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Old Age Institutions - Focus on Mumbai




While the Indian population is ageing fast, the lack of effective implementation of strong regulatory measures to safeguard the interests of this demographic, especially when it comes to old age instituions is an imporant concern. The Integrated Programme for Older Persons, under the National Policy on Older Persons (NPOP), was implemented in 1992 and supports NGOs by subsidizsing most project costs involved with running old age homes. The National Policy for Senior Citizens (2011) promises an array of State interventions – support for financial security, healthcare, shelter and welfare, special focus on older women, protection against abuse and exploitation and special attention to rural areas. The policy highlights the plight of several vulnerable groups as well as the issues faced by elderly women due to socio-economic barriers strengthened by cultural prejudices and the prevalence of patriarchy in Indian society.
The concept of an old age home is relatively new to India, having been adopted from the West due to changes in societal norms and the popularity of the nuclear family model. The shift from traditional households comprising up to four generations living as a joint family to nuclearization has also resulted in issues of abandonment for the elderly – a large number of those residing in old age homes do not actively choose to do so. Though the issues of comfort, safety and security may be addressed by an old age home, the emotional and mental needs are often overlooked in favour of basic physical and medical needs.

Some of the factors that contribute towards the elderly taking up residence in old age homes include:
  • Migration of younger people from rural areas to major cities in the country and even abroad in search of better job opportunities
  • Differences in attitudes and generational values between elders and their children who seek greater independence and freedom to make their own decisions
  • Medical needs or ill health that cannot be taken care of by children or when living alone
  • Safety and security from crimes against senior citizens living alone
  • Legitimate cases of abandonment arising from property disputes or financial difficulties

Elderly women in old age homes in Mumbai

Approximately 11.1 million citizens above the age of 60 live in Maharashtra. With the disintegration of the joint family system, the ederly especialy women are found to be most affected, suffering not only from the lack of facilities catering to their age but emotional vulnerability as well.
The new concept of day care centres is gaining acceptance from elders and their family members on account of elders being alone and idle and family members being unable to give enough time and attention to ward off their loneliness. In Mumbai, there are ten institutions cater exclusively to elderly women. This study focuses on four of these institutions, highlighting some of their good practices.

Shraddhanand Mahila Ashram, Vasai

One of the most famous old age homes for women in Mumbai, Shraddhanand Mahila Ashram completed 85 years in 2011. The facility takes in non-paying residents on the basis of recommendations from social workers and other reliable NGOs, while paying residents are taken in through a registration process involving the concerned family, with no difference in the amenities provided to both categories in accordance with their strict ‘Non Discrimination’ policy.
Encouraging intergenerational interaction, the home allows children from a nearby school to come by in the evenings to play games or share snacks with the elderly residents. Most of these children, being orphans, also benefit from the initiative which itself works well to contribute towards building a better community. The home also arranges for vocational training classes including tailoring, thereby helping the residents to take up productive pursuits that not only keep them occupied but also strengthen their sense of self-worth.

Our Lady of Piety Home, Chira Bazar

Maintained by the Our Lady of Piety Church Trust in Goa, this institution presently caters to 14 elderly women, all of whom work together and depend on each other. All the residents are admitted without payment and the facility is maintained by the Trust as well as through sponsorships and donations received from regular contributors. When they die, the residents are ensured a proper burial as per tradition in a patch of land reserved for the home in a nearby cemetery.

The Dignity Dementia Day Care Centre, Dadar

The centre, with its staff of eight paid workers and four or five volunteers from different social sciences backgrounds, maintains a daily routine of innovative activities while providing the special care required by persons suffering from dementia and Alzheimer’s disease. The centre arranges for frequent visits by school and college students in order to raise awareness about these ailments while simultaneously helping combat the feelings of loneliness experienced by the residents. Not only do students actively engage in conversation and study of the residents but also put up musical acts for their entertainment.

