A STUDY OF OLD AGE HOMES IN THE CARE OF

THE ELDERLY IN GUJARAT

Project Report prepared

by
N.P. Das
Urvi Shah

Population Research Centre

Department of Statistics
Faculty of Science
M.S. University of Baroda
Baroda-390 002

December 2004

PROJECT TEAM

Dr. N.P. Das, Ph.D., D.P.S.

Director

Research Investigator/Field Investigator

Saroj Bhavsar, M.Sc.

Nitin H. Bhatt, M.A.
Arvind J. Mistry, M.Sc.

Urvi Shah, M.Sc.

Varsha Chitania, M.Sc.,
DCA

Rajnikant M. Patel, M.Sc.,

MPS

Nilam V. Panchal, M.A.

Computer Assistants

Varsha Chitania, M.Sc., DCA

Mayank Ray, M.Sc., DCA
Rupesh Shah, M.Sc. DCA

Secretarial Assistants

Y. N. Vaidya
K.M. Upadhyay
Bela Dalal

Alpana N. Parikh
R.R. Mali (Driver)
P.S. Vasava (Peon)

A STUDY OF OLD AGE HOMES IN THE CARE OF

THE ELDERLY IN GUJARAT
INTRODUCTION
The ageing of population is an obvious consequence of the process of
demographic transition. While the countries of the west have already
experienced and have planned for their elderly population, it is only in the
last one and half decades that countries in Asia too are facing a steady
growth of the elderly, as a result of the decline in fertility and mortality,
better medical and health care and improvements in the overall quality of
life of people. Within Asia, as India and China are the two largest countries in
the region, it is expected that they would have a significant proportion of the
worlds elderly because of their large population base. In fact, the situation in
India presents two different scenarios with certain states grappling with
curbing their high fertility rates while others, which have controlled high
fertility rates, are already experiencing or are poised to experience an
increase in their elderly population.
There has been a progressive increase in both the number and
proportion of the aged in India over time, particularly after 1951. Between
1901 and 1951, the proportion of population over age 60 increased
marginally from 5 percent to 5.4 percent, while by 2001 this had increased to
7.0 percent. When changes in the decadal growth rate in the general
population are compared with those for the elderly population, it is noted
that the latter grew at a relatively much faster rate than the general
population, since 1951. Furthermore, the decadal percent increase in the
elderly population for the period 2001-2011 is likely to be more than double
the rate of increase of the general population. The size of the elderly rose in
absolute terms during the last century from 12 million in 1901 to
approximately 71 million in 2001 and is likely to reach 113 million in 2016.
Yet another feature of ageing in India is the fact that the proportion of elderly
is much higher in the rural areas than in the urban areas. The sex-wise
pattern of growth of elderly population reveals that the increase is greater
among women in the recent past, which indicates that elderly women will
outnumber elderly men in the future.
There is therefore an urgent need to examine the various aspects of
this new and fast growing population to ensure the design of appropriate
policy and programmes directed to meet the varied needs of this vulnerable
and dependent group. India, like many traditional societies, today faces a
unique situation in providing care for its elderly as the existing old-age
support structures in the form of family, kith and kin, are fast eroding and the
elderly are ill-equipped to cope alone with their lives in the face of infirmity
and disability. The onus of caring for the elderly is therefore now much more

on the state than the family and will necessitate the creation of adequate
institutional support. While the western countries have a fairly well organised
network of institutions for the care of the elderly, the growth and
development of these facilities in India, which began as early as 1901, still
remains inadequate. As per recent statistic, there are 1018 old age homes in
India today. Out of these, 427 homes are free of cost while 153 old age
homes are on pay and stay basis, 146 homes have both free as well as pay
and stay facilities and detailed information is not available for 292 homes. A
total of 371 old age homes all over the country are available for the sick and
118 homes are exclusive for women. A majority of the old age homes are
concentrated in the developed states including Gujarat (Directory of Old Age
Homes in India, Help Age India, 2002).
The concern for the elderly in the country is reflected in the adoption of
a recent National Policy on Older Persons in 1999, which has identified
principal areas of intervention and action strategies. These include financial
security for the elderly in the formal and informal sector, health care and
nutrition, shelter and housing and development of trained manpower to meet
the special health needs of the elderly. The construction of old age homes
and multi-service centres for the elderly through special financial assistance
to non-governmental organizations has also been articulated in the policy.
However, few studies have been undertaken to document the condition of
the elderly in the country and those living in old age homes (Dandekar,
1993, Das and Shah; 2001; GOI, 1991; 1998; 2000; Ranjan et al., 1999; Rao
et al., 1982; Sharma, 1999; Sharma and Xenos, 1992; United Nations, 1987).
In this context, the present study is an attempt to fill some of the gaps
in the study of the elderly population and the existing institutional support
available to them. The study was undertaken with the overall goal of
understanding the existing institutional facilities available for the care of the
elderly in the state of Gujarat and to obtain a perspective of the elderly on
various aspects associated with institutional living.
The specific objectives of the study are:
1.
2.
3.
4.

To understand the functioning of the old age homes with regard to

service provision
To identify the various problems in ensuring the smooth functioning of
the old age homes.
To know the various health problems experienced by the elderly
inmates and their management of the same.
To know the opinion of the elderly inmates regarding the adequacy of
facilities and services, their satisfaction and their views on such
institutional living.

