The new old age homes
I was in Australia and visiting a relative, an elderly uncle living in a retirement home in Melbourne. The visit was an eye-opener. I realised that many countries are building places to live for older people with all facilities. This home had a clubhouse, an age-friendly swimming pool, a very good library and residences which were modest by Australian standards but very comfortable and clean with excellent facilities. The home was also disabled-friendly.
My uncle has a pet dog named Bimby, a Jack Russell, and they adore each other. The home has a facility for giving the pet special food on all days. When loneliness is such a common feature, these pets are a relief for the aged. I could not see a single defect in the retirement home. The environment it provided for the elderly was much better than being alone in a colony in New Delhi.
India has been living in denial, a very common self-defence mechanism, when it comes to building old age homes. It is often argued that the provision of old age homes would take away the responsibility of the children and the family of looking after their elderly and the homes would become dumping grounds.
However, there is a proportion of the elderly for whom staying in an old age home is the only option. This is especially true if the person has no children or is single because he or she never married, is a divorcee, a widow or widower. There is often news about the elderly being neglected or abused by their own children. In such cases an old age home is a better option than living alone or staying under someone else’s roof.
The need for old age homes is not just another urban phenomenon. The break-up of the joint family has isolated the elderly in both urban and rural areas. Most of the elderly, whether rural or urban, face the ‘empty nest syndrome’ when their children leave in search of work opportunities or better living conditions and lifestyles. They might choose to migrate out of the country or shift to a different city.
Old age homes are credible alternatives to caring for the elderly when they fall sick, when they don’t have anyone to look after them and to provide solace and emotional support without fear of prejudice or contempt. The old age home also meets the elderly person’s basic critical need of food, medicine and shelter.
HelpAge India has compiled a list of 484 old age homes in 2010 from just 15 metros and non-metros alone. Each of these old age homes had an impressive waitlist. Figures from an earlier nationwide survey of old age homes in 2009 present a list of 1,279 old age homes with an average capacity of 35 elderly people.
It is no doubt important to uphold and build traditional Indian family values and impress upon children the need to take care of their old parents. But there should also be a fallback option, especially for the destitute poor among the elderly, since most old age homes with appropriate facilities are private ‘pay and stay’ homes. Only a handful function on the charity-based model.
Here the concept of old age retreats — vibrant facilities where the elderly poor would live as residents and not as inmates — would be suitable. Such homes of the aged need to be supported by Central assistance. Old age retreats would encompass the philosophy of ‘assisted living’ that differentiates itself from other forms of residential care by focusing on a model that promotes independence, autonomy, privacy and dignity for elderly residents, but with supervision or support when needed.
The first old age home came up in Thrissur, Kerala, in 1911. It was set up by the Raja of Cochin and was called the Raja Varma old age home. Kerala has been ageing faster than the rest of the country. The elderly comprise almost 14 per cent of the total population. The northern states remain younger, barring Punjab and Haryana which have aged considerably.
The first retirement homes came up in Pune in Maharashtra and Coimbatore in Tamil Nadu. In Pune, Paranjape Builders started Athashree Homes while in the south, Col Sreedharan started Covai Homes — the best retirement homes in the country.
In Delhi, Servants of the People Society began Godhuli Senior Citizens Home in Dwarka, a suburb of Delhi. HelpAge started Age Ventures India to promote retirement homes. It has collaborative projects with Brigade Group in Bengaluru, the Neotias in Kolkata, the Sriram Group in Chennai and the Laburnum Group in Gurgaon. It is difficult to predict how these will run their life course. Such projects are welcome. But they are all real estate projects or builder retirement homes. What happens when the builder loses interest?
There are things you have to consider while moving to a retirement home:
- Will there be caregiving and medical facilities on-site?
- Is transport available on call and is there an ambulance?
- What are the maintenance charges (including electricity and water) apart from food and laundry? Are there any hidden costs?
- Are there any visitor rooms or guest rooms? Usually, children and relatives visit for longer than a day so can they stay close by?
- What medical costs need to be incurred?
- What happens after you die? Can the property be willed or resold to another person? Many contracts/agreements do not permit this.
The biggest issue in such retirement homes has been the long-term issue of maintenance and caring. Very often, in the beginning, most homes are in great shape and there is exuberance in the new abode. However, over time, most of them develop Resident Welfare Associations and there is long-term conflict. Property developers and real estate providers are very weak in this aspect and prefer to get out of these arrangements quickly. Abroad, these homes have property maintenance companies which are run professionally.
In the long run, the family home is the best place to live and die. However, the pursuit of happiness in old age can be a fantasy and everyone needs to prepare for old age, including perhaps choosing a retirement home for the future. I think the time for such homes has arrived in India.
Mathew Cherian is CEO of HelpAge India. To know more about old age homes: http://www.helpageindia.org/programs/old-age-homes.html