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RUHSA DEPARTMENT
CHRISTIAN MEDICAL COLLEGE
RUHSA CAMPUS P.O. 632 209
VELLORE DISTRICT,
TAMIL NADU;
INDIA.
ACKNOWLEDGEMENT
This publication is the result of the efforts put in by a number of
individuals covering nearly a five year period. It is the pooled effort of these
individuals that has finally resulted in this booklet.
The first efforts were initiated through an exploratory study carried
out by Ms. Marion Crozer and Ms. Pam Peterson in 1999. They carried out
a survey among the elderly and arrived at some conclusions.
The second effort was made by Ms. Linda Pater and Ms Nella
David in 2001. In addition to a survey of elders, two seminars were also
organised with key resource persons providing the inputs. They also visited
a number of projects pormoting the care and welfare of the elderly Based
on their study and with RUHSA faculty inputs, a number of strategics were
identified and described.
A camp was organised earlier for the elderly and the various strat
egics earlier identified were discussed as to their appropriateness. Along
with these elders a set of messages on promoting the care of the elderly was
also prepared. The third effort also consisted of a survey. Besides social
aspects, it also covered health and nutrition assessment of the elderly. This
was carried out by Mr. Ralf Jonas and Ms Patricia Senior. The third group
had the major responsibility of summarising the findings and recommenda
tions from the previous students’ work and a final ready to print draft was
prepared by them. They also tried out some of the strategies listed.
While the three sets of students from the University of South
Australia, Adelaide have contributed significantly to prepare this booklet.
significant contributions have been made by RUHSA staff also. Ms.
S.Jayalakshmi coordinated the work of the first set of students as well as
contributing to the work of the third set of students. Ms. E.Vijayakumari
coordinated the work of second set of students. Mr V.Jebaraj coordinated
the work of the third set of students. The inputs of these have been
considerable.
Formally as the overall programme coordinators Dr. Frank Tesoriero
from the University of South Australia and Dr. Rajaratnam Abel from the
RUHSA Department have supported the students in different ways to ensure
that there was progressive gain in knowledge of the care and welfare of the
elderly. Necessary and timely inputs were provided so that the strategies
presented here were clearly conceptualised and described so that they can be
readily applied not only within RUHSA hut by others as well.
Table of Contents
1.
2.
Introduction
Studies carried out at RUHSA
2.1 Summary - Report I
2.2 Summary - Report 2
2.3 Summary - Camp Cum Seminar
3. The Problems
3.1 Health
3.2. Socio-economic
4. Strategies
4.1 Government Old Age Pension (OAP)
4.2 Food Programs
4.3 Psycho-social Support by Peer Elders
4.4 Health Care
4.5 Funeral Scheme
4.6 Income generation Scheme
4.7 Elders Self Help Group
4.8 Old Age Homes
4.9 Day Care Centers
4.10 Remarriage of Elderly
4.11 Care of Elderly by own Family
5. Feedback from the elderly
6. Messages
6.1 For the Elderly
6.2 For the younger Generation
6.3 For the Community
7. Schemes of assistance
7.1 Direct to the Elderly
7.2 Government scheme of assistance to
Voluntary Organisations
8. Conclusion
9. References
10. Appendix 1
I 1. Appendix 2
'Ptcaec eta not dee/dic me
1 am too old in t/tc
Acad and ettoatdena. too inadcauatctc' ic/toolcd at t&c
ute and ante a^ today. (mt eince *) (ivc Acte t/ticc
acoic ifcaio and 1 am not
at Coca, wiee and
wcalt/tq. *) auxdd 6e Cftiate^al
“7 am aaccfeted.
Source : 1 & 2 Asian and Pacific Women's Resource and
Action Series : Health
1. Introduction
In India 10 crores of older people make up 10% of the population.
It is anticipated that this figure will increase to 15 crores by the end
of 2020. The social problem commonly known as the “Greying of
the Nation” is starting to preoccupy the minds of everyone as to how
to positively respond to the needs of the millions of elderly in the
nation. (CHETNA NEWS 2001). Two major socio demographic
changes have contributed to bring about significant changes within
the family and are having a major impact on communities through
out India. The first one is the increased longitivity of people due to
improved health and development services. The second one is break
up of the joint family due to improvement in the condition of women
and the economic and political changes that have taken place nation
ally and internationally. Both have considerably affected the living
condition of the elderly population in the community. Intergenerational
conflict, filial expectations, familial power structures, and the general
well-being of the elderly have become a major concern to the eld
erly. (R.L. Coles 2001).
While major health problems are being handled effectively through
both the Government and private sectors, the time has come to devote
more efforts to ameliorate the condition of the elderly, which if not
handled correctly could cause tremendous problems not only for the
elderly but also the community at large for generations to come.
However, even in those countries where programs for the elderly are
in place, they do not meet all the needs of the elderly. While the
young people place their elderly in respective homes, there is inad
equate interaction between the generations, resulting in loneliness
among the elderly. To respond to this emerging situation, RUHSA
has taken up a program for the elderly so that appropriate interven
tions could be provided in a sustainable manner protecting the inter
est and needs of both elderly and the subsequent generations within
the cultural context of India. This report is based on attempts by
RUHSA to define its own strategy for achieving the goals to provide
for the care of the elderly.
2. Studies carried out at RUHSA
Previous studies on the elderly have been carried out in the K.V.
Kuppam Block. In 1999, a study was undertaken by University of
South Australia students Ms Croser and Ms Peterson. The report
entitled "The In-depth Study of the Problems and Needs of the Eld
erly and Strategies for Addressing Them" is available to view in full
at the RUHSA library.
In the following year in 2000. Ms Davis and Ms Porter, also from
the University of South Australia completed a study entitled "An
Analysis of Aged Care Programs Suitable for Implementation in
K.V.Kuppam Block Tamil Nadu". This report is also available for
viewing at the RUHSA library.
In 2003, Mr. Ralf Jonas and Ms. Patricia senior attempted to imple
ment a program for the welfare of the elderly. In addition to utilising
the information obtained from a camp organised in 2002, a survey
on the elderly including their health and nutritional status was carried
out. Finally they attempted to implement as many of the strategies
documented earlier.
2.1
Summary - Report 1
"The In-depth Study of the Problems and Needs of the Elderly and
Strategies for Addressing Them"
The Researchers interviewed 90 aged people from 3 villages of the
K.V.Kuppam Block and extensively examined health, social and
economic factors. The report revealed that in 1999 an estimated 2.76
million aged people nationwide were receiving the government OAP
(Old Age Pension), approximately one third of those who met the
eligibility requirements. This left an alarming 5.5 million elderly who
were likely to be needing assistance. According to RUHSA statistics
in 1998 approximately 17,000 people in the K.V.Kuppam Block were
aged 60 and over.
Of the sample group of 90 elderly, the survey found that :
*
*
73% were satisfied with the care they were receiving at home.
22% felt that their meals were inadequate
*
14.5% were receiving the government OAP
*
40% were relying on their sons for support
*
*
25% worked as coolies in agriculture
*
18.9% felt the non-marriage of their children was a continuing
problem.
59% of the group felt that there was a need for the government
to provide a pension to meet their basic living needs.
*
30% felt that their poor economic situation (Low or no income)
was their greatest difficulty
Despite all the hardships 70% of this group reported that they
would not like to live in a home for the aged.
2.2
Summary - Report 2
“An Analysis of Aged Care Programs Suitable for Implementation in
K.V.Kuppam Block, Tamil Nadu"
Visits were made to agencies providing
services to the aged to gain background
information into organisational structures,
funding bodies, client groups and the range
of programs provided. A one day learning seminar was conducted
with guest speakers from the agencies visited. A continuation half
day seminar was also conducted to gain input from RUHSA staff on
the .suitability of a diverse range of programs for the K.V.Kuppam
Block.