DATA AND METHODS

For the present study, an effort was made to compile and update the
list of existing old age homes in the state from various sources including
from Department of Social Justice, Government of Gujarat and other NGOs. A
list of 99 old age homes, located in various districts of Gujarat, formed the
universe to draw a sample of institutions and the inmates residing in them,
for the study. A sample of 25 old age homes were selected to represent
government aided and NGO supported institutions, across the various
regions of the state of Gujarat. Since the proportion of NGO supported homes
was more than the government-aided homes, a larger number of the former
type of institutions was selected. From each selected institute, approximately
9-10 inmates were selected from the list of inmates to represent the views of
both men and women about institutional life and other issues.
Thus, a total sample of 233 elderly inmates comprising elderly men
(114) and elderly women (119) living in these 25 institutions was interviewed
with a view to explore the physical and socio-emotional aspects associated
with institutional living. In particular, interviews focussed on the reasons for
choosing institutional living arrangements, the problems faced in such an
arrangement, the type of accommodation, amount of money paid, if any, for
accommodation
and
other
services,
and
the
various
health
problems/illnesses experienced by the elderly. Their satisfactions and
dissatisfactions with the various services provided were also explored. An
attempt was also made to understand the attitudes of the elderly towards
institutional living versus familial living and whether they still consider,
children (especially sons) as the main support for the aged in the context of
changing familial values in India.
Interviews were also held with the heads/managers of the institutes to
obtain information on various aspects related to services provision (including
health care) as well as to understand the type of problems faced by them in
providing various services to the elderly, the available governmental support,
the arrangements made by the institution so that the elderly can maintain
contact with their children/family and the adequacy of infrastructural
facilities to ensure appropriate service provision.
Study Instruments
Data were obtained using semi-structured interview schedules. Two
types of schedules were used, namely, those for interviewing the elderly
men and women and those for interviewing the managers of the selected old
age homes, to obtain the requisite information on the above described
aspects.
RESULTS

The results are presented in two sections. Section I deals with the
analysis of data obtained from interviews with the managers of the 25
selected old age homes while Section II presents the perspective of the
selected elderly men and women living in these old age homes.
I. Perspectives of Institutional Managers
This section is based on interviews conducted with the
managers/heads of the 25 old age homes selected for the study and deals
with the facilities and services provided for the elderly, the adequacy of
these facilities and the problems faced by them in service provision.
Characteristics of the Old Age Homes
An analysis of the characteristics of the old age homes such as year of
establishment, type of institute, nature of management, source of funding
and charges for service provision, presented in Table 1, reveals that 56
percent of the homes have been in existence for more than 15 years, one
fifth had been established in the recent period i.e. less than five years and
another 12 percent each have been in existence either for 6 to 10 years or
11 to 15 years. All the twenty-five homes are residential in nature and 7 of
them (28 percent) are government aided, whereas the majority i.e. 18 do
not have such assistance and
Table
1:

Background Characteristics of the Old Age Homes in Gujarat,

2003
Background characteristics

Years since establishment

< 5 years
6-10
11-15
15+
Type of institute
Day care
Residential
Others
Whether Government aided
Yes
No
Whether any government control/
supervision on the institution
Yes
No
Source of funding

Number of institutions (in

percent)

20.2
12.0
12.0
56.0

(5)
(3)
(3)
(14)

100.0 (25)
28.0 (7)
72.0 (18)
20.0 (5)
80.0 (20)

Government
Religious organization
Individual donors
Trust
Person/Institution who established the
Institute
Trust
Individual
Religious organization
Charges for service provision
Free for all
Free for those who cannot pay
Subsidised payment
Compulsory full payment for all
Total

28.0
16.0
68.0
56.0

(7)
(4)
(17)
(14)

56.0 (14)
40.0 (10)
4.0 (1)
36.0 (9)
12.0 (3)
8.0 (2)
44.0 (11)
100.0 (25)

are entirely private in nature. Similarly 20 of the respondents reported that

there is no government control or supervision on their functioning. Regarding
the source
of funding, multiple sources have been reported with the majority, (68
percent) reporting about individual donors followed by private trust (56
percent) as their source of funding while 28 percent have mentioned about
government funding and 16 percent have reported about religious
organization as a source of funding. Fourteen (56 percent) of the old age
homes have been established by a trust, individuals had established 10 old
age homes (40 percent) while only one had been established by a religious
organization (Table 1). Finally an enquiry about charges which the elderly
have to pay for their stay in these old age homes reveals that 36 percent (9
homes) do not charge anything, 12 percent (3 homes) reported that they do
have a charge but provide free accommodation for those who are unable to
make payment, 8 percent or two of the old age homes charge a nominal
amount from the inmates as they are subsidized from their source of funding,
but as high as 44 percent (11 homes) require compulsory, full payment from
all those residing at the old age home.
Intake Capacity and Criteria for Admission
Information on the capacity of the selected old age homes for
accommodating the elderly indicates that 6 old age homes may be
considered small as their intake capacity does not exceed 25, two homes are
large as they can provide accommodation to more than 100 elderly, 7 homes
have a capacity ranging from 50 to 100 inmates and the remaining i.e. 10
institutions can accommodate between 26 and 50 elderly inmates (Table 2).
With regard to the sex wise norms for accommodating the elderly, it can be

noted from Table 2 that 60 percent (15 institutions) do not have any specific
norms about the number of men and women to be admitted. Three of the
homes have provision to accommodate equal numbers of men and women
and three other institutes stated that they can accommodate more men than
women, while one of them has provision for more women than men. Out of
25, three institutes are for single sex inmates, two are exclusively for women
and one for men only (Table 2). This indicates that almost all of the old age
institutes studied have the provision to accommodate both men and women
and only three institutes are exclusively for one sex only.
Regarding the criterion for admitting an elderly person in the institute,
19 of the 25 homes studied admit persons who are at least 60 years old
whereas 55 years is the minimum age criterion in the remaining 6 institutes
(Table 2). Economic consideration is the other criterion considered before
admitting an elderly inmate. In this regard, as can be noted from Table 2, 11
Heads/ Managers of old age homes have reported that they only admit those
who are able to pay the required institutional charges whereas 4 institutes
are essentially for those who are destitute, have no one to care for and, have
no means of economic support. What is surprised to note from Table 2 is the
criterion that the person must be able to take care of self (84 percent or 21
institutes) and that the person must be free from any diseases and must be
in good physical and mental health (20 institutes). Discussion on this aspect
with Heads of the institutes revealed that, as they are not equipped to look
after ailing inmates. In fact, they reported that the

Table
2:

Percentage Distribution of the Old Age Homes by their Intake

Capacity, Admission Criteria, Actual Strength and Requirement
for such Homes Among the Elderly, Gujarat, 2003

