My Return to India (R2I) story > R2I Chapter 8
The primary reason for us to move back to India was to be closer to aging parents, especially to be around to support my dad’s flailing health. Not surprisingly, a few weeks after we landed, my mom said that dad was due his “six monthly injection” and checkup at the Airforce’s Command Hospital where he was undergoing treatment for prostate cancer. She explained that it was generally a day-long excursion, and they packed their lunch for the trip. They had a ‘regular’ auto driver who would generally take them to the hospital, about 12 kilometers from home. Mom handed me dad’s ID and medical records and said I could accompany them the next time.
On the day of the appointment, the three of us bundled into
our Maruti and Raju drove us to the sprawling hospital complex spread over
100-acres. Some of the buildings in the complex dated back to World War II when
it was built for convalescing soldiers but looks can be deceptive as I quickly
discovered. The staff were well trained, and the equipment modernized to keep pace
with rest of the world.
The facilities in the complex are reserved for military
personnel and their families but were open for consultation for retirees about
twice a week. After checking in at the entrance, mom directed the driver to
take us to the Urology department where we handed the treatment book and ID to
the receptionist.
There were about a dozen patients ahead of us and we waited
for an hour before we met the doctor, an Army Colonel. He looked at dad’s
records and explained that dad had been diagnosed with advanced stage prostate
cancer. Among the cancers, this was perhaps the most benign one and by itself
wasn’t life threatening. He explained that the “hormone therapy” consisted of a
bi-annual intravenous injection and a quarterly booster. He also asked us to
take another blood test to check the PSA levels to gauge the progression of
cancer. The previous quarter’s report showed that the progression was holding
steady.
After the Doctor consultation, mom explained the next steps
– we would have to go over to the Pathology for blood test and to the
dispensary department to get an approval for the hormone-injection the doctor
had prescribed, before coming back to Urology to have the injection
administered. Each of these departments is about half-kilometer apart and were
glad to have Raju drive us around.
At the dispensary, the pharmacy-Sargent explained that most
prescriptions didn’t need this 3-step-approval process. These hormone
injections were expensive – costing about Rs 80,000 a dose – and the hospital
wanted to ensure the right checks-and-balances while dispensing them.
Later that evening while narrating the accounts of the day
to Suja, the reason for our return was obvious. Even with the world class
medical care at their disposal, it was difficult for this elderly couple to
manage the logistics of treatment.
Over the next few months, I became very familiar with Aging
and elder-care in contemporary India, and also began fielding questions from
friends and colleagues living overseas who were in the same boat.
Indian Military Hospitals
One of the most remarkable benefits available to Indian
defense personnel and veterans is access to healthcare via the Military
hospital system. Growing up as an Air Force officer’s son, I had on occasion
visited the local clinics and Military Hospitals (MH), and my earliest memory
is the distinct odor of tincture of iodine that would permeate the clinics and
MH’s. During those days, the service personnel gamely accepted the few
standardized services and preventative medication provided. The running jokes
included the use of paracetamol for all ailments. On entering adulthood, I was
no longer eligible for the family medical benefits, and the MH system faded
from memory as I migrated to live in Europe, Canada and the US.
During the past couple of decades, I had an opportunity to
visit and patronize hospitals and clinics in the US, UK, Switzerland and
Canada; sometimes for self, and to accompany my (then) pregnant wife, and later
after Vijay was born. In the meantime, the medical system in India had been
marching ahead. The Military Hospital system I had experienced in my childhood
had also transformed. After visiting the campus a few times with my dad, I came
away with a renewed appreciation for the men and women in uniform, serving
fellow servicemen and retired veterans.
With a large concentration of service personnel and
retirees, the facilities and infrastructure at the Command Hospital are really
stretched thin. Each department – including neurology, oncology, urology etc –
is overflowing with patients. Not surprising since most government
services are overburdened with an increasing population in India.
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| Immage source: indianairforce.nic.in |
Caregiving for elders and senior citizen in India
A generation or two ago, it was quite common for joint
families – three or even four – generations to live together. One would
frequently come across middle class families with grandparents living with
uncles, aunts, cousins and siblings and their kids. In many cases, the families
would live in a large house, under one roof or in a compound with co-joint
units. Even when families didn’t live together under one roof, they lived in
close proximity – perhaps the same village or town – giving them a sense of
belonging and being there for each other.
