OLD AGE: HELL on EARTH?

OLD AGE: HELL on EARTH?

Mangalore Today News Network

Mangalore August 25, 2011: "The worship of Father, Mother and Teacher is most important" (Mahabarata, Shanti Parva CVIII). Identical words are found in every sacred book of any religion in one form or another. The relationship has a much wider interpretation to suit various purposes. On a  day in June 2011, the people of Mangalore and particularly the elders and those living ’alone at home’ were in a flux and agitated. The news was that - right in the heart of the city, a lady of about 79 years ’living alone’, named Marie Aranha, a Konkani Christian/Catholic was found  dead. The  surprising observation was that the mummified skeletal condition of the body was in a natural lying down posture in her bed. More shocking was that rough estimates said that she would have died months ago; the matter is now under investigation. Her husband, a retired Defence Officer had passed away  probably ten years ago. They had no progeny and  this elderly  lady was living alone and was perhaps not in good terms with her kith and kin. However, the modern day attitudes that none of the many neighbours, acquaintances, passers by or even the Church circle, who have a sort of net working with their members or anyone else too failed to raise any alarm even after months. It was by chance that the Police stumbled on this macabre episode as they were investigating some drug addicts and bad characters around this area. The house was found to be ransacked and rummaged and no valuables remained.

 

Apparently, a string of bad characters, who were aware of the dead woman’s remains, had ample time and opportunity to swipe all valuables and even use the place as a hide out for their nefarious activities.  But, it reflects even more that the human or civil society in the vicinity, had no sense of civilization over long months to bother as to what was the fate of one lonely aged helpless sick woman. Surely this is a matter that condemns the attitudes of society in deeply disturbing terms and brings to the surface the value attached to the aged, sick and helpless around us day in and day out. This may be a gruesome case, but its basics are not at all rare. A lot of cases are on record faced by the aged senior citizens everywhere today. Not too long ago the torturous case of Lotika Sarkar in her late 80s in New Delhi; she was known as the ’mother of feminist jurisprudence’ a famous professor and legal luminary whose dignity was looted under the noses of  apex law enforcers. Such cases are aplenty in our country. Huge amounts of money and valuables are looted and hoarded by leaders, lay and religious too.

What are the causes and solutions - this indeed is a question that is beyond simple answers and involves the human element. Parts of the complex picture may be visible but never the whole.    

The Aging Crisis & Family:
To ’be afraid’ is the worst hurdle for a human being. The family pattern and mechanics have altered drastically. Economy and wealth perceptions have transformed unimaginably in the last decade or so. The 60 plus are gripped with rational and irrational fears. In most cases, the savings put away for retirement in middle classes which make up the majority sections are turning out to be a drop in the ocean with revolutionary commercialism and materialism driven by big money. Today, one speaks in superlative ’crores’. A few ordinary folk who have immovable wealth may sustain the escalating situation. Those whose children  and dear ones accept to support are able to tide over and move on. With bank interest rates not favourable the plight of retired people with fixed incomes is pathetic. The Post Office MIS rate at 8% is a big damper. Others face a bleak situation of insecurity when it is most needed and further undermines the shattered physical and mental well being. Many organized institutions are set up only to exploit the troubles of old age to maximum limits. Estimating the damage that old age scourges like dementia, rheumatic crippling, diabetes, heart and joint aliments, Parkinsons, Alzheimers, and even the normal geriatric problems are  impossible. These disease cause not just serious illness but the personality, physical character, emotional mood swings, memory and mental instability can alter drastically.  In India little or no geriatric facilities and training are available to the medical and social  segments. Probably everyone male or female above  60  is faced with one or more age related ailment. Dedicated assistance is vital for all those who are above  80 years of age. The aging process is never uniform in two given individuals of externally identical  conditions - the downward slide in physical and mental abilities are unique. This being the case it is not an easy task for society or the Government to eliminate problems. There needs to be a combined sustained system basically towards symptomatic correction at the ground level by motivated and trained  personnel - at best by dedicated statutory regulatory bodies under given laws.

In India, presently there are said to be 90 million elderly above age 60, who seriously suffer in ’God’s language’ which is ’silence’. In Karnataka alone the ageing population in 1951 was around two million; in 1981 it rose to over 8 million. By 2001 this figure shot up to 1.7 crores in; 2011 its over the sky. Significantly, the progressive demographic increase in number of elderly is visible everywhere. Census  reports currently confirm that the decadal growth of the 60 plus age group is higher than that of the general population- the reasons are multiple.

