Elders: To care or not to care

Remember how I was looking at options for OAH/RCs*? While I most certainly didn’t want to go into a depressing OAH, the RCs looked interesting. But I soon realized that I was not looking for organized fun, outings or activities, nor was I lonely, hard to care for or wanted to retire from cooking and housekeeping. ‘You can live life the way you want to,’ exhorted the ads. But wasn’t I doing just that in my own home? And when I am not able to take care of myself and my spouse, I would not need a RC or an OAH, but a care-home. So there!

Ah care homes! We will come to those later in the post, shall we?

In any healthy family, the grown up children want their elders happy, fit and busy with their lives – in their own social groups, religious/spiritual activities or pursuing other interests whether they live with them or alone. The more active they are, the happier the children, because that leaves them relatively free to pursue their own careers and hobbies, and take care of their familial matters. Elders are happy too because they have ‘got a life’  and are independent!

Of course, being fit and healthy does not preclude the possibility of a crippling accident or a deadly virus that might render an elder prone.  And therein hangs the dilemma. Despite the best intentions and efforts of children, it often becomes impossible to care for such elders. Paucity of space, time, distance, resources – all, or some come in the way.

There was this online debate on caring for one’s parents in their elder years. Those who vetoed the idea were just marginally ahead of those who supported it. The reasons of those who voted for were predictable, while the ones put forth by those against it were eye-openers.  For many it was payback time – for the perceived and real harm they were done as children. This is a debate in a western society, but might throw up similar results if held in India. For or against, the nagging guilt remains when they are unable to care for ageing elders.

One often hears, ‘My father/mother/FIL/MIL is getting old and beset with health issues but refuse to come and live with us.

But think this one through. Are they merely having health issues or do they need active care? Because, if they are not in need of such care, it wouldn’t be wise to for two independent sets of families to start living together at this stage. It will be hard if not be downright impossible. And God forbid, what if the elder is a hypochondriac like the one in Piku? Or if the female elder is a control freak who wants everything done her way? Or if one or both of them plonk themselves amidst your friends and hog the conversation – er…..turn it into a monologue? Or….or….

As for the elders’ dilemma – what can they do if they have to wake up five times a night and then wake up for the day when their kids are just going to bed? Oh yes, it happens in our house! Can they change their body clock? As for eating all kinds of food, it is fine for a few weeks. For instance, I love pastas, baked potatoes, croissants, waffles, subs and more, but a few meals of those and I need to go back to my rasam and curd rice. The tongue is willing but the stomach is weak, you see! As one ages, the craving for the food one is used to, is overpowering besides being suitable to the system. And then, I might not approve of the way the youngsters do things and might be tempted to start the litany of ‘Hamare zamane mein…..’ inviting vociferous protests or deafening silences. Jokes apart, it is a very serious decision and not one to be taken in an emotional moment.

And when I hear, ‘Elders should live in OAH/RCs. It would be best for everyone,’ I shake my head. Not in disagreement, but at the thought that these are considered the panacea for all problems and anticipated problems concerning elders.

There is no point in presuming a disaster and jumping the gun to ask them move to an OAH/RC. Have you wondered how ‘unsafe’ by comparison to a strange OAH are friendly neighbourhoods where someone is at hand to help in a crisis? Unless the elder is bedridden and alone, don’t even begin contemplating any such move and then don’t stop at OAH/RCs.

My friend’s father, a widower, lives alone in the village refusing to come to live with his children. He is taken care of by his neighbours and distant relatives who live in the village and is actively involved with social and temple activities. The family has wisely let him be but is in touch with the relatives and neighbours.

Mine and the earlier ones are probably the last generations which still communicate with relatives and friends in real time and so have a reliable support group. Why not tap that group, keep in touch with them and have a firsthand source of information of the welfare of the elders? And oh, if this includes a few of those sinister ‘log’ (read Shakunis and Mantharas), learn to ignore them royally. They will neither help the elders nor be a support to you.

Here, let us not forget the elders who live in joint families – conventional and otherwise. So many of them take care of the house and properties of their children who live abroad or are pursuing punishing careers; some look after their grandchildren as their parents live in countries where education is not good; some are jet-setting global caregivers. Those living with their children also do their bit and sometimes more than a bit too – cooking, babysitting, shopping, etc. even while keeping to their routines and religious and social activities. The families are happy, the elders happy too. Would the family send off the elder for having become  ‘non-productive’  if an active one suddenly becomes bedridden?

