The ageing of population is an obvious consequence of the process of demographic transition. While the countries of the west have already experienced and have planned for their elderly population, it is only in the last one and half decades that countries in Asia too are facing a steady growth of the elderly, as a result of the decline in fertility and mortality, better medical and health care and improvements in the overall quality of life of people.
Within Asia, as India and China are the two largest countries in the region, it is expected that they would have a significant proportion of the world’s elderly because of their large population base. In fact, the situation in India presents two different scenarios with certain states grappling with curbing their high fertility rates while others, which have controlled high fertility rates, are already experiencing or are poised to experience an increase in their elderly population.
There has been a progressive increase in both the number and proportion of the aged in India over time, particularly after 1951. Between 1901 and 1951, the proportion of population over age 60 increased marginally from 5 percent to 5. 4 percent, while by 2001 this had increased to 7. 0 percent. When changes in the decadal growth rate in the general population are compared with those for the elderly population, it is noted that the latter grew at a relatively much faster rate than the general population, since 1951.
Furthermore, the decadal percent increase in the elderly population for the period 2001-2011 is likely to be more than double the rate of increase of the general population. The size of the elderly rose in absolute terms during the last century from 12 million in 1901 to approximately 71 million in 2001 and is likely to reach 113 million in 2016. Yet another feature of ageing in India is the fact that the proportion of elderly is much higher in the rural areas than in the urban areas.
The sex-wise pattern of growth of elderly population reveals that the increase is greater among women in the recent past, which indicates that elderly women will outnumber elderly men in the future. There is therefore an urgent need to examine the various aspects of this new and fast growing population to ensure the design of appropriate policy and programmes directed to meet the varied needs of this vulnerable and dependent group.
India, like many traditional societies, today faces a unique situation in providing care for its elderly as the existing old-age support structures in the form of family, kith and kin, are fast eroding and the elderly are ill-equipped to cope alone with their lives in the face of infirmity and disability. The onus of caring for the elderly is therefore now much more on the state than the family and will necessitate the creation of adequate institutional support.
While the western countries have a fairly well organised network of institutions for the care of the elderly, the growth and development of these facilities in India, which began as early as 1901, still remains inadequate. As per recent statistic, there are 1018 old age homes in India today. Out of these, 427 homes are free of cost while 153 old age homes are on pay and stay basis, 146 homes have both free as well as pay and stay facilities and detailed information is not available for 292 homes.
A total of 371 old age homes all over the country are available for the sick and 118 homes are exclusive for women. A majority of the old age homes are concentrated in the developed states including Gujarat (Directory of Old Age Homes in India, Help Age India, 2002). The concern for the elderly in the country is reflected in the adoption of a recent National Policy on Older Persons in 1999, which has identified principal areas of intervention and action strategies.
These include financial security for the elderly in the formal and informal sector, health care and nutrition, shelter and housing and development of trained manpower to meet the special health needs of the elderly. The construction of old age homes and multi-service centres for the elderly through special financial assistance to non-governmental organizations has also been articulated in the policy. However, few studies have been undertaken to document the condition of the elderly in the country and those living in old age homes (Dandekar, 1993, Das and Shah; 2001; GOI, 1991; 1998; 2000; Ranjan et al. 1999; Rao et al. , 1982; Sharma, 1999; Sharma and Xenos, 1992; United Nations, 1987).
In this context, the present study is an attempt to fill some of the gaps in the study of the elderly population and the existing institutional support available to them. The study was undertaken with the overall goal of understanding the existing institutional facilities available for the care of the elderly in the state of Gujarat and to obtain a perspective of the elderly on various aspects associated with institutional living.
The specific objectives of the study are:
- To understand the functioning of the old age homes with regard to service provision
- To identify the various problems in ensuring the smooth functioning of the old age homes.
- To know the various health problems experienced by the elderly inmates and their management of the same.
- To know the opinion of the elderly inmates regarding the adequacy of facilities and services, their satisfaction and their views on such institutional living.
DATA AND METHODS
For the present study, an effort was made to compile and update the list of existing old age homes in the state from various sources including from Department of Social Justice, Government of Gujarat and other NGOs. A list of 99 old age homes, located in various districts of Gujarat, formed the universe to draw a sample of institutions and the inmates residing in them, for the study. A sample of 25 old age homes were selected to represent government aided and NGO supported institutions, across the various regions of the state of Gujarat.
Since the proportion of NGO supported homes was more than the government-aided homes, a larger number of the former type of institutions was selected. From each selected institute, approximately 9-10 inmates were selected from the list of inmates to represent the views of both men and women about institutional life and other issues. Thus, a total sample of 233 elderly inmates comprising elderly men (114) and elderly women (119) living in these 25 institutions was interviewed with a view to explore the physical and socio-emotional aspects associated with institutional living.
In particular, interviews focussed on the reasons for choosing institutional living arrangements, the problems faced in such an arrangement, the type of accommodation, amount of money paid, if any, for accommodation and other services, and the various health problems/illnesses experienced by the elderly. Their satisfactions and dissatisfactions with the various services provided were also explored. An attempt was also made to understand the attitudes of the elderly towards institutional living versus familial living and whether they still consider, hildren (especially sons) as the main support for the aged in the context of changing familial values in India.
Interviews were also held with the heads/managers of the institutes to obtain information on various aspects related to services provision (including health care) as well as to understand the type of problems faced by them in providing various services to the elderly, the available governmental support, the arrangements made by the institution so that the elderly can maintain contact with their children/family and the adequacy of infrastructural facilities to ensure appropriate service provision.
Study Instruments Data were obtained using semi-structured interview schedules. Two types of schedules were used, namely, those for interviewing the elderly men and women and those for interviewing the managers of the selected old age homes, to obtain the requisite information on the above described aspects.
The results are presented in two sections. Section I deals with the analysis of data obtained from interviews with the managers of the 25 selected old age homes while Section II presents the perspective of the selected elderly men and women living in these old age homes. I. Perspectives of Institutional Managers This section is based on interviews conducted with the managers/heads of the 25 old age homes selected for the study and deals with the facilities and services provided for the elderly, the adequacy of these facilities and the problems faced by them in service provision. Characteristics of the Old Age Homes
An analysis of the characteristics of the old age homes such as year of establishment, type of institute, nature of management, source of funding and charges for service provision, presented in Table 1, reveals that 56 percent of the homes have been in existence for more than 15 years, one fifth had been established in the recent period i. e. less than five years and another 12 percent each have been in existence either for 6 to 10 years or 11 to 15 years.