The village of Sethuvandai in the K.V.Kuppam Block was selected
for the purpose of researching the needs of elderly residents and
implementation of pilot programs to address the identified needs. A
2 day training and information workshop was developed and imple
3
merited for the representatives of the six Women's Self Help Groups
from Sethuvandai with the aim of educating the women on the needs
of the elderly and in the completion of Old Age Pension (OAP)
applicants. The "Passing on the gift" program was also implemented.
2.3
Summary-Camp Cum Seminar
Canip Cum Seminar on developing strategies
for care of the elderly
35 elderly people participated in the camp con
ducted at RUHSA on the 19th August 2002 over
3 days. A number of experts in the field of Age
Care had also been invited to participate and together with the Eld
erly explore their concerns. In response to the problems, a number
of strategies have been explored and their effectiveness, usefulness
and advantages were discussed with the elderly.
4
3. The Problems
The previously mentioned studies in addition with other participatory
processes involving a variety of community groups from various ages
have identified a number of problems regarding their health and their
socio-economic status. In general poverty or the impact of poverty
relating to no or low income was identified by the majority of eld
erly permeating into almost every aspect of their lives. Elderly stated
that the lack of income contributed to many of the present health and
social problems. This was especially noticeable within the backward
castes.
3.1
Health
The most outstanding health problems that the elderly were suffering
were poor eye sight and cataracts, joint pain in their arms and legs
and problems relating to their teeth like missing and decayed teeth
and tooth aches. Also a significant number of the elderly have been
identified as suffering from asthma, associated with wheezing and
dry cough and severe back pain.
Due to their heavy workloads in their daily life, the overall health
and well being was affected. The nutritional intake of the elderly
also seemed inadequate with only two thirds of the elderly stating
that they consumed 3 meals per day.
3.2
Socio-economic
Many elderly had expressed a feeling of isolation and in particular,
those who have lost their husband or wife were suffering from finan
cial hardship as well as a lack of emotional support and the inability
to share information with others. Another concern was the inadequate
conversation in particular with the younger members of the family
leading to a lack of respect and misunderstandings within the family.
The younger generation also finds it increasingly difficult to support
the elder members of the family due to their own financial situation
with many expecting the parents to contribute to the family budget.
Many leave their village in search for work leaving the elderly be
hind. It restrain them from supporting (he Elders.
5
4. Strategies
Identifying and evolving strategies for the care and welfare of the
elderly has been an ongoing process. Two sets of social work stu
dents from the university of South Australia, input by experts and
those involved in programmes for the care of the elderly, staff of
RUHSA. backed by relevant literature review together contributed to
describing each of the following strategies in greater detail.
4.1
Government Old Page Pension (OAP)
Theoretically the Government Old Age Pension should be available
to all eligible people over the age of 65 years. This pension varies
considerably in value from state to state in India. In Tamil Nadu it
is Rs. 200 per month and the entitlement also includes 4 kgs of rice
per month and 2 pieces of clothing per year, cither two saris or two
lungis.
The eligibility criteria in Tamil Nadu excludes those with a son over
18 years, although this is waived if he is severely disabled. It also
excludes those who own land, or have other pension income and
those living in housing other than thatched huts. If an aged person
is disabled or a cardiology patient, a certificate is required from the
authorized specialist and forwarded with the application form.
For the aged there are many difficulties involved with applying for
their entitlement. The form is lengthy and presents a problem for
those with no literacy skills. The aged person must find someone
willing and able to complete the form on his or her behalf. Proof of
age is required, and due to births generally not being registered 65
years ago, a government doctor must verify this. A photograph is
also required, which can be difficult to obtain for some residents of
rural villages.
When the application form is completed it must be verified by the
local Panchayat Board President and then ultimately passed to the
Deputy Thasildar in the Revenue Department of Taluk Office. Dur
ing research of this model of service the project team received re
6
ports of ‘leakage’ in the form of money being demanded, by offi
cials, at various stages of the application process. This was reported
as being between Rs. 300 to 700 per application.
Despite the growing number of aged people eligible for government
assistance in the form of the Old Age Pension, the Deputy Thasildar
in KV Kuppam block reported that only 20% of the need is being
met locally. This is due to the limited budget allocated to this area
of service and the quota given for each region annually. Once this
quota has been filled the applications of other needy aged people are
rejected, creating a situation where, theoretically as aged people ex
pire, another person can receive the benefit.
To assist the eligible aged people to avail themselves of this benefit
a procedure needs to be put in place, in their community, to assist
them to make the application. Ideally a central register should be
kept of people al the eligible age and a person in the community.
appointed to be responsible for coordinating the scheme. By training
this person, or persons, to complete the application form and meet
the requirements in the community, it will become a self-sustaining
project.
As the aged population of India grows the whole community would
benefit from the elderly having a secure income, as they would ul
timately be less of a financial burden on others. This aspect adds to
the incentive for this model to be a self-sustaining one in each com
munity.
Research has shown that the eligibility criteria, for the OAP, has not
moved in line with the changing pattern of family life in India. Many
elderly are not living in joint families as sons often migrate to urban
areas and are therefore not taking the responsibility for the rural
aged in the family. With these changes in mind, it is envisaged that
the government could be lobbied to review the eligibility criteria.
Important aspects for review would be the ineligibility of those el
ders who have sons over 18 years, as research has shown that many
7
of the aged in rural areas live alone, or with their spouse. There are
also many daughters who are looking after the aged parents.
4.2. Food Programs
The need for the provision of a food program for the aged is often
linked to the destitution caused by their inability to rightfully obtain
the government old age pension.
So strongly did Djurfeldt & Lindberg (1980) feel about the hungry,
destitute, aged in India that he described the notion of dying of old
age as an euphemism for dying of starvation (cited in de
Souza, p. 13).
At present some aged are entitled to a midday meal at the Balwadi
centre. However, this is restricted to those in receipt of a government
pension and leaves the destitute aged still in need of assistance.
The project personnel could identify the needy aged within the com
munity and issue them with identity cards, entitling them to the regular
meal. A suitable venue could be chosen that is in an accessible location
for the majority of the recipients. Ideally the midday meal program
can be implemented as part of an established day care centre or
support group service.
The benefit of the food program would be two fold. The nutritious
meal would improve their general health and it would also serve as
a form of social interaction and support within their community.
By recording the daily attendance, using the identity cards, it would
become apparent to the coordinators who was not attending. The
more able-bodied members could then visit the absent person and
offer further support or assistance if it was required. This community
support is valuable for the lonely, destitute and aged in rural areas,
who have no family regularly caring for them. It also builds up a
strong support network, which will contribute to the food program
becoming self-sufficient in the community.
8
4.3
Psycho-social Support by Peer Elders
This model of service could take a number of forms. Peer elders are
people in the age group of 55 years and above who provide support
to one another. A younger person may be linked up with frail, weak
and destitute elders or the economically well to do elders may be
linked up with those suffering economic hardships. The entire group
of elders in an area may be trained to provide peer support to one
another according to their needs, capability and availability of time.
Primarily this relationship provides emotional and psychosocial sup
port and very rarely the physical needs of money, food, clothing,
shelter and health Care.
Peer elders will generally be those skilled in listening to the prob
lems of fellow elders and have good communication skills. There is
no expectation that they are to solve the problems of the elders, but
that they will provide social and emotional support by regular com
munication.
Some of the peers may have more skills ability to provide further
support. Elders may be facing an acute crisis in their life, which may
include loneliness, conflicts with children, lack of food, or health
problems etc. The peers with higher level of skills and ability can
be trained to be resourceful to access the appropriate community
resources, such as community leaders, charitable and service-minded
individuals and self help groups to meet the needs of their fellow
elders.
The benefits of this model are to reduce the isolation, which many
rural elders face, thereby becoming a reliable source of psycho-so
cial support. Many elders have the available time to motivate others,
provide counselling and encourage change. It could assist with de
pression by modifying behaviours and attitudes that have become
self-defeating.
