03 December 2012 Society society: care-givers

Not a Care Untended

At-home help for the elderly isn’t just about a home nurse. It’s about people who care.
Not a Care Untended
Sanjay Rawat
Not a Care Untended

Care for the elderly

  1. Epoch Elder Care Delhi-NCR, Mumbai (from Dec 1) Providing social, intellectual companionship www.epocheldercare.com
  2. First Seniors Delhi, Calcutta, Ahmedabad, Chandigarh, Bangalore, Mumbai, Jaipur, Indore, Gwalior Helps plan daily routines for the elderly, provides mental stimulation through sudoku, crosswords, card games etc. www.firstseniors.in
  3. India Home Health Care Bangalore and Chennai Reading, playing board games, simple exercises, and anxiety-reducing activities www.indiahomehealthcare.com
  4. MayaCare Mumbai, Pune, Bangalore, Chennai, Hyderabad, Delhi-NCR, Meerut, Ahmedabad, Nashik and Nagpur Taking senior citizens to doctors as also social and cultural events www.mayacare.com
  5. Calcutta Metropolitan Institute of Gerontology Calcutta Providing psychological support www.cmig.in


In her plush Gurgaon home, Dr Smriti Biswas, in a crisp cotton sari, neatly done hair and flashing an enigmatic smile, effuses charm and elegance. Age has only added to her sparkling wit. Melting into a conversation with ease, she recounts her 89 years with delight. A former gynaecologist, Biswas has worked in the UK, Ghana and Bahrain and cultivated her passion for cooking, travelling and gardening. But what keeps her busy now is translating Tagore’s verses into English, dishing out her favourite recipes, winning a game of cards, or retaining her “copyright over her bed”. Her companion in these pursuits is Mrigna Nagraj, not a relative or friend, but a professional care-giver.

It’s 11 am. At their cosy Thane residence, Madhukar and Mangla Mandlekar wait anxiously for Sudha Gokhale. Madhukar, 84, who is partially blind, has already finished his daily chores and whipped up the day’s news. What he is waiting for now is for Sudha to read out the edit and op-ed articles from newspapers.

Care-givers like Mrigna and Sudha drop by a few times every week to spend time with the elderly—to read, write, blog, skype, e-mail, play games, tend to the garden, pay bills, make travel arrangements, help with the packing and routine medical check-ups. Even to take them out for walks, grocery shopping, family functions, temple visits, social engagements, or makeovers at beauty parlours. “Mrigna and I are like friends. She’s a patient listener. We often make secret plans and surprise others,” says Dr Smriti. Mrigna, an Epoch Elder Care employee, loves her job. She says she gets so much in return from the elderly.

Kabir Chadha, the man behind Epoch Elder Care, thought of the service when his grandmother could not get help at home when she needed it the most. A former McKinsey consultant based in New York, Chadha gave up his cushy job to start operations in Delhi-ncr in January. “It satisfies my intellectual curiosity, business-mindedness and the desire to reach out to those in need,” says Kabir.

"Mrigna and I are like friends. She is a patient listener. We often make secret plans and surprise other people." Dr Smriti Biswas, 89, Delhi, Care-giver: Mrigna Nagraj. (Photograph by Tribhuvan Tiwari)

But why home care? In overcrowded, fast-paced cities such as Mumbai, Bangalore, Pune or Calcutta, and in a time of changing, target-induced, stressful work cultures, double incomes and geographically mobile families, joint families are on the way out. The basic emotional and physical needs of the aged are often ignored. “Jobs keep the adults busy for 12-14 hours. Also, youngsters are now working in different cities or countries. Small cities still have the culture of joint families, but in the metros, it is fading away, resulting in seniors living alone,” says Manjiri Gokhale, who runs MayaCare in 10 cities. MayaCare doesn’t provide servants, nurses or maids and is not equipped to handle medical emergencies, but can step in as surrogates for a son, friend or daughter-in-law, and for free. Only those willing to pay are charged. But this model may be tough to replicate, says Sheilu Shrinivasan, Dignity Foundation. “Young entrepreneurs have to see profit prospects in this. The society will have to learn to pay for this service,” she says. Epoch Elder Care charges between Rs 11,000-16,500 a month, depending on the nature of care. First Seniors, a unit of the United Kingdom Home Care Association, provides eldercare services in most metros, charging between Rs 10,000-1 lakh.

With Indians programmed to care for their parents, there is a stigma associated with the institution of old age homes.