Ashadaan, Sankli Street

Launched in 1976 by Hindustan Unilever Limited (HUL), the initiative supported Mother Teresa and the Missionaries of Charity in setting up Ashadaan, a home in Mumbai. Located on a 72,500-square feet plot belonging to HUL in the heart of Mumbai, Ashadaan’s capital and revenue expenditures for maintenance, upkeep and security of the premises are all borne by HUL. The institution is the largest of its kind for elderly women in Mumbai, with almost 130 residents occupying the home at any point in time, most of whom have been abandoned with no family to support them. The Missionaries of Charity provide all needs of the women from clothing, to food to medical aid.

The essential features that make these homes an example of good practice are given below:

  Shraddhanand Mahila Ashram Our Lady Of Piety Home Dignity Dementia Day Care Center Ashadaan
Type of Old age home Paid and unpaid residency with the responsibility of maintenance being shared by a trust Unpaid with support from government and other local charities sponsors Private, paid day care center Charity based old age home founded by Mother Teresa
Medical facilities In-house nursing staff on internship basis; weekly and monthly check ups by local doctors; yearly checkups by specialist On-call physician; free-of cost treatment for minor ailments Trained employees for dementia care; on call physician Sisters trained in medical care; on call physicians
Medical facilities In-house nursing staff on internship basis; weekly and monthly check ups by local doctors; yearly checkups by specialist On-call physician; free-of cost treatment for minor ailments Trained employees for dementia care; on call physician Sisters trained in medical care; on call physicians
Domestic Aide Two- full time domestic aides, another two on shift basis One full- time domestic aide for menial and heavy chores; while the women in the home cook for themselves on regular basis Food prepared by cooks hired on the basis of daily wages; eight volunteers to look after all other chores Full time aides along with residents who can work allowed according to a schedule
Vocational training and opportunities to earn Staff often finds work for some of the residents to help them earn; basic computer training is encouraged Residents permitted to seek work outside on both full-time and part-time basis    
Celebration of Festivals and group outings Picnics arranged twice a year for the residents; families of residents often visit to celebrate their birthdays; all major festivals celebrated A small picnic to a nearby spot is arranged once every year; all major festivals celebrated Picnics arranged only under strict professional guidance; birthdays of the residents and all major festivals celebrated.  
Intergenerational programmes An hour in the evenings interacting with children from a nearby orphanage on a daily basis Occasional visits from school and college students Regular visits from school and college students from across the city; mostly psychology students Visits are often discouraged due to the size of the institution; however certain institutions are permitted to make yearly visits
Counselling Monthly counsellor visits Only called upon when required Counsellor always available Counsellors and social workers always available

Challenges and Limitations

  • Ageist attitudes and biases based on stereotypes reduce elderly people to inferior or limited positions. Segregation from the workforce proves to be detrimental to their mental health and well-being.
  • The lack of funds at every institution call for more legal and structural contribution by the Centre and state for the maintenance of old age homes. It is essential that the care of the elderly is seen not only as the responsibility of the family unit but of the community.

Recommendations

  • Intergenerational housing: Depending on their resources or preferences, old age homes can choose to incorporate all or one of the following types of intergenerational housing
  • Intergenerational vocational training: Younger destitute women could be trained along with the residents of the old age home
  • Free education services for children from financially disadvantaged families: By hiring a teacher and using any appropriate and available space for conducting evening classes for such children, not only would the old age home be making a positive contribution to the community but also helping elderly women feel less lonely or restricted to interacting only with their peers or caretakers.
  • Working Girls’ hostels: Reserving a wing or section of the premises for use as a working girls’ hostel, would provide safety to residents of both kinds and allow for events and occasions where interested residents of the girls’ hostel could volunteer with ease.
  • Home-based services: Many elderly persons would prefer to continue living in familiar surroundings if adequately supported, often feeling disoriented and lonely when rehabilitated. It is also possible to identify medical practitioners, locality-wise, who can regularly visit the residences of the senior citizens as and when required.
  • Protective services: A security system with a follow-up organisation comprising of members sensitive to senior citizens who would facilitate a mechanism for investigation of cases of elderly abuse and crime.
  • Grading of institutions serving the elderly: The lacuna with respect to prescribed norms for old age homes and other elderly care services in India must be addressed by the legislature. There needs to be standardization and grading on a regular basis by an independent body under the Central and State Governments which would then serve as a reliable guide for the elderly as well as their children while determining the most suitable institution as per their needs. This practice, which is commonly followed in developed countries like the UK and USA, has helped individuals and their families to decide on the best option for the care of their elderly.
  • Cohousing: Cohousing, originating in Denmark and has become a very popular concept in some parts of the USA. Balancing social needs of the elderly with lower energy costs and environmental friendly designs, cohousing remains an underdeveloped concept in the subcontinent. However, replication of such a model would have a high chance of success owing to the pre-existing culture of community and sharing already existing in India.

