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Do We Care Enough for the Elderly?

A Survey of Old Age Homes in Delhi

Indu Choudhary (induchy@rediffmail.com) teaches economics at Kalindi College, University of Delhi.

The increasing proportion of the elderly population calls for proper planning and implementation of institutionalised care services for them. In this context, the distribution of geriatric care services across time, region, economic class, gender, and ownership of the old age homes operating in the National Capital Region are surveyed.

The elderly population in India is the second largest in the world with its share increasing over time from 5.6% in 1961 to 8% in 2011 (GoI 2016). This is further proposed to rise to a whopping 20% by 2050 (HelpAge India 2015). This implies that in another 40 years, the usual pyramidal configuration of the Indian population will take the form of a cylindrical structure, with almost as many old persons as the young. The rising proportion of the elderly in the total population, along with growing levels of urbanisation and modernisation, evoke the need to understand and assess if institutionalisation of care services for the aged could act as a reasonable substitute for the necessary support to be provided to them in the future.

The present study surveys all the existing old age homes operating in the National Capital Territory of Delhi (NCT) and looks at the distribution of geriatric care services across time, region, economic class, gender and ownership.

According to the census data for 2001, 5.2% of the total population of Delhi comprised of persons who were 60 years and above. This translates into an absolute figure of around 7,00,000 old persons. Assuming that the proportion of the aged in the population remained constant—to give a conservative estimate, since the corresponding figure from the 2011 Census for Delhi is not publicly available—a total population of 16.75 million in 2011 yields a figure of 8,71,000 old persons. This is an increase of more than 1.5 lakh in the population of elderly over a decade, and is likely to cross the
1 million mark by the 2021 Census.

Methodology

Our study attempts to evaluate if Delhi can support this growing elderly population. The data for this study was collected from a primary survey of old age homes in Delhi carried out from December 2015–February 2016 as part of the University of Delhi Innovation Project to analyse the socio-economic condition of the elderly population residing in the old age homes of Delhi. A comprehensive list of old age homes was obtained from the non-governmental organisation (NGO) HelpAge India in New Delhi. From this list, the old age homes falling within the Delhi region were shortlisted, after carefully excluding: (i) those that were part of the National Capital Region: Noida, Gurugram, Faridabad and Ballabhgarh; (ii) one old age home catering strictly to defence personnel, maintained by the Air Force; (iii) orphanages and cancer-patient homes housing children and youth along with the elderly. This exercise yielded a list of 24 old age homes that were selected for the survey. Separate questionnaires were prepared for the residents and the management of old age homes. The questionnaire for residents included questions covering demographic, socio-economic, psychological, medical and other aspects. Through the management questionnaire, information was sought on the nature of the institution, intake capacity, admission criteria, norms, facilities, source of funding, etc.

The ownership of the old age homes has been classified as being private or public. The old age homes are further classified as being purely charitable, partly charitable (mixed category) and paid ones. The privately-run old age homes operate either as trusts, societies or NGOs.

At present, there are five government-run old age homes—three by the New Delhi Municipal Council (NDMC) and two by the Delhi government—and 19 privately-run ones in the city. Prior to the survey, it was expected that the government would be the primary caretakers of the homeless elderly population, and that perhaps the first old age home would have been set up by the state in keeping its role as outlined in the Directive Principles of State Policy. However, contrary to popular belief, the earliest old age homes were established not by the government, but in the private sphere by Christian missionaries and temple trusts (such as the Arya Samaj Mandir Trust), and have been operational since 1957 and 1960, respectively. These have thus been in existence for over 50 years. In fact, it was found that the non-government or private old age homes outnumbered the government ones. It is only later that the government contemplated setting up old age homes in its role as a welfare state. Article 41 of the Directive Principles of State Policy lists some of these welfare-enhancing roles of the government, including provision of social security for the aged.

Catering to the Elderly

While it took 20 years for the government to realise the need for building a second old age home in the pre-1990 period, it was found that in the last decade and a half, three government old age homes have been established with an average gap of less than eight years. This points towards the acuteness of the problem and acknowledgement of the issues that changing demographics are likely to pose. Greater preparedness in terms of providing institutionalised care services is needed to cater to the growing needs of the aged population as the relative share of this group increases in the total population.

Interestingly, three of the government old age homes (run by the NDMC) are paid ones, while one is in the “mixed” category, offering charity in part. Unsurprisingly therefore, the data reveals that the occupants of the government-run old age homes belong to either middle or upper-middle class.

The last two decades have definitely witnessed a mushrooming of institutionalised geriatric care. Around 55%, that is, more than half of the existing old age homes were established in the post-2000 period. Three-fourths of these operate in the private domain. This significant rise in the number of old age homes in the private sector further indicates the rising awareness of the need for institutionalised geriatric care services and their viability as a future business or market opportunity. While the need for such care services is embedded in growing urbanisation, disintegration of joint families and longevity (Visaria 2001; Alam 2006; Dubey et al 2011; Siva Raju 2011; Mane 2016), the market-oriented approach is substantiated by the following fact. Whereas in the pre-1990 period the privately-run old age homes were all charitable in nature, more than half of the old age homes that have come up in the post-1990 period are profit-oriented, implying that many see the changing Indian demographics as having a potential business opportunity. Nevertheless, the privately-run charitable old age homes still perform the primary role of providing shelter to the lowest sections of society, particularly the destitute in the metropolis.

