With longer life expectancies, both spouses working and no experience of caring for the elderly, what can we learn from the West to make it better for everyone?
“Old age is curse!” I kept hearing from my grandfather who was writing a draft for his autobiography. I was around 10 years old and although I didn’t quite understand what it meant, I didn’t like the sound of it.
This was my first brush with old age and its agonies. The second was at Churchgate (Mumbai’s commercial area) where I encountered a shabby looking old man lying on the road. I came to know that he was an IAS officer who was left to fend for himself even though he had a sister living nearby. Another encounter was with an old lady who was in poor health but was left to ‘get lost‘ for the third time by her only son.
These incidents stayed with me and made me realize the gravity of the situation. I felt the need to do something for senior citizens. But I wanted to do that in an organized, professional manner, when I discovered that it was a full-fledged subject called Gerontology. But this course was not available anywhere in India. Hence I went to the UK not just to study, but also to understand the kind of services provided to facilitate caring for the elderly out there.
India has around 100 million elderly persons at present, and the number is expected to increase to 323 million by 2050, which will constitute 20% of the total population. On account of the ageing population rising not just in India but all over the world, ageing and issues related to older persons are increasingly being recognized and studied by various disciplines around the world.
What are the options that older persons have if they require help to look after themselves? We, in India, are still stuck with the premise that the family will take care of the elderly. But with loss of the joint family system, both spouses working and no experience of looking after an elderly person, we do not have too many options when it comes to caring for the elderly.
Just a walk along many of our roads make us realize that we lack basic infrastructure like evenly built sidewalks, that can help our elderly navigate these with ease, which can go a long way in ensuring their independence. Facilities like ramps and railings in public places and transport, travelling concessions which help them to remain mobile, etc. are a far cry, and also rare. Concessions in transport, separate queues, reserved seats which are very few can help elderly to remain mobile while being independent. Services for older persons in India are centered mainly in urban areas and limited to select residential facilities. Even in urban areas there are very few options like recreational day care centers and availability of intellectual companionship – which are placed in specific areas and could be expensive.
It is acknowledged all over the world that be it a child or an older person, they need to stay in their own homes, and an old age home or a residential facility should be the last resort. Moreover, in India, with almost 70% of older persons staying at home (mostly) with their sons, caring for the elderly in their own homes is the need of the hour.
Families need to be encouraged and supported in caring for the elderly at home. In India, this responsibility mainly falls on the daughters in law, who become the primary care-givers. This needs to change, and they need to be given support in caring for the elderly.
In this regard, we have a lot to learn from services provided in the Western countries. I had the opportunity to work with the local Government in the UK after completing my Gerontology course, and realized that there was a lot of deliberation, concern and meticulousness that went into providing services for any vulnerable group – be it children or older persons. There is a great effort to ensure that the older person is the focus of attention, and their views regarding their own care are given prime importance, hitches and glitches notwithstanding.
Some of the services are noteworthy – such as case management. Local authorities have a duty to assess anyone who has care and support needs. So once it is established that a person has needs which fulfill the national eligibility criteria, the local authority has to make sure that these needs are met.
Social care is not free and the local authority also assesses how much the person needs to contribute towards his or her care. The service is then put in place, which includes preventive services like simple aids for mobility or pendant alarms. Pendant alarms are bands which are tied to the wrist or as a pendant, which has a button connected to the local emergency unit, and if pressed during an emergency can lead to quick medical attention.
The care and support plan might also include home care services, adaptations to homes, or placement in residential homes (homes for mobile or healthy seniors) or nursing homes. Home care involves a trained assistant helping the older person with basic daily activities of living, like bathing, dressing, cooking, shopping, etc.
In cases where it is likely that the older person is vulnerable to neglect and abuse, risk analysis of the older person staying at home v/s staying in the safety of a care home is carried out. There were cases where I saw people fond of hoarding things and living alone in their homes. They were allowed to do that as they had a right to decide where they wanted to stay unless it was a risk to their life.
In the UK they also have direct payments which means that after the older person is assessed he/she is given funds by the local authority to arrange for his/her own care. So the person can actually buy services and avail of day care service, home care, transport, etc. They have the option of receiving cash payments in lieu of community based social services so that they can choose, arrange and pay for their own care.
In the US I encountered the PACE program. In this, people who need nursing care are served in the community itself without being placed in a home. Some of the services provided are day care, medical care, a personal care assistant to help with basic needs, transport, and placement in a care home where necessary. The person has to be certified to need nursing care in order to enroll in the PACE program, but studies show that only 7% PACE participants nationally reside in a nursing home.
In the US, I also had the opportunity to visit a hospice. Hospice is a place for people with life-limiting illnesses, their families and caregivers. A hospice addresses a patient’s physical, emotional, psychological, and spiritual needs.
During their stay they receive treatment to reduce pain and to alleviate other afflicting symptoms, to improve quality of life. No aggressive treatment is given and the patient receives love, care, compassion and skilled attention from trained medical, nursing and support staff. The hospice team also consists of spiritual counselors who are trained to create safe environments in which concerns are explored and feelings expressed without judgment. Hospice services with personalized care are also provided at home so that person is more comfortable surrounded by family.
Another interesting feature of services provided to older persons in the West is ethical wills. Unlike traditional wills which transfer worldly possessions, ethical wills bequeath values, ideas, and personal reflections to the younger generations. They are not legal documents. They reinforce the fact that one does not have to be wealthy to leave a legacy as it provides a way to live on after death.
It is never too late to learn. This is exemplified by the University of Third Age which is a movement-cum-organization where retired and semi-retired people come together and learn not for qualification but for the joy of learning and discovery. It is an international movement whose aims are education and stimulation of those in the ‘third’ stage of life based on the recognition that older persons have something to contribute even after retirement. Here the emphasis is on learning and sharing without formal links to traditional universities.
This is just a brief overview of the some of the services available for older persons in the West.
What we require is a range of services for older persons who are fit and looking for work, or those who want to volunteer their skills and experience to those who are partially dependent, to those who are totally dependent.
We need more professionals in Gerontology who will take this up as a career. Although we do not have too many organizations working with the elderly, this situation will have to change. Professionals will be needed to help families caring for the elderly do so in their own homes where possible and place them in care homes only when the situation demands so.
The dignity and independence of the elderly needs to be respected, and they need to be valued for their knowledge and experience. Just mouthing clichés like ‘elderly and their experience needs to be respected’ will not help in dealing with the needs of an increasing ageing population.
The very basic of infrastructures needed for the elderly to be mobile on their own, which we lack, needs to be looked into – so that those who fairly independent, can remain so, adding to their sense of dignity and well-being.
We need to look toward the future and make these changes, not only for our current elders, but also as those in middle life will soon join the ranks of the elderly, and it is in our hands to improve our own quality of life! These changes will also make it easier on their children, as the problem of caring for the elderly can often be fraught with social angst, especially in a patriarchal society like ours.
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