Towards A Community of Concern for the Elderly

Studies on ageing conclude that institutional care of the elderly is not desirable for their emotional well - being, though their basic needs of food, clothing and shelter are met by the homes for the aged. Further, such an approach for the welfare of the elderly would legitimize the segregation of the elderly from their homes and familiar surroundings. In financial terms, homes for the aged are costly propositions while the number of beneficiaries is very small. As an elder care service, institutionalization should be considered only as the last resort.

At a time when home for the aged was the only form of service for the elderly in India, Centre for the Welfare of the Aged (CEWA), formed in 1979, pioneered community-based elder care services in association with Helpage India.


Vision
A society where people of all age-groups living together without discrimination of age, gender, religion, caste and social class in an environment of security and mutual respect.

Mission
CEWA works with and for older persons in general, and the poor and the disadvantaged among them in particular, with their active involvement in partnership with their families and the communities in which they live so as to enable them to lead their lives with self-respect, dignity and usefulness to others.

Major Objectives

• To promote community - based services for and by the elderly so as to enable the older people to function as active participants in the families and communities, and in the larger social context.
  
• To serve as a centre for research, documentation, training and communication on ageing, welfare of the elderly and related issues.
  
• To influence social policy formulation on the welfare of the elderly through conferences, seminars, workshops, and collective action by the elderly. 

CEWA’s Convictions

• The best place for the well - being of the elderly is the family.
  
• Services to the elderly should be extended where they live or as near as possible.
  
• Elderly are resources of the community. Their talents and resources are unlimited which should be identified, recognised, developed and utilised.
  
• The elderly themselves will be able to manage programmes for their well - being with necessary support from social welfare personnel as facilitators.
  
• There must be continuous educational campaigns to create awareness in society of the problems, needs and capacities of the elderly. It is also necessary to enhance the positive self - image of the older persons.

Community – Based Services
CEWA is the first organisation in the country to operationalize the concept of community - based services for the elderly in partnership with Helpage India and Help the Aged, UK. The Annual Report of Helpage India (established in 1978) observes:

“We are particulary pleased to be acting in partnership with the new Centre for the Welfare of the Aged, Madras, to undertake an entirely non - residential service to the aged of that city. This project is pioneering a new field of social service for the elderly which we hope others will follow”.
(Annual Report, 1980)

Day Centres
As the vast majority of the elderly in India are not benefited by any service, it is necessary to have less expensive, easily replicable, community - based services for the elderly. On these premises, CEWA started day centres in the communities in which the elderly live.

CEWA started day centres at a time when voluntary organisations and social workers considered homes for the aged as the only one type of elder care service possible. There was scepticism among social welfare and religious organisations, which were running homes for the aged, about the feasibility of organising day centres successfully. But once the day centres started functioning with the active involvement of the elders, keen interest was shown by the media, social workers, welfare agencies and the government.

Copac, Manual on Cooperatives for the Aging, a joint publication by the Copac Secretariat at Rome, and the United Nations Office at Vienna, Centre for Social Development and Humanitarian Affairs, published the following about CEWA’s day centres:

The Centre for the Welfare of the Aged (CEWA) works to foster self-help among the aged who do not benefit from any age care services. CEWA regards ‘care’ not as a treatment to be ‘given’ to passive objects, but as the attention to all the needs of the person. CEWA believes that the best place for the well-being of elderly people is within their families and communities. This is in contrast to widespread assumptions that the best ‘care’ of the elderly is ‘given’ by professionalised and specialised institutions. The elderly themselves are in large measure capable of attending to their own needs and the needs of their peers. At times, expert consultation may be needed and the services of doctors, legal advisers, ophthalmologists, and physiotherapists may be required, but the process of mutual ‘caring’ and self-help cannot be professionalised.

Because CEWA is confident that the elderly can help themselves, its work is the forging of links amongst the elderly themselves and between the elderly in need of a few specialised services and the trained personnel who can help them. Beginning in the early 1980’s it organised meetings for the elderly in low - income neighbourhoods of Madras in southern India to explain the concept of self-help through local day centres and it conducted a household survey with the dual aim of spreading the idea of community care for the elderly through day centres and of collecting basic information on the families of the elderly people in the neighbourhood.

The first day centre was established in a small hut in a low - income neighbourhood. A weekly clinic was arranged by CEWA. Because the centre is near their homes, the elderly can attend the day centre clinic with much less difficulty than the state hospital. Because the elderly gather in one place, the attending medical officer can see them all in much less time than would be the case were it necessary to visit each person at his or her home. Special trips are made to bed-ridden elderly while serious cases are referred to the geriatric department of the state hospital. CEWA has also arranged for a physiotherapist to treat cases referred by the medical officer and all the elderly may have their vision tested at regular intervals by a specialist who comes to their centre.

