A DIGNIFIED OLD AGE

May 2014

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• http://pique.pk/society/06-May-2014/a-dignified-old-age

Caring for the aged: Are we resting on our laurels when it comes to looking after our elderly?

Rabia Ahmed

In Pakistan people are increasingly concerned about old age and its related issues with every new candle on the cake.  Odd, isn’t it, seeing that our culture lays such stress on caring for the aged? In fact we feel rather superior to Western cultures on this account.

Well, Mark Twain said that all generalisations are false including this one, and this particular one is certainly so, because as reported by AFP, Pakistan figures as the third worst country to grow old in.  Western countries on the other hand are among the best in a list of ninety one countries ranked by an International advocacy group and the UN, comparing relevant data.  Sweden is the first among the best ten followed by Norway, Germany, Netherlands, Canada, Switzerland, New Zealand, USA, Iceland, and Japan. Britain at thirteenth ranks ahead of Australia and France. Lower down are China at thirty five and India at seventy three; Pakistan ranks eighty ninth, ahead only of Tanzania, and Afghanistan.

The fact is there are many institutions for the aged in the West, and many more studies and protocols that deal with geriatric care.  This is misread as proof that Western children abandon their parents.  This post on the web represents public opinion in Pakistan: ‘It is an absolute disgrace that old people’s homes have sprouted in Pakistan. The idea of putting old parents in old people’s home has sprung from the west, and that despicable act has caught up in Pakistan.’

The presence of aged care facilities is actually characteristic of a society that cares for its elderly, one that is concerned enough for their quality of life to be unwilling to abandon the welfare of its aged to chance.  This includes all elderly persons, not just those lucky enough to possess families willing and able to care for them.

It is well to remember that a room in the family home is no guarantee of care. With the best will in the world and in spite of our cultural values, children may not always be able to care for parents, much more so today. Cultural values change because of several factors, such as in this case the dispersion of families around the world, or from rural to urban settings physically separating the young from the old. In todays expensive times the reason for being unable to provide care may also be monetary for the less affluent.

Some individuals would rather live independently.  There are others who have neither children, nor carers in the family, nor funds. What are the options for all these people when independence is no longer possible?

Old people’s homes are a necessity. In fact ‘respite care’ is also required, for carers who can place the person he or she looks after in a respite home for a short while in case of emergency such as the carer’s own ill health or temporary absence.

In Pakistan aged care facilities do exist although not abundantly as in the West. These are run mostly by non government organisations and some by the government.  However all their numbers together are woefully insufficient for the population and its requirements. Typically, the Edhi Foundation runs the largest number of homes for the aged, caring between them for the greatest number of persons at all levels of disability and care. 

The institutional care that is available in Pakistan is almost exclusively for the poor, not for the affluent. For those who can pay, the only option if the family does not bear this responsibility is private care provided by professional carers supplied by agencies that specialise in this field.  Full time care by unqualified carers costs around Rs 30,000 a month. The cost of skilled nursing is much higher. It is only a small fraction of the population that can pay this amount in addition to other essential requirements, such as food and utility bills. Funds however are only part of the problem. There is great risk of ill treatment and security threats at the hands of carers if unsupervised.

Care for the affluent in the West includes ‘independent living homes’ where the Management provides help if required and takes care of transport, maintenance and arduous chores. The level of care increases with the disability.  In Pakistan the Parsi community has residential colonies for its people regardless of age or wealth. These include homes where the rent is nominal, community centres and welfare organisations. The colony is maintained by the wealthier section of the community.

According to an Alzheimer’s Disease International report, ‘elderly care needs are set to treble by the year 2050,’ and warns that the world is set for an Alzheimer’s epidemic. It also says that as world population ages ‘the traditional system of informal care by family, friends and the community will need much greater support.’

While Western populations shrink and the existing population lives much longer requiring expensive care, aged care for the growing population of poorer countries is more than a question of finances. It calls for a change of attitude.  One reason for the lack of aged care facilities in Pakistan is that this poor country is unable to afford it, another that the governmental will to provide it is absent, which explains the preponderance of NGOs in the field. 

Another huge reason is popular attitude towards the issue.

Society is unfortunately not always the intelligent entity it needs to be because of the misguided values of the very culture it encompasses.

Located on a busy road in the Lahore cantonment, in a purpose built building on four acres of land is a remarkable place: a children’s school as well as a clean and peaceful home for the aged, a beautiful juxtaposition of old and young, surrounded by gardens. This home is administered by a trust set up by the owners of a leading brand of shoes in Pakistan.

The approximately twenty five elderly inmates of the home are all over sixty years of age, and poor. Here they are fed, clothed, housed and their medical needs taken care of free of charge. The organisation does not accept any person financially able to afford care.

Several of these aged residents have children, and some of these children would have cared for their parents, but being daughters, they are not allowed to do so. This is because of an outstandingly senseless cultural norm which says that parents must live with their sons, not with married daughters. 

Even religion which lays great stress on the responsibility of parents and children, both sons and daughters, towards each other is overridden in this case. So although these residents’ daughters are married to ‘very religious men,’ the parents live here because of the cultural reasons mentioned above.

Pakistan’s issues are growing with the rapidity of its population.  Aged care is just one of these issues, and it too requires serious and urgent thought.  But to achieve results we must cultivate the habit of questioning tradition and some of our most commonly held views. It is the only way to bring about meaningful change.