Changing contours of Care giving for the Elderly in India | Minakshi Biswas

by Minakshi Biswas*

The past few decades have witnessed a major shift with respect to care giving in general and for the elderly in particular. The onus of care giving previously rested upon the family. Within the family, the women being relegated to the private sphere were expected to perform the role of caregivers. Along with many other tasks to do with domestic chores, like performing household duties, nurturing and rearing children, they also played the role of caregivers for the elderly members of the family. The family as a unit of social reality held a different connotation altogether until its disintegration into nuclear forms. A single family housed several generations collectively and women among them generally delivered the labour which was unpaid in nature. Traditionally, women who were essentially assigned the role of such caregivers within the family have now become aware of their rights, mainly in the urban parts of India. As rights-bearing individuals they too desire financial independence in order to gain a sense of empowerment and are making great efforts towards becoming equal partners with men in the modern salaried workforce.The diminishing role of family as a caregiver has been accompanied by several other factors inclusive of rapid trends in rural-urban migration, migration to metropolitan cities to avail better education and employment opportunities whereby the elderly members of the family are left behind in their native places.

The elderly in many cases even on being financially secured tend to be treated as a liability by their own children. Although in some cases they may act as the babysitters of their child’s offspring/toddler, after a certain period of time when they physically become frail and dependent they as considered as liabilities by many. They are also regarded as causes of inconvenience due to the other forms of supportive care that they may require. Also which merits attention is the advancement in medical care that has led the life-span of any given individual to be truly stretched to a large extent. The elderly now live longer even with multiple diseases due to various kind medications in place. However, the quality of life stands compromised for many of them in their last stages of life. This is to imply, the nature of the quality of their lives that suffer due to a prolonged life span with heavy multiple medication and despite that lack of proper mobility due to different joint and bone disorders. They suffer from hypertension, diabetes, reduction in minerals and nutrients in their body due to old-age and are also bedridden in various cases. Under the scenario of a transformed structure of the system of Indian families in the contemporary times concomitant with extended life-span of the elderly the quality of care that they are due to experiences multifold neglect without proper support. Hence it becomes imperative to explore and comprehend the nature of services and support systems that can be viewed as an alternative in the absence of the old order of things that favoured the elderly.

Elderly caregiving services by private for-profit bodies are recent practices of the contemporary urban India. Nevertheless, private bodies driven by profit maximization are investing in elderly care services across different parts of urban India. These institutions provide several types of care facilities depending upon the needs of the elderly people. Private bodies like, Portea, Life Circle, Max Healthcare are providing home based medical care to the elderly who can afford it. This mode of care is aimed at creating a hospital like set-up within the confines of one’s home as per the requirements of the elderly person. The facilities that one can avail under this category of care ranges from ICU care to that of regular, round the clock service by a private caregiver, services by physicians, nurses and physiotherapists. An elderly ailing person in such a scenario is secured within a comfortable zone in his private sphere in the absence of caregivers within the family. Apart from these setups, an elderly person can also avail non-medical psycho-social services at home through private for-profit agencies that provide for fellow volunteers. These volunteers may serve as companions for the elderly who may avail such a facility from the private agencies in return of a payment. Such companions would provide service by listening to an elderly, talking to them, taking them out for a walk or shopping, helping them with their bank related work. They may also read stories, news and other items of the interest to the senior citizen who is being provided service. The purpose mainly is engaging with a senior citizen in different ways in the absence of a family. Hence these home care services for the elderly provide for a gamut of services to those who are in requirement of them, can act as consumers of these special customized packages in return of a certain specified amount in the comfort of their homes. These services claim to provide quality assured care where the elderly consumer within the confines of their familiar space can avail large number of facilities in a hassle free manner without causing any form of inconvenience to the rest of the family members.

Apart from home based medical care and supportive services, another significant development in the genre of elderly caregiving is the proliferation of institutional residential set-ups for them. A variety of such mechanisms are mushrooming across Delhi-NCR and other parts of India in the name of retirement homes, assisting senior living centres and so on. These institution based care facilities are usually being situated at a distance from the city to provide the elderly with a calm and natural environment. Such housing projects are been taken by up big business owners and real estate agents who are aiming to cater to the differential needs of the elderly. These are sophisticated homes, prerogative of the section of the elderly who can afford high end expenses in return of overall care. The facilities in such projects cover food, secured living, on call physicians, physiotherapists, entertainment services consisting of gyms, club house, library and spiritual healing session to name a few. Some even cater to dementia care for the elderly who need it.

However, what needs to be taken cognizance of in this process of transition of care giving for the elderly by their families to different for-profit caregivers is the fact that it remains confined only to a particular section. The segment of elderly population who are economically independent and affluent alone can avail the services provided by market forces that are at play. Most of the elderly people who belong to economically weaker sections continue to depend upon whatever state facilities are available in the absence of a family.

A huge section of the elderly population completely depends upon the state care and support for the redressal of their problems. Many of the economically dependent elderly people either live alone or live with their equally dependent ailing and aged spouses. They lie outside the purview of sophisticated care facilities provided by market forces.
Although, one may regard the flourishing of the elderly care market in India as a positive move the need for state sponsored care facilities cannot be understated. There is an equal need by the Indian state to provide for more elderly support structures with the increase in their numbers. As projected by UN, the elderly population of India will amount to 158 million people by the year 2025. Out of this, considering the present scenario, a huge chunk would remain being a part of the unorganized sector with no economic security. Hence, state action would be the only panacea for the economically dependent, physically frail elderly population. Better accessible healthcare, universal pension facilities and care units in form of state-sponsored shelters and homes can only serve as measures to create some form of an enabling environment for the vulnerable elderly population.

* (Author: Dr. Minakshi Biswas, Assistant Professor, Bamanpukur Humayun Kabir Mahavidyalaya, West Bengal State University)