Bringing professional health service into the community was a priority of CEWA and a task particularly well-suited to an outside agency. However, by no means was it envisaged by CEWA that the care of the elderly ended with specialised professional services. Other aspects of care also need development and the people best equipped to identify those needs and develop responses to meet them are the elderly themselves. Therefore, the elderly have the responsibility of managing the centre through the Association of the Elderly. The CEWA social workers serve as facilitators.

The day centre remains open not only for clinics, but as a social centre where the elderly can meet to discuss current events and take tea. An elderly volunteer convenes regular meetings in order to collect information on the problems and needs of the older people. The association also organises outings, family counselling, and the celebration of festivals. All of these provide the opportunity for the elderly to make a contribution to their community and to maintain social contacts in a supportive environment. The association addresses strictly material needs by organising a daily meal for the poorest elderly. However, this also provides useful work for the elderly who help out in all aspects of its preparation. Some members of the association work producing incense and paper bags. The proceeds are divided among these members according to the contribution of each one.

The Chairman of the Tamilnadu Social Welfare Advisory Board (Mrs. Tara Cherian), who led a Committee of the Central Social Welfare Board in January 1985, made the following observations:

“The members very much appreciated the day centres run by CEWA. They wanted to run such centres all over the country and I am very happy that this programme of yours is very much appreciated.”

Economic Support For Self – Employment
Elderly persons, despite age, prefer to be on their own and would like to be contributors to the family income, unless serious illnesses or handicaps restrict their capacity. Most of the elderly in self-employment are in marginal occupations with meagre returns. They borrow money from money - lenders at daily or weekly rates of interest which are exorbitant. Though the weaker sections are eligible for loans from nationalised banks at differential rates of interest the poor elderly find it difficult to avail of loans as they are not in a position to guarantee security. Advanced age itself is a disincentive for the banks to consider loans to the elderly.

CEWA stood guarantee for elderly men and women, and arranged bank loans for self - employment. The Social Workers of CEWA would make home visits and discuss the self-employment project in detail. The details of the loan assessment were then sent to the bank with CEWA’s recommendation. Regular follow - up visits were made. In the cases of day centre members, the respective associations recommended the applications. The elderly persons were generally prompt in repayment of loans unless some unexpected events like sickness of self or members of the family, visits to villages for urgent purposes, rain and loss in business took place.

Social Work With Elderly Patients
The Geriatric Unit of the Government General Hospital, Madras, established in 1978, is the first of its kind in India. The Unit came forward to collaborate with CEWA in 1982 to improve the quality of geriatric care to the elderly. This unique collaboration between the leading government institution and CEWA, a non-governmental organisation, was very beneficial to the elderly patients.

The services extended by the CEWA team of social workers were as follows:

• Interviewing and preparation of case histories.
  
• Listening to the problems in the family, financial difficulties and worries, which were closely related to their state of health; and extending emotional support and counselling service.
  
• Helping the elderly patients who sought clarifications about their diseases and medical treatment, guiding elderly patients to the different departments and helping them with tests. 
  
• Providing information on old age pension, loans for self-employment, sources of help for the members of the family, etc.
  
• Rehabilitation services such as arranging financial assistance, loans for self - employment, spectacles and other aids. Often the elderly persons remarked that “half of my sickness is over when I talk to Amma” (referring to CEWA Social Worker).
  

Elder Care Volunteer Programme
While the number of older people has been on the increase, the services and opportunities for their well - being have been highly inadequate. CEWA, therefore, launched an Elder Care Volunteer Programme in 1993. CEWA had sensitized 182 persons till December 1999 for elder care volunteer service: 126 of them were women and girls. The vast majority of the volunteers were younger persons. A beginning effort was also made to reach out to the impressionable group of school students in the 15-16 age group. Initial training of volunteers was followed by regular review sessions once in two months. The volunteers, who had undergone the training, were unanimous in their appreciation of the exposure on ageing and elder care. Many of them stated that they took the elders for granted and often ignored their needs and problems.

Training and Elder Care Consultancy
CEWA has encouraged many organisations in the country, particularly in the southern states, to start community - based elder care services as well as to improve the quality of care in residential institutions. CEWA also had the privilege of giving guidance to a Bangladesh organisation in initiating a community care programme for the elders.

In collaboration with the National Service Scheme (NSS) Unit of the Madras University, a training seminar was organised in March, 1983 by CEWA for the Programme Officers of NSS for the development of a plan for involving the college students in programmes for the welfare of the elderly. The seminar was attended by Professors and Assistant Professors from the Madras city colleges.

A ten - day training programme for the personnel of voluntary organisations from the four southern states caring for the elderly was organised by CEWA in collaboration with Helpage India in August 1985. It was sponsored by the Department of Social Welfare, Govt. of India. A five - day training in organising day centres was arranged for the personnel of non-governmental organisations in February 1993.

A three - month certificate programme in elder care was organised in 1995 in collaboration with the Tamilnadu Slum Clearance Board. The trainees were women from slum communities. They were trained to work as Home Nursing Aides.