A possible weakness of the peer elder model is the unpredictable
length of time available to establish an association between the two
9
parties. There could also be restrictions on the part of either the peer
elder or the persons in need of assistance due to physical problems
or the time required to meet the needs of the relationship.
To carry out an effective peer elder’s program in the community,
trained project personnel need to identify all the elders in the spe
cific habitation or village. They need to be categorized by age, sex,
physical ability, socioeconomic status and their willingness to be
part of the peer elder’s program. Those suitable for the role of a
counselor need to be trained to develop their capacity to play the
role of peer elders and be made aware of suitable community re
sources. Subsequently, they may be linked up to elders, based on
their shared skills, interests and aptitudes. Project personnel need to
periodically interact with participants and evaluate the service.
There is no major cost in monetary terms. A person’s time and
willingness to assist in the community is the essence of the program.
Once established, and with periodic and timely follow up, peer el
ders can become a sustainable model of service which meets some
important needs of the ciders within a rural community.
Support by peers offers many advantages
4.4
Health Care
Established models of health care for the aged in KV Kuppam block
include RUHSA hospital facilities and mobile health clinics and the
government hospital at Gudiyatham.
10
The Mobile Health Clinics are presently operating on a weekly basis
and are catering for the community. The aged are using this service
and the necessary medication is being provided. However the elders
living in habitations away from the clinic, access is difficult.
This service could be expanded and upgraded to further meet the
needs of the aged in the community. Those who arc physically
disabled or chronically ill and receiving no family care may have
difficulty getting to the centre.
By introducing a system of identifying the needy aged and allocating
identity cards it would enable the project personnel to give free treat
ment to the poor and chronic elderly patients. Individuals could be
monitored on a regular basis and health progress charts kept. This
would assist if their health deteriorated and they were without ad
equate care at home.
Project personnel could identify a volunteer in the community to give
specific training regarding the recognition of common diseases, com
mon medicine requirements, educational needs and the appropriate
activities for the aged. The women’s Self Help Group could be uti
lized to assist with this.
4.5
Funeral Scheme
Funeral expenses and arrangement are usually
taken care of by the son or the daughter of the
deceased. This scheme is mainly aimed to as
sist the middle aged without siblings and would
be ideally linked to their savings plans. If this
was the case it would then alleviate some of the
financial distress of old age and the additional
economic burden on their families.
11
Poor financial circumstances created by economic insecurity can create
anxiety about future costs. This can cause further emotional distress
and add to the problems of the destitute who cannot rely on family
for their needs in their old age.
To enable this specific model of service to operate, a specific savings
scheme could be implemented within an established support service.
A support group or self help group for the aged could be formed in
the community and could meet at regular intervals in a pre-deter
mined place.
This scheme can be self sufficient in the community as the savings
would be both a personal and a joint commitment of the group
members. The savings are held individually in a personal account,
but also recorded as a group activity. Saving together becomes a
bonding experience giving valuable social support for each other,
while the personal aspect adds to their sense of empowerment.
4.6
Income Generation Scheme
A variety of simple schemes are available which can help the elders
to earn some income. Their selfworth in enhanced when they con
tribute from their own earnings to the common family expenses,
without feeling dependant on others. However it must be realised
that every elderly person could earn an income. One sustainable model
is discribed below :
To generate an income, a gift of young goats or young chicks are
given to the needy aged, who are able to care for them. By raising
these goats and chickens they are eventually able to become selfsufficient.
The scheme for giving young goat kids to the poor, aged is called
“Passing on the gift". To lake advantage of this scheme the elderly
must be mobile enough to be able to move the goats to new pastures.
A single young goat is given to a person to care for and after 6
months it is mated and generally produces two kids. An average of
4 offspring can be expected each year and by selling one goat every
three months a person can become financially independent. By
continuing to breed from the goat or goals every six months, the herd
will increase and give financial security and a sense of psychological
satisfaction to the owner.
The owner of the goat that was gifted to him/her is expected to give
the first-born female kid to another aged person. This ensures that
the scheme is self-sustaining and that it guarantees future assistance
to another needy person in the village. The ‘Backyard Poultry’ scheme
involves giving 5 young chicks to a person who then raises them at
a minimal cost. After 6 months they can be sold for a profit, or
some of the chicks can be kept for egg production which can provide
additional income.
Keeping occupied can be beneficial for the old person as well as the conununity
4.7
Elder’s Self Help Group
The self-help group model has proven a successful method for assist
ing and empowering a diverse range of groups.
13
The concept has
been applied to marginalised sectors of the community such as. people
with a mental illness, physical disabilities, women and the aged (Sneh
Lata Tandon 2001. P.25). The Self-Help Group model can challenge
‘the systematic oppression of excluded groups' (Ward 1998, P. 157)
Self-help groups can develop the socioeconomic status of elderly
people and strengthen the joint family system in the society with the
objectives to
*
Gather the aged into Self Help Groups and guide them for
group activity.
*
Adopt saving systems in their SHG's.
*
Get recognition and respect for older persons from the society
and family.
*
Inculculation of the credit system among the SHGs of older
persons.
*
Avail government services for the aged through SHGs.
*
Develop the habit of helping others by aged members of the SHG.
*
Guide the members of the SHGs to do trades of their choice.
*
Encourage rural and agro based income generating activities by
the older persons.
*
Arrange and organise meetings between the aged and the youths
to appreciate the abilities and experiences of the aged.
*
Avail the medical facilities with the help of SHGs
*
Discuss and find solutions to issues affecting the life of older
persons.
No self-help group can be formed without a worker or community
member recognising the needs of the elderly and the set of circum
14
stance that can be addressed by the group process (Sneh Lata Tandon 2001. P.27). The Elder’s Self-help Groups require the assistance
of a worker to perform the role of facilitator and initiate the group’s
formation. The facilitator can identify interested individuals and
link them with others to form the group. They can also provide
moral support to the informal leaders within the group by assisting
with the identification of specific roles and tasks (Sneh Lata Tandon
2001, P.26). The facilitator’s role may include locating premises and
the necessary resources for the meetings.
Participation in the group should be voluntary, with an emphasis on
self-determination. With minimal assistance from the facilitator, the
group can establish their own goals and objectives, code of conduct
group rules and guidelines. The democratic process encourages self-
reliance and independence, maintains self-respect and increases con
fidence. However, the facilitator can help participants make deci
sions by providing relevant information and resources and assist with
difficult issues.
The sustainability of an Elder’s Self-help Group is high, as the es
tablishment and ongoing maintenance of the group requires minimal
financial input. The group can be accommodated in already existing
meeting places, such as day care centres (see Day Care Centre Model)
or community halls. Once a meeting place is established, other
resources required may be located within the community or supplied
by non-government agencies. The social situation in which the group
is placed, will influence the degree of independence of the group.
The group, with the assistance of the facilitator, can decide what
they can do for themselves and how much help they would like to
accept from the outside world (Sneh Lata Tan-don2001, P.26).
15
Steps in
establishing a SHG
Source : Help Age India
16
4.8
Old Age Home
Old Age Home (OAH) models of institutional care pro
vide residential accommodation for the elderly. OAHs
vary considerably, from government run institutions to
privately operated homes based on a philanthropy model.
Residents in privately run homes can pay substantial
contributions for services in contrast to those based on charity model
and managed by church organisations or other non-govermnent
organisations with the residents being poor and destitute.
In India there are nearly 1,000 OAHs (Help Age India, 2000, P. 12).
According to Gurumurthy (1 998,P. 142) the establishment of OAHs
is a recent phenomenon in India. Traditionally, the elderly parents
relinquish his home and property to his sons and then remains with
the family in the family home. The son inherits the property and
takes on the responsibility of repaying his parents for the care they
demonstrated when raising him through his childhood years
(Gurumurthy 1998, P. 142). This sense of moral obligation and duty
to the elderly parents has eroded over time, leaving many needy
elders without the essential care and provisions they require.