Majority of the elderly - more than 60% are totally dependent on others for economic support, while about 16% are partly dependent. Meager old age pension is received by a very small segment of the aged. Medical expenditure is a cruel nightmare which the retired find impossible. When one is  30 or 40 he or she  never imagines that they too  will be old and helpless and death will soon come calling. Today’s business called medicine is such that it not only is a misery or torture in old age but unaffordable too. A UN projection for year 2050 states, elderly would make up near 1990 million of the World’s population, of these 1240 million (60% plus) would be in Asia.

According to HelpAge India, the families of elders today are rarely equipped to cater to their support, the hurdles are obvious. It says "With more older people living longer ........stress, marginalization, isolation and insecurity among older persons is increasing". Abuse from family members and caregivers is a critical consideration. A study has recently published that  almost 70% face abuse of one form or another and the UN recognizes elder abuse as a public health and human rights issue. Institutions caring for elders even at the high end appear to extort money to the maximum extent when opportunity presents. The Banks, who give you an umbrella when the sun shines and take it away when it rains, has introduced a "Reverse Mortgage Scheme" for the properties of Senior Citizens which is again a precarious facility which serves few older people and biases the kith and kin. It better serves vested interests perhaps! Banks must extend  personalized service to elders as per their need.

The government’s law "Welfare of Parents and Senior Citizens Act,2007" is indeed a good one like most laws on the books. But the vital question is how is it put into practice? For the aged and weak all such laws that need protracted court examination are useless - procedural redressal of grievances under Sec125(1d) of the CrPC needs cumbersome formalities. More tribunals and regulatory bodies are the urgent need of the day and not just meetings and celebrations by well meaning social clubs and associations. It may be worth considering bringing Old age Homes under the ’ Senior Citizens Act.2007.’  

Care of older people is visualized to be a vital need at present and in the near future. Younger family cannot provide the needed care. Old age homes are an answer even though they are liable to cause depression among residents. Regulating bodies are needed to keep tabs and bring transparency to prevent money spinning trends clearly seen. Homes where good payment is demanded could be brought more closely under the "Consumer Protection Agencies" for better service delivery. 
    

Institutional Option:
Fear is the key of human feelings. Somehow in India older folks fear going into an old age care institution/home - and they are justified going by many an experience. Often the elders and the family face a certain inexplicable stigma and that too has some unexplained reasoning. There is certainly some basis that she/he loses individuality, identity and dignity when living in an institution for the aged -whether it is a paying one or otherwise-four star or no star. It should not be so. Perhaps it is the regimental attitudes and rigidity that we see adopted by those running the institutions, compared to the natural laid back free policies of Governments  in other lands. The set ways of older people are not adaptable easily ; therefore it may not be easy and flexibility must be the rule in the sun set years. Whatever it may be, there is a long way to go for our communities; immaterial what caste or creed is at the helm, to have an accepted position in society. It is vital that a proper attested agreement is drawn up where payments are received to pin point duties, responsibilities and entitlements on both sides.
’Out of the vague shadows and images into the fullness of truth’.    

Some of the points recited by experienced inmates of  homes for the aged which also have high payment terms, goes something like this, indicative of a justified  "trust deficit", (the plight of the destitute homes can be well constructed by the readers) :
People running the homes need better education and training for the work and often they do so just by trial or remote experience. It must be realized that the old persons are not in need of discipline or lessons but for honest care and support for the financial payment they make. Nursing should be professional with basic medical information recorded to deal with emergencies.  They should  be treated with human dignity. An overseeing regulatory body is vital.

Many paying homes are quite flexible when it comes to food and service timings, however, there are also those that are unreasonable and insist on residents to come to the dining room even when disabled at fixed times with the threat that they have to pay additionally. When some who have physical and mental difficulties per se cause disturbance the meal of all the rest is spoiled.  The other common complaint is that food is doled out miserly  in a rude way  instead of  self help at least for basic items, this hurts the dignity and appetite of paying residents. It is not unusual that older people ’live to eat’  for it is an emotional prop. Understanding and adjustment purely rests with those running the homes.