Non-governmental organisations, developmental and welfare, have been working in different spheres of social life and with different sections of the population. Perhaps there is no aspect of human life which is not the concern of NGOs. These organisations have extensive reach and resources. But most of the NGOs concentrate on their “target groups and areas”; and the elderly often go unnoticed. Many developmental NGOs have the mistaken notion that working with the aged will dilute their organisational fervour and thrust. For example, there are many NGOs working with the Dalits ; they mobilise the Dalits for collective action; but they often ignore the needs of the elderly among the Dalits who are, in fact, doubly deprived because of socio-economic oppression and age-related debilities. Developmental organisations working with the slum communities and women are other examples. An organisation may vociferously be fighting for gender justice and mass mobilisation of women without showing any interest in the well - being of elderly women. In order to strengthen the integration of the elderly with the vibrant community life and to promote the well - being of a large number of older persons, if not all, with minimum financial requirements, NGOs have a crucial role. Hence workshops for NGOs were organised by CEWA. During the period 2000-2002, seven workshops were organised to sensitize the NGOs from Chennai city and the districts of Tamilnadu; 96 NGOs participated in the workshops.The government agencies, the Tamilnadu Social Welfare Board and the Tamilnadu Slum Clearance Board, actively collaborated in organising the workshops.

Elder Abuse Awareness
The prevalence of elder abuse in different forms is a painful reality in the Indian society. A survey of older people in Chennai city conducted by CEWA about ten years ago indicated disturbing findings. Nearly three-fourths of the elderly agreed with the statement that “these days old parents are neglected by children” . They mentioned many types of elder abuse prevalent in the city : shouting, making them wait for food, delaying or even denying medical treatment, leaving the sick elderly in soiled clothes, discarding the personal belongings of parents as junk, not taking them to social functions, preventing them from visiting neighbours for fear of gossiping, not consulting them on family matters, not introducing them to visitors, denying elderly couples privacy, and assaulting physically. On the occasion of the first World Elder Abuse Awareness Day on 15th June 2006 CEWA conducted a survey of older persons in five urban poor settlements in Chennai ; 71% men and 76% women reported that they experienced ill- treatment in the families.

A national workshop on elder abuse, organised in March 1996, was the first effort in the country to focus attention on this serious issue. The workshop brought together a group of social workers working with the elders, academics engaged in gerontological research and legal practitioners. Various aspects of elder abuse and case studies were discussed by the group.

As elder abuse has been on the increase in families, irrespective of social class, CEWA has initiated an awareness campaign to sensitize children in schools on elder abuse and its prevention through a variety of programmes.

Advocacy
The elderly segment of the population is not a homogeneous group; they are highly heterogeneous in terms of capabilities, problems and needs. However, broadly speaking, they could be divided into two categories. The first category consists of elderly who have independent income from employment pension, property, investment, or other sources. They have organizational support too in the form of pensioners’ associations, senior citizens’ groups, etc. The second category comprises older persons who are deprived of even basic necessities of human existence. Without a viable social security programme for the elderly, the only alternative support at present is the social assistance of the state government for the older persons who are aged 60 and above, without an adult son / grandson, and without any means of sustenance. But securing old age pension is not an easy task because of procedural bottlenecks and delay in sanctioning the pension. Most often external support is needed. While employment pensioners have strong associations, the old age pension recipients do not have any forum. Though the middle and higher sections have associations of senior citizens or clubs, the poor elderly do not have any organization of their own. In the absence of planned welfare and development programmes, it is necessary to mobilise the poor elderly into self-help associations to enable them to improve their quality of life.

CEWA believes that community - based services create strength among the elderly and in course of time enable the elders’ associations to function as social action groups capable of influencing Government policies. So since 1984, CEWA has been organising Elders’ Days to bring together elderly people from different parts of the city and even outside to discuss common issues.

In 1985, CEWA organised a national workshop on ageing and care for the elderly in India. Social workers in the field of elder care, social scientists, and government representatives participated in the workshop. The workshop had drafted a national plan of action for the welfare of the elderly which received national attention.

The incidence of Alzheimer ’s disease (AD) is on the increase in India. But most of the families are ignorant of its symptoms and progression. Services for AD and other types of dementia are scarce. Hence an article titled “Silent Killer of Minds” by Dr.T.K.Nair, Chairman, was published by The Hindu on 2008 World Alzheimer’s Day (September 21).

Recognition
In 1988 CEWA was invited to be in an International Panel discussion on “Coming of Age” at London, which was telecast for global viewing by Channel 4 in London.

The United Nations (ESCAP) invited CEWA to participate in two workshops on ageing in 1996 and 1997 at Bangkok and Macau, respectively.

An observation made by a representative of the globally famous organisation GRAY PANTHERS, USA:
“The most unique aspect of your work was your belief in the need to organise people to exercise their own power. This seems to be the sine qua non of CEWA”.