Government based homes were developed to assist the poor and des
titute elderly. The homes are often in the cities and the elderly are
required to break ties with their familiar rural settings to receive the
benefits. Private agencies also developed OAHs to meet the growing
need.
OAHs provide an ‘all of life’ approach to elderly care, providing
accommodation for both men and women, from different religious
backgrounds and marital status. Men and Women, are segregated in
either dormitory type rooms or individual or married couple quarters.
Meals are typically prepared and served by the staff. The quality
and variety of accommodation and meals varies significantly between
OAH models. It is greatly determined by both the socio-economic
status of the residents, the organisation and its funding body.
17
OAHs provide medical services, some being attached to hospital
facilities whilst others employ trained nursing staff and utilise hos
pital and medical services in the community. Recreational and
social.activities, based on the skills and abilities of the client group,
may also be provided.
The organizational structure and maintenance for OAHs require sub
stantial funds and trained staff. With the significant increase in the
ageing population through extended longevity, it has become eco
nomically unviable for governments, worldwide to fund OAHS. There
is a concern that with increasing aged population, the government
revenue will be insufficient to meet the growing demands.
Given the global concern, a comparison can be made with current
policies, within western nations such as Australia. Government poli
cies in Australia, as with other industrialised countries, which have
been faced with age related issues for sometime now, are placing an
increasing emphasis on the families of the elderly to take responsi
bility in performing the care giver role. Australia has the 6th highest
life expectancy for men and women aged 65, following Japan, Hong
Kong, France, Switzerland and Canada (Tongue & Ballenden 1994,
P.4).
Government policies are now promoting ‘community care’ and have
established government funded bodies to assist the elderly to remain
at home. In Australia, from 1963 to 1985, the number of nursing
home beds per 1 000 people aged over 65 increased from 29 to 47
with ten times the amount being spent on institutional services as
compared with community based services (Minichiello & Coul-son
1999, P.35). It became evident that such a trend was not financially
sustainable and the necessary shift to home-based care was initiated.
In 1985 services were developed with the objective of providing a
range of programs to assist primarily older persons to remain in their
home and thereby reduce numbers seeking accommodation
The United States’ policy trends for the ageing has also de-emphasised
institutional care and promoted the development of in-home and
18
community based services as a strategy for containing the rising costs
of long-term care’ (Krout 1994, P.133). Despite the changing global
trend, there will always remain a percentage of the ageing population
who will require accommodation in an institutional aged care frame
work.
The improved medical and life-style changes have also extended the
life-span of people with an intellectual disability and for people with
acquired head injuries. A proportion of the population will require
more intense, long term care. Weiner. Brok and Snadowsky (1978)
state that people requiring institutional care in their later life have
not been able to cope adequately and are unable to utilize existing
support systems. This is the case of the elderly and persons with a
disability in rural India, who do not have the support of the family
system (p.56)
As previously mentioned staffing and funding of OAHs on a sustain
able basis is costly. Without adequate social backing, the establish
ment, maintenance and ongoing management is greatly prohibitive.
Help Age India have provided support to 15 OAHs in 1999-2000
(Help Age India 1999-2000 p. 12) but this does not meet the capital
costs of large institutions. Some OAHs operate income generation
programs to supplement their incomes.
This is the case with St. Anne’s at Gudiyatham, where residents
make match sticks. At the Grace and Compassion Nursing Home at
Tiruvannamalai, residents are involved in art and crafts activities and
the handicrafts are then sold. The Little Drop Public Charitable
Trust in Chennai is self-sufficient due to its income generation pro
gram operating on the premises in the form of a goat farm (Help
Age India 1999-2000, p. 12). Staffing requirements can also be prob
lematic as dedicated and trained staff are necessary to provide the
quality care for the elderly (Gurumurthy 1998, p. 144).
In the rural areas the proportion of the people over 60 years is
increasing. Gurusarmy (2001) states that is due to the elderly having
19
close tics to their villages, and thus preferring to remain in their
familiar surroundings (P.5). Given adequate community and / or family
support, many elderly may be able to maintain independent living
within their village environment.
However, it must be acknowledged that, despite the costs, OAHs
provide a much needed service for the aged with a mental illness,
people with an intellectual disability, those who are frail and the
poor and destitute. An important role of community support agen
cies is to formalize systems to best identify those in need of insti
tutional care and refer to established OAHs in close proximity to
their traditional homes.
4.9
Day Care Centre
Day Care Centres (DCCs) provide an important
service to meet the ongoing- needs of the elderly and
their families in the community. DCCs are meeting
places, where the elderly can gather on a formal and
regular basis, in an environment conducive to their
physical, mental, psychosocial and spiritual well
being. It is not only the elderly that benefit from
the DCC model, they also provide a useful function for the primary
care givers of the elderly.
With the global trend towards providing community support to assist
in maintaining the elderly in their homes, thereby avoiding institu
tional care in nursing homes, an increased burden on an elderly
spouse and other family members who perform the primary care
giver role, can often occur. The DCC model provides services to the
elderly whilst providing a respite service to their families. When the
elderly family member attends the DDC, their spouse/family is free
to pursue employment or recuperation activities. The impact of care
giving on the general health, including the physical and emotional
well being of the caregiver has often been neglected (Schofield &
Terman 1993, p21). The supportive role of the DCC can ameliorate
the circumstances of caregivers and care recipients.
20
DCCs vary in service provision, and organizational structure. They
are occasionally attached to hospital services with the focus on the
health needs of the participants. Old age homes can also have a day
care center within the facility, with the primary objective of provid
ing leisure and recreational activities for the residents. However, in
both rural and urban settings, there are DCCs that are separate,
individual institutions, often established by voluntary organizations
and supported by community involvement (Services for the
Elderly 1997, p. 189).
People attending DCCs are generally frail aged community members,
younger people with a disabling condition and retired aged, who are
still physically active and in good health. A DCC with individualized
program is able to provide a diverse range of services and programs
to satisfy the diverse needs of people from varying backgrounds.
Programs implemented within the community based DCC model, with
a primary focus on enhancing the quality of life of the elderly, are
based on the identified needs of the elderly and their families. They
include the provision of a shared meal, recreational activities and
social interaction opportunities (Hills Maquire 1985, p. 1 89).
The general areas of attention include the provision of leisure and
social resources for the elderly. Loneliness is prevalent amongst the
aged and isolation can be overcome by elders meeting together for
a range of activities such as arts and crafts, games, sport and fitness
programs and group discussions. Programs encourage the elderly to
continue with ’former, current and potential interests, abilities and
skills’ (Hills Macquire 1985, p. 186). DCC programs also assist in
maintaining current physical, intellectual, emotional and social skills
and can provide opportunities to extend their abilities to more chal
lenging levels.
Humans are social beings and as such need a sense of relationship
with others (Weiner, Brok & Snadowsky 1978, p. 177). The social
needs can be enhanced through programs which encourage social
and creativity and experiences that support the development of a
feeling of self-worth, usefulness and independence (Hills Macquire
193 5 p. 1 86).
The DCC model provides a central venue for health professionals to
visit to consult with the elderly on health, nutrition and fitness issues
and to promote improved health practices. Community education
programs with an emphasis on the elderly can also be conducted
from a DCC facility.
DCCs can be housed in available centrally located venues, in the
community, thereby limiting the transportation difficulties. Basic fur
nishings, such as tables and chairs, kitchen facilities and a range of
activity items are required to establish the service initially. Addi
tional items can be acquired as the need arises.
Staffing structures vary between centers. They can be staffed by
volunteers, with a coordinator to oversee the general operations.
Community participation ensures community ownership of the project
whilst providing an economically viable and sustainable structure.
Trained professionals such as diversional therapists and social work
ers can assist with training volunteers to perform program tasks while
health aides and family care volunteers can refer clients with health
problems to the health professionals.
