- For the many elderly parents, life in America with their children is not always suitable, but returning or staying back in India where living conditions leave a lot to be desired, is equally problematic.
Indian Americans with aging parents in India are sandwiched between their responsibility toward them, their own careers and their commitments to their family and social life. Some parents move to the U.S. to stay with their kids, while others don’t. Visiting parents find it difficult to keep themselves busy here, and often feel that their independence is compromised. Some find it hard to adapt to the American way of life and the isolation. Those who have aging parents in India have a few options: Home help or an old-age home. Many children make frequent trips to India to visit their aging parents as well. I have experienced this firsthand.
For the last several years, I have been spending a few months every year with my mother in Odisha who is now 85. In the neighborhood of Cuttack, most of my uncles and aunts I grew up with are now gone. Those who are around are suffering from numerous ailments. My schoolteacher’s wife who is in her 80s is bound to the bed with a hip fracture. Even though she lives with her younger son and his family, she has a full-time caregiver for her daily needs.
Last year, while I was doing research on aging issues in India, I asked a friend, Dr. Bhagban Prakash, a senior advisor at Election Commission of India, about his views on aging in the country. He was in the process of moving from Delhi to his hometown Bhubaneswar after retirement. “Look around you,” he told me. “Every household is an old age home now.”
Suddenly I realized it is quite true, especially in the middle class.
Reminders of this phenomenon are all over my neighborhood in Cuttack. Like the old man across our house who sits all by himself and nods at people passing by. He lost his wife a few years ago and is in and out of hospital. Or, a friend’s mother in her 80s who is losing her memory and is cared for by three attendants. From California, this friend manages the eldercare arrangement. She FaceTimes her every day and finds it increasingly hard for the mother to hear her.
India is undergoing a demographic transition. Out of a population of 1.3 billion, over 100 million are 60 years and above according to the 2011 Census. The numbers are expected to increase to 20 percent of the total population by 2050. The rise in old age population is challenging the elderly care and family as the caregiving institution.
The problem is not just the increase in the elderly population. It has to do with their care. Dr. Lena Ashok and her colleagues in their 2009 study “Health and social problems of the elderly: A cross-sectional study in Udupi Taluk, Karnataka” report that “nearly half of the entire elderly population are of poor socioeconomic status.” They suffer from financial and health insecurity due to loss of employment and poor health infrastructure in the society. The safety net to take care of the needs of the elderly are not yet developed in India.
The Past and the Present
I have fond memories of my mother managing a house full of people while raising five of us in Cuttack. In his village, my father was the first one to graduate from college and settle in the city. My mother raised her younger siblings, my father’s siblings, and many nephews and nieces who had moved with us for their education. In the 1970s, I do not remember ever having a meal at home with just five siblings. Now in her 80s, my mother lives with two caregivers, none of them are family. We visit her occasionally.
After my father passed away, my mother lived with me for seven years here in California. She was not happy here. She was horrified at being addressed by her first name by young children in the neighborhood in the age group of her grandkids. Besides, she was appalled by the idea of using toilet paper to clean herself. She would sit at the living room window and watch outside endlessly. One day she asked me, “Where are the people in the neighborhood? Do they all live between their houses and cars?” She missed her familiar networking, and being a dependent bothered her.
After her grandchildren went to college, she was very happy to go back to her home in Cuttack. Now, after a hip and femur fracture, she is enduring physical pain but emotionally she is at peace with herself living in her own home and speaking her own tongue with the people who care for her. She has made up her mind to die where my father did. She misses us — her children who have to fly long hours to visit her. She lives for the long-distance phone calls every day — missing it even one day makes her worried.
Those of us who care for our aging parents remotely, and make frequent trips to India to visit them, the state of India’s hospitals and other institutions sometimes throws us off.
In 2018, when my mother had her femur fracture, I had to admit her at a private hospital for surgery since the condition of the government hospital was deplorable. All the reputed doctors draw their salary from the government hospitals but render their service at the private facilities for hefty fees. A week-long stay at this hospital costs about30,000 rupees a day ($400). Private health care is extremely expensive. People sell their land, mortgage their homes and pawn their belongings to provide health care for their family. A majority of the elderly in India may not have pension or health insurance. Hence, health conditions are a major reason for the increasing suffering of the elderly.
Rise in Home Health Care in India
The family is still regarded as the primary institution to take care of its elderly.The state has also enforced family care of the elderly as a legal obligation with the passing of the Maintenance and Welfare of Parents and Senior Citizens Bill, 2007. This became a law in 2009 and now adult children may be fined 5,000 rupees and jailed for up to three months if found guilty of neglecting parents.
In the last two decades, when the children are moving away from home for better opportunities, home nursing care facilities for the elderly have become popular.
In 2002, Sushrusa, the first home nursing care, was introduced in Bhubaneswar. It trains young rural women, mostly school dropouts, to take care of the elderly at home. Now these facilities are in great demand. Many of my friends from the U.S. make trips to India to arrange home care help for their aging parents.
