Director Shoojit Sircar’s Hindi film Piku based on a father-daughter relationship starring Amitabh Bachchan and Deepika Padukone struck a chord in the hearts of movie-goers and set the box office jingling.
Almost every Indian caring for the elderly at home could identify with the dichotomy and dilemma faced by young Piku (Deepika) trying to balance her career and personal life while caring for a dominating, at times-hypochondriac father, whom she loves but whose old-age antics prove to be a constant stress in her life.
Piku has come at a time when most of young India is grappling with geriatric care issues. If we go by the United Nations Population Fund report, they are set to become worse. The report projects that the number of people over 60 will increase from around 100 million now to more than 300 million by 2050 putting an additional strain on families, health and welfare services.
India’s population is expected to increase from 1.2 billion to above 1.6 billion by 2050 – by when it is expected to overtake China’s ageing population.
But thanks to the country’s social system, the elderly have always been cared for by their children. In fact, the elderly put in all their savings and retirement money in the education and marriage of their children knowing that they would be looked after by them in their old age.
But the social scenario is changing. While more and more young people are flying the nest in search of a better future, little has been done by the government to build a support system for geriatric care. While on the one hand this has resulted in missed opportunities, rising medical expenses and stressful lives for young people who are taking care of the elderly, this has also led to a sharp rise in elder abuse in India.
If caring for the elderly has become an issue in India, a number of factors are responsible for it.
Breakdown of the extended family
Indians predominantly lived in extended families, in large homes bustling with family members. Even if a few moved to other cities or abroad, others used to stay back to take care of senior members.
They used to pool their income to meet the costs of running a large family. However over the years, due to many factors, most extended families ceased to exist although some still stand as relics of the past. The nuclear family is the norm these days.
Advent of the nuclear family
A typical nuclear family comprises parents and their children, which is limited to two in most cases. Often grandparents live in the same household. Even in rural India, the scenario is somewhat the same. Trouble begins when brothers quarrel over property leading to vicious court battles or when self-centered individuals don’t want to pump in their income into a large household and instead prefer to live separately, sometimes within shared premises.
In such situations, the elderly become the victims of a tossing game where no one wants to take care of them.
Nitish Sarkar, 35, hails from a village in Burdwan in West Bengal and works as a watchman in Kolkata. Recently, he moved his wife and daughter to his Kolkata quarter. Back home, his younger brother, who is left to care for their bedridden father and aged mother, is so upset with Nitish’s decision that he is threatening him with suicide every other day.
Nitish defends his move. “My wife was caring for my father but my parents had little appreciation or empathy for her. I had to take a decision.”
Lack of support system
In the absence of proper geriatric day care units or hospitals, the full brunt of care falls on grown up children. Many employ maids or trained nurses to help them at home but not all can afford it.
Dr Indira Sharma, former president of the Indian Association of Geriatric Mental Health, said: “The lady of the house, in most cases the daughter-in-law, if she is not working, is singled out to take care of the elderly at home. It is usually assumed it is the job of the women to give geriatric care. This attitude needs to change, especially in Asian societies. Family members need to share care-giving duties.”
My friend, who does not want to be named, had been caring for her mother and mother-in-law for years. Recently, she decided to move her mother to an old age home in Kolkata. But the ones that were affordable were not good enough and the ones that she thought were OK were too expensive. So she went back to caring for them herself.
Dr Sharma said, “There should be day care centers for the elderly like they have for children. But this concept virtually does not exist in India. ”
Sacrifice and compromise
Many young people who move abroad or to other states of India to pursue their career later move back to their home states to care of their ageing parents.
Rashi Sen, 35, left her job as a scientist in the UK to care for her ailing mother in India. “I had appointed a caregiver from a professional organization. But that lady spiked my mother’s tea with drugs and ran away with her money. I had no alternative but to return,” she said.
Many Indian parents refuse to move to where their children live. A successful Indian doctor in the US said: “I’ve bought an apartment in the same building I live in so my parents can move in with me. My father is willing but not my wheel-chair bound mother. She wants me to return to India although she was the one who always said I should settle abroad. It is such a difficult situation for me. I have to travel to India every two months.”
In many households, young people, especially women, have chosen not to get married because they know they would not be able to care for their parents if they move away from them. Frustration and antagonism builds up that way as was with Piku in the film.
No change in mindset
Old age homes in India are not looked upon as a place for good geriatric care by the elderly. They are regarded as places where the elderly are forced to move to because their children don’t want them.
The high-profile old-age homes provide swanky rooms, personal butlers, excellent medical services and even personal transport. The fee for these homes ranges from Rs 25,000 (US$394) to Rs 60,000 (US$946) a month, which many expatriate Indians are willing to pay. In places like Pune and Delhi, such homes have become the current option. But in places like Kolkata, there is still resistance among the elderly to regard these as a home away from home.
Another growing concern in India is abuse of the elderly. Many elderly people spend all their money on their children and do not keep away any cash for themselves.
Parents are often physically abused, made to do all household chores or not given proper food. In some rural areas, elderly people are even administered medicines and injections that would ensure an early death.
Dr Sharma said: “The government should take steps to prevent elder abuse within the family. Often, children take away their parents’ financial assets and abuse them. Parents do not complain to the police or take legal recourse for fear of further abuse. If they manage to file a case, speedy justice should be ensured.”
The way forward
Dr Sharma lists a few steps to provide better geriatric care:
* Meeting the needs of a vast population is not easy because with increasing life expectancy, the population of elderly people is fast growing. With technological development and recent advances in medicine, a whole range of new drugs/ prosthesis/ surgeries for elderly are available. With surgical procedures like coronary bypass and joint replacement, life expectancy can be prolonged along with improved quality of life. However, these are very expensive and the government needs to take steps to bring the charges down.
* The government should ensure adequate number of trained (professional) caregivers because there is a great need for them. More and more women are stepping out to work and joint families are breaking up so there is greater need for professional caregivers.
* Development of different models of care to suit the elderly in various situations is the need of the day. There should be institutions, homes, day-care centers and respite care centers to take care of the elderly. Domiciliary care should also be available.
* It is also important to reach out to elderly people living in remote areas.
* Elderly people living alone need special attention. In addition to medical concerns, security of such older people should be given utmost importance.
* NGOs should focus on the elderly. Public and private partnership is needed for care of elderly. Insurance companies must provide better packages for them.
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