them alone while Rita is in the shower, trying to imagine which suggested activities could belong to their lives. The advice offers techniques, but does not resolve the underlying imbalance between Elena’s mounting needs and Rita’s finite capacity. Across the novel, filial duty is neither dismissed nor presented as a debt that can be repaid neatly: it is an ongoing relationship, made through specific acts of bodily care, contested by exhaustion, and constrained by the choices and services available to both women.