They feel that the people responsible do not even make systematic inquiry of their welfare and health and keep records. They are preoccupied with their pet projects with bills paid from the old peoples funds.  But, when the inmate’s  children/kin come visiting (from abroad particularly) they get all kinds of cordiality and attentions. This is visibly to extract in cash and kind from these gullible egoistic folk who get carried away by flattery and fail to enquire, check and evaluate the care and concern the organization is actually providing and never question on the records and system of which actually nothing exists.

The kith and kin visiting are brain washed and exploited through religious brain storming and rhetoric with a lot of  inducement-a form of corruption. And there are always a group of hangers on who get some crumbs from the masters table who are there to clap and cheer the  power centers.

When sick or hospitalized inadequate support is extended and  a paid care taker is forced and the charges are exorbitant. To take such inmates even the long standing ones  back to the institutions a huge bonus payment and unreasonable higher fees are demanded as practically experienced, burdening all concerned to make a fast buck.

There is a clear perception of mass diversion of funds; and old age homes charging heavily are set up as lucrative ventures to corner wealth and valuables like gold, FDs, property and so on and  on. "It’s easy to make a buck. It’s tough to make a difference". The active kin have a right to examine the services delivered and must do so.

Some homes give no consideration to adjust even a basic amount when an inmate is absent, say  once a year outing for a couple of weeks, this creates a sense of wastage of resources for seasoned elders and they are mentally traumatized.

In some institutions there is a subtle compulsion to celebrate different occasions of the individuals, creating an unhealthy sense of competition and comparison. Large contributions are demanded and food is sponsored from caterers with various other rituals done. Though no discount is given on the usual charges of the residents they are compelled to participate and at times sensitive elders demand that they be given only their entitled food it is met with unfair ridicule.

The managements in many cases charging high monthly maintenance on the other hand advertises that the whole thing is a charitable work and collects big donations in cash and kind, while it is put to use for other purposes and diverted to other ventures. No doubt some who are dependents of those running the homes get secret discounts with accounts often cooked up. 

A Larger Outlook: 
Considering many factors, some countries have adopted ’Euthanasia’
 (Mercy Killing) which is a choice to end one’s life at a stage when life is not worth or too great a burden physically and financially. Here, in our own country several have petitioned courts, but a time is not far off when changes are visualized.  An interesting though alarming practice has been unearthed and published about a ritual practice prevailing to end the lives of  the aged. For an over view of the same see the box below (CEREMONIAL FAREWELL or MERCY KILLING?).

 

A large percentage of our political leaders are above 65 years; still the awareness of needs of Senior Citizens has not significantly been impacted and addressed. There should not be two levels of consideration 60 years for some matters and 65 years for others - a flat  60 years must be set and one single card must suffice to get Senior Citizen benefits.

CARE GIVERS: There is inadequate formal  training in place. Whether in  family or institutions for the greater good there must not be work overload and burn out in their work with the old and dying.  I’ll- do- it- for- you, attitudes should be distanced and older people even if slow must be encouraged to do their own things as much as possible. The care givers need their own space too and must be given due training and facility.  

Government run homes rarely have good reputations,  all old age homes are not poorly run. Increasingly those setting up private homes visualize lucrative commercial ventures. Most are not transparent and refuse to come under public gaze. It is time the civil society leaders demand and legislate for transparency and statutory scrutiny and regulation to make the lives of old people better in their sun set years.

Managements of Old age Homes in a local area could get together and form a body to exchange ideas improve/standardize practices which will help streamline and improve matters. Closed attitudes must be overcome.

Distinctly the manner and way inmates of Homes are treated soon surfaces, even the most balanced and cordial social personality gets contaminated with "cattle class syndrome" and  inmates are converted to heartless aliens and anti social robots/zombies sooner or later with human dignity lost.  

It is very often noticeable that public do not respect the rules set out for the care of Senior Citizens which is a right, like: Seats reserved for the older folks ( also physically challenged) are rarely made available on demand. Queues for services don’t allow consideration for old /sick people even though boards indicate. The authorities attending too turn a blind eye  thus diluting the norms. At the school level awareness is useful.