Ongoing costs may be met by a ‘user pays’ approach where partici
pants who can afford contribute. Initial capital costs may be over
come by funding proposals to agencies such as Help Age India,
which has assisted with the establishment of DCCs in the past. While
the DCC model would successfully provide services for the elderly
and their families, it requires significant funding, planning and a
responsible co-coordinator during the planning and implementation
stages.
4.10
Remarriage of the Elderly
Retirement blues and loneliness of the elderly referred as “the empty
nest syndrome” is driving an increasing number of elders to remarry
for support, care and companionship.
22
Many elite have remarried and are basking in the joys of compan
ionship, thus combating retirement blues, loneliness and the prospect
of sage celibacy thrust on them after spousal death.
Marriage of the elderly need not mean remarriage of a widow or
widower, it could also mean marriage of the older bachelor or older
spinster.
The elderly who want to marry say, “I need love, understanding ,
companionship and mutual support’.
That is not old age, but age of reason.
4.11
Care of the elderly by own family
In Indian culture children especially males are responsible for the
care of the elderly. When the joint family system operated, this was
followed more systematically. With the break of joint families and
with the establishment of nuclear families, and with increasing
urbanisation, children with their families leave the elderly parents in
rural areas to fend for themselves and move over to urban areas.
Simulltaneously, daughters are taking up the care of parents more
than sons. However many elders are left on their own. This is not
healthy for both the elders and the younger families. Grandparents
and grand children need one another. With most families having
only two children it would be ideal if all children can take care of
their elderly parents.
If elders can stay with their children and grand children it would be
the ideal. For various reason this is not always possible. Therefore
when distances separate both families should plan to frequently visit
one another. Elders should visit their children and grandchildren and
vice versa. As far as possible elderly should not become a burden
on any one child but should visit different children in turn. As often
as possible, grand children and grand parents should interact with
23
one another. The loving affection and care of grand parents to their
grand children is entirely different from that of the parents and this
relationship should be nurtured. Elders should avoid showing par
tiality to any one child's family, but treat them equally as far as
possible. Children should understand the problems of the elderly,
their needs and change in moods. If relatives could retain this age
old tradition then almost half the needs of the elderly would be met.
Elders should be encouraged to work as long as possible.
Children should provide some monthly allowance to their elderly
parents on a regular basis. It must also be realised that some ciders
would like to be on their own. This should be respected and sup
ported. Plan for one’s old age on the day of your first child’s
marriage.
This is the most cost effective way of caring for the elderly.
Perhaps one of the best solutions.
The family that works together and looks after each other
24
5. Feedback from the elderly
During a camp for the elderly , which was conducted at RUHSA in
2000, 10 core strategies to assist the aged were presented and ex
plained to them to obtain their feed back.. The following responses
have been received.
Old age pensions
In rural areas, the aged people are finding it very difficult to lead
their life. The sons and daughters are not always looking after them.
The government should consider modifying the requirements for
entitlement and to give pensions, also to those people who have sons
and daughters.
Food program
The midday meal scheme is not appreciated by many elders. They
prefer to have 4 Kg of rice instead so that they can cook according
to their taste and requirement. Alternatively, a suitable venue for all
elderly should be chosen that is in an accessible location for the
majority of the elderly. Also the Midday Meal Program can be
implemented as part of an established Day Care Centre Support
Service.
Psychosocial support by Peer Elders
First of all elders should be identified for forming an elderly Group.
This would involve the age group of 55 years and above. The entire
group of elders may be trained to provide support to one another
according to their need, e.g. capability and availability of time. The
relationship provides emotional and psychosocial support and the
physical needs, e.g. money, food, clothing, shelter and health care
etc.
25
Health Care
RUHSA already has 16 out-reach clinics functioning for 1/2 day
once a week. Preference and priority in treatment should be given to
the elderly in Mobile Clinic and the RUHSA Hospital. Similarly a
separate geriatric clinic could be arranged in the RUHSA Hospital,
so that elderly need not wait long hours. Health check ups and risks
factors to be identified and appropriate counseling to be given. Blood
sugar, examinations should be done on concession rates. Subsidised
and free medication could be given to all poor and chronically ill
elderly in Mobile Clinics and the RUHSA Hospital. RUHSA should
provide appropriate and relevant medical services for the elderly.
Home Health care should be provided. This should be inexpensive,
training can be given to the young unemployed persons in the vil
lages.
Income Generation Scheme
Many simple schemes can be implemented to generate income for
the elderly . A gift of chicks or a goat could be given to the needy
aged who are able to care for them. By raising the stock, they will
eventually be able to become self sufficient.
Elders Self Help Group (ESHG)
The aim is offering psycho-social support to others. The income
generation may be one of the objectives of the self Help Group.
They should be given training in the various aspects. It can offer
the participants a feeling of motivation and hope.
Funeral Scheme
ESHG should form small groups of 10 and each should try to save
Rs.5 to 10 per month and the amount should be deposited in the
bank and taken out only for the specific purpose of funeral expenses.
26
Women’s Self Help Groups or Self Help Groups for the aged could
be formed in the community which could meet at regular intervals
and predetermined place to operate this program.
Old Age Home
The participants are fortunately not aware of the existence of OAH.
The elderly are also very reluctant to stay in those homes as they
mainly wish to stay with their sons or daughters.
Day Care Centres
All elderly considered this to be a good approach. Programmes
could be implemented within the community. Day Care Centres
would primarily focus on enhancing the quality of life of the elderly
persons and on the identified needs of the elderly and their families.
This may widen the provision of shared meals, recreational activities
and social interaction opportunities.
Remarriage of the Elderly
All participants condemned the remarriage of elderly women as it
is against Tamil culture. Only two men said that it is a good
suggestion.
27
6. Messages
To ensure (hat an appropriate programme of support is provided at
the community it was felt that education of the entire country would
from the major component. For effective education a need for key
message was identified. Initially RUHSA staff prepared a set of mes
sages. The elders al the camp further developed this. The following
set of messages is the result.
6.1
For the Elderly
1.
Understanding the situation of the younger generation and act
ing accordingly will help to reduce the problems of the elderly.
2.
Help your family members in whatever way you can.
3.
Considering and treating the daughter-in-law as a daughter will
reduce the problems in the family.
4.
Remember, your son is now also responsible for another women.
5.
When your son spends time with his family, either inside or
out-side the house, don’t condemn it. Remember it is nature's
law and their right.
6.
If you are in a family where both husband and wife are em
ployed, don’t feel neglected, when you do not gel the needed
attention.
7.
When your children forget to enquire about you due to their
work load, don’t take offence. Instead you go and enquire
about them.
8.
Never blow small problem out of proportion and leave your
children. By cultivating a tolerant attitude many problems can
be solved amicably.
28
9.
To meet your day to day economic needs, try to start a small
income generation programme based on your experience and
capability.
6.2
I.
Messages for the younger generation
Consider your father-in-law and mother-in-law as parents and
treat them with love and respect.
2.
Along with your busy schedule, try to provide the elderly
the needed care (food, medicine etc.) that is due to them at the
right time.
3.
Spending a lot of lime with the elderly may be difficult for
you. At least spend 10 minutes a day to enquire about their
needs.
4.
This will make them very happy.
Spending time with the grand children will make them happy.
Allow your, children to play with their grand parents.
5.
When your husband or wife wants to spend time with his or
her parents, don’t prevent them. Remember it is their right and
they enjoy it.
6.
Never blow small problem out of proportion and leave your
parents to start a nuclear family.
Remember, a family with
elders has also many advantages.
7.
Don’t forget the fact that you will also become elderly one day.
Prepare yourself for that role now itself.
8.
Consider the elderly as a asset to your family. Their help and
advice can act as pillars of strength to uphold your family life.
9.
Taking good care of your health from the age of 30 years will
help you to have a healthy life during old age.
29
Young people also need to know about the problems of the elderly.
They can help and one day they will be old too.
6.3
Messages for the community
1.