But the argument:  ‘It is fine when they were together, but now that one has passed on, it is better that they live in a place where they can be cared for,’ makes me shake my head right off my neck. Come on, the elders can’t die at the same time, can they? One has to precede the other.

Generally, the older a couple grows the more tolerant they become of each other – the habits, the quirks and special needs. They find the energy and strength to care for each other out of love and a lifelong commitment. A single elder is somehow perceived as hard to care for, especially if it is a male — but not always. I know of an elder who lived independently till he died at 97. He cared for his sick and bedridden wife till his early 90s, with his only son living abroad and not involved with his parents in any way. He nursed, cleaned, bathed and fed her lovingly. After she passed on, he joined an assisted OAH, where he lived till he passed on.

Now, let us assume that both the parents are already in an OAH/RC with one of them needing care.  What if suddenly one of them passed away, and unfortunately it was the healthier one who was caring for her/his spouse? What then? How comfortable would the children be to leave the surviving parent there knowing that they are so ill? For that matter how many senior homes are equipped to handle elders who can’t care for themselves as in the case of Alzheimer’s?

In earlier generations, when families had more children, elders who needed care were sometimes ‘rotated’ between the siblings. While this was a good way to ease the burden on one son/daughter, it could be traumatic for both the elder and the caregivers. Today even that luxury is not there for many families with one and two children.

Remember Sundar from my post on global families? Recently he had to rush to India when his octogenarian mother had taken critically ill and was admitted to a hospital. After her discharge, he arranged for home nursing before leaving. Apparently she had asked him to get her admitted to an assisted OAH, but he didn’t want to do it would have been difficult for relatives and friends to visit her, as it was on the outskirts of the city. He is happy that his aunt is there to keep an eye on the nurses and look after her sister.

Keeping an eye, can’t be stressed enough where paid caregivers are involved as the following story of the nonagenarian elder shows:

Being an ex-army man he was very fit and active even at the upmarket OAH he had joined. One day while on his walk, he tripped and fell into a ditch and was unable to get up or call for help as his mobile had got damaged. He remained there in pain for a whole day before his absence was noticed and a search launched! With his only son not bothered with phone calls to the facility, and with relatives who didn’t have the time to visit him frequently as it was way out of town (as most of such OAH/RCs are), the caregivers had become lax.

This is not to scare anyone off nursing homes or assisted care OAHs. But just to say that even upmarket homes like the one he was in, can slip up especially if the relatives and children don’t keep a regular check with phone calls and visits.

I read this eye-opener of a story about apathy in care-homes in the UK, which has been doing it longer than us.

Home nursing is also slowly gaining ground in India. Many opt for this as Sundar did, though it is expensive, because they can keep an eye on the elders and their caregivers. Elders often bear the cost from their pensions and savings, to help their children out.

My niece who is in the US, spoke of a new type of home nursing that is becoming popular there. An apartment with four or five rooms is rented and elders who need assisted care from that area are boarded in it with medical and nursing care, a housekeeper and cleaner. This is a very doable thing in India too, as the expenses are shared and the elders are close, leaving the children and grandchildren space enough to pursue their routine and work. Visiting them on a daily basis is very easy and the elders are happy too.

So if you are worried about your elders needing care in their later years, look for a good nursing home or for home nursing facilities in your town or the town where your elder lives, instead of asking them to move into an OAH/RC — like now! Some pointers for this can be found here.

As things stand now, since the conventional joint family system still thrives albeit with tensions galore, the very old of the previous generation are cared for by their families and extended families of my generation. The conventional and global joint family is taking care of my generation, with many of us also looking at OAH/RCs as options. These are also perfect choices for those who have no children or extended families. As for Gen Z, it is growing up with the idea of OAHs and RCs for the elderly, so no worries on that count as they will be fully prepared when the times comes!

And elders, start letting go — of children to begin with, to remain happy. A handful of sand can tell you how. Come back to read it!

In all the discussion on eldercare, we have to remember that we are privileged to be caring and cared for.  Let us then spare a thought, a smile, a little time and some money if possible, for the lonely, destitute and abandoned elders – who make for a huge number in India. Next time you see a lonely elder in the park or on a bench in your colony, try to make small talk with her/him and see the difference it makes to them. I speak from experience.

*OAH/RC – Old Age Home/Retirement Community

Earlier posts in the series:

The Problems of a greying India

Don’t label elders, it sticks!

The global joint family

Old Age Homes — Orphanages or Summer Camps?

