Parenting A Parent: Caring For The Elderly In India

Parenthood is tough.

Especially when they turn a certain age.

After a point, they stop listening to what you are saying, and eat that extra sweet any way. The forbidden samosa eaten on the sly is also something I discovered recently.

Calls to not walk near slippery floors go unheard. As do the constant reminders about most things under the sun.

Parenthood is tough. Especially when you’re parenting a 62-year-old you call ‘Maa’.

Independence From Raja Betas

Elderly or geriatric care in India is broadly divided into two main categories:

  1. The ungrateful children who abandon their parents
  2. The Raja Betas who go ‘beyond their means’ to look after them.

I say beta because patriarchy doesn’t allow for most married Indian women to do that.

As is evident (or not), this categorization does not include those who, for example, don’t have children. Or, more importantly, account for the fact that the elderly might not want to live a life of dependence.

Recently, I, (who my mother is still unsure of which category to put in) bought my mother three pieces of jewellery that she hasn’t taken off since.

Sitting pretty on her right hand is a shining white cast made from the best plaster of paris, Paris has ever seen.

Adorning the left is a customized (via velcro with highest quality stickiness) elbow belt best suited for those with a tennis-ish elbow, also known as didn’t-go-to-the-doctor-when-my-daughter-asked-me-to.

Bracing the right knee is a resplendent knee cap that is just the right fit for those who go for morning walks on rainy days.

The knee cap came in a pair. But the other one is worn for special occasions like when there’s an urgent meeting with her “team”, which, I was convinced with a straight face, might have national consequences if missed.

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My mother works for a network marketing company.

Network marketing is basically a form of pyramid selling where a company sells goods to a ‘salesperson’ who then sells the product while also recruiting further salespeople to do the same.

This creates a hierarchy in which each member receives returns from the sales made by those under them, as well as from sales they make themselves.

Given how twisted that description sounds, it is easy to guess that the money, though significant for those with no other income source, is not phenomenal and also fluctuates a lot.

There are no targets to meet. It is essentially a self motivated venture for each individual.

Bottom line, it is not something that a mother of two decently earning children most absolutely needs to do for financial reasons.

But my mother, a sexagenarian, works over 10 hours a day on most days, with with a team of mostly women- many of who come from very different and lesser privileged social groups.

In the time that I’ve stayed with my mother since I moved back from a different city, I’ve realized that the money she makes from this, however little or much, holds value beyond its monetary worth.

With the money, she ‘earns’ her independence. A livelihood which can potentially sustain her if everyone else fails.

With the independence comes an often-ignored aspect of elderly care in India- good mental health.

My mother enjoys the independence of enabling people she recruits, mostly home-makers or women with no other major jobs, to earn a living. She enjoys the networking, the “team meetings”, et al.

This independence of hers becomes stark as I see many of her peers in salaried jobs plunging into depression or other mental illnesses after retirement. While in many cases, this is about ‘not having anything to do’, it is also equally about lack of financial independence.

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Income security among the elderly is not often deliberated about in India where over 8.5 per cent of the population is above the age of 60.

A AISCCON survey from 2015-16 shows that 66 percent of the elderly in India are either ‘very poor’ or below the poverty line.

The same study says that 60 percent of those living with their families face abuse or harassment.

NSSO data has shown that families with elderly kin spend 3.8 times more per month on healthcare than those without. This makes elderly people more vulnerable and highly dependent on their children.

Experience with my mother has also shown that even the thought of complete dependence on someone to whom they were once a care-giver adversely affects an elderly person’s sense of self.

And as a good parent-to-parent (that’s the term I’m using for the likes of us), I could never let that happen.

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Ayah Centres & Old-Age Homes

Over the past few years, there have been several start-ups that have made huge progress in setting up assisted living.

Parent-to-parents also face the guilt of not giving their parents enough time. And the constant anxiety of not being there when they might need you the most.

“What if she slips in the bathroom?”

“What if something happens in the dead of the night?”

In my case, more specifically, it is also about ensuring that she is bathed before I leave for work, that I’m available to feed her at the times she needs to be fed and that she is reminded to take all her medicines on time and in the order they are supposed to be taken in.

The logistical problem in most cases is the lack of time and the inability of children, who are either early-on or in the middle of their professional lives, to be physically present around the parent in the latter years of their lives. It is here that the concept of assisted elderly living comes in.

Assisted living is usually of two types: One where a professional or a group of professionals assist the elderly at their place of stay. Another, is when the elderly physically move into an assisted living centre, commonly known in India as “old age homes”.

Over the past few years, there have been several start-ups that have made huge progress in both these areas. However, the cost of affording such services, due to their private nature, makes them inaccessible.

Private-run ‘ayah’ services which is the cheapest one can get to a (informally) trained professional in India are often dubious in their background checks and the ayahs lack medical knowledge. More importantly, they do not assume responsibility of the household, but just the person they are catering to. This is unlike countries like Canada and Switzerland, where a living assistant literally assists the elderly in everything- from cooking, to laundry, to paying the electricity bills.

There is also a social worker in these (and many other) countries who is assigned to a particular elderly citizen. The social worker takes regular updates of the person’s well-being and is a point of contact for any information on the said person.

The problem with old-age homes, on the other hand, is that of quality. While private homes are once-again, prohibitively expensive, others can’t maintain basic living standards. Under the Integrated Programme for Older Persons (IPOP), the central government gives financial aid to over 400 old-age homes, but stories of ill-treatment of the elderly in these homes are rampant.

There’s also a social stigma associated with ‘being left at’ an old-age home. The AISCCON report states that 39 percent of senior citizens are abandoned by their families. The choice to live in an old-age home, therefore, is more often than not, devoid of any actual choice.

As I write this, parent is upset over something she said but I didn’t pay heed to.

“Drop me off at an old-age home, if you don’t want to pay attention to me”, comes the threat.

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Attention > Money

A study states that depression is the most common cause of mental (and physical) distress among the elderly in India.

The above-mentioned threat was followed by my mother’s compulsive need to plan out weekends, since she has had her fall.

“I haven’t been to a movie in years.”

“When was the last time you took me out for dinner?”

“There’s a sale at the mall. Let’s go buy something for the festival season.”

“But you can barely walk!”, I say.

“That’s alright. I’ll limp. I feel so much better when I’m outside”, comes the reply. “I’ll have to start walking soon if I need to attend my meetings.”

Being a parent-to-parent also helps you realise how royally ignored geriatric mental health is. A study states that depression is the most common cause of mental (and physical) distress amongst the elderly in India.

Geriatric depression is especially dangerous as elderly people usually do not meet all the criteria for major depression. This is called sub-syndromal depression and can snowball into major depression if left untreated, as it usually is. The study also states that factors such as widowed status, nuclear families, and stressful life events are what trigger this kind of depression.

Believe it or not, most of these triggers can be fixed just by a little attention.

Some countries like Norway and Sweden offer training to family care-givers to deal with geriatric mental illnesses. This has proved to be a cost-effective way of dispensing mental health services.

For some like me, it took some time to figure out that irritability, mood swings, recurring physical pain and lack of good sleep was my parent’s body telling me that they needed attention. Not attention in terms of resources or money but in terms of mental stimulation and care.

Parent-children, much like actual children, are mentally vulnerable and extremely impressionable. This makes the situation all the more tricky because their care-givers are more often than not mentally exhausted too because they have very little help.

Parenting a parent is a difficult job. Anyone who says otherwise is lying. However, it’s not the physical or mental exertion that makes it so tough- but that sinking feeling you get as you watch your parents gradually grow old.

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