Are families a safety net for the elderly?

Lionel WIJESIRI

Arguably, Sri Lanka's single most stunning achievement during the past century is longevity. According to international indices, the combined effects of increased longevity due to improvements in health and nutrition and declining fertility led to a maturing of the age structure with a high concentration of the population in older groups. In a population of almost 20+ million of people in Sri Lanka, nearly 10 percent are elders. Due to the rapid increase of the ageing population in Sri Lanka, nearly 300-350 persons cross the threshold of 60 years of age every day. (The UN defines a country as 'ageing' where the proportion of people over 60 reaches seven percent.)

The current population of two million seniors is estimated to double in the next 20 years, and triple by 40. The population growth rate predicts escalation of this figure to reach 50 per cent by the year 2050. This will create a real geriatric situation in the country leading increased medical care for the ever increasing number of sick, infirmed and terminally ill.

Our public services available for the average senior to have a contented and barrier-free life are woefully below world standards. The country is yet to apply a policy to meet the widening needs of the older generation, in health, legal and social welfare. The traditional policy up to now has been the reliance on family network. Consequently, the development of extra ordinary services to meet the growing need for the services for the senior community and their family caregivers, should be encouraged and supported.

Old is gold

Not withstanding our adage "old is gold", life for many older people is less than happy. When young people leave their villages for the towns and cities, the old are left to fend for themselves. In urban areas women work outside home and, as a result, cease to be the traditional carers for old people. Families are becoming more nuclear. Their function as a social safety net for the elderly is eroding fast. The perception of the old as the repository of collective wisdom is also on the wane. Being economically unproductive, they do not have the same authority and prestige as before; older people are perceived as burdens.

In industrialised countries, pension systems cover the economic needs of the old. In Sri Lanka, where 75 percent of the total workforce is employed in the informal sector, social security offered by pension schemes is only available to the 25 per cent retiring from the organised sector. There is a Government scheme for destitute persons above the age of 65 years. The amount currently paid is quite insufficient to meet the bare necessities of an elderly person. According to a study by Help Age International, only one in five people of those eligible receive this paltry benefit. Being illiterate and poor, many are not able to fill in the relevant forms or produce age certificates.

In Colombo, where the wealthy elderly have been able to live independently, paying for a variety of services, some have suffered assaults and even murders. There is a growing trend among the well-to-do to live in special houses built for elderly people, with medical and recreational facilities.

In Colombo suburbs, I visited an old age home, for people from professional backgrounds. The home accommodates 44 women. Mrs. RT, 70, a retired headmistress, told me, "I am quite happy here. I am well looked after." Also a long time resident, 74 year old MP said, "My son threw me out. I was so happy when they took me in." A deposit of Rs. 125,000 would secure a place on the waiting list, which, according to Superintendent, stands at 250. Monthly rent is Rs. 20,000 upwards. "We have 12 single rooms and four dormitories with eight beds in each. We have television, a library with books, magazines and newspapers and a puja rooms for praying. Food is nutritious. We organise outings... I feel we have a good atmosphere here," he explained. But despite these initiatives Sri Lanka remains badly under provided in residential care. There are thousands of elderly, on both sides of the economic divide, who need care and comfort.

To see the situation in rural Sri Lanka, I travelled to Kurunegala: in the villages, I found that often the old were left to fend themselves after the young had gone for jobs elsewhere. If the young remained, they did not have the financial means to look after their aged parents.

A retired professor of surgery told me that he and a few other elderly people had bought a plot of land to build a residential home where they would have the care and security that they lacked.

Five decades ago, we were concerned with our accelerated population escalation. In order to decrease or control the growth rate, we began to adopted birth control measures. These measures were mainly encouraged by the state. And, in some cases, they are pursued by individuals on a voluntary basis as they prefer to have a small family unit. Today, it is the question of an ageing population. Now it has become necessary to reverse this trend as it has brought in its wake several undesirable social and political consequences destabilising the normal life in the society so affected.

An ageing population brings both challenges and opportunities. The next five years provides a window of opportunity to put in place policies and programmes to meet the emerging needs of an ageing population.

Action

Its time the Government seriously consider arriving at proper policy decisions to prepare ourselves for an ageing population. We need find out how, along with the public and private sector, we could make growing old in our country a pleasant and fulfilling experience. Few points, which I have gathered from Sri Lanka, come into my mind.

1. Elder-Friendly and barrier-free society - Sri Lanka should be an elder-friendly place, one that allows and encourages older persons to live as part of the family and community. Starting from the home, flats and buildings should be elder-friendly. Coming out of their homes, the built environment and transport system should be barrier-free.

They should afford seniors a safe and unhindered travel passage; via accessible lifts, walkways and transport pick-up points, complemented by a user-friendly transportation system to their destinations.

2. Holistic Affordable Healthcare and Eldercare - Older Sri Lankans in need of care should have access to a seamless continuum of healthcare and eldercare services, ensuring that the dignity and quality of life of seniors are maintained. This could be achieved by an efficient and cost-effective Government-subsidised healthcare and eldercare services that are easily accessible to seniors living in the community.

Respect

At the individual level, we want our seniors to be healthy, active and secure. They should age with respect and dignity, and lead independent and fulfilling lives as integral members of their families and communities; at the family level, we want to see strong, extended and caring families. Family relationships of interdependence should complement the seniors' independence; at the community level, we want a strong network of community services, opportunities for engagement and integrated communities. We want to foster a deep sense of community ownership and a high degree of participation in securing the well-being of the senior and the family; and at the national level, we want to develop a high level of national preparedness for the ageing population, a competitive and vibrant economy as well as social cohesion and rootedness.

Seniors should be valued as contributing and participating members of society, and should be enabled to remain physically, mentally and socially active for as long as possible. Our national policies must cater to seniors who are well and healthy, not just those who are frail and ill.

Our traditional belief that the family is the primary care-giving unit and the bedrock of support for seniors should be sustained at any cost. The family must be supported and strengthened in its ability to care for its older members to ensure that institutionalisation remains a measure of last resort; We should uphold the "Many Helping Hands" approach of involving the community, the family and seniors themselves in ensuring the holistic well-being of seniors. The starting point, however, must be individual responsibility to plan and prepare for old age. The family is the first line of care. The community is the second line of support to enable families in their care-giving role. The role of the State is to provide a framework that enables the individual, the family and the community to play their part.