In the disturbing movie, The Ballad of Narayama directed by Shohei Imamura, the elderly are the victims of a supposedly ancient Japanese tradition. Having outlived their utility at the age of 70, they are taken by their kinsfolk to a desolate and remote place and left to die of exposure to the elements or starvation. Now this may be an imaginary place but in an extreme manner it raises the plight of the elderly in societies that do not have any safety net for them.
In India, we have been happy to deceive ourselves that ours is a caring society where the family will take care of its elderly, paying them back for the sacrifices that they have made to strengthen and nurture the family unit. Indeed, in many Hindi movies, the older generation is seen as the font of wisdom and joyous participants in family occasions. To many of us, the western tradition of putting older people in homes is abhorrent. In India, such facilities are few and far between and most of us would consider this alien to our culture. It would somehow diminish us in the eyes of society and of our peers if it were known that we had put a parent or elderly relative in an old age home.
This, however, should not be as unacceptable as it seems. Very few old people have the resources or physical reserves to manage things on their own. Few states have easily accessible medical care or services to cater to the elderly. In fact, in joint family systems, the health of the elderly often does not take precedence over that of the ‘earning’ members and the young.
The need for specialised geriatric care is still a rare concept in India. States like Kerala are perhaps the exception, but then healthcare itself is vastly different there than in other states. This was brought home to me, a staunch and now somewhat repentant critic of the Kerala development model, when my father recently had a massive heart attack. At 2 am, a fully medically equipped ambulance reached my parents’ countryside home through winding roads with no signs within 12 minutes of the attack. The nearest hospital in a small town was so well-equipped, the chief cardiologist Vellore-educated Dr George Koshy, so remarkably competent, that his team was able to save my 88-year-old father. But things could have turned out very differently for my parents, living alone in the quiet countryside, had they been in another state without easy access to medical care. In Kerala, if you can afford it, medically trained help is available at home, an option many elderly people chose over living with their children. Even hospitals in small towns have world-class doctors, have state of the art technology and compared to metros are reasonably priced. So the elderly have more than a fighting chance of surviving serious ailments.
I have often felt that it is children burdened by the guilt of not sparing enough time for their parents who think that they need to move in with them in their old age. Very often, people like my parents, value their independence far too much to want to live with their children. The fact that our parents do not need us is in some way upsetting to many of us. We simply refuse to accept that they do not want to adjust to our lifestyle or be grateful that we have invited them into our lives and homes. The main problem is that they don’t have the facilities, like accessible and affordable medical care customised for the elderly, to exercise that independence. In fact, we have very few services of any sort that cater to the aged.
Very long ago, a prescient proprietor of a newspaper I worked for told me what I then thought was a loopy idea. In hindsight the proprietor seems possessed of clairvoyant abilities. I was told that India should charge a fee to countries like Japan to send its aging people here where an army of geriatric care professionals would look after them till the end of their days. The old would benefit as would the Indian exchequer. Now, that is a thought for some smart entrepreneur.
However, in states like Kerala where the life expectancy is 72, geriatric care is becoming a booming industry. Professionals trained to deal with the needs of the aged are being churned out. It is one state where the concept of trained home medical attendants is now the norm. The state from which the young seem to flee for lack of job opportunities now has a staggering number of old people left to fend for themselves. If they live with their families, they are often subject to mental and physical abuse, made to work as unpaid servants and generally considered as being way past their shelf life.
What we need is more old age homes where the elderly can live with dignity and not be made to sing for their supper. There have been many instances of NRIs carting their parents off abroad and expecting them to double up as housekeepers and babysitters. The successful children are often ashamed of their parents, their inability to speak English and fit in with life abroad. I have come across several cases of old people committing suicide, driven to despair in an alien environment.
Instead of depending on the vagaries of their children, old people should have the choice of living in assisted surroundings. In the case of those who cannot afford it, the state, which pays so much attention to its young population, should consider investing more in facilities for the elderly. For the most part, they seem to be an invisible part of our society both in the family and in official policies.
Like our so-called reverence for women, our respect and caring for the elderly is also very much a part of our collective hypocrisy. Real life is not all about dutiful children listening to granny’s home remedies and homilies. Even the best intentioned are often too busy or otherwise preoccupied to pay the elderly the attention they need both emotionally and physically. Another aspect is that today, the well-heeled older person is not content to sit around knitting socks or joining laughter clubs. They seek adventure in the form of travel or even romance. This is not always welcomed by their offspring who are almost ashamed that their parents have worldly desires after a ‘certain’ age. While this may be a minuscule section, we need to shake off our patronising attitude to the elderly.
With its young population, India is in a position to take the lead in geriatric care both for domestic reasons and even for the international market. This will generate both employment and better care for the aged.
Geriatric care is a very grey area today in India. The elderly deserve a little more clarity than that.