At a time of increasing concern over the lack of adequate care for older people, even in villages, it is important to remember that in any future planning for elder care, families and communities must continue to bear the primary responsibility, although they should be assisted in thoughtful ways by the State and civil society organizations.
In a country like India, the scale of the task of caring for older people is such that even with expansion, institutional care can be only a small part of the solution. Available estimates indicate that by 2050 India will have about 319 million people over the age of 60. Despite trends of urbanization, the majority of them are likely to continue living in rural areas. Many younger villagers who migrate to cities for shorter or longer periods still tend to leave older family members in villages because of inadequate urban accommodation, the need to maintain a rural base, and other factors.
India is known to have possessed rich traditions that accorded high priority and respect to the care of older people. While cherishing this tradition, it must be honestly acknowledged that it has suffered significant erosion in recent years and decades. There are many factors behind this decline, and these need to be understood and studied as a first step towards remedial action. At least two broad aspects of the challenge ahead deserve emphasis: first, that family and community remain crucial in ensuring proper and dignified care, and second, that this role has come under increasing pressure and needs to be strengthened.
Initiatives working at the grassroots level to improve care for older people must therefore also reckon with the role of families and communities in bringing about sustainable improvements, beyond the direct assistance they themselves provide. One such initiative that has received appreciation for its innovative work in elder care is Prabal Yatra, implemented by the voluntary organization ARTH in south Rajasthan. During a recent visit to villages covered by this project, questions related to the role of family and community repeatedly emerged in group meetings. It became evident that many elderly villagers were not receiving the level of care one would normally expect from younger family members. Several were living entirely alone, and some were uncertain about where their next meal would come from.
A key lesson from these discussions was that while working directly with older villagers and assisting them in various ways is essential, there is also a strong need for wider engagement with community members to understand why family-based care has declined and how it can be improved. In such discussions, some younger men and women, girls and boys invariably express strong concern about this issue, and their support can be enlisted to spread messages about better care for older people across villages.
During the visit, I met an elderly couple living in desperate conditions. One of their sons, after learning about their situation, returned from Surat to care for them, while the other son, who lived in the same village throughout, offered no help at all. In another case, a very old woman was living on the brink of destitution, yet her son, who resided in the same village, not only refused to help her but actively discouraged others from doing so. Further inquiries revealed that he was an alcoholic. Several villagers observed that once a young man spends heavily on alcohol, it becomes highly unlikely that he will fulfill his responsibilities towards his parents. Given that alcohol consumption is increasing in many villages, this trend is deeply worrying. At the same time, it raises a glimmer of hope: could campaigns against alcohol and other intoxicants also carry a strong message about caring better for one’s family, including older members? Such campaigns would also benefit elderly persons who themselves consume alcohol or other intoxicants, by protecting their physical and mental health.
Another question discussed in these meetings was whether the growing trend of older individuals or couples living alone can coexist with better care. If a couple has two sons and one provides day-to-day care, the other could contribute financially, thereby sharing the economic burden. There are, in fact, several possible arrangements that can ensure better care; what matters most is that those arrangements which best serve the welfare of older people are given priority.
The broader lesson emerging from these experiences is that, alongside programmes focused on the multi-dimensional welfare of older people, there is a need for deeper engagement with communities and prevailing patterns of family and social life. This engagement is essential to understand how changes conducive to the well-being of older people can be promoted, while trends that undermine proper care can be checked. A holistic understanding of elder care, and effective action to improve it, requires involvement with wider community issues that closely influence the lives of older people.
This perspective also connects to a larger understanding of human progress as an improvement in human relationships. Care of older people can be seen as a vital part of this broader challenge. As efforts to strengthen social relationships gain ground, progress in elder care is also likely to follow. Conversely, beginning with the issue of old-age care can provide a pathway to improving social relationships at many other levels, leading to wider and more enduring social gains.
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The writer is Honorary Convener, Campaign to Save Earth Now. His recent books include A Day in 2071, Hindi Cinema and Society, The Guardians of Himalayas, and Planet in Peril
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