Criteria

Number of institutions (in

percent)

Intake capacity of old age home

Upto 25 inmates
26-50
51-100
100+

24.0
40.0
28.0
8.0

(6)
(10)
(7)
(2)

Norm to accommodate specific

number of elderly men and
women
Only for men
Only for women
Equal numbers of both sex
More men than women
More women than men
No specific norm

4.0
8.0
12.0
12.0
4.0
60.0

(1)
(2)
(3)
(3)
(1)
(15)

24.0
76.0
84.0
80.0

(6)
(19)
(21)
(20)

Criteria for admitting an elderly

person
At least 55 years old
At least 60 years old
Able to take care of self
Free from any diseases/No
infectious diseases/good physical
and mental health
Able to pay institutional charges/
able to support self economically
For those who are destitute/have
no one to care for/have low
income
Religious affiliation
Demand for accommodating the
elderly in the home
Unable to meet the demand
Able to meet the demand
Total

number

of

elderly

44.0 (11)
16.0 (4)
12.0 (3)

72.0 (18)
28.0 (7)

admitted in the home

25 or less
26-50
51-100
100+
None (No male/female inmate)

Male
64.0 (16)
24.0 (6)
- (0)
4.0 (1)
8.0 (2)

Female
76.0 (19)
12.0 (3)
8.0 (2)
- (0)
4.0 (1)

Total
48.0 (12)
32.0 (8)
16.0 (4)
4.0 (1)
- (0)

old age homes do not have staff to even look after those elderly who may
require hospitalization and in such circumstances the Heads are forced to ask
family members to take the elderly away from the institute. The Heads of the
institutes regretted that they could not admit any person who could not look
after himself /herself but they were helpless to do anything as they did not
have the required staff and other funds to look after ill inmates. It is also
evident from Table 2 that religious affiliation is the other criterion reported
from only three of the old age homes.
The fact that there is a big demand for such old age homes is evident
from Table 2, as 18 out of 25 Heads have reported that they are unable to
meet the demand and some of them have a long waiting list of people
seeking admission. Only 7 old age homes are able to meet the demand.
Finally, Table 2 provides information about the actual numbers of men,
women and total elderly living in the 25 selected institutes. As can be seen
from Table 2, 48 percent of old age homes have twenty five or less elderly,
32 percent have between 26 and 50 elderly while the remaining i.e. 20
percent have more than fifty inmates. The sex wise pattern of distribution
indicates that three fourths of the institutes have 25 or less women, 12
percent have 26 to 50 women, and 8 percent have between 51 and 100
women. One intuitional head has reported that they do not any women. On
the other hand almost two thirds of the institutes have 25 or less men, about
one-fourth have between 26 and 50 men and 4 percent have more than 100
men. Two of the institutional heads have reported that they do not have any
men living in the old age home (Table 2).
Facilities and Service Provision
As all the old homes in the study are residential in nature they are
expected to have all the facilities and services that are necessary for daily
living. An assessment of these aspects, presented in Table 3, indicates that
92 percent (23 homes) of the old age homes have their own kitchen with
cook and helpers, or rely on facility of the trust/hospital with which they are
attached. Only two of the selected old age homes do not have kitchen
facilities and inmates have to manage by eating food that is available
outside. It may be noted that one of these homes has just been established
and therefore does not have enough inmates while the other is used more
like a destitute home and the elderly, many of whom work in the city come
to the home only at night to sleep. The picture with regard to other facilities
and services such as laundry, sweeping and mopping and cleaning of
utensils, reveals that in many of the homes, staff that is employed by the
institute does all these tasks. For example, laundry is done by paid staff of
the institute in 11 homes, cleaning of utensils in 13 homes and 16 heads
have reported that sweeping and mopping is done by staff employed for the
purpose (Table 3). Of the remaining, eight heads of old age homes have
reported that inmates wash their own clothes, 2 have reported about the

provision of a washing machine whereas 4 have reported that inmates use

the facility of washer-man (dhobi). The cleaning of utensils and sweeping and
mopping in some of the institutes is done by the elderly. As can be seen from
Table 3, in 36 percent of the institutes (9 old age homes), the staff of the
institute does the sweeping and mopping of the common
Table
Percentage Distribution of Old Age Homes by Various
3:
Service Provision and Facilities, Gujarat, 2003
Services & Facilities
Kitchen facility
Own kitchen with cook and
helpers
Kitchen of main trust/hospital
No kitchen facility
Medical facility
Full-time doctors
Part-time doctors
Hospital facility of trust
No regular visit of doctor/no health
facility
Nursing staf
Available
Not available
Laundry facility
Washing machine
Washer man (dhobi)
Self (by inmates)
Paid staff of institute
Cleaning of utensils
Done by paid staff of institute
Done by paid staff partially
(inmates are expected to clean
utensils used by them for meals)
No kitchen facility (eat out)
Sweeping and Mopping
Done by paid staff completely
Done by paid staff partially
(inmates are expected to clean
their rooms)
Provision of entertainment
None
Yes:
TV/Radio

Number of institutions (in

percent)
80.0 (20)
12.0 (3)
8.0 (2)
20.0
24.0
20.0
36.0

(5)
(6)
(5)
(9)

28.0 (7)
72.0 (18)
8.0
16.0
32.0
44.0

(2)
(4)
(8)
(11)

52.0 (13)
40.0 (10)
8.0 (2)
64.0 (16)
36.0 (9)

16.0 (4)
84.0 (21)
95.2 (20)

Library
Newspapers/Magazines
Katha, bhajans and other
religious activities
Trips to religious places such as
Dakor, Ambaji, Shreenathji
Movies/Picnics

Services & Facilities

Facilities for sports and games
None
Yes:
Volley ball
Carrom
Playing cards
Managing the death of an inmate
i) Experience of death of inmate
No inmate has died at the old age
home
Experienced deaths of inmates
ii) Procedure followed in the
event of death
Inform relatives/Inform referee
mentioned on the application form
iii) Action taken if informed
person does not come
Last rites performed by institute
according to persons religion
Not experienced such a situation

