Helpage India’s recent survey finds that 23 per cent of the elderly report some form of abuse. As the joint family breaks down, a look at how retirement homes could provide one solution.

Thirteen years ago P.S. Ragavendra Rao’s wife was diagnosed with Alzheimer’s disease. With his two children living in the U.S., Rao consulted experts there only to be told that there was no cure for the disease yet. Today, Rao’s wife is bed-ridden and needs medical attention 24x7. But on that day 13 years ago, Rao made a decision that would have a profound impact on all their lives.

“Both my children are computer engineers and well settled in the U.S.,” says the 80-year-old veteran, who served in the Indian army as a commissioned officer for 24 years. “I’ve visited my children in the U.S. seven times and, after my wife’s diagnosis, they asked us to come and live with them. But taking care of an ailing person is not an easy task. Moreover, our wavelengths are different. I want to maintain my independence and individuality and I want to walk with my head held high. If we were to live with my children I would have to depend on them even for a cup of coffee. In such a situation, I don’t live; I merely exist.”

Rao decided to remain in Chennai and be the sole care provider for his wife. But his aging body could not keep up with the demands of being a fulltime care-giver. That’s when Rao made another life-altering decision. He decided to move into a retirement community on the outskirts of Chennai where his wife would get the medical attention she needed, and he professional support.

On the other side of the globe is Ravi Mahalingam, a research professor at the University of Colorado, School of Medicine. Ravi has struggled with the issue of being a care-giver for his parents while living half a world away. In the late 1980s, he moved back to India to be close to his family. But research opportunities in India at that time were not very exciting and, more importantly, his father felt he would be better supported financially if Ravi was in the U.S. After a few years of giving return-to-India a shot, the neurology researcher moved back to the U.S.

Both Ravi and his sister, who also lived in the U.S. at the time, tried persuading their parents to move to the U.S. and live with them. “My parents are extremely independent. They have their own routine and way of doing things. They did move in with my sister and her family in Detroit, but things did not go well. After a few years, they surrendered their green cards and went back to India,” reminisces Ravi.

Back in India, Ravi’s parents did not want to be burdened by the task of maintaining a home and with household chores. They decided to move into a retirement community. Says Ravi, “My wife and I did a lot of research and flew to India to scout for facilities that will support my parents’ lifestyle and be equipped to take care of their basic medical needs.”

Today Ravi’s parents, 85 and 92, seem to have settled well into the routine of their community. There is a temple within the sprawling campus and activities for different age groups. “A year ago my mother had a heart attack but she did not realise it. Thankfully, the nurse on the campus saw her sweating profusely and rushed her to a hospital. I’m so grateful that this kind of system is available in India today. That’s the reason I am able to sleep at night,” says Ravi.

Ravi’s parents and the Raos are not alone in opting for assisted living in India. As the joint family breaks down and as young people migrate to other countries or cities for work, they leave behind aging parents who now have to fend for themselves.

Senior communities in India were originally charitable institutions. “They were called old age homes and had a negative connotation. They were set up to look after the poor and destitute elderly who either had no family or had been abandoned,” says Colonel Sridharan, who runs the Serene group of retirement communities in Tamil Nadu.

“Children are unable to do much because they work far away from home. Parents are reluctant to lose their independence by moving in with their children. As one grows old, there is a tendency to be fiercely independent,” he adds.

Adding complexity to this rapidly evolving social dynamic, India’s elderly population is set to increase dramatically over the next four decades. According to the United Nations Population Division, by 2050 India’s over-60 population will reach a staggering 323 million — a number greater than the total U.S. population in 2012. Today, people aged 50 and above are at 16 per cent of the Indian population, which is relatively small. But the number is set to increase steeply to 34 per cent by the middle of the century.

Mathew Cherian, CEO, HelpAge India, one of the largest non-profit organisations working for senior citizens in the country, points out that although retirement communities are mushrooming, the growing aging population will require better facilities and services in coming years. Cherian points out that there are over 4,000 old age homes, of which only around 130 are designed as retirement communities, geared towards the expectations and demands of the rising middle class and affluent NRIs.

