Special issue with the Sunday Magazine
AGEING: October 18, 1998
Homes of the future?
IN less than 400 days, on October 1, 1999, nations round the globe will observe the International Day of Aged Persons. The United Nations has decided that the Year of the Older Persons will begin on October 1, 1998 and has plans to highlight the special needs and plight of the elderly.
On that day, there will be pious promises, crocodile tears, and forced sighs of empathy; and piles of charters which the member nations will ratify wholeheartedly. But precious little will be achieved to embrace the many feeble-in-body-but-strong-in -will aged who harbour hope amid hopelessness. To hundreds upon thousands of these helpless but not hopeless souls round the world, each minute of their life is like a mural in a half-lit cave that they would rather not see but have to nevertheless, and crave for what they know they will never get. A touch, a kind word, and a loving embrace from the ones for whom they sacrificed their all.
Shunned by those whom they breastfed, whose midnight tantrums they endured, whose mess they cleaned without ever covering the nose with eau de cologne-swabbed towel, whom they perched on their shoulders and with whom they played and sang, and whose every whim was more sacrosanct than the Ten Commandments, the ignored aged have no choice now but to exist in the cages of old age homes. The decision of their children or kin to dump them in an old age home is replayed again and again in their head, like a squealing track on a damaged disc.
It is easy to browbeat our feeble parents to live in an old age home. On an average, the aged neither have the ability nor the desire to protest. "You become a burden to others when you are old," says Dr. Nirupama Naik, an elderly spinster who is still an active gynaecologist in Bangalore.
With nearly seven per cent of the population of over 90 crores shuffling across the line that defines the elderly (over 65 years old), India will have over 6.3 crore people by the year 2010. Our society is not prepared to handle the tide - a group that will burgeon in future.
The directory compiled in 1995 by the Centre for the Welfare of the Aged (CEWA) lists 482 homes, of which 17 per cent is for women, 34 per cent charge for the service, 53 per cent is secular and the rest run by Christian missionaries, of which a large number is in Kerala. A few homes are run by other minorities.
Even if one is optimistic, there are no more than 700 homes for the aged today which can handle at the most 30,000 people at any point of time. So our nation needs 217 lakh more homes to shelter all the elderly. Though many will bite their lips and stay with their children, the need for a large number of homes remains.
"No children, no support is as untrue as more children, more support," says Dr. Ramesh Kanbargi, Institute for Social and Economic Change, Bangalore. Falling death and birth rates have added to the number of elderly in India. So, better healthcare has worsened the plight of the aged. Decrying the Government pension of Rs.60 a month for destitutes Dr. Kanbargi says, "That is how we are maintaining poverty and the poor."
According to Dr. E. Haribabu, department of sociology, University of Hyderabad, "The main reason for their plight is the demographic transition in our country. Unlike rural households, urban families are not units of production. Migrating from rural to urban areas, people have learnt to sell their labour. This alienates the elderly who can neither bid effectively in the job market nor share their expertise, which becomes obsolete overnight." In other words, the elderly are redundant today.
The size of family units is crumbling because of power sharing conflicts. The highest earner decides the policy which may not please the lower income members. The split follows as a corollary to the theorem of conflict. It leaves a trail of victims, mainly the elders, who can no longer tie the feuding groups with love, a fragile emotion which is crushing in the stampede towards higher and higher rungs up the social ladder.
The homes across the nation, where the aged are dumped, are often worse than a sty where overcrowding and grunts are common. In a 14ft-by-10ft room, for instance, six steel cots are lined, leaving hardly any space to move around. Intravenous fluid pouches hang from nails on the wall and medicines lie scattered on folded newspapers under the hard cot, often without mattresses, on which the residents (whom even the gods seem to have forsaken) lie lifelessly. Stains on the bed and floor are a common sight almost everywhere.
In response to the demand for old age homes, many have set up units for profit. Though they profess a strong commitment to the welfare of the aged, there are holes in the care delivery system which cannot be plugged unless one ploughs back a large part of the net income. This is not done.
D. Venkatesh of S.V. Home for the Aged, Arumbakkam, Chennai says, "My home is one of the very few in Madras which takes care of the infirm, the aged and the dying destitutes. I even have waterbeds which you won't find in most places. Working couples often cannot spare the time to take care of their parents and seek the old age homes. We take care of them till they die."
"During the summer it is worse, and deaths are more," he says, holding his cellular phone. The chill in his air-conditioned office was a telling contrast to the sultry heat of a July afternoon that hung like an invisible cloud in all the other rooms of his Home. It was worse on the first floor where an open terrace had become a room with a thatched roof. The fan, running at full speed, only circulated the hot, asphyxiating air within.
