S. Raymond, a senior citizen and an amputee is one of the more recent members of the “family” at the Pope Paul Mercy Home in Nanjanad, Udhagamandalam. He was left at the care facility for the elderly and persons with disabilities by his family as they could no longer take care of him.
Mr. Raymond, who used to work in the Middle East, had married in his 40’s, and has no children. “After I got diagnosed with diabetes, they had to amputate my leg below the knee, and my wife and family said that they could no longer take care of me, and left me at this home over a year ago,” he said.
Sister Mercy, the Sister Superior at the Pope Paul Mercy Home, says that cases such as those of Mr. Raymond are common. “The families bring old people, who have a medical condition and leave them here. They either don’t have the resources or the time to look after them. Some even claim that the person they are dropping off are not even related to them,” she said.
Though Mr. Raymond is looked after by the sisters at the care facility, he lauds the government health sector and the local dispensary, where he gets vials of insulin every day. “It would simply be too expensive for me to buy insulin from a pharmacy, but the government dispensary always has a stock, and I get it for free,” he said.
Looming health burden
At the country level population studies suggest that 80% of the elderly live in the rural areas, and this makes service delivery a challenge. Secondly government projections suggest that “feminisation of the elderly population” is occurring, with 51% of the cohort likely to be women by 2016, and there is likely to be a steady increase in the number of the older-old persons, that is, those above 80 years of age. Finally it is a matter of concern that 30% of the elderly are below poverty line.
Data from the 60th round of National Sample Survey paints a comprehensive picture of the status of older persons in India. Analysis of the data in a report by the U.S. National Institutes of Health suggests that the “prevalence and incidence of diseases as well as hospitalisation rates are much higher in older people than the total population.”
The NIH study notes that per the NSS survey, a good or fair condition of health was reported by 55-63% of people with a sickness and 77-78% of people without a sickness. In contrast about 13-17% of the survey population without any sickness reported ill-health. “It is possible that many older people take ill health in their stride as a part of ‘usual/normal ageing,’” report authors R. Verma and P. Khanna note, adding that this observation was highly significant as self-perceived health status is an important indicator of health service utilization and compliance to treatment interventions.
While home-based health solutions such as Portea have cropped up to cater to the demand for healthcare services by the elderly within the middle class, much less is available in terms of affordable models of health and social care for the poor, which is inconsistent with the changing needs of this cohort.
While in India the families of the elderly are the primary care givers it is quite likely that this “model” may crumble over time given that the elderly population is increasing rapidly and there is likely to be a shift in the disease pattern from communicable to non-communicable.
At the heart of any solution for healthcare services provision must be the realisation that “disease and disability are not part of old age and help must be sought to address the health problems,” according to the NIH report.
Unable or unwilling?
Yet it is not always about resource-crunched families being unable to provide medical care for their aged parents. S. Indirani, a 70-year-old woman from Karumbalai in Madurai, was leading an independent life working as a domestic helper until she had a stroke one fateful night two years ago, which made her partially immobile.
Though she recovered to an extent after treatment at the Government Rajaji Hospital (GRH) in Madurai, prolonged treatment in a bed-ridden state and inability to earn income strained her relationship with her son’s family, with whom she was staying.
Recently, she was admitted by her daughter Indirani at the Nethravathi Pain and Palliative Care Centre in Madurai. R. Balagurusamy, Managing Trustee of the centre, says that Ms. Indirani’s story was a typical example of the cases frequently referred to the centre.
“Though spending on medicines for the elderly is a significant burden for some families, money is often only the secondary reason for them to abandon ailing elders,” Dr. Balagurusamy said. “The primary reason is the inability and hesitance to take care of them, particularly when they suffer ailments like stroke or neck of femur fractures that hamper mobility and make them often dependent on others even to answer nature’s call,” he added.
Role of police
The elderly from among the destitute population face additional procedural complexities in terms of admitting institutions intimating the local police station and getting an approval from them. Even though the Maintenance and Welfare of Parents and Senior Citizens Act gives the police a major role, they are usually overburdened and not sufficiently trained to handle such cases in a compassionate manner.
According to V.P. Manikandan of Madurai, who is actively involved in the rescue and rehabilitation of abandoned elders, “We should instead look at well-functioning systems like Childline and District Child Protection Committees, which act as the first point of contact for the children in need.”
He said that a similar set up is needed in rescuing and providing healthcare to abandoned elders, with participation from NGOs that have trained professionals. “There should be a helpline for elders like they have the 1098 helpline for children,” he said.
Echoing his views, Dr. Balagurusamy said that the government should also adopt Public Private Partnership model to set up palliative care centres in every town, preferably inside hospitals, that can primarily cater to the needs of elderly and terminally ill patients. “Today, we have homes for the elderly in many towns. However, they are ill-equipped in taking care of their health needs. That is where palliative care centres with participation of NGOs can help,” he said.