52.4 (11)
47.6 (10)
57.1 (12)
66.7 (14)
9.5 (2)
Contd.
Number of institutions (in
percent)
76.0
24.0
50.0
50.0
50.0

(19)
(6)
(3)
(3)
(3)

12.0 (3)
88.0 (22)
100.0 (22)

90.9 (20)
9.1 (2)

areas whereas the inmates are expected to clean their own rooms. Similarly,
in 40 percent (10 institutes) of the old age homes, the inmates are expected
to clean the utensils they use for eating while the staff of the institute cleans
the utensils used for cooking and preparing meals (Table 3).
The picture with regard to medical facility indicates that 20 percent of
the old age homes studied have access to hospital facility of the trust they
are managed by, another 20 percent have full-time doctors and 24 percent
(6 institutes) have part-time doctors. The remaining 36 percent (9 homes) do
not have any health facility or regular visit of a doctor (Table 3). Managers of
institutes, which did not have any medical facility, were therefore asked

about the arrangements they made in the event that an inmate required
medical attention. Some of the heads reported that they have contact with
private doctors who are immediately called and others stated that inmates
have contact with their own doctors whom the institute would call if needed.
Nursing staff is available in only seven of the old age homes studied which
means that the majority do not have this facility making it difficult, as
discussed earlier, to care for the sick or ailing elderly.
The provision of facilities for recreation sports and games and
entertainment was explored next. As can be seen from Table 3, 16 percent of
the old age homes (4) do not have any facility for entertainment while as
high as 76 percent (19) do not any facilities for sports and games. Institutes,
which have facilities for entertainment, have indicated the availability of
TV/radio (95 percent), library (52 percent), organizing trips to religious places
(67 percent), organizing religious activities such as katha, bhajan (57
percent) and the availability of newspapers/magazines (48 percent).
Regarding the availability of various facilities for sports, indicated by just 6
(24 percent) of the old age homes, three each have reported about the
provision of games such as carrom, cards and volley ball (Table 3).
Finally, Table 3 presents information regarding the management of
death of an inmate. As can be noted, three of the managers reported that
not a single person had died at the old age home since its establishment.
When those who had experienced death of an inmate (22 institutes), were
asked to state the procedure normally followed in the event of a death of an
inmate, cent percent of the managers (22 institutes) stated that they
informed the relatives or the referee mentioned on the application form. In
the event the person informed did not come to claim the body, the last rites
were performed by the institute according to the persons religion, as
reported by 91 percent of managers (20) of the institutes, while the
remaining two managers stated that they had not faced a situation where
the informed persons had not come.
Financial, Infrastructural and other Problems Experienced
In Management of Old Age Homes
The management and ensuring good service provision can be affected
by inadequate staff, infrastructural facilities, funds and by the inter-personal
relations among the inmates and between the managers and the inmates.
Information was therefore sought from managers of the old age homes
regarding the types of problems faced by them in ensuring smooth
functioning of the institute.
As can be noted from Table 4, two-fifths of the managers (10 institutes)
have stated that they do not face any problems in providing various services
in their old age homes, indicating that three fifths of them do face some

problem. The various problems reported are inadequacy of staff (8

institutes), unable to provide care for those elderly requiring hospitalization
reported by 4 institutional heads/managers and lack of discipline among
inmates and their resentment in carrying out the tasks assigned to them
(Table 4).
With regard to financial problems, 11 heads/managers of the selected
institutes reported that they did not face any problem whereas an equal
number stated that the grant was inadequate to meet the various expenses
(Table 4). Four managers of the old age homes opined that the charges fixed
for the inmates was insufficient, three of them felt that the funds for medical
care were inadequate and two of them reported about the problems of delay
in receipt of grant from the government (Table 4). Infrastructural facilities
were found adequate in a little over half of the old age homes studied as
reported by 13 institutional managers. Five respondents have reported about
the inadequacy of space to accommodate more numbers of elderly as the
demand for such homes, they feel, is growing. Inadequate staff (reported by
4 respondents), inadequate water and electricity
Table
4:

Percentage Distribution of Old Age Homes by Type of

Problems Faced in Smooth Functioning of their Institute,
Gujarat, 2004

Type of problems faced in smooth

functioning of the old age home on the
following aspects
Service provision
No problem faced
Inadequate staff
Unable to care for inmates who require
prolonged hospitalization
Lack of discipline among inmates and do not
like to do assigned work
Others
Funds
No problem
Inadequate grant to meet expenses
Charges paid by inmates are insufficient
Inadequate funds for medical care
Delay in receipt of grant from government
Others
Infrastructural facilities
No problem
Inadequate space to meet the growing

Number of
institutions
(in percent)*
40.0 (10)
32.0 (8)
16.0 (4)
12.0 (3)
20.0 (5)
44.0
44.0
16.0
12.0
8.0
20.0

(11)
(11)
(4)
(3)
(2)
(5)

52.0 (13)
20.0 (5)

demand
Inadequate staff
Inadequate water, electricity supply
Building requires repair
Others
Dealing with relatives of inmates
No problem
Relatives demand special privileges
Other problems
No other problem
Staff is poorly motivated to work due to
inadequate salary
* Percentages may add to more than 100 due to multiple responses.

16.0
12.0
8.0
8.0

(4)
(3)
(2)
(2)

96.0 (24)
4.0 (1)
80.0 (20)
20.0 (5)

supply (3 respondents) and the inability to carry out much needed repairs of
building (such as paint work, leaking roofs, uprooted floor tiles etc) reported
by 2 heads were the other problems related to infrastructural facilities.