It’s not just care, but also the need to give the elderly a reason to remain optimistic and not sink into depression. With both her children settled abroad and an ailing husband to care for, Romilla Kapur needed more than medical support. Her son Janardhan says, “My father is not well. After my mum suffered two hip dislocations, she couldn’t take care of him. That was bothering her.” Weekly visits by Ishita Mukherji of Epoch, however, have done her good. Diwali and Karva Chauth shopping, playing scrabble or cards interspersed by peals of laughter or getting her eyebrows shaped at a parlour make a difference to her otherwise dull day. “I used to love gardening. Samples of my miniature gardens could be found at Sheila Dikshit’s house,” says Romilla, with a twinkle in her eye.  Ishita, who has a masters in counselling psychology, adds, “We plan to go out for coffee and get nail art done.”

Care-giving can improve life expectancy and helps treat illnesses that affect the elderly, says Dr Harish Shetty, a leading psychiatrist based in Mumbai. “But more importantly, it prevents depression which may go unnoticed for a long time and improves their sense of well-being.” At a time when the neighbour next door is no longer neighbourly and individuals live in enclosed spaces, an eldercare specialist has a cathartic effect, says Smriti Shah, a clinical psychologist working for First Seniors. While one can’t alter the ageing process, a skilled care-giver can bring about a real change in the quality of life of seniors. The elderly are given more freedom to choose the kind of care they receive, which helps remove the mental stigma of it being institutionalised. “What’s integral is to make them independent and believe they don’t need a crutch,” says Hammad Raza, a senior care specialist at First Seniors, Delhi.

Shiv Rangaraj (name changed), a diabetic, needed more than just round-the-clock nursing. India Home Health Care (IHHC), based out of Bangalore and Chennai, stepped in to provide companionship. Care-giver Chaavi Jog (name changed) pays Shiv weekly visits to help him stay mentally agile. Nothing too taxing: it’s mostly playing memory games, scrabble, carrom, reading out books on herbal remedies, or taking him to the beach and assisting him with bank work. “While we regularly assess general health and ensure a fall-proof home environment for our clients, we also teach them simple exercises, take them out for walks and engage them in lively discussions,” says Dr Anitha Arockiasamy, IHHC. Prakash Borgankar, director, HelpAge India, says that more than 55 per cent of seniors suffer from chronic ailments, but can move around. “They do not need medical support, but need to feel involved and wanted.” He often gets calls on his helpline where the elderly “just want to chat.”

The fear of spiralling crimes against seniors in cities and an inability to manoeuvre around traffic in the absence of open spaces keep many cooped up at home. Like Nirmala Islur, 62, who suffers from a chronic ailment and needs a walker to move around the house. “I am very scared of going out and because of vertigo, I hate using the lift. There is nothing to do other than read and watch TV. That’s why I am grateful to Sumitra of MayaCare, who gets me books from my favourite library in Vile Parle,” says lslur.

For care-givers, however, it’s no cakewalk. While progress can be painstakingly slow and compassion, empathy, creativity and perseverance are prerequisites, it also takes grit and determination. The recruitment process is tough. “We accept people from all walks of life fulfilling the prerequisites. Those with masters in psychology, human development, social work, food science or work experience with an NGO may know about geriatric care, but passion is most important,” says Sunil Sood, the vice-president of First Seniors. While caring for the old can be rejuvenating, it can also bog you down. They can be rigid, have idiosyncrasies, and may not always vibe well. Adapting can be a big problem for a caregiver. “There’s also a lot of mistrust about male volunteers because of security issues,” says Dr Shetty. The cultural baggage is also hard to shrug off. “We have had strong views regarding old age. The seniors feel they are through with their duties. There are also philosophical and cultural thought processes at work in our society, with mixed ideas about life and death,” says Dr Gaurang Desai of Hiranandani Hospital in Mumbai. He says well-trained eldercare specialists can help change some of these attitudes.

With Indians culturally programmed to care for their parents, home is clearly where the heart is. While in the West, posh retirement homes, long-term insurance and advanced at-home care form the backbone of healthcare, in India there’s always been a stigma associated with admitting one’s parents into an old age home, which makes it a more daunting task. Dr Indrani Chakravarty of the Calcutta Metropolitan Institute of Gerontology feels nearly 88 per cent of the elderly prefer to stay at home than go to the impersonal setting of an old age home.

With an elderly population of 100 million people—projected to an average of 200 million by 2040—sophisticated at-home caregiving can help revitalise their sunset years. HelpAge India plans to launch short-term geriatric courses spanning 60 to 90 days. Experts feel what will evolve is a mixture of voluntary and commercialised services, including family, friends and neighbours, for the elderly. That can happen when it has to. In the meantime, at the Mandlekar residence, a lively discussion about Obama’s re-election and US politics over glasses of cold Tang is under way, punctuated by spurts of laughter and peppered with memories of their trip to the US. With Sudha’s help, Madhukar plans to cajole his wife to go on a trip to Nagpur next.

By Priyadarshini Sen with Prachi Pinglay-Plumber and Dola Mitra

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