Do whatever is possible to make the elderly in your village
happy.
2.
Ensure that there are no elderly in your village who are iso
lated and lonely without care.
3.
When you see an elderly struggling to meet the basic needs,
get their relative or friends to help them in time.
4.
Encourage young couples to continue to have their elders live
with them.
5.
Help the elderly in your village to obtain old age pension and
other benefits from the Government.
6.
Realise that both the younger generation and the elderly need
each others’ support.
7.
Each one can contribute to the welfare and happiness of the
other.
8.
Remember that elders lamp with their children is the best so
lution for all the problems of the elderly. Hence promote sys
tem in your village. Which will facscultate such care of the
elderly.
30
7. Schemes of Assistance
A number of Schemes are available through the Indian government
directly to the elderly and for services provided by Non Government
organisations.
7.1 Direct to the Elderly
ANNAPURNA SCHEME
SCHEME : The Annapurna Scheme, launched with effect from I
April 2000
OBJECTIVE : The Annapurna Scheme aims at providing food
security to meet the requirements of those Senior Citizens who though
eligible have remained uncovered under the National Old Age Pen
sion Scheme (NOAPS). Under the Annapurna Scheme, 10 kg of
food grains per month are to be provided ‘free of cost’ to the ben
eficiary. The number of persons to be benefited from the scheme
will, in the first instance, be 20 per cent of the persons eligible to
receive pension under NOAPS in States I Union Territories.
ELIGIBILITY : Central assistance under Annapurna Scheme will be
provided to the beneficiaries fulfilling the following criteria:
*
The age of the applicant should be 65 years or above
*
The applicant must be ‘destitute’ in the sense of having little or
no regular means of subsistence from his/her own source of
income or through financial support from family members or
other sources. In order to determine destitution, the criteria (if
any) currently in force in States/UT’s could also be followed.
*
The applicant should not be in receipt of pension under the
GAPS or State Pension Scheme.
As mentioned above, the Beneficiary would be entitled to 10 kg of
food grains (wheal or rice) per month free of cost.
-
IMPLEMENTATION PROCESS AND PROCEDURE : The Depart
ment of Public Distribution, M/o Consumer Affairs and Public Dis
tribution will ensure the supply of required quantities of prescribed
quality food grains from the god-owns of the FC1 to the agency
designated by the State Government.
At the Slate level, the State Departments of Public Distribution (D/
o Food and Civil Supplies) and at the District level, the Collector/
District Magistrate/Chief Executive Officer, Zilla Panchayat will be
responsible for the implementation of the scheme.
The Panchayats will identify the Beneficiaries and communicate the
same to Collector/CEO. The Nodal Department implementing the
NAPS in the State would have the list of identified Beneficiaries
awaiting coverage under the NOAPS. The State Food and Civil
Supplies Department may make use of these lists. The State Gov
ernment should communicate to the Union Ministry of Rural Devel
opment for each quarter ending June, September, December and
March every year.
IDENTIFICATION OF BENEFICIARIES : The Grain Panchayats
will give wide publicity to the Scheme and will also be responsible
for the dissemination of information in regard to the procedure for
securing benefits under the scheme. The Gram Sabha will select the
Beneficiaries for the Scheme and the lists of beneficiaries, so se
lected by Gram Sabhas, will be displayed by the gram Panchayats.
The Gram Panchayats will distribute the Entitlement Cards to the
Beneficiaries in Gram Sabha meetings.
The Municipalities will be responsible for the above activities in the
implementation of the Scheme in their respective areas.
The State Government would communicate the targets for
Annapurna to the Panchayats/Municipalities for identification of the
Beneficiaries.
32
NATIONAL OLD AGE PENSION SCHEME (NOAPS)
OBJECTIVE :
The objective of the National Old Age Pension Scheme is to provide
financial assistance to old persons who are destitute in the sense of
no regular means of subsistence from their own sources of income
or through financial support from family members or other sources.
SALIENT FEATURES OF THE SCHEME :
*
Age of the applicant (male or female) should be 65 years or
above.
*
The applicant must be a destitute in the sense of having little
or no regular means of subsistence from his/her own sources of
income or through financial support from family members or
other sources.
*
The amount of pension is Rs. 75/- per month per beneficiary.
The State Government may add to this amount from their own
sources.
*
Upper ceiling on the number of beneficiaries for a State / UT
is prescribed by the Central Government.
FUNDING PATTERN :
The National Old Age Pension Scheme (NOAPS) is a Centrally
sponsored scheme for which 100 per cent Central assistance is made
available to the States/UTs to provide benefits to the older person
according to the norms, guidelines and condition laid down by the
Central Government. The funds arc released directly to the districts
in two installments during the year.
IMPLEMENTING AGENCIES :
The scheme is implemented by the district level implementing au
thorities headed by. the District Collector / Magistrate / Deputy Com
33
missioner. Il is implemented with the assistance of the Panchayals
and Municipalities in the delivery of social assistance to make it
more responsive and cost-effective
Beneficiaries have to directly apply to the state government
agencies on their prescribed performa.
7.2 Government scheme of assistance to Voluntary
Organisations
The State Governments have been providing old age pensions, main
taining old age homes for the destitute aged and providing grants-inaid to voluntary organisations maintaining such home. So far, there
is no specific scheme of the Government of India to take care of the
aged, though some assistance to voluntary organisations under the
General Grant-Aid Scheme in the field of Social Welfare is given for
the aged welfare.
Objective : The scheme aims at providing physical, social, emotional
psychological and economic support to the aged (60 years and above)
with a view to help them to continue to be usefully active members
of the community. The aged who lack family support and are unable
to fend for themselves and / or do not have assured income usually
will have a prior claim of the benefits available under the scheme.
The object of the scheme is to encourage voluntary organisations in
general and organisations of the elderly in particular to provide old
age homes, day care centres, medical services / adoption services and
non institutional services for the aged.
Eligibility for Assistance : The scheme will be implemented through
voluntary organisations / institutions, statutory bodies like panchayat
raj institutions, red cross activities, municipal bodies including chari
table trusts or other registered bodies set up by the industrialists /
business houses etc, which have a performance record in welfare
work (especially those which are already providing services for the
34
The aim of this programme is to keep the aged integrated in their
respective families and to supplement the activities of the family in
looking after the needs of the aged. Both groups of the aged viz.,
well-to-do and the poor in the age group of 60 years and above
should benefit from the program.
A day centre for the aged will aim not only to provide services to
its members but also to work as local point of services to the elderly
in the area.
Old Age Homes (Maintenance and Service of Old Age Homes)
The Old Age Home will be the residential unit for at least 25 poor
/ destitute aged persons of 60 years and above. Aged persons com
ing from lower income group and middle income group of society
without any income, in desperate need for shelter can also be con
sidered for admission in these Homes subject to thorough enquiry
and discretion of the Voluntary Organisations concerned.
Under this program, physical and psychological well-being of the
aged inmates will be taken care of by way of provision of part-time
Medical Officer and Trained Social Worker / Counselor. Medicines
up to limited extent will be provided.
Under the scheme, the voluntary organisations/institutions can
establish Old Age Homes in a rented accommodation or in a build
ing owned by themselves.
Grant for construction of Building or Extension of Building for
Old Age Homes
The assistance for construction of building or extension of existing
building or Old Age Homes is being given (staff quarters are ex
cluded except in the case of Warden, Dhowkidar etc). In this case,
the rent of the building housing the old age homes is not claimed
to the organisation. Normally no construction grant shall be funded
except in very rare cases.
36
Supporting and Strengthening Non Institutional Services for
the Aged
In the wake of various forces of change at work in familiar relations
and value systems, the care of old persons is day by day becoming
a problem. The present scheme aims at providing physical, social,
emotional, psychological and economic support to the elderly (60
years and above) with a view to help them to continue to be usefully
active members of the community. The aged who lack family sup
port and are unable to fend for themselves and I or do not have
assured income, usually will have a prior claim to the benefits avail
able under the scheme. However, in order to encourage the elderly
to organise themselves better for their own welfare, minimal infra
structure facilities and supports will be provided to organisations
catering to aged of other income groups also.