In addition to the above aspects, the heads were also asked whether
they encountered problems in dealing with the relatives of the inmates or
faced any other problems in managing the old age homes. All except one
institutional head reported that they did not face any problems in dealing
with relatives and 20 of them also did not have any other problems (Table 4).
The only problems reported by one respondent were that sometimes
relatives, especially those known to a member of the trust, demanded
special privileges. Among other problems, the low motivation of the staff due
to the inadequate salary was the only problem reported by 5 respondents
(Table 4). This affected the way they carried out their tasks and also affected
the service provision for the elderly.
Finally, the managers of the institutes were asked about their own
satisfaction and how satisfied they perceived the elderly were with the
service provision in the old age homes. The opinion about the managers
own satisfaction is almost equally divided with 14 of them expressing
satisfaction and 11 reporting dissatisfaction (Table 5). The various reasons
reported for feeling satisfied were that the required infrastructural facilities
are available (6 respondents) and that they are able to provide good services
to the elderly (6 respondents). Among the dissatisfied group, the paucity of
funds for medicines and better health and medical care was the major
reason reported by 73 percent (8 respondents) of heads. This was followed
by the lack of funds for various purposes such as for accommodating
disabled persons, providing clothing to the elderly and for appointing adhoc

staff for maintaining the cleanliness of the old age homes (Table 5). Two of
the managers each have mentioned about the lack of space to meet the
growing demand for accommodation and luck of funds for constructing
building. Inadequate water supply and the high expectation of the elderly,
which the managers are unable to meet, were reported by 1 institutional
head each.
The perception of the managers regarding satisfaction of the elderly
with the service provision in the old age homes, also presented in Table 5,
shows that the majority of them, 19 out of 25, have reported in the
affirmative, indicating that according to them, the inmates are satisfied. The
major reasons reported for this were that food is available at nominal or no
cost. (12 respondents), good accommodation, all the required care is
provided and adequate time available for the elderly to carry out their
religious activities (7 managers each), the availability of medical care (6
respondents), personal safety and security of the elderly at the old age home
(4 managers) and the companionship of age mates (2 respondents). Those
managers who perceived that the elderly were dissatisfied (6 respondents)
reported the following reasons. Sixty percent attributed this to general
dissatisfaction among the elderly with all the services provided (Table 5),
followed by 1 respondent each who reported about the lack of vehicle facility
at the institute which prevented then from taking out the elderly on
excursions and day trips, the unhappiness of the elderly with the food
provided and the difficulty the elderly faced in mobility in multi-storeyed
buildings which did not have a lift (Table 5).

Table 5: Managers Satisfaction and Inmates Satisfaction with the

Various Services Provided in the Old Age Homes as Perceived
by the Manager of the Institute, Gujarat, 2003
Opinion of the managers
(a) Satisfaction of the Manager of the
Institution
Yes
No
Reasons for satisfaction
Able to provide good services to the inmates
Have all the needed facilities
Others
Reasons for dissatisfaction
Inmates need better health medical care/need

Number of institutions
(in percent)
56.0 (14)
44.0 (11)
42.8 (6)
42.8 (6)
14.3 (2)
72.7 (8)

funds for medicines

Need more funds to accommodate disabled
persons/provide clothing/appoint adhoc staff for
cleanliness of home
Need more space to meet growing demand
Requires fund for building
Inadequate water supply
Unable to meet expectation of inmates
(b) Whether inmates are satisfied
Yes
No
Reasons for satisfaction
Food at nominal or no cost
Good accommodation
Adequate time for religious activities
All the required care is provided
Medical care is available
Personal safety and security at the old age home
Companionship of age mates
Reasons for dissatisfaction
Dissatisfied with all the services at the Home
Inmates are unhappy with the food
Difficulty of mobility in multi-storied building
No vehicle facility

27.3 (3)
18.2
18.2
9.1
9.1

(2)
(2)
(1)
(1)

76.0 (19)
24.0 (6)
63.2
36.8
36.8
36.8
31.6
21.1
10.5

(12)
(7)
(7)
(7)
(6)
(4)
(2)

60.0
20.0
20.0
20.0

(3)
(1)
(1)
(1)

II. Perspectives of the Elderly Living in Old Age Homes

As described earlier, a sample of 114 elderly men and 119 elderly
women living in the 25 old age homes selected for the study were
interviewed to obtain their views and feelings about institutional living
arrangements, their satisfactions and dissatisfactions with the same and
their attitudes regarding children (especially sons) as old age security in a
changing familial value system.
Background Characteristics of the Elderly Inmates
The socio-economic background characteristics of the elderly men and
women residing in the selected old age homes are presented in Table 6. It is
evident from this table that more than half of the inmates (55 percent) are
living in private institutions with more women (60 percent) than men (51

percent) choosing to live in private old age homes than government aided
ones. The recency of choosing institutional living can be noted from the fact
that a little over three-fourths of the elderly (76 percent) had reported their
duration of stay at the old age home as less than six years (Table 6). Table 6
further shows that about 7 percent of the elderly had reported that they had
been residing at the institution for more than 11 years. With regard to the
age distribution, it can be noted that about 61 percent were above the age of
69 years, 32 percent were between 60 and 69 years while the remaining 7
percent were less than 60 years old. No significant differences in this age
structure were noted between elderly men and women (Table 6). The
background characteristics further reveal that about 29 percent of the
elderly men as against 8 percent of the elderly women had never married.
Table 6 also reveals that the proportion of widows was much higher (64
percent) than widowers (35 percent) while 30 percent of men and 21 percent
of women were found to be currently married. Table 6 further reveals that 16
percent of the currently married elderly were living with their spouse at the
old age home while 12 percent were not living with their spouse.
The educational characteristics indicate that about one fifth of the
elderly did not have any education, thirty percent had reported primary
educational attainment, and another 9 percent had completed middle school
while about 8 percent had completed college or university education.
Between men and women, more men than women were found to have been
educated (Table 6). The low educational attainment of the elderly is also
reflected in their last occupation. As can be noted from Table 6, only 2
percent of the elderly men had been engaged as executives or were in some
white collar profession, about 23 percent of men and 13 percent of women
had either worked as school teachers/clerks or other related service groups,
about 44 percent of men and 14 percent of women were either labourers in
agricultural or non-agricultural occupation or were class IV servants (Table 6).
Among women, two-fifths of them had been housewives, about 2 percent
had been engaged in carrying out a business and four percent were skill
workers such as tailors, embroiderers. The picture with regard to their
current occupation indicates that the majority of men (97 percent) and
women (94 percent) were not pursuing any occupation. More women (6
percent) than men (3 percent) reported that they were gainfully occupied.
Some of the women were helping in certain