In the past couple of decades, the Indian society has
transformed. Rapid and widespread urbanization, migration of population from
villages to cities, and emigration of the younger generation to western
countries has changed the social fabric considerably. Younger generation of
Indians are increasingly aping western model of independence and self-reliance,
leaving home as soon as they are ready for college, and then continuing to
pursue their jobs and careers wherever opportunities beacon.
The logistics and expectations of senior care in India,
however, has not kept pace with the changing needs of the society. Builders and property developers are beginning
to capitalize on this opportunity to develop flats and communities for ‘senior
living.’ The sweet-spot is the relatively affluent class of empty nesters
and newly retired senior citizen in their sixties who are looking to downsize
from their flats and villas to planned senior communities. Such planned
senior-living communities and old-age homes address only a small segment of the
needs, especially since senior citizen have unique health and other
challenges.
In the west, the fragmenting of joint families was
accompanied by an emergence of senior-care system across a wide spectrum. Care
giving for seniors is a serious and lucrative business. Organizations and
entrepreneurs provide services ranging from senior living apartments and
condos, assisted living homes and a network of hospice and terminal care
systems. This has led to a large network of service providers focused on
various aspects of home-healthcare to meet medical and caregiving needs. These
facilities are designed to accommodate people from across social, economic and
demographic segments.
Old age homes, that in earlier generations were the last
refuge for poor and destitute are starting to transform. Some facilities in
larger cities in India also advertise “elder day care” where one can drop off
elders during the day to engage and entertain with fellow seniors. Such planned
senior-living communities and old-age homes address only a small segment of the
needs, especially since senior citizen have unique health and other challenges.
Many old-age homes are being designed to cater to the needs
and desires of the urbane, affluent middle class, and the needs of the NRI
community. Some of them advertise modern amenities, 24-hour care and security
along with communal facilities including access to nursing and medical care.
A few cities also have caregiving centers that cater to
specialized care needs of elders. For instance, the mother of a friend of mine
living in California was diagnosed with Alzheimer's and
he found a nursing home in Pune that catered to elders with Alzheimers and
Dementia. Although the monthly fee was expensive, he was satisfied with the
quality of care and personal attention at the center.
Hiring Caregivers
Given the unique needs of the Indian middle class, an entire
cottage industry has sprung up in this sector. Most caregivers are either
individuals or small ‘agencies’ employing a few people who get clients via
word-of-mouth referrals. Unlike other
menial services – like hiring servants or cleaners - caregiving for the elderly
and infirm is a highly personalized affair. The needs can range from simple
care-and-feed to more unique care depending on medical and other health-related
conditions.
Caregivers in India are generally independent contractors
who work for small-time agents. A few elder-care ‘chains’ like Portea are also
trying to grow in this market by hiring and training caregivers and might
include other ‘packages’ like service of nurses and doctor home visits.
During the rushed trip to India in February, we had hired a middle-aged
caregiver, Kamala, who would come at around 8 in the evening and spend the
night at home, and after the morning walk and breakfast with dad, would leave.
Her temperament was well balanced, and she brought in a rich background in
caregiving from her previous experiences.
This setup continued for about a year and half, before my
dad’s condition abruptly took a nosedive after a mild stroke. After a few weeks
in the hospital, he was discharged and advised homecare while he continued to
be bedridden. We realized that the night-caregiver wouldn’t be sufficient, and
that Kamala alone wouldn’t be able to manage my father’s advanced needs. After
additional word-of-mouth research, I decided to engage a live-in caregiver from
another small organization.
If you are looking for a reliable caregiver, you should
begin with a simple checklist based on your specific needs and commitments that
may include
- What are the activities, basic care and feeding of the senior citizen you require
- Help with bathing or sponge bath and a change and washing of clothing and general hygiene (e.g to prevent bedsores if the person is bedridden)
- Change of diapers and cleanup, and fixing a catheter and urine bag as required
- Administering medication and assistance with basic medical needs like a nebulizer or inhaler
- Generally keeping the environment clean and sterile to prevent infections
- Plan for specialized equipment, bed and accessories that you may need for the senior citizen
A checklist like this can be handy while vetting and hiring a caregiver since you will have to guide her/him with your specific needs during the initial days after they join your family. If you are hiring a live-in caregiver, you will also have to plan for other basic logistics like a living area and food for the caregiver and the elderly so that it doesn’t intrude into the day-to-day activities for the rest of the family.
You may also be interested in this viewpoint - Aging and caregiving in India
What does it all mean to you?
Vetting and hiring a good caregiver can certainly help with
the basic needs of the elderly, but others in the family need to continually
chip-in. A caregiver also needs to be continually monitored.
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