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For those who care

"Help wanted. I’m in a very difficult situation. Mum’s caregiver has upped and gone without notice after three years due to a situation in her family and doesn’t plan to return. Mum has multiple health issues like epilepsy, Parkinson’s, drug-resistant UTI (urinary tract infection). She recently survived brain hemorrhage and is on a catheter. So I need a 24-hour long-term caregiver (not nurse, they are unaffordable for the long haul).” The anonymous plaintive plea for assistance posted on the Worldwide Zoroastrians Facebook page resonates in an aging and shrinking community.
The Bombay based lady explains that she is a single earning person who has been permitted to work from home. She adds, however, "It’s very difficult to manage mom’s care and work simultaneously.” At best she can afford Rs 20,000 to Rs 24,000 a month. "The caregiver will live with us, and in addition to the salary I will cover all meals and snacks. Happy to take care of a few medical expenses and offer plenty downtime. She rests when mom rests.” The lady is determined to keep her mother with her: "Please don’t suggest old age homes. That’s not an option.”
Many prefer to keep their dependents with them. But finding a full-time carer in Bombay for Rs 24,000 is problematic. As the city’s population ages, the demand for carers is mounting. Qualified nurses charge Rs 3,000 a day; ward boys and hospital maids charge up to Rs 1,000. Unqualified people will come for less but the demand is often greater than the supply and one can never be sure how long the carer will stay. While the lady who placed the appeal is fortunate her employer permits her to work from home, others may not be that lucky or the job may require their physical presence. Also not everyone’s home may be large enough to accommodate a 24-hour caregiver. 
Qualified carers with a basic knowledge of English can secure jobs overseas. Carers in the United Kingdom can earn UKP 25 (Rs 2,600) an hour. In the West and wealthier countries, governments offer subsidized or free assisted living facilities. But even so the high cost involved in caring for the elderly is taking its toll. Wikipedia notes, "Care for the elderly in the UK has traditionally been funded by the state, but it is increasingly rationed, according to a joint report by the King’s Fund and Nuffield Trust, as the cost of care to the nation rises. People who have minimal savings or other assets are provided with care either in their own home (from visiting carers) or by moving to a residential care center or nursing home. Larger numbers of old people need help because of an aging population and medical advances increasing life expectancy, but less is being paid out by the government to help them. A million people who need care get neither formal nor informal help.” 
In Canada, like in the UK, where medical costs are largely provided or covered by the state, assisted living facilities are covered "on a sliding scale, based on annual income. In Ontario there are waiting lists for many long-term care homes, so families may need to resort to hiring home healthcare or paying to stay in a private retirement home,” notes Wikipedia.
The National Alliance for Caregiving (NAC) in the USA ( notes in regard to caring for someone at home, "One in four caregivers finds it difficult to take care of their own health.” The Alliance states that aside from health, caregivers may face financial insecurity. Short-term and long-term savings (retirement, education) erode. Fifteen percent borrowed money from family and friends; 20% paid bills late or left them unpaid and 11% were unable to afford basic amenities like food. "As more people need care and there are fewer potential family members to tend to their needs, there will be greater pressure on individuals within the family,” cautions NAC. 
In most parts of the world the primary caregivers are women. Even where an elderly person lives with her or his son, the main caregiver will most likely be a female member of the house. In some cases the carer may even be a child. 
An article in The Wall Street Journal of April 30, 2024, headlined "Millions of Children are Caregivers Now: They help care for relatives, as families cannot afford or find in-home care,” states: "There are an estimated 5.4 million children under the age of 14 providing care to parents, grandparents or siblings with chronic medical conditions or functional decline, up from 1.3 million nearly 20 years ago.” The number of child caregivers is growing because families can’t afford or find in-home care, say researchers in the field.
If these wealthy and developed nations find it difficult to offer medical facilities to their senior citizens what will be the situation for an aging, shrinking and largely retired community like the Parsis? With around 30,000 Parsis in Bombay, most of whom are aging, the demand for such facilities can outstrip the supply. Even if the daughter were to opt for an assisted living facility, admission would be granted as and when a vacancy occurs. Most senior citizen centers in Bombay and elsewhere require the person admitted to be mobile. 
The Bombay Parsi Punchayet (BPP) had cut back expenditure on "Other charitable objects” by two-thirds from Rs 3.59 crores (USD 429,847) in 2021-2022 to Rs 1.38 crores (USD 165,233) in 2022-2023.  The B. D. Petit Parsee General Hospital had a loss of Rs 16.6 crores (USD 1,989,067) in the financial year April 2022-March 2023 (see "Another year, another loss,” pg 26).
"How the global Zarathushti community addresses the challenges of a large aging cohort will determine how we are judged by history. Did we abandon our seniors and leave them to struggle alone? Or did we mobilize our immense creativity and partnership to care for them to make their sunset years safe and joyful?” asked a white paper prepared by Dr Dolly Dastoor and Nawaz Merchant on "Aging Across the Zarathushti World” presented at the 12th World Zoroastrian Congress in New York in July 2022. "There is an impression that aging Zoroastrians in the West have all their problems solved. This is not so, as loneliness and lack of transportation isolate immigrants to a terrible degree.”
There are many community organizations and trustees that assist the elderly. Perhaps their efforts could be coordinated and their findings shared. 
We are duty bound to assist the elderly. After all we will be joining their ranks someday if we have not already done so.

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Excellent and timely editorial. You write "There are many community organizations and trustees that assist the elderly." Do you have a list of such organizations and trustees, along with the nature of assistance they provide?
- and Mrs Jamshed A Modi
- 08-May-2024


Villoo Poonawalla