Room for improvement Old age homes in India should focus on ‘continuum of care’, says Indira Jai Prakash With its 300 year-old history of providing long-term care to older people, India recorded the establishment of its first old age home in 1782. Most old age homes are still run by secular organisations, religious groups and the state. Society and the state have always relied on joint families to provide long-term care to seniors. Co-residence with children was, and is still, the preferred living arrangement. While estimates vary, there are over 600 registered old age homes — 52 per cent of them in South India with Kerala leading the list. The need for old age homes is a reflection of the demographic and social changes around us. Lifespan has increased and people are living well into their later years. Families are smaller and nuclear. Traditional caregivers (usually women) are not available 24×7. Migration of the youth results in older people living alone. When family or community care is not available, institutions emerge to fill the need. But unlike in the West, old age homes have not been part of our ‘normal’ social scene. However, they are now mushrooming in urban areas — this is prompting state governments to support NGOs to start and run them at district levels for people below the poverty line. Old age homes are still viewed as the last resort as planned long-term care, disability-free ageing, quality ageing, community-assisted independent living arrangement and comprehensive geriatric care are all concepts still vaguely understood and yet to be practised in India. How good are old age homes in India? There are obviously some very well-run institutions providing quality care with or without residents paying for services. Abhayashram in Bengaluru is one of the oldest homes providing free care to many destitute elderly. There have also been instances in the city where the Elders’ Helpline run by the Nightingales Medical Trust had to ‘rescue’ old people from homes where they were virtual prisoners. The Federation of Senior Citizens’ Forums of Karnataka attempted to check on old age homes advertised in local newspapers. The ratio of actual (really existing) to bogus (on paper) old age homes was 1:4. There were homes where mentally challenged, chronic psychiatric patients and destitute elderly were herded together. The visiting team was denied entry in some places. At present, only around 1 per cent of the elderly are living in institutions. Soon, out of necessity or choice, more people may opt for old age homes. If living in a care facility has to be a viable option for seniors, certain issues have to be looked into. People who manage old age homes need to be trained to provide appropriate care for the changing needs and increasing dependence of elders. It requires knowledge, empathy, communication and stress management skills. One has to plan systematically for every ‘resident’ — which sounds better than the term ‘inmate’ — taken in. Financial, legal, familial, social, medical and emotional issues need to be worked out in detail. The aim should be to provide quality care till death, so that the dignity and autonomy of the person are respected. Inclusion is the key word. The family (even extended) and community should be involved in old age home activities. Across the country, old age homes should provide regular, uniformly appropriate services to every person who needs them, no matter who manages the institution. Supervision to prevent abuse and exploitation is mandatory. Old age homes should not be waiting rooms for people about to die but centres where active ageing is promoted. The focus should be on ‘continuum of care’ — from minimum assistance to live independently to maximum end-of-life care when required. In short, they should be supervised and monitored; the staff should be trained and empowered; and the management held responsible and accountable. Indira Jai Prakash, 58, is a Bengaluru based Gerontologist Featured in Harmony Magazine June 2010