Table
6:

Background Characteristics of Elderly Inmates Living in

Old Age Homes in Gujarat, 2003

Characteristics
Type of old age home
Government aided
Others
Sex of the inmates
Male
Female
Age of the inmates
< 60 years
60-64 years
65-69 years
70-74 years
75 years & above
Marital status
Never married
Currently married
Widow/Widower
Divorced/Separated
Educational attainment
Illiterate
Pre-primary
Primary
Middle
High school
Higher secondary
College & above
Last occupation
Professional/Executive
Clerk/School teacher & related
service groups
Business
Skill worker
Housewife
Labourer
Class IV servants/non-agricultural
job
Landlord/Cultivator
Unemployed

Percentage distribution
Male
Female
Total
49.1(56)
50.9(58)

40.3(48)
59.7(71)

44.6(104)
55.4(129)

48.9(114)
51.1(119)

6.1
14.0
19.3
28.9
31.6

8.4
16.8
13.4
22.7
38.7

7.3
15.5
16.3
25.8
35.2

28.9
29.8
35.1
6.2

7.6
21.0
63.9
7.6

18.0
25.3
49.8
6.9

10.5
11.4
39.5
13.2
9.6
5.3
10.5

31.9
10.9
37.8
4.2
3.4
5.9
5.9

21.1
11.2
38.6
8.9
6.4
5.6
8.2

1.8
22.8

13.4

0.9
18.0

6.1
15.8
16.0
28.1

1.7
4.2
40.0
3.4
10.9

3.9
9.9
21.4
8.6
19.3

5.3
6.2

0.8
23.5

3.0
15.0

Contd..
Characteristics

Percentage distribution
Male
Female
Total

Present occupation
Not working/Unemployed
97.4
Engaged in some gainful
2.6
occupation
Religion
Hindu
90.4
Christian
3.5
Parsi
2.6
Jain
3.5
Independent source of income
Yes
43.8
No
56.1
Residing at the old age home
with spouse
Yes
15.8
No
18.4
Never married/Not currently
65.8
married
Duration of stay at the old age
home
< 1 year
16.7
1-2
27.2
3-5
31.6
6-10
19.3
11-15
1.7
16+
3.5
Type of family
Nuclear
25.4
Joint
46.5
Lived alone
28.1
Place of stay where lived for
most of the life
City/Town
81.6
Village
18.4
Total
100.0(1
14)

94.1
5.9

95.7
4.3

89.9
3.4
4.2
2.5

90.1
3.4
3.4
3.0

42.9
57.1

43.3
56.7

16.8
5.9
77.3

16.3
12.0
71.7

11.8
28.6
37.0
13.4
5.0
4.2

14.2
27.9
34.3
16.3
3.4
3.9

20.2
59.6
20.2

22.7
53.2
24.0

78.2
21.8
100.0(1
19)

79.8
20.2
100.0(233
)

tasks of the old age home e.g. cooking, cleaning for which they were paid
some salary. Among men, the nature of their occupation was tailoring/
stitching. The picture with regard to their current economic condition further
reveals that only about 43 percent of the elderly have an independent source

of income either in the form of pension or savings interest which means that
more than half of them are without any financial security (Table 6).
Finally, the background characteristics regarding familial and
urban/rural traits, reveal that a little over half of the elderly (53 percent) had
lived in a joint family, while about 23-24 percent each had either lived in a
nuclear family or had lived alone, prior to coming to the old age home. Sex
differentials on this aspect can be seen as more women (60 percent) than
men (47 percent) had lived in a joint family. Equal proportions of women had
lived alone or in a nuclear family (20 percent each) while more men (28
percent) had reported that they had lived alone. The urban characteristic of
the elderly is clearly noted as almost 80 percent had lived in a city/town for
most of their lives. However, as about one-fifth of the respondents reported
that they had spent a major part of their lives in villages, information about
such institutions has reached villages in the proximity to towns and cities.
Services and Facilities
This section describes the services and facilities available for the
elderly living in the selected old homes, the expenses incurred by them for
accommodation and other services and how they meet these expenses. The
section also looks at the circumstances of the elderly which influenced them
to decide in favour of institutional living. The results on these aspects are
presented in Tables 7-9.
This section at the first place presents information on the type of
facilities and services available within the old age homes for the elderly.
Information on this aspect is summarized in Table 7. With regard to the
nature of accommodation, the majority of the inmates i.e. 86 percent share a
room between 2-3 persons (52 percent) or between 4-6 persons (34
percent). Just 5 percent of the inmates each is provided with single room
accommodation or double room for couples while 3 percent of the inmates
reported that they share a room with seven or more persons share a room.
As regards the availability of furniture/fixtures in the room, most of the
inmates (88-93 percent each) reported the availability of beds with mattress
and pillows, cupboards and fans, although less than two-fifths reported the
availability of table/chair. About 62 percent of the inmates have
bathroom/toilet facility, either western style, or Indian style which is attached
to the room. More women (71 percent) than men (53 percent) have reported
about this type of facility. The remaining inmates reside in homes with
shared bathroom/toilet facilities. Three fourths of the inmates reported that
homes provide all meals including morning and afternoon tea, breakfast,
snacks, lunch and dinner while almost all the remaining (24 percent)
reported that they are provided just lunch, dinner and tea but no snacks. One
percent of the inmates reported that the home does not provide any meals
(Table 7) and the inmates eat out. While the majority of the inmates (79
percent) are satisfied with the quality of the meals, the remaining are not

satisfied with the meals as it does suit their health or for other reasons (Table
7).
Regarding availability of medical facility, 45 percent of the women and
one fourth of the men have reported that all medical facilities are available
free of cost, about 17-18 percent of the men and women each reported that
they have doctors who are available full time whereas 25 percent of the
women each reported about the availability of either part-time doctors or
hospital facility of the trust managed homes. Lack of health facility or no
regular visits by doctor was reported by 13 percent of the elderly women and
28 percent of the elderly men (Table 7). Thus, some form of medical facility is
available for most of the elderly in the institutions. The next aspect
explored, with regard to facilities and services in the
various old age
homes, was about the availability of entertainment and
Table
7:

Type of Services and Facilities Provided in the Old Age

Homes: Inmates Perspective, Gujarat, 2004

Type of services and facilities

Type of accommodation
Single room
Double room for couple
2-3 persons per room
4-6 persons per room
7 or more persons per room
Furniture/fixtures in the room
Bed with mattress and pillow
provided
Cupboards/Lockers to store personal
belongings for each person
Chair/table provided
Fans (ceiling/pedestal) provided
Common cupboards
Bathroom/toilet facility
Attached with room, western style
Attached with room, Indian style
Shared, western style
Shared, Indian style
Type of meals
All meals including breakfast, lunch,
dinner and tea twice
Only lunch, dinner and tea but no
snacks
No provision of any meals
Quality of meals
Satisfied with all meals

Percent distribution+
Men
Women
Total
5.3
6.1
52.6
31.6
4.4

5.0
5.0
50.4
37.0
2.5

5.2
5.6
51.5
34.3
3.4

93.9

92.4

93.1

87.7

87.4

87.6

42.1
83.3
5.3

35.3
92.4
7.6

38.6
88.0
6.4

42.1
10.5
16.7
47.4

44.5
26.9
18.5
31.9

43.3
18.9
17.6
39.5

73.7

77.3

75.5

25.4

21.9

23.6

0.9

0.8

0.9

79.8

79.0

79.4

No special food for people with

health problem
Not very satisfied
No provision of any meals
No comment/cant say
Entertainment/Recreation facilities
Television
Library
Newspapers/Magazines
Religious activities (katha, bhajan,
satsangh, religious discourses etc.)
Trips to religious places (such as
Ambaji, Dakor, Shreenathji)
Movies/hotels/picnics (once a year
or occasionally)
Others
None

11.4

1.7

6.4

16.7
0.9
-

16.8
0.8
1.7

16.7
0.9
0.9

65.8
48.2
36.8
49.1

72.3
44.5
42.9
53.8

69.1
46.4
39.9
51.5

29.8

36.1

33.0

3.5

7.6

5.6

8.8
15.8

9.2
5.0

9.0
10.3

Contd
Type of services and facilities
Medical facility
Doctors full time
Doctors part time
Hospital facility of trust
No regular doctors visit/No health
facility
All medical services are free
Consultation of the doctor is free
but medicine charges are borne by
inmates
Others
Services for personal needs
(a) Facility for washing clothes
Use washing machine at the
institute
Clothes washed by staff of institute
Use services of washerman (dhobi)
Wash own clothes
(b) Facility for cleaning utensils
Utensils cleaned by staff
(completely)
Utensils cleaned by staff (partially)
Utensils cleaned by inmates
(c) Facility for sweeping/cleaning
room
Sweeping/cleaning done by staff
(completely)
Sweeping/cleaning done by staff

Percent distribution
Men
Women
Total
17.5
18.4
23.7
28.1

16.8
25.2
25.2
12.6

17.2
21.9
24.5
20.2

23.7
18.4

45.4
16.0

34.8
17.2

4.2

2.1

5.3

2.5

3.9

36.0
0.9
57.8

31.9
2.5
63.1

33.9
1.7
60.5

36.0

31.9

33.9

43.0
21.0

51.3
16.8

47.2
18.9

36.0

31.9

33.9

47.4

58.8

53.2

(partially)
Sweeping/cleaning done by
inmates
Ways of meeting/maintaining
contact by inmates with
children/relative/friends living
outside the institute
Relatives can come and meet at
fixed timings
No restrictions of any type on visit/
relatives can come and meet any
time
Inmates can go outside with
permission
Keep in touch by telephone
Total

16.6

9.3

12.9

40.4

42.0

41.2

31.6

30.3

30.9

43.0

35.3

39.1

1.8
100.0(114)

2.5
100.0(119)

2.1
100.0(233)

+ Percentages may add to more than 100 because of multiple responses.

recreation facilities. As evident from Table 7, the majority of the old age
homes (90 percent) have some form of facilities or organised activities for
the recreation of the elderly. The availability of television is reported by 70
percent of the elderly women and men, 46 percent have reported about the
availability of library facility whereas newspapers/magazines have been
reported by 40 percent of the women. Organised activities such as religious
activities (bhajans, religious discourses, satsangh have been reported by half
of the elderly inmates. In addition, about one third of them have reported
that they are also taken on short trips to places of religious importance such
as Dakor, Ambaji or Shrinathji. Interestingly, occasional visits to
movies/hotels or being taken on picnics have also been reported by about 6
percent (4 percent of men and 8 percent of women) of the elderly. This is
indeed encouraging as such outings are likely to promote greater interaction
between the elderly as well as increase their exposure to the world outside.
Information on the provision of facilities for the fulfillment of other
basic personal needs, such as laundry, cleaning of utensils, cleanliness of
rooms, also presented in Table 7, reveals that two thirds of the elderly
reported that they wash their own clothes, 19 percent reported that they
clean the utensils used by them and 13 percent stated that the sweeping
and cleaning of the institute including their rooms is done by them. On the
other hand, 34 percent of the elderly have reported that the staff of the old
age homes carries out all these activities and they do not have to do
anything. A fairly large proportion of the elderly reported that the staff of the
institute washes the cooking utensils (47 percent) and sweeps the common
areas of the institute (53 percent), whereas they have to wash the utensils
used by them for eating and sweep and mop their rooms themselves (Table
7).

