Organised aged care

AN INCREASINGLY URGENT REQUIREMENT

Some issues are set to overtake all others, such as the question of aged care. It belongs right up there with global warming, shortage of fuel and water, and in fact it is far more imminent than any of these, particularly in countries like Pakistan

The rate of migration from Pakistan is high and has been so since the 1970s. Skilled and unskilled, Pakistanis left mainly for the Middle East initially, and then for everywhere else until now there is almost no country in the world without a Pakistani community. Not that the outflow has made any difference to population figures here at home which have kept up with and even outstripped the haemorrhage. Migration has split families all over Pakistan, taking some members out of the country, leaving some behind. Those left behind are predominantly the elderly.

Some migrants return home after a few years. They have problems, such as disorientation, perhaps a lack of communication between long separated persons, and difficulty in adjusting to an environment that was home until their horizons were widened. Those who do not return are faced with a different set of problems, one of the greatest being the question of how to organise care for the older family members left behind. It is difficult to look after someone remotely, yet taking older family members along involves legal and economic issues, and raises a different set of questions regarding care in those new environments. Meantime back in Pakistan there is no organized system of aged care whatsoever.

The Libertarian party, in some ways the third strongest political party in the United States, would like to ‘eliminate the entire social welfare system. Individuals who are unable to fully support themselves and their families through the job market must, once again, learn to rely on supportive family, church, community, or private charity to bridge the gap.’ That scenario right or wrong sounds uncannily like Pakistan as it is now, where the family is the mainstay and there is no help from supportive governance (laughter) or ‘supportive mosques’ (more laughter). The supportive communities that once existed have become too large, non-cohesive and disorganised to be supportive any longer. Where once the elderly were absorbed into large, often joint families as a normal, easily cared for segment of society, migration, the changing structure of families and growing expenses means that the elderly are now often without any means of support and have become ‘a problem’.

Charity is one of Pakistan’s strong points. Almost the only institutions for the elderly that exist in Pakistan are charitable and these are many. A destitute person can always obtain shelter in homes such as those organized by the Edhi Foundation and other charitable homes for the elderly dotted across the country, almost always in urban areas.

Pakistan’s population however is too large. The existing homes do not by any means suffice for the poor and the destitute. As for the relatively well-off, organised facilities for them are virtually non-existent. The only option available to well-off persons is home care which is a far from satisfactory option if family is living too far away to supervise and the person being cared for is unable to do so.

Home care does not come cheap. Semi-skilled twenty four hour care costs well upwards of Rs. 40,000. The middle class suffers the most because the cost of this care is beyond their reach while the charitable homes fall too short of expectations. As always it, the middle class falls into that nasty hole somewhere in between.

Solutions must be found to this problem for everyone, and very soon. More free or inexpensive homes for the elderly are required, and for the many disabled and elderly persons without support on the streets.

For those who can afford it independent living centres are required in Pakistan. These are independent home units managed by a central authority that provide facilities to residents based on the level of care required. A person of eighty may be fairly independent and may require just some assistance with shopping and someone to contact in case of emergency. Another may be more dependent and require greater assistance with mobility, paying the bills etc. In addition there will be people who are bedridden or more senile who require total care with every aspect of life. These levels may and do change over time.

The centres may be built as townhouses, apartments, suites, or single rooms to suit varying financial capacities.  In every case carers must be whetted, supervised and monitored. The authority at the centre can provide these services, of whetting, supervising and adjusting the level of care as required.

Nothing can replace a family that cares for its own elderly. But in the absence of this, and this is becoming the case in an increasing number of homes, institutionalised care has become a vital, an urgent need. Contrary to what most people piously argue, these homes for the elderly and helpless are a sign of a society that cares for its aged not the other way around. When circumstances separate families as they are increasingly doing in Pakistan, this is the only solution.