The angst of Ageing

The problem of ageing is fast becoming youth centric:

If achieving longevity was one of the triumphs of the 20th century, taking care of the elderly will be the challenge of the 21st century.Traditionally, the elders in a community were seen as an asset.

In a patriarchal society, the reverence accorded a chieftain implied respect for age; an old woman came with the tag of wisdom attached. No one questioned the authority of the head of the household. The idea of a family was grounded on the idea of a mutual contract, a balance between head and body, root and branches that would support each other in perfect symbiosis.

In the changing scenario of a modern, competitive society, however, where the needs of the individual have fast overtaken that of the family unit, the position and status of the elderly have been badly shaken.

The care and protection they used to enjoy have been undermined by several factors. These range from urbanisation and migration, and the breakdown of the joint family system to a global consumer society and the consequent change in the role of women from care-givers to career makers.

Are old age homes the answer?

Old people's homes do not appear to be the obvious answer for the majority of the Indian elderly, when they are questioned on this delicate subject.

There is a social stigma attached to 'sending parents to a home'; the 'home' is often confused with destitute homes for the elderly, and grim images spring to mind. But women, more than men, are seemingly pragmatic about their own old age and old age homes.

Says Mumbai-based hypnotherapist Devika Iyer, "My mother is no more and my father suffers from Alzheimer's. There are not many places where they care for people who have such a serious condition. I think there is a definite need for such places.

My elder sister has great reservations about sending Dad to an old age home, because it is an emotional issue with her. It took me a while to come to terms with the idea myself and I have not only reconciled to it but I also think it's a very good idea. I'm very open to the idea of spending my old age in a home!"

Ruth Thomas from Cochin works with a five star hotel chain and was offered a big break in her career recently. She was torn between her need to pursue her personal ambitions and the duty she felt towards her own parents.

She says, "I was offered a very good job in Mumbai and was raring to move, but I stayed back because my parents are old and need me to be with them. I would feel a bit guilty about leaving my parents in an old age home, no matter how good the facilities are.

I don't want them to feel unwanted and I think they would feel betrayed and sad. They belong to an era where children were expected to look after their elders."

Bangalore-based Sangeeta Laxman's parents chose to move into an old age home. She explains, "My sibling had gone wayward and it was necessary for my parents to live on their own after I married and moved away.

I did not feel any guilt and my parents did not feel any sense of 'abandonment' because it was their choice. But, if parents do not have any alternatives or no one to take care of them, I would think an old age home would work for them." Sangeeta's parents hate the life in their old age home, and are planning to move out into an independent flat. She explains.

"Why old age homes don't work quite often is because people who are still mentally, physically and emotionally very fit and energetic - like my parents - may find themselves trapped with a bunch of senile or very inactive, and mentally ill people, and find it dispiriting to see this day in and day out."

The cost and comfort factor

Upmarket old age homes are usually possible only in urban scenarios, and if you have the money to afford them. "If you are slightly lower middle class, then God help you!" says Sangeeta.

She adds, "In my old age, I'd probably like to live in a self sustained township where there are other old people, and facilities like banks, medical stores and departmental stores.

There would need to be a central security system installed, power and water systems in place, and of course, amenities like a carpenter or painter for when you require one. I know of a township that exists like this in Rishikesh, where different kinds of dwellings - from little villas with rose gardens, to simple dormitory type facilities - are available... all at different prices of course. It's also a spiritual centre, and one would meet like-minded people in such a place."

No doubt the family has so far been the most effective provider of old-age support in India in the absence of institutional support.

But with an increasing imbalance between a generation of golden oldies - who are not only living longer, but who have every expectation of continuing into an active old age - and a younger generation of persons who are not willing or not able to support them, who will provide the former with the means to a comfortable and safe life in our increasingly crowded cities?

There may be no immediate answers, but good old age homes, well planned and well run, might be part of the solution.

Is this the solution?

In the US, there is the concept of the residential centre that provides a safe environment for the elderly. At these,they are given basic care for common aliments like mild dementia and typical conditions like a broken hip. These establishments are ideal for those who have been living alone for some time but are no longer able to function well on their own.

Younger people are at hand to assist them with simple errands like shopping, driving, bathing and cooking their meals as well as quite often arranging small outings to keep them active and interested in the outside world.

The medical care teams in these homes monitor simple issues like blood pressure or skin eczemas, but they do not take care of those seriously ill, who may be bed-ridden, have broken bones or need nasal feeding. It is in this way that the residential homes distinguish themselves from nursing homes.

Residential homes in the USA have become intermediary steps that help old people live with dignity and discipline.

Deal with the situation

It's difficult deciding to place a parent in a home. Here are some helpful tips to help you deal with the strong mix of emotions this decision inevitably brings with it.

Choose a home that allows you to be involved in your parents' care Give the staff as much information about your parent as you can - her interests, her grandchildren, her friends, what her preoccupations were, it will help them see her as a person, rather than just another inmate. If they don't want to know, it's perhaps not the right home.

Meet the resident doctor and discuss your parent's care intensively with him or her. Let them know that you want to be very involved with all medical decisions.

Remember, it's okay to cry and to be emotionally overwrought after the first few visits. You will soon come to realise that your parent is benefitting from the round-the-clock care and companionship that you probably could not provide.

And keep in mind that you're not betraying anybody by getting on with your life if you've tried every other alternative.