Homepage pic: Swati Maheshwari

25 comments

  1. […] Any relationship will thrive if it gets a little space to breathe – not when the members are breathing down each other’s necks! I had written about how ageing elders increasingly wish to maintain their own space in the series on elders and eldercare (here , here and here) […]

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  2. […] To care or not to care. That is the question.  […]

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  3. A need of the hour post.. and your wisdom shines through as always..
    Caring for the elderly is becoming a major issue in my home state, Kerala too. This brought to my mind an advertisement that came in the local NP.. a son is willing to give his house for rent, provided his elderly mother is also taken care of! Ha! such is the dilemma in a State which is slowly exploring elderly homes and assisted living. My MIL in her 80’s is living alone while we phone her morning and evening each day. She is healthy enough now but one has no idea what the future holds. My parents too live alone with only phone calls from 5 siblings spread all over the globe. One need to take help from relatives, neighbors and many others in the society to ensure their well being. This is the only way for many who do not like to leave their homes and environment which they got used to.

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    1. No matter how well we adapt ourselves to changing times, we always seem to be running a losing race because things change ever faster. I have heard of such people too — rent free if they took care of their mothers/aunt — never an elder male! And Asha, it is not just getting used to the environment. Many people just wilt away, get depressed and worse. I know of an elderly lady whose son shifted into a new housing society that didn’t have too many residents and what was more, they lived on the 15th floor. Being one of the furthest in the colony, there is no sound, not even of traffic! In her earlier home she used to go down and chat with all neighbours coming and going and was greeted by all. And you know what? she got so depressed that she suffered a heart attack within a month of shifting! It is indeed a big issue but one which needs individual solutions — arrived at with empathy and compassion for the elderly especially of they are pretty aged. And yes, neighbours and relatives are precious commodities in elder care!

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  4. sagarika · · Reply

    Hello Zephyr the Social causes you are posting are more important in Real-time. To deal with what is going to come to have options at hands are how one can be notified early onto.
    Going to be glued to your Blog. 🙂

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    1. Welcome to my space, Sagarika. Glad you liked the posts and find them useful. Looking forward to your future visits 🙂

      Liked by 1 person

      1. sagarika · · Reply

        You can count on me Zephyr 🙂

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  5. Found In Folsom · · Reply

    A bit late in reading this one. All the time and effort you have put in writing this series is worth it. while you have made it sound, it is not that bad; your options gave answers to many questions. It is good and nice feel to read everything but when it really comes to making decisions, I don’ know what and how I will do. 😦
    I liked your last line.These days I do the same. The other day I smiled an Indian parent in a store and you should see how his smile broadened. He asked where I was from, I told him and looked the content face.

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    1. Thanks for reading it, even if late. I am sure when you need to make a decision either for one of the parents or for yourself, you will remember this series 🙂 Glad to note you are doing what I always do and find joy in seeing the joy in the elders’ faces. Sometimes they are dying for some human contact other than family and might talk, so make sure you have a few minutes to spare!

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  6. This was the perfect summation to the series. 4-5 people living together and sharing expenses is a wonderful idea…. as long as one is mobile and reasonably healthy. I’m sure I’d find Jabalpur wanting in that regard though. Sigh. Weird people in my town really.

    I’ve learned so much from the series. The thought of my own old age doesn’t make me anxious as it did before. You’ve given so many options. Moreover, reading the comments has made me realize that others too have these concerns. “Company in misery” syndrome I guess. 🙂

    Thank you for the entire series. It was not only informative and supportive… it was also very validating. As everyone knows, once you reach that place, you get the courage to conquer anything. ❤

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    1. Why, I don’t think Jabalpur is any different from other cities and towns and even villages of India. I liked the idea of small groups of elders needing care sharing a flat. It is actually a mini nursing home, only since it is in the neighbourhood and houses elders of a community or locality, the ease of keeping an eye on them increases. Normally care homes and OAH?RCs are on the outskirts of the city making it difficult for regular visits. This will eliminate that problem. Validation was the main reason why I started the series, because I see so many defeated and depressed elders around me and felt compelled to pen my thoughts. Thanks for seeing that point out of all the others to comment upon. I feel vindicated 🙂 And yes, we find reserves of strength and mental resources to deal with it when we reach the place!

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  7. This is very informative! My parents have explored a number of options and they are pretty decided that they don’t want to go to an Old age home. They are very active, have a huge social group, many close relatives, and a number of NGOs they volunteer at. I am concerned about their physical health, but we have a family doctor close by and live-in household help who are like family! All this makes me very comfortable too!!