Many in the home said they were taken good care of and almost everyone who chose to speak of their background said they had become a burden on their well-placed kin. A number of them said their children visited them regularly.
The expense varies depending on the need of the resident. At the S.V. Home for the Aged, total care of the infirm means Rs.2000 a month, including food and medicines. Guardians of the mentally-disturbed young and aged inmates fork out Rs.2000 a month, but able-bodied aged pay Rs.850 a month. The mandatory donation is Rs.5000 and there are 40 free beds out of 180. Venkatesh says it is a difficult vocation and he earns "a fairly decent sum every month." As every family member of Venkatesh draws a salary, the net profit on the balance sheet is likely to underestimate the income the family earns. So the return on the investment of time, effort and money is impressive.
Can one condemn the homes run for profit? After all, they add to the total supply of beds for the aged. If the entrepreneur were an incorrigible philanthropist, the business would fold up. That the homes thrive shows that beds are needed. A typical private unit maximises the number of beds in a room as each extra bed means money.
The K.J. Home for the Aged in a litigation-ridden building in Chennai is literally falling apart, but the residents are a happy lot. The wit of the matron, Rohini (79), a spinster from Pallakkad, Kerala is razor-sharp and her saucy comments on the reality of life are truth distilled from years of freedom she enjoyed, the double-standards of her kin that she had seen, and her role in the freedom struggle.
Sushila (71), a resident who owns a palatial bungalow in Perambur, prefers the home because here she is free. "Don't be mistaken. My son wants me to be with him but I don't want to be a source of trouble for him. I enjoy and want the company of people here," says Sushila, who retains a subtle finesse.
Far down the road to Mamallapuram is the home managed by the Vishranthi Charitable Trust, headed now by Savithri Vaithi. Its quality is amazing as "it runs on a non-profit basis." The rooms are sparkling clean, the kitchen spotless and the residents all well dressed, having no trace that they were destitutes once.
The Association of Senior Citizens' Resorts next to MGM Dizzee World in Chennai is not quite a home for the aged though it is enlisted in the Centre for the Welfare of the Aged (CEWA) directory as one. Conceived of as a resort for retired bureaucrats and professionals, its price tag is hefty - an initial outlay of about Rs. 2 lakhs for a suite and a recurring expense of about Rs.1500 a month. "We have a community kitchen here. The food is right for us as we have to be careful of salt, sugar and oil," says P. Prabhakar, a resident. The independence is total, but one hurdle is the distance from the city. The nearest multi-starred unit, Malar Hospitals, is over 15 km away. The other difficulty is, there is no vacancy and entry is controlled strictly by the trustees.
The missionary-controlled homes almost everywhere shelter quasi-destitutes. The one in Pondicherry run by the Sisters of Cluny, France has around 150 residents, including distressed women. The charge is nominal, around Rs.1000 a month. The quality of life the residents enjoy is average with the rooms fairly clean. A resident says it is expected that non-Christians will convert in course of time.
As Sister Colette of the Little Sisters of the Poor, Bangalore affirmed, "Many destitutes get a fresh lease of life once they come here. It is not easy to take care of the aged. It needs total devotion. After they die, we give them a decent burial." The home run by the sisters stands as an example of what devotion can achieve.
One missionary-managed old age home that does not seem to offer much comfort to its residents is the Sneha Sagaram at Kovalam. The dilapidated, tiled-roof building in the church complex is a testimonial to the quality of life within.
The residents of Vrudashram, Bangalore seemed happier than what each would have been with their children. "You know nothing about old age and you never will till you grow old," said a former Government official while explaining what old age meant and what brought him to the home.
The Canara Bank Relief and Welfare Society on the outskirts of Bangalore houses 32 aged persons, including couples. It is an expensive home and as everywhere else, there is a long waiting list.
The Senior Citizens' Home close to the National Police Academy in Hyderabad throbbed with life. Its uniqueness was the infectious happiness of its residents. K. Bhaskara Rao, the warden, said he wanted to study religion and philosophy. "People make so many demands. My son will ask me to go to the market, my grandchild will want some chocolates, my relatives will want me to do this-and-that. Don't you think that after spending years for the welfare of my family, I need some time of my own?"
The Rama Naidu Charitable Trust Home for the Aged seems to be the best of the lot. Located nearly 65 km from Hyderabad, the layout and landscape are amazing. Each room is elegantly designed with an emphasis on utility. The residents are rich, but they realise that wealth never guarantees peace and happiness. The Sisters of Charity of Saints Bartholomea and Vincenza Gerosa hold the brief to extend emotional and spiritual support to the residents.
