This article appeared in Ceylon Today on Tuesday July 2 2015 under the title ‘Betrayal of the Elderly.
Professor Indralal De Silva, Senior Professor of Demography, University of Colombo, estimates that 25 percent of the population of Sri Lanka will be over 60 years of age by 2040. He argued that unless our development process is improved and sustained we would have a lower level of income to support this aging population.
Last week, I wrote that the “problem” of increasing numbers of elderly people in the world was seen as an “opportunity” for some entrepreneurs. The danger is that businesses providing care for profit might put profit before care and that abuse might take place undetected.
Abuse in Sri Lanka
I was prompted to look into this subject following a recent trip to Colombo to rescue my wife’s aunt. She had been in a so-called “care” home for three years. It seems that anyone can set up an Elders Care Home without any experience, training, qualifications or aptitude for caring for elderly people. People who seem to detest senior citizens see that as no bar to “caring” for them. I very much doubt if the home I saw had ever been inspected.
To protect the guilty I will not mention names. The home in which my wife’s aunt was languishing was run by a person I will call “The Matron”. She had no training or expertise in the care of old people. She was a retired teacher who spent a great deal of time in a wheel chair because of arthritis in her knees. She had only one assistant who told us she was not paid a salary- what little money she had was often “borrowed” by the Matron.
We kept in regular telephone contact with the Aunt and visit whenever we can. Recent calls caused concern. Aunt said she wanted her nails cut. When we asked Matron to arrange this, she said she had given Aunt some scissors and she could cut her own nails. At one point Matron said that 80% of what Aunt said was lies and she did not like my wife’s tone.
This seemed an unusual approach to customer service, a strange way to address someone who is providing your only income. The Matron became reluctant to communicate and the Aunt kept repeating in a robotic fashion, as if brainwashed, that she was very happy and that Matron and Assistant were very good to her. We heard from another source that Aunt was crying and saying Assistant was pushing her and digging her nails into her arm.
We searched around for a better home (we had not chosen Matron’s place ourselves but were paying for it on behalf of, and with contributions from, family members). We found something that seemed suitable but were finding it difficult to get to Colombo to inspect it. Before we could get there, Matron said she was no longer able to care for Aunt and asked us to remove her. Fearing that further abuse might occur in these changed circumstances, we made it to Colombo and collected the Aunt while Matron was out at a temple releasing caged sparrows for merit. Assistant was somewhat discombobulated, but we told her she had no choice but to release Aunt.
For the first time I had the chance to inspect the premises. Aunt was sitting in darkness, enduring the intense heat without a fan. Our driver asked to use the toilet and came back looking as though he was about to vomit. I went to have a look. As someone from a working class British background, I am familiar with the concept of the “outside toilet”. Working class toilets were outside in the sense that they were in the yard, but they did have a roof and a door. This one was completely exposed to the elements. There was no roof or door and dirty old saris formed the walls. There was no lid on the cistern. The whole thing was filthy. Close to the toilet was a gas hob with a shelf of dirty spice jars. It seems that this spot near the open latrine was where meals were prepared.
We placed Aunt in an establishment which provided 24-hour nursing care with a nursing station by her door. She has her own bathroom. She can have a TV in her room but she chose to have a radio. There is a menu which changes every day and which offers different options. Matron had provided only a plain bun for breakfast and bought most meals in from outside. She would not provide milk and sugar with tea. She would not allow her to bathe or use a fan.
We will visit Aunt as often as we can to ensure good conditions are maintained but so far, she is very happy and means it. We can even talk to her on Skype.
Should Sri Lanka Depend on People like the Matron?
If you search the internet, you will find worse cases of abuse than this. We are all going to get old- some of us sooner than others, as a callow internet troll reminded me. Yes, even you bright young things enjoying the full bloom of youth will be like the Aunt one day. Anicca. Who is going to care for you? Who is going to care for me?
Changing social modalities means that the traditional way of caring for elderly people within the family unit is no longer possible. My English grandmother lived to be 97 and she would not have dreamed of ending her days in an institutional care home. It might have been good for her to be able to spend her final years in her own home but the burden of caring for her blighted the lives of her two youngest daughters who never married.
Caring for the Elderly
Institutional care homes are essential but who should provide them? The state has a responsibility to protect its elder citizens. More homes are needed but they need to be like the one that is now caring for the Aunt not like the one operated by the Matron. I have often pointed out the downside of privatisation particularly in areas like social services. I read with horror that the UK government is planning to privatise child protection services and give the job to a security firm that made a mess of its remit during the Olympics, has killed a few asylum seekers and makes a handsome profit from running prisons.
However, I would accept that private homes such as the one now accommodating the Aunt have a valuable part to play when the state cannot afford to provide such facilities when it cannot get its fiscal house in order or get its spending priorities right . Only today I read the news that Sri Lanka’s trade deficit widened 15.1 percent to US$ 782.9 million in April from US$ 680.2 million a year earlier. I would not have much confidence that the government could develop new capacities for caring for the elderly or mobilising the human resources necessary. Homes like the one I recently visited do have that capacity and they are ploughing back their profits to develop new ventures such as sheltered accommodation and hotel units.
The government does have a role to play in monitoring the care services provided by the private sector. Viewing the Matron’s establishment made me wonder whether there is anything in Sri Lanka like the UK Care Quality Commission, whatever its faults. If there is such a body, it is ineffective. Monitoring “services” provided by the likes of the Matron will be difficult because such small establishments will sneak under the radar unless whistleblowers notify the authorities of their shortcomings.