My discussions with the elderly in Odisha made it clear that they made a conscious choice to educate their children, giving them an opportunity to succeed. This has led their children to leave home seeking jobs far and wide. Children still bound by the duty towards their parents are now outsourcing their responsibility to these home nursing care facilities like Sushrusa.
Although old age homes are now emerging in India, they are not very well regarded. Anthropologist Sarah Lamb in her 2016 publication, “Traveling Institutions as Transnational Aging the Old-Age Home in Idea and Practice in India,” observes that “less than one percent of India’s elders live in old-age homes.” Many of them are run by nonprofit agencies and are subsidized by the government. They are viewed as philanthropic agencies meant for the lower class, needy and destitute. The ones I visited in Odisha were very welcoming but did not have facilities for proper health check up, physical therapy, nutritious diet, and trained assistance for the elderly.
In 2018, I visited one such home called “Sraddha O Sadhana,” which literally means “Reverence and Meditation,” run by the local Rotary Club in Cuttack. It has two wings: one free for the elderly destitute, and the other, a paid wing. The free section was full but the paid wing with about a dozen small suites was sparsely occupied. The monthly cost was about $75 per suite. Here I met a charming old lady who was living by herself. The staff told me that she was the wife of the deceased director general of police and all her three children were settled in America.
She was very quiet. Last year when I visited this home, I was told she passed away.
In the paid wing, I met an elderly couple. The husband was visibly bitter, angry and was disappointed with the poor services in this home; the wife was quiet. He said that his two sons and their wives were too busy to take care of them.
Old age homes are still considered a stigma and the middle class elderly feel ashamed to talk about their family’s negligence. It also goes against the family as the primary caregiving institution. Help Age India in 2014 reports that a majority, 72 percent of 5,014 elders interviewed will not report any abuse citing “maintaining confidentiality of the family” as the major reason.
The Loneliness of Cities
In cities across India, with migration, modernization and westernization, the intergenerational family dynamic is fast changing. More and more parents are left to themselves with their children leaving home for better economic opportunities. The elderly are lonely, isolated and feel alienated.
Kasturee Mohapatra of Long Beach, California says that her friends in India in their 60s send WhatsApp messages on the ever giving, sacrificing, suffering Hindu mother and parents in the image of living Gods and they complain about the individualistic attitude of their children living in the U.S.
Similarly, Bollywood films like “Bhagban” and a new television series titled “India Wali Ma” (Mother From India) are addressing the issues of elderly parents. In “India Wali Ma,” focuses on sacrificing mother, disrespectful son from abroad and misunderstood mother-son relationships. It emphasizes the importance of family, especially the value of a mother. Similarly, the 2003 Bollywood film, “Baghban” depicts the misery of the elder parents being separated between their two sons. The father was made to stay with one son while the mother stayed with the other son. The sons split up the parents for their convenience. It emphasizes the importance of family and the moral and spiritual value of offering care or respectful service (seva) to older parents.
That brings me to a story written by an elderly friend. It is focused on the loneliness of an Indian couple while their only son is settled in America. When the mother passes away and the father is heartbroken, their son arrives at home. The father is very happy but is bewildered by his strange behavior. He would not eat anything and would be very quiet. He was very mechanical in his movements. After a few days the father receives a phone call from his son. He was surprised. How could he be on the phone? He is around. The son shares that since he had no time at work, he sent a look alike robot to take care of him. So much of the anguish of the author’s loneliness was reflected in this story! The author lives with her husband in Bhubaneswar while their son and his family live in Kansas and their daughter lives in Toronto.
Here lies the dilemma. The adult children who have immigrated find it hard to juggle between their duty towards their parents — they worry about their health, personal needs, and well-being and their struggle with the work pressure and family in the U.S. It really becomes a challenge for the children as well.
The Corona pandemic has made it harder for the immigrant children to visit their elderly parents. A friend laments that last month, he failed to travel to Bhubaneswar to perform the funeral duty as the eldest son for his deceased mother and had to reconcile to Zoom streaming of her last rites. Another friend had to make an emergency trip to Bhubaneswar to see his father just before he passed away. He performed the last rites as the only son at the risk of getting infected himself.
This year I could not go to see my mother who is totally home bound with multiple surgeries. On the phone, she asks me, “When are you coming”? When I explain, she understands the pandemic situation and reconciles to the unpredictable future.
(Top photo by Anup K. Venu, courtesy Deccan Chronicle)
Annapurna Devi Pandey teaches Cultural Anthropology at the University of California, Santa Cruz. She holds a Ph.D. in sociology from Jawaharlal Nehru University, New Delhi, and was a postdoctoral fellow in social anthropology at Cambridge University, U.K. Her current research interests include diaspora studies, South Asian religions, and immigrant women’s identity making in the diaspora in California. In 2017-18 she received a Fulbright scholarship for field work in India. Dr. Pandey is also an accomplished documentary filmmaker. Her 2018 award-winning documentary “Road to Zuni,” dealt with the importance of oral traditions among Native Americans.