An integrated Program for Older Persons
Goal : Building a Society for all Ages.
Aim: To empower and improve the quality of life of older persons
Objectives:
1.
Reinforce and strengthen the ability and commitment of the
family to provide care to older persons.
2.
Foster amiable multi generational relationship
3.
Generate greater awareness on issues pertaining to older per
sons and enhanced measures to address these issues.
4.
Popularise the concept of Life Long Preparation for Old Age
at the individual level as well as at the societal level.
5.
Facilitate Productive Ageing
6.
Promote Health Care. Housing and Income Security needs of
Older persons.
7.
Provide care to the Destitute elderly.
37
8.
Strengthen capabilities on issues pertaining to Older Persons of
Local Bodies I State Governments NGOs and Academic / Re
search and other institutions.
Strategy : Developing awareness and providing support to build the
capacity of Government, Non Governmental Organisations and the
Community at large to make productive use of older persons and to
provide care to older persons in need. Sensitising children and youth
towards older persons, reinforcing the Indian family tradition of pro
viding special care and attention to older persons and organising
older persons themselves into coherent self help groups capable of
articulating their rights and interests.
Target Group : While the basic thrust of the program will be on the
older persons (of age 60 years and above) particularly the infirm,
destitute and the widows among them, broad based interventions
targeting the family and the community shall also be undertaken
within the overall context of improving the quality of life of Older
Persons.
Programmes Component :
*
Programmes to reinforce and enhance the commitment and ability
of the family to take care of older persons.
*
Programmes to build and strengthen, intergenerational, relation
ships particularly between children/youth and older persons.
*
Programmes emphasising and contributing towards the need to
undertake Life Long Preparation for Old Age.
*
Programmes facilitating productive ageing
*
Programmes enabling formation of Self Help Groups / Associa
tions of older persons and advancement of their rights and in
terests.
38
Programmes facilitating and improving the health care of older
persons including development of trained manpower / para
medicos to provide care and attention to old persons.
Programmes attending to the housing needs of older persons
particularly shelter to the destitute elderly.
Programmes aimed at promoting the income security needs of
older person particularly those engaged in agriculture, non for
mal sector and those living in rural areas.
Programmes for providing institutional as well as non institu
tional care / services to older person.
Advocacy and awareness building programmes in the field of
ageing.
Research. Training and Documentation in the field of Ageing
and
Any other programmes in the best interests of Older persons.
39
The aim of this programme is to keep the aged integrated in their
respective families and to supplement the activities of the family in
looking after the needs of the aged. Both groups of the aged viz.,
well-to-do and the poor in the age group of 60 years and above
should benefit from the program.
A day centre for the aged will aim not only to provide services to
its members but also to work as local point of services to the elderly
in the area.
Old Age Homes (Maintenance and Service of Old Age Homes)
The Old Age Home will be the residential unit for at least 25 poor
/ destitute aged persons of 60 years and above. Aged persons com
ing from lower income group and middle income group of society
without any income, in desperate need for shelter can also be con
sidered for admission in these Homes subject to thorough enquiry
and discretion of the Voluntary Organisations concerned.
Under this program, physical and psychological well-being of the
aged inmates will be taken care of by way of provision of part-time
Medical Officer and Trained Social Worker / Counselor. Medicines
up to limited extent will be provided.
Under the scheme, the voluntary organisations/institutions can
establish Old Age Homes in a rented accommodation or in a build
ing owned by themselves.
Grant for construction of Building or Extension of Building for
Old Age Homes
The assistance for construction of building or extension of existing
building or Old Age Homes is being given (staff quarters are ex
cluded except in the case of Warden, Dhowkidar etc). In this case,
the rent of the building housing the old age homes is not claimed
to the organisation. Normally no construction grant shall be funded
except in very rare cases.
36
Supporting and Strengthening Non Institutional Services for
the Aged
In the wake of various forces of change at work in familiar relations
and value systems, the care of old persons is day by day becoming
a problem. The present scheme aims at providing physical, social,
emotional, psychological and economic support to the elderly (60
years and above) with a view to help them to continue to be usefully
active members of the community. The aged who lack family sup
port and are unable to fend for themselves and / or do not have
assured income, usually will have a prior claim to the benefits avail
able under the scheme. However, in order to encourage the elderly
to organise themselves better for their own welfare, minimal infra
structure facilities and supports will be provided to organisations
catering to aged of other income groups also.
An integrated Program for Older Persons
Goal : Building a Society for all Ages.
Aim: To empower and improve the quality of life of older persons
Objectives:
1.
Reinforce and strengthen the ability and commitment of the
family to provide care to older persons.
2.
Foster amiable multi generational relationship
3.
Generate greater awareness on issues pertaining to older per
sons and enhanced measures to address these issues.
4.
Popularise the concept of Life Long Preparation for Old Age
at the individual level as well as at the societal level.
5.
Facilitate Productive Ageing
6.
Promote Health Care. Housing and Income Security needs of
Older persons.
7.
Provide care to the Destitute elderly.
37
8.
Strengthen capabilities on issues pertaining to Older Persons of
Local Bodies I State Governments NGOs and Academic / Re
search and other institutions.
Strategy : Developing awareness and providing support to build the
capacity of Government, Non Governmental Organisations and the
Community at large to make productive use of older persons and to
provide care to older persons in need. Sensitising children and youth
towards older persons, reinforcing the Indian family tradition of pro
viding special care and attention to older persons and organising
older persons themselves into coherent self help groups capable of
articulating their rights and interests.
Target Group : While the basic thrust of the program will be on the
older persons (of age 60 years and above) particularly the infirm,
destitute and the widows among them, broad based interventions
targeting the family and the community shall also be undertaken
within the overall context of improving the quality of life of Older
Persons.
Programmes Component :
*
Programmes to reinforce and enhance the commitment and ability
of the family to take care of older persons.
*
Programmes to build and strengthen, intergenerational, relation
ships particularly between children/youth and older persons.
*
Programmes emphasising and contributing towards the need to
undertake Life Long Preparation for Old Age.
*
Programmes facilitating productive ageing
*
Programmes enabling formation of Self Help Groups / Associa
tions of older persons and advancement of their rights and in
terests.
38
Programmes facilitating and improving the health care of older
persons including development of trained manpower / para
medicos to provide care and attention to old persons.
Programmes attending to the housing needs of older persons
particularly shelter to the destitute elderly.
Programmes aimed at promoting the income security needs of
older person particularly those engaged in agriculture, non for
mal sector and those living in rural areas.
Programmes for providing institutional as well as non institu
tional care / services to older person.
Advocacy and awareness building programmes in the field of
ageing.
Research, Training and Documentation in the field of Ageing
and
Any other programmes in the best interests of Older persons.
39
8. Conclusions
Preparing and consolidating the information on the strategies
for the care and welfare of the elderly is the first step in organising
appropriate programmes. This document is primarily a blue print for
RUHSA to carry out work among the elderly. Even as these strate
gies were finalised, an attempt was made to apply some of them in
the community gaining valuable feed back.
This booklet also forms one way in which RUHSA’s expe
rience is being shared with others who are interested in initiating
programmes for the eldelry. Efforts have been made to describe each
strategy in as great a detail as possible. However as others apply this,
further refinements may need to be incorporated. In that sense, this
is available for further development.
Except for the strategy on remarriage all others appear to be
culturally acceptable especially in the Indian context. Therefore, dif
ferent agencies might choose one strategy over another. In the long
run it would be most useful to network among various partners so
that ongoing experiences are shared.
Although these strategies have been clearly articulated, it
does not necessarily mean that all of them can be readily applied.
Some such as providing health care, pension and insurance are as
pects that need reasonably heavy inputs. Therefore, further local level
planning may become necessary.