Over 50% of the surveyed old age homes provide residential services free of cost. Only 38% require some sort of payment. The average occupancy of 105, persons is higher for the two old age homes in the “mixed” category. These offer free as well as paid services. The average reported intake of the 13 free homes is about 48 persons, while that of the nine paid homes is 38 persons. There was a noticeably higher degree of variability in the intake for the free homes—ranging from eight to 150 residents—and much lower for the paid ones, falling between 12 and 60 residents. However, the study did not find any statistically significant difference in the average intake of free and paid homes, suggesting that payment does not necessarily restrict intake. There is also a visible conscious choice among elderly persons from economically well-off families opting for institutionalised care.

Increased Dependence

During the interviews, it was revealed that most of the residents of paid homes either had children who were settled abroad, or only had daughters. Staying with one’s daughter post her marriage is still considered a taboo in the Indian society. This aspect lays down important concerns with regard to changes in the superstructure, which occur relatively slower as compared to other technology-based changes.

As far as the regional distribution of old age homes is concerned, we find that most of the old age homes (33%) were located in the southern part of the city, with an almost equal number (21%–25%) located in the central, northern, and western zones. The affluence of the southern part of the city is visible in the larger presence of paid homes in this region; in the other regions, the proportion of free homes outweighed that of the paid ones.

Another surprising finding is the absence of any old age homes in east Delhi. The reason could very well be the fact that the socio-economic composition of this area is such that the prevalence of joint family structures are still prominent. However, this aspect merits a further in-depth analysis of the causes. The locations of the government-run old age homes are more equally spread in terms of region with one each in north, south and west, and two in central Delhi. The ones in the north and west are run by the Delhi government, and the remaining, by the municipal corporation.

The old age homes are largely gender-neutral with only three old age homes being specifically for women. One of these was being run by the government (NDMC) and offers both paid as well as free facilities. Still, the current occupants in this home were all from the upper-middle class.

As regards location, two of the old age homes for women (including the government one) are located in central Delhi, while the third one is in south Delhi. The private trust-run old age home in central Delhi boasts of being among the oldest (about 57 years old) and having an occupancy of more than 100 women, all of whom are paying for the services provided.

A glance at the economic profiles of residents of the old age homes reveals that 21 of the homes have occupants hailing from middle class (15 homes) and upper-middle class (six homes) families. Only three old age homes accommodate persons from lower classes. This suggests that the kind of institutionalised care that is being offered is not enough to cater to the economically weaker sections. Also, most of the old age homes that are being established are in the private sector and are not charitable in nature. Government efforts are clearly lacking in this sphere.

Even though the traditional Indian society and the age-old joint family system have been instrumental in safeguarding the social and economic security of the elderly people in the country, with the rapid changes in the social scenario and the emerging frequency of nuclear family set-ups in India in recent years, the elderly population is likely to be exposed to emotional, physical and financial insecurity in the years to come (Rajagopal 2017). With an increase in urbanisation, living spaces in cities are shrinking. Furthermore women, who have been the primary caretakers of the old within the Indian family system,
are progressively becoming part of the labour force (Dubey et al 2011; Siva Raju 2011). As warranted by these circumstances, old age homes are increasingly becoming a reality for the old, especially in urban areas. It is not too far into the future that old age homes will provide
a substitute for the care provided by children/heirs in the traditional Indian society. The findings of our study suggest that although the number of such service providers has increased in the past two decades, it remains short of the requirement of the fast-changing demography and economics of the region. Adequate provision of geriatric services is a real problem which, in the absence of proper planning and implementation, is likely to result in a catastrophic situation as the elderly population in India increases in the coming decades.

References

Alam, Moneer (2006): Ageing in India: Socio-economic and Health Dimensions, Issue 66 of Studies in Economic Development and Planning: Academic Foundation.

Dubey, Aruna, Seema Bhasin, Neelima Gupta and Neeraj Sharma (2011): A Study of Elderly Living in Old Age Home and Within Family Set-Up in Jammu,” Studies on Home and Community Science, Vol 5, No 2, pp 93–98.

GoI (2016): “Elderly in India: Profiles and Programmes,” Central Statistics Office, Ministry of Statistics and Programme Implementation, Government of India, http://mospi.nic.in/sites /default/files/publication_reports/ElderlyinIndia_2016.pdf.

HelpAge India (2015): “The State of Elderly in India Report 2014,” New Delhi, https://www.helpageindia.org/wp-content/themes/helpageindia/pdf/state-elderly-india-2014.pdf.

Mane, Abhay B (2016): “Ageing in India: Some Social Challenges to Elderly Care,” Journal of Gerontology & Geriatric Research, 5, e136, doi: 10.4172/2167-7182.1000e136.

Rajagopal, V (2017): “Old Age Homes as a Fact of Life,” Hindu, 20 August, https://www.thehindu.com/opinion/open-page/old-age-homes-as-a-fact-of-life/article19523768.ece.

Siva Raju, S (2011): “Studies on Ageing in India: A Review,” Building Knowledge Base on Population Ageing in India (BKPAI), Working Paper No 2, United Nations Population Fund, New Delhi.

Visaria, Pravin (2001): “Demographics of Ageing in India,” Economic & Political Weekly, Vol 36, No 22, pp 1967–75, http://censusindia.gov.in/.

Updated On : 15th Mar, 2019

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