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The old country

“As families become nuclear, their function as a social safety net for the elderly erodes”

a Help Age mobile medical unit outside Bhubaneswar, Orissa.

Waiting to collect medicines and see the doctor: a Help Age mobile medical unit outside Bhubaneswar, Orissa.

“When young people leave their villages for the towns and cities, the old are left to fend for themselves” 

The old country

India is a land where age and wisdom are traditionally respected. But improved longevity is challenging age old assumptions, says Prodeepta Das.

How old is old? In the western world, improved health and longevity have changed the definition of what it means to be elderly. Does India live up to its old traditions? The revered sage Manu spoke of life in four stages: brahmacharya or celibacy came first; then it was grihastha or householder (when a person is expected to shoulder the responsibility of a citizen and discharge debts to parents by begetting children); next came vanaprastha (which entailed giving up worldly pursuits in order to follow spiritual growth by leaving home for the forest) and the final stage was sanyasa or renunciation and asceticism. Vanaprastha thus indicated old age – winding down social obligations.

But now this traditional pattern is shifting. Arguably, India’s single most stunning achievement during the last century is longevity. While it took France 120 years for the population of the elderly to double, it took India just 25 years. This population shot up from 12 million in 1901, to 19 million in 1951 and 77 million in 2001. It is anticipated that by 2021 it will reach 137 million. India now has the second largest aged population in the world.

A reduction of fertility causing a decline in the proportion of the young in the population, a decrease in mortality arising from a longer life span for individuals and improvements in public health and medical services leading to control of infectious diseases. The UN defines a country as ‘ageing’ where the proportion of people over 60 reaches seven per cent. India has already exceeded this and is likely to reach 12.6 per cent by 2025.

But a fast rise in the aged population adds to the socio-economic challenges that face India. Notwithstanding the Indian adage “old is gold”, life for many older people is less than happy. When young people leave their villages for the towns and cities, the old are left to fend for themselves. In urban areas women work outside home and, as a result, cease to be the traditional carers for old people. Families are becoming more nuclear. Their function as a social safety net for the elderly is eroding fast.

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The perception of the old as the repository of collective wisdom is also on the wane. Being economically unproductive, they do not have the same authority and prestige as before; older people are perceived as burdens.

In industrialised countries, pension systems cover the economic needs of the old. In India, where 90 per cent of the total workforce is employed in the informal sector, social security offered by pension schemes is only available to the 10 per cent retiring from the organised sector. There is a government scheme for destitute persons above the age of 65 years. The amount currently is Rs 150 (just under £2) a month, which is insufficient to meet the bare necessities of an elderly person. According to a study by Help Age International, only one in five of those eligible receives the benefit. Being illiterate and poor, many are not able to fill in the relevant forms or produce age certificates.

In Delhi, where the wealthy elderly have been able to live independently, paying for a variety of services, some have suffered assaults and even murders. There is a growing trend among the well-to-do to live in special condominiums built for elderly people, with medical and recreational facilities. Integrated housing schemes have been developed in Kerala and Tamil Nadu. These two states now have 57 per cent of all old age homes in India.

In Kolkata, I visited an old age home, supported by Help Age India, for people from professional backgrounds. The home, Navanir, in Tollygunj accommodates 44 women. Nileema Som, 70, a retired headmistress, told me, “I am quite happy here. I am well looked after.” Also a long time resident, 74 year old Malina Roy said, “My son threw me out. I was so happy when Nanvir took me in.”

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A deposit of Rs 60,000 (approximately £720) would secure a place on the waiting list, which, according to Superintendent Priti Bhattacharya, stands at 250. Monthly rent is Rs 5,000 (£62). “We have 12 single rooms and four dormitories with eight beds in each. We have television, a library with books, magazines and newspapers and a puja rooms for praying. Food is nutritious. We organise outings… I feel we have a good atmosphere here,“ Priti explained.

But despite initiatives like Nanvir, Kolkata remains badly under provided in residential care. There are thousands of elderly, on both sides of the economic divide, who need care and comfort.

To see the situation in rural India, I travelled to Orissa: in the villages, I found that often the old were left to themselves after the young had gone for jobs elsewhere. If the young remained, they did not have the financial means to look after their aged parents. In the two major cities, Cuttack and Bhubaneswar, the old of independent means found living unsafe. A retired professor of surgery, Sukumar Das, told me that he and a few other elderly people had bought a plot of land to build a residential home where they would have the care and security that they lacked.

Help Age India in Orissa are now commissioning smaller NGOs to undertake specific programmes – for example, they are financing a project near Sakhigopal, which encourages young people to look after their aged parents by providing them with viable means of livelihood. Here, they are given money and technical assistance to grow flowers for the open market. The scheme has proved successful and will be replicated. The agency’s Mobile Medicare Units in Orissa are the most successful in India. I followed a unit to villages near Bhubaneswar. Staffed by a doctor, a pharmacist and an administrator, it visits rural areas and slums twice a week. When we arrived, there was already a large gathering. They had come to see the doctor and collect medicines. I asked why they did not go to the nearest hospital instead. Suna Behera, aged 83, had no doubt why she preferred the mobile unit: “Here, we have the same doctor every week. He finds out why we are ill or if we need vitamins. And they are never out of stock.”

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There is no doubt of the government’s intention to meet the challenges of an ageing population head on. India is committed to the basic principles of the International Plan of Action on Ageing: financial security, health care, shelter and protection against abuse and exploitation. But the Ministry of Social Welfare has fallen behind in its mandate to make a detailed review, after every three years, of the progress made.

At present, over 500 NGOs are given grant in aid for providing services like old age homes, day care centres and mobile medical units, and an inter ministerial committee is reviewing these provisions. “The government is taking steps to accord special facilities to old people, such as concessionary railway and air fares, priority in telephone connections and hospital appointments, and earlier court hearings.” said a senior official in the Ministry of Social Justice and Empowerment. “We are using the media to promote care and respect for older persons in keeping with our ancient traditions.”

True, there are myriad demands on the government’s limited resources, but the old are among the most vulnerable sections of society. Voluntary agencies like Help Age India have a seminal role to play. The response to the rise in ageing population will need to be well orchestrated and multi-sector, based on systematic planning which takes note of the wishes of the old people themselves.

“Fostering independence for older persons is important as the traditional family structure is eroded, “ said Anuradha Mohanty of PECUC, a leading NGO in Bhubaneswar. “The task is colossal and needs government, NGOs and civil society to work together.”

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