Wing Commander (retd) M.K.M. Raju (60), who fought for the country during the post-independence skirmishes with Pakistan and China, is now a heart-broken man. His knowledge of air warfare has not helped him overcome the handicap of his damaged leg. He said he felt better after coming to this home. "The company is excellent. I suffered from loneliness when I was with my son's family. It is such a pleasure to be here now," said Raju. His opinion was reciprocated by B.S. Abhishekam, M. Rangadasu, and V. Narasimha Reddy. What if they needed urgent medical care? "Who cares?" they said.
The Anurag Services - Old Age Home, a simple unit run by Srinivasa Rao in Hyderabad, is another example of total commitment. Srinivasa Rao who started the home in 1992 after a bitter experience in real estate business, is now helped liberally by well-wishers. Rao, aged and ailing, lives with the residents who have free access to him and his wife. The plight of a silk-sari clad woman proves once again that wealth finally does not matter. She lies on the bed in a single room, whimpering in pain. A victim of uterine cancer, her sons brought her here as they were "unable to take care of her any more." In the final lap that remains till her pain-enveloped life is snuffed out, she cries out suddenly for one of her sons and then for Rao who runs to her.
Later Rao says, "She wanted her last son. Then she called for me because she knows he is not here." Rao gives the residents his all and they love him. "I have even done the last rites for those whose children either refused to come or could not as they were abroad," he said.
The State-run home for the destitutes everywhere seem to have similar constraints. Financial support is weak and not all employees worry about the aged. The Home for the Aged and Infirm at Lawspet, Pondicherry was so dark within that one would need infrared vision aid to move around. The residents were happily munching rice bathed in watery sambhar (dal) when the officious matron drove this correspondent out saying only the superintendent could speak.
Lying almost diametrically opposite at another end of the country is the State-run home for destitute women and helpless persons in Bamunigao, Guwahati. Standing on a sprawling 80 acres, the barracks have tin roofs. The rooms are dark and the smell of mildew is overpowering, but most of the residents are lively and active - fetching water, helping in the kitchen or cleaning the place. There are 20 women and two men sheltered here.
Sunpahi Phukan, superintendent of the home, says that if the Government had money, it would have done a lot more. She chose not to live in Guwahati because she wanted to be with the residents here. "Nobody can tell when someone will need me," she mused. A very rare trait among Government officials these days.
Mr. P. K. Pincha, joint director, Social Welfare and Anjali Dutta, superintendent, State home for destitutes and women at Jalukbari, Assam explained why there were not many takers among the aged. "Our people are probably less materialistic than elsewhere, and our children respect their elders. Nevertheless we would appreciate it if greater importance is attached to old people in the homes," they said.
As it stands, the homes that promise to meet the special needs of the aged are too few to shelter all who need them. The ones for the rich are expensive and those for the destitutes fall short in quality. There aren't many homes for the middle class and those which exist rake in money without offering reasonable comfort. Interestingly, not a single room in any State-run home for the aged had anything to cheer up the spirit of the elderly. The walls wore a dark distemper, the windows were either small or non-existent, and the cots were not meant for comfort.
"The main problem is, there are no rules and no organisation to control these homes," says T. Krishnan Nair, secretary, Centre for the Welfare of the Aged (CEWA), Chennai.
In the West, the care system for the aged is more refined because of a longer innings of material progress. Isolating the aged has moved in step with the pace of tangible progress there. Familial relationships are weak and youngsters break out early. Couples are estranged and marriages break down. The trend is therefore to provide for one's own future welfare as there is no expectation from the young. In India, this is a recent trend.
Though laws exist in most western countries to punish the errant homes, there are countless incidents of the aged being harried, robbed, assaulted sexually or physically, and tortured psychologically. The Detroit Free Press ran a series of essays on the violations in old age homes in and around Michigan, and even suggested a checklist for selecting a home.
None can deny that the Western lifestyle offers a role model to the successful, young professionals in India today. With just 24 hours available each day, the demands of the job as well as the stress of material needs swallow a large chunk of the disposable minutes. The professionals realise they have less time for the elderly parents who gave them the first push. But emotion is least welcome in their rationally-charted course of life. The easy option is to dump their parents or the single, elderly kin in professionally-run homes and pay for the service regularly. The emotional needs, of anyone except one's own children, are not a flagged priority in the memorandum of power-driven professionals today.
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