Besides these strategies, a set of messages on the care of the
elderly have been presented. These were prepared in consultation
with the elders in local camps at RUHSA. These may need further
revision, refinement and additions to make it more widely relevant.
40
The programmes of government support of the care of the
elderly has also been provided. This could be a means of support to
organisations interested in initiating programmes for the elderly.
Sustainability has been given adequate thought while for
mulating these strategies. Some are more sustainable than others.
However, there is every desire to move away from centre based
programmes to community based and owned programmes. It is
recognised that because of the nature of their problems as well as
very advanced age some elders may need homes or centres. Ulti
mately the goal of these startcgics is to keep the elders in their
homes and or communities as long as possible.
41
9. References
1.
Centre for Health Education Training and Nutrition Awareness
(CHETNA) News. October - December 2001, Spotlight.
2.
Roberta 1. Coles, Elderly narrative reflections on the contradic
tions in Turkish village family life after migration of adult chil
dren. Journal of Ageing studies 15 (2001) 383-406, Department
of social and Cultural Sciences. Marequette University, Milwau
kee, USA.
3.
Marion Croser, Pam Peterson, 1999. "The In-depth Study of the
Problems and Needs of the Elderly and Strategies for Address
ing Them", unpublished report.
4.
Nella Davis, Linda Porter, 2000. “An Analysis of aged care
programs suitable for implementation in K.V.Kuppam Block,
Tamil Nadu”, unpublished report.
5.
Patricia Senior, Ralf Jonas, 2003 A Program for the Welfare of
the elderly. Unpublished report.
6.
Camp cum Seminar report. “Care of the Aged - RUHSA’s Plans”,
unpublished report.
7.
A De Souza, W.Femandes, 1982. Ageing in South Asia.
Theoritical Issues and Policy Implications. Indian Social Insti
tute, New Delhi.
8.
Government of India, Welfare Schemes : To meet your needs.
Directorate of Advertising and Visual Publicity, Ministry of In
formation and Broad-casting, Government of India, New Delhi.
9.
Help Age India, Annual Report 1999 / 2000. New Delhi, India.
42
10.
Help Age India, A Guide Book for Facilitating NGO’s in Man
agement of Micro Credit Program for Older Persons, New Delhi.
11.
India Today, Aug 5, 2002. 76-77.
12.
Kroul J.A. 1994. Providing Community-based Services to the
Rural Elderly, Sage Publications, California.
13.
Minichicllo. V, Coulson 1. Family Support and community in an
Ageing Society”. Family Matters, Vol. 52, 1999. 34-39.
14.
Schofield H. & Herman.H. Characteristics of Carers in Victoria.
Family Matters. Vol 34, 1993, 21-26.
15.
Snehlata Tandon, Self Help : New Mantra for Empowerment
Social Welfare. Oct 2001, Vol. 48, 25-32.
16.
A Tongue, N Ballenden. Families and Ageing in the 21s' Cen
tury, Family Matters, Vol.52, 1994 4-8.
17.
D Ward 1998. Groupwork. In R Adams, L Dominelly, M Payne
(eds) Social Work Themes. Issues and Critical Debates
Macimillan.
18.
MB Weiner, A J Brok, A.M. Sandowsky, 1978. Working with
the Aged. Prentice-Hall, UK.
43
10. Appendix 1
Resource Persons and Institutions
A number of resource persons and lheir institutions provided inputs
in developing RUHSA's programme for the care of the elderly. These
are listed below.
I.
Dr. Alka Ganesh
Head, Medicine - III
CMCH, Vellore.
2.
Mr. Dass
Senior Project Office
Helpage India, Chennai.
3.
Mrs. Prema Singh
Shanthi Malai Research & Development Trust
Thiruvannamalai.
4.
The President
SANDS
Suvisheshapuram, Ittamozhi.
5.
P.C. Jayaraman & Sons
Sri. Kumaran’s Charitable Trust
61, Usman Road, T. Nagar, Chennai.
6.
St. Ann’s Home for the Aged
Shanthi Illam, Gudiyatham.
7.
Benedictine Order of our Lady of Grace and Compassion
Old Age Home
57, Anna Salai, Thiruvannamalai.
8.
Dr. T.S. Kanaka
Sri Santhakrishna Padmavathi Health Care
& Research Foundation
Amarnath
5, Santhakrishna Street,
Nehru Nagar, Chromepet. Chennai - 600 044.
44
11. Appendix II
Elders Camp
Systems Approach
INTRODUCTION
Ten percent (11,505) of the total K.V.Kuppam block population con
sists of elderly who are above 60 years of age. The elderly popu
lation is increasing day by day also due to epidemiological transi
tion. Elderly has the problem of understanding the need and prob
lems of the today’s younger generation. Lack of understanding cre
ates problems and paves way for the emergence of nuclear families.
As a result, the elderly are left in isolation without care. Migration
of the younger generation to urban areas for job together with emerg
ing nuclear families, has severe impact on the care of the elderly.
Hence it is necessary to develop strategies for the care of the elderly,
so that they can cope up with life and lead a happy life till they
finish their race in this world. This 3 days camp cum seminar is
organised with the goal of “Developing appropriate strategies for the
care of the elderly in K.V.Kuppam block.
OBJECTIVES
I.
To discuss the problems of the elderly.
2.
To analyse the problems and needs of the younger generation
and its impact on them.
3.
To discuss the skills needed to cope up with life during old age.
4.
To identify strategies appropriate for the care of the elderly in
to-day’s generation within Indian culture.
METHODOLOGY
Lecture, Group Discussion, Role Play. Games.
45
RESOURCE PERSON :
Dr.Kanaga, Dr.Rajaratnam Abel, Dr. Inbakumar Joseph. Mr.Jebaraj,
Mrs. E.Vijayakurnari, Mrs.Jayalakshmi, Mr.Selvakumar, Mr.Kalaimani,
Mr.Subash and Mr.Mathew Asirvatham..
External Resource Persons.
IMPLEMENTATION
Duration
3 Days
Venue
RUHSA Campus
Co-ordinator
Mr. V.Jebaraj
11. Appendix 2
PROFILE OF THE PARTICIPANTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Amirtham
Chinnathai
Hari Krishnan
Kalyani
Kannamma
M. Raman
Lakshmi
Neela
Manickam
M. Mani
Mahalakshmi
Muniammal
Maragatham
Munuswami
Mahadevan
64
65
51
60
53
55
60
75
67
61
63
45
63
70
F
F
M
F
F
M
F
F
M
M
F
F
F
M
M
46
Latteri Colony
P.K.Puram
Kilvilachur
Rajapalayam
Kavanur
Senji
Melkavanur
Senji
Kavasambattu
Annangudi Colony
Panamadangi
B.N.Palayam
Keelmuttukur
16.
17.
18.
19.
20.
21.
Nagammal
Padmavathi
Periakulandai
Padmanabhan
P.Pattu
Rani
F
F
F
M
M
F
70
61
55
40
65
62
22.
K.Rajagopal
M
78
23.
24.
25.
26.
27.
28.
29.
30.
Seethammal
Sulochana
A Sclvam
C Sambanthan
Vallikannu
Vinayakam
Valliammal
Valli
F
F
M
M
F
M
F
F
65
60
60
50
53
72
60
47
Sethuvandai
K.V.Kuppam
Annangudi Medu
Panamadangi
Annangudi
Kamatchiamman
Pcttai
Pudupettai
Old Krishnapuram
P.K.Puram
Kavasambattu
Netted
Melmoil Colony
Kanguppam
Rajapalayam
P.K.Puram
This publication has been made pos
sible by the grants made available by
DfID, UK through Healthlink World
wide, London, UK. Healthlink has pro
moted the Communication for Health
India Network (CHIN). The partners in
India are CHETNA Ahmedabad, CINI,
Calcutta, CMAI, New Delhi and
RUHSA, Vellore.
48
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