As retirement communities get smarter, savvier and more in touch with the needs of this new clientele, they are losing the negative tag. Many parents are actively looking at these homes as an alternative lifestyle. T.S. Srinivasan (73) and Usha Srinivasan (66) chose to move into a retirement community in Coimbatore in 2007. With both children living abroad, the Pune-based Srinivasans began to seriously consider shifting base to a retirement facility where other family members also lived.

“I enjoy being here,” says Usha. “I am surrounded by people of my age group and most of our children live abroad; so there is a common bond. When it’s festival time, we organise a small skit or dance, we have daily puja sessions, and a group of us are actively involved in social service. If people fall sick, we hold prayer meetings and we all take care of each other.”

Her husband points out some of the drawbacks. “The food is not always to my liking and, because the community is on the outskirts of Coimbatore, it can be very expensive going to the city. Moreover, we have to travel about 22 km to get to the medical centre.” He also says it can get scary to be surrounded by people of his own age group when they fall sick or die.

The Srinivasans might have embraced retirement community living fairly well, but it is still not quite a national phenomenon. Mathew Cherian says, “Given our value system, there is a continued expectation that children will look after their parents in old age. The stigma of abandonment continues to persist.” As Dr. Puni Kalra, a Denver-based clinical psychologist specialising in cross-cultural trauma, says independence is a very important marker of aging. “Senior community living does not have to be a negative option. If we can have the discussion early between parents and children about what parents want to do or achieve, instead of making assumptions, it will make the decision-making process easier when it’s time.”

Depression brought on by loneliness is a major problem among residents at such communities. “There is not enough love and care in these places. Phone calls, Skype conversations, and rushing to India when a parent falls sick are just not enough,” says Cherian. And with the phenomenon still fairly new, the issues relating to remote care-giving and other physical and psychological issues are uncharted territory as well.

Of course, retirement communities are not the right answer for everyone. Radha Sankaran (75) lost her husband in 2000, and with both children abroad, she was at a crossroads. “I became lonely; managing maids became a huge problem. A few people suggested I check out a retirement community.” Unfortunately, it did not turn out to be quite what Radha expected. “I felt like I was surrounded by sick people all the time; it was very depressing. In my flat, I would enjoy seeing people of all ages and have children playing outside. I felt far removed from the city I had lived in for more than 50 years.” Her children could not stand to see their mother unhappy and made arrangements for her to return to her apartment.

Good retirement communities don’t come cheap. They cost anywhere upwards of Rs. 10,000 per person a month depending on the kind of arrangement chosen. Other variables like medicine, utility charges, TV and Internet connection are extra.

Not everyone is comfortable with the way retirement communities are evolving in India. “In the U.S., it is a highly regulated industry,” says Dr. Vish Venkatesh Iyer, who is a certified medical director of various nursing homes in the Pittsburgh area. “Here, if a resident does not get medicine on time, authorities can take action against the facility. If there is a pattern of abuse, it is a criminal offence. There is a high level of accountability.” He worries that, with the lack of clear laws and legislations, assisted-living facilities in India can become money-making entities that leave the elderly vulnerable to scheming business ventures.

Colonel Sridharan agrees, and says that his company’s homes are modelled after assisted-living facilities in the U.S, with stringent guidelines for design, safety and accessibility. Their staff receives training on how to behave and treat elders. “I have become a senior citizen myself during the journey of creating these retirement homes and, to me, this is very personal. However, with the lack of legislation, fly-by-night operators without any track record are entering this market.” The need of the hour, he points out, is clear laws that de-link senior communities from real estate ventures.

Meanwhile, back in Chennai, Rao — who has been in the assisted-living facility for over 10 years now — has a piece of advice for senior citizens. “I love my children, but money is the most reliable plan for old age.” He points out that parents must become more mature as they age. “You cannot expect your children to change your diapers all the time. Senior citizen homes are here to stay and whenever there is change, there are bound to be problems and conflicts. It’s just the way society evolves.”

Does he have any regrets over his decision? “No, it was the right decision,” he says. “The only thing is I love to travel and experience life in small villages. I’ve not been able to do that in the last 13 years,” he says. That’s because he continues to care for his ailing wife. “My only wish is for her to die before I do. Nobody can take better care of her than me,” he says with obvious pride.