It is important that live-alone elders take due precaution from being targeted by youth with rowdy and criminal tendencies right in their homes. Alcoholic, drug addict and juvenile delinquent youth can cause tremendous misery to elders. The Police and other security agencies must act fast and where cases are filed courts must fast track the cases. Pension disbursements must be made without pressure on the sick and aged. Most cities have ’Elders Helplines’  but few are run efficiently mainly due to frequent staffing changes and the Department concerned not releasing sufficient funds; facilities like ’caller ID’ ’Mobile access’ and so on must be supported by authorities. The Senior Citizens too must keep regular contact with the helplines.   

Sunsets: 
When those you love become memories, memories become treasures. To conclude it may be pertinent to go back to August 16,2010 when the ’Senior Citizens National Protest Day’ was observed all over the Country and from every nook and corner suffering elderly in conjunction with NGOs’ and so on appeals were made to The President, Prime Minister leaders at the center and states. Visible action or concern and action is yet to surface. Perhaps those in authority are  keen only on scams and corrupt acts and have no time and inclination for constructive work. It is time that the demands are looked into before a full fledged revolution happens and more home-alone deaths surface.

The main demands for immediate implementation from the Aged sufferers are:

1. A separate Ministry for Senior Citizens’ welfare at the Center.
2. A National commission of Senior Citizens to regulate and monitor institutions and care of elderly and particularly of BPL elders and monitor their entitlements.
3. Sincere total implementation of the existing ’National Policy on Older Persons’  and   "Maintenance of welfare of Parents and Senior Citizens Act’ (MWPSC ACT) of 2007.
4. Satisfactory effect of all available welfare schemes and benefits for Senior Citizens country  wide with committees to monitor and document action taken all over India.

Above are only some of the specific and reasonable demands which need immediate action.

The Governments should note that Senior Citizens are 20% of the effective electorate and should not be ignored. Former UN Secretary General, Kofi Annan says, "Senior Citizens, in spite of their number, collective wisdom and experience will continue to be ignored and marginalized, unless they unite".

Some facts need to be recognized: Those who are now  60 plus belong to a generation who earned in low cost economy era, earnings and savings were small as needs were small compared with present figures. Making ends meet currently with those old meager savings and high inflation is a defeating task which in itself produces depression and ailments. Channels to obtain cheaper essentials, including health care and services as also higher returns on investments (at least +2%) are all challenging tasks given the support available to this segment. Those living in outlying places are further hit. All these are live difficulties. 

Implementing the rights of citizens guaranteed in the Constitution of India should not be neglected as it will give rise to incalculable negative forces in the country. Is there any need for the Aged  to face hell on earth? Never, if a proper sensitization and awareness exists among the ruling governments and civil society. Man cannot reach heaven by creating hell on earth!

CEREMONIAL FAREWELL or MERCY KILLING?
In an area of the Southern most part of the country, reports of a gory practice to do away with burdensome parents and aged people (65-75 age range) voluntarily or otherwise, has been reported. It is inhuman at a glance, but justification boarders on reason and no serious action has resulted. Reports say that this practice among a cross section of economically marginalized labour class is not so new, nor restricted to one single caste or group. Labeled "thalaikoothal" - ceremonial anointing. It appears to be an organized affair with variations and is not too remote from the ’ehunasia’ philosophy. Younger family members push infirm parents, elderly dependents to death as they can not  afford to care for them, the potential victims often look at their dear ones who have such an idea in the mind without malice and say that what else can they  do in such circumstances?  There is wide acceptance from several quarters in this matter but officially ignored and even considered a service; falling in the shadow space between crime and desperate acts of poverty, ignorance and lack of better alternatives.

 
Several cases are on record. The basic form is likened to an infant,  the aged victim (knowingly or otherwise) is given an elaborate oil bath at dawn followed by a lot of tender coconut water (anathema normally);  for in such a scenario excess of tender coconut water causes renal failure, high temperature and  death. Also many other variations are available. Often the person male or female is  tranquilized and milk poured into the mouth and nostril which aspirates in to the respiratory system to cause complications and death. Poisoning by  injection for a fee  has been an option it is evident. Many a time the victims run away when they become aware of the plot against them. It is not that the young do not love their elders but, the option is seen as a solution to something impossible and worse other wise. Many ask isn’t it a form of practical love? An elderly medical practitioner of this area said the practice is prevalent for over 30 years  or more and not confined to any single community. In this scenario  perhaps whole villages are accomplices. The society must seek and find solutions to such compulsions and infringements, in reality no worse than other conventional solutions in the larger  perspective.

I J Saldanha-Shet
(with inputs from various sources)