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    1. We have to go with what suits our circumstances the best and with the clear conscience that we are doing what is best and right for everyone. I can understand your parents’ decision to continue being socially active and do their bit for the society too and to live by themselves. From so many cases I have observed in my family and around me in society, I have realised that this is the next best thing to living in a joint family with one’s blood relatives and be cared for.

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  8. Perfect last line – it is a privilege to be caring and to be cared for! Only you could have taken on a vast and multi-layered topic like this one and done such a thorough job with this, presenting so many possible sides and perspectives. Thank you for giving all of us so many great pointers to consider carefully and deeply, because we all are going to be in some situation someday when we have to make these decisions – for our elders and for ourselves.

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    1. I am grateful to the readers who liked the posts and found something useful in them to refer to in their own lives. Ultimately each one of us has to come up with our own solution to our unique problem which can be so different from another’s even though the issue of elder care is common to all. Sometimes I wish things were as simple as they had been a few generations ago. And ah, the line about caring and cared for has struck you too? 🙂

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  9. You’ve rounded off the series well. I guess if one views things from the prism of gratitude of having someone who cares and of being caring, it does feel better. While your post tells us to reconsider our paranoia when it comes to our parents living alone even when in good health, it also hopefully asks the elders to seek help when they feel that their health is failing and they are not able to do it on their own.

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    1. Yes, Rachna, both the parties need to be open about offering and asking for help when needed. But for that the personal relationships matter too, making it easy for one to offer and the other to ask/accept the offer. And since we are talking about normal families, I didn’t deal with the angles of abuse and abandonment, which complicates these issues. I am happy that the most important statement in the post has struck a chord with the readers — of caring and being cared for 🙂

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  10. Perfectly ended! The issue of a good care facility – OAH or Home nursing – needs to be studied but, at the end, what IS important is that both the children and the elderly care for each other. There is never going to be a one-size-fits-all solution since the needs, the relationships and the circumstances will vary from person to person but what ought to be a common denominator is that willingness to care.

    And, yes, it is blessed indeed to have someone who cares for you in your dotage.

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    1. Thanks for the comment, Suresh, but I was hoping you’d have something to add 🙂 As I was writing the posts, this one thing kept going round in my head — we the privileged and had to add it in the last one. As you say, once the willingness is there, a way can be found but ultimately it is the personal dynamics that make any arrangement a success.

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    2. And here I was trying to curb my tendency to write a post in the comments to other people’s posts 🙂 My circumstances are such that there are likely to be no major emotional issues with children about my own care when I am in my dotage 🙂 Since I presciently avoided the problem by not having children by the unique method of not getting married :)) So, my selfish concern was about whether we had workable care for the elderly. 🙂

      As for the rest, every case comes with its own unique combination of circumstances. The only true commonality that we can seek to achieve is that both parents and children are understanding both of their own needs and the needs of the others. With understanding and compassion on both sides, there is no problem on Earth that cannot be sorted out, without ill-will, though maybe not satisfactorily if the necessary facilities do not exist. The truth, though, is also that even with everything working in your favor, you can generate enormous pain and ill-will, because one person in the mix refuses to be understanding. THAT is the real tragedy AND the real test of Human beings – that for good to come of anything, ALL have to be good; for pain to come, ONE being not good (OR even just not sufficiently empathetic) suffices. THAT applies to elder care too.

      Which is why I stressed the ‘willingness to care’ in the closing post of your series 🙂

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      1. Oh, please don’t hold back while sharing any thoughts you might have however long the comment might be, Suresh. You look at things with an analytical eye and thus are able to come up with points I might have missed by being emotional or sometimes even being confused 🙂 You are so right about how everyone needs to be good for any good to come out of an issue. Like they say oru paanai paalil oru thuli visham — one cussed person of either generation can upset the equation in any relationship and the one between generations is a tricky one at best of times and when it concerns the elderly it gets even more ticklish. Thanks for insightful comments, Suresh.

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  11. Very nice and pertinent post Zephyr.It has given me lots of information about this subject.I agree with all you have written down.
    Thanks.

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    1. Thank you so much for the approval, Indu. /having spoken about these things with you, I know your views agree with mine 🙂

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  12. Wonderful objective look at problems of senior citizens and their children.

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    1. Thanks for reading and liking and retweeting, Deepak 🙂 Have I covered all aspects, do you think?

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