Some innovative practices followed by Old Age Institutions from other cities

Ma-Dhaam, Guild of Services, Vrindavan:
The women at the home are actively engaged in language classes and various vocational activities for which they are paid a small allowance by the Guild. In addition to outings to other holy towns and celebration of festivals, the residents’ emotional and mental needs are attended to by a counsellor living on the premises. Along with proper access to medical aid, the women are also provided with physiotherapy as and when needed. Younger dependents of the residents are trained at the facility alongside the residents themselves, incorporating an intergenerational aspect by enabling interaction and learning in a healthy environment.

Premdaan, Kolkata:
The home provides a space with all old age facilities to elderly and destitute women free of cost, with special attention given to elderly disabled women. Women do not have to apply or register to be accepted – they are accommodated immediately or rescued from the streets.

Kalyan Ashram, Kolkata:
In addition to its basic function as an old age home, this institution has successfully taken on the role of an age-care facilities hub for elderly women in Kolkata. The services available include Certificate courses for caregivers, physiotherapy for residents of homes for the aged and an Elders’ Helpline and a Senior Citizens’ SelfHelp initiative.

Divya Chaya Trust, Palam Vihar, Haryana:
The innovative measures unique to this home include the guest lectures organized on various issues and a library with a wide variety of books that add to the overall mental contentment of the residents by providing intellectual stimulation. This is often overlooked in many old age homes that prefer to provide less time and management intensive forms of entertainment to their residents. The interactions of the residents with members of local corporate institutions also provide for stimulating discourse that benefits both parties – the CSR commitments of corporate bodies are fulfilled while promoting a culture of sensitivity towards the concerns and issues of older generations. The basement of the building is utilized as a computer laboratory and education centre where underprivileged children in the area are given free lessons in the evenings. The home integrates intergenerational living through running the school, which presents the residents with opportunities to spend time with the children.

Ashoka Niketan, Mahila Seva Samiti, Kolkata:
Evolved out of a need to address the issue of elderly women’s rights, Ashoka Niketan supports its residents in leading a dignified and secure life, counselling their family as and when needed in order to root out thinking that would allow behaviour that violates the human rights of aged women. The organisation consistently advocates for mainstreaming of old age issues by networking with relevant agencies, citizens and the local government.

Conclusion

All institutions studied have good policies of regular health check-ups and ensure caregivers’ presence to ward of loneliness among the women. At an older age when economic or survival needs are reduced to the basic needs plus healthcare, it is often the latter that requires most attention. In addition to the development of the existing old age home models, promotion of a value system that supports and positively includes older generations is essential. Though state policy and laws ultimately aim at reform, it is generally observed to be highly challenging for a set of policies to directly, successfully and immediately impact societal norms and values, especially those that already highly devalue the human worth of the vulnerable group. For the welfare and care for the older persons, efforts must be made to preserve existing social support systems/traditional social institutions including family units, neighborhood and community bonding and community participation not only in cities but in rural areas as well. Intergenerational care and involvement of the community can also help in bringing about a sense of responsibility among teenagers, who then learn lessons of care giving and the need to respect elders while ensuring emotional bonding and creating an agefriendly environment. Senescence often brings along a myriad of psychological problems, and even those unaffected by these ailments admit to feelings of loneliness or a general decrease in self-worth. Assimilating intergenerational elements in institutions catering to the elderly would work as social catalysts for better values in younger generations while allowing older generations to experience more fulfilling solutions to their intangible needs.
 
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