Finally, Table 7 provides information on the arrangements made by the

institute so that the elderly can meet or maintain contact with their family
and friends. As evident almost two fifths of the elderly each have reported
that their relatives can visit the old age home at fixed times everyday or that
they themselves can go out to visit with the permission of the
Superintendent or that there are no restrictions of any type and the relatives
of the inmates can visit the old age home at any time.
The next aspect was about payment made for accommodation and
other services by the elderly in the old age homes. As can be seen from Table
8, about 48 percent of the respondents have reported that they have to pay
for accommodation and other services while the rest do not have to incur
any expenses towards institutional living. Even in government-aided
institutions almost two fifths have stated that they paid towards
accommodation and other services as against 55 percent of the respondents
in private homes. Of those who reported about having to pay for
accommodation, 39 percent in government aided and 34 percent in private
institutions paid less than Rs.200/- per month while 29 percent in
government aided homes made a payment of Rs.600/- to Rs.800/- per month
and another 20 percent paid more than Rs.800/- per month. On the other
hand, 34 percent of the inmates in private institutions paid Rs.200/ to
Rs.600/ per month, although more than 20 percent reported about paying
more than Rs.1000/- per month.
Information on amount of monthly personal expenses incurred (bus
fares, alms/temple) indicates that about one-fifth of the respondents had
reported that they did not have any personal expenses while two-fifths had
reported that they spent less than Rs.100/- per month on their own needs.
About 11 percent stated that their personal expenses were about Rs.400/- or
more while the remaining 28 percent spent about Rs.100/- to Rs.400/- per
month.

Table
8:

Percentage Distribution of Elderly Inmates by Various

Expenses Incurred by them for Institutional Living,
Gujarat, 2003

Type of expenses at the old age

home
Whether
payment
made
for
accommoda-tion
and
other

Percent of inmates
GovernPrivate
ment
aided

All
Institution
s

services
Yes
No
Amount of monthly payment
made to the institute (in Rupees)
< 200
200-400
401-600
601-800
801-1000
1001-1600
1601+
Total
Amount of monthly personal
expenses (in Rupees)
No personal expenses
<100
101-200
201-400
401-600
601+
Source of money for meeting
various expenses at the institute
Own savings/investment/pension
Assistance from children
Assistance from relatives
Current earning/gainful
occupation
Individual
donors/visitors/neighbours
Trust/Trustee
Total

39.4
60.6
39.0
2.4
9.8
29.3
9.8
9.7
100.0(41)

55.0
45.0

48.1
51.9

33.8
35.7
12.7
8.9
21.1
17.0
2.8
12.5
7.0
8.0
11.3
10.7
11.3
7.1
100.0(71) 100.0(112)

20.6
39.9
16.3
12.0
9.0
2.1

42.2
16.6
26.7
7.5

7.5

7.5
100.0(233)

Regarding the source of money for meeting various expenses at the

institute, the major sources reported, which are presented in Table 8, are
personal
savings/investments or pension (42 percent), followed by assistance from
relatives (27 percent) and assistance from children (17 percent). About 8
percent each have reported that their main sources are either from their
current earnings or, assistance from neighbours, individual donors or visitors
to the institute or assistance from the trust or trustee of the old age home
(Table 8). The fact that assistance from relatives rather than children is
reported by a greater proportion is due to the fact that some of the elderly
had not married and therefore had no children. Further, some had no

children despite being married while a few reported that their children did
not give them any monetary assistance.
Circumstances which Influenced the
Decision for Institutional Living
An exploration of the reasons for choosing institutional living provides
glimpses of lives of the elderly in present day Gujarat under changing
familial values. This aspect is further discussed a little later in the report. As
evident from Table 9, the major reasons for choosing to live in an old age
home are due to own or spouses ill health or disability or not having anyone
to take care of them (45 percent), nominal or no cost for the fulfillment of
basic needs (38 percent), to avoid familial conflict (especially with children)
or for peace of mind and to be cared for in a better way (34 percent each).
Two other reasons, which indicate the physical and psychological state of the
elderly are lack of physical space for of the elderly who live with children and
grandchildren or that they did not want to be a burden on family members
(19 percent) and to be able to live a life of dignity and self respect (11
percent) which the elderly felt they did not enjoy by staying with married
children. No major differences are noted on this aspect between the elderly
men and elderly women respondents.
A related issue explored was the person or persons who were
instrumental in the decision of the elderly to seek institutional care. Almost
three fourths of the men and a little over half the women reported that it was
their own decision to live in an old age home (Table 9). A further 45 percent
of women and 21 percent of men reported about the role played by relatives
in helping them decide on institutional living as a better option over familial
living. Neighbours or friends have been instrumental in case of 30 percent of
men and 9 percent of women while children have played a role in the case of
22 percent of women and 8 percent of men (Table 9). Regarding information
about the source of knowledge about the old age home where the elderly are
residing, neighbours/friends/relatives have been reported as the major
source (55 percent), followed by the respondents own contact with the
institute or that the institute was of repute and therefore was known to them
(Table 9). Mass media and social workers have played minimal role in
creating adequate awareness in this regard.

Table 9: Percentage
Distribution
of
Elderly
Inmates
by
the
Circumstances which Made them Opt for Institutional Living,
the Persons Instrumental in this Decision Making and their
Source of Knowledge About the Old Age Home they Chose to
Live in, Gujarat, 2003

Decision making for

institutional living
Circumstances that influenced
the decision for institutional
living
To be cared for in a better way
Due to familial conflict/For
peace of mind
Did not want to be a burden on
family members/lack of physical
space
Due to own/spouse ill-health
or dis-ability/have no one to
take care of self
For companionship
All basic needs are taken care
of at a reasonable cost/free
To live a life of dignity/live with
self respect
Others
Persons instrumental in the
decision
Self
Children
Relatives
Neighbors/friends
Social worker
Religious leader
Trustee of old age home
Others
Source of knowledge about the
old age home
Own contact with
institute/well-known institute
Children
Media
(Newspapers/Magazine/Radio/
T.V.

Percent distribution+
Men
Women
Total

30.7
32.5

37.8
35.7

34.3
33.9

15.8

21.0

18.5

42.1

47.1

44.6

7.0
42.1

2.5
34.5

4.7
38.2

11.4

10.1

10.7

8.8

10.1

9.4

73.7
7.9
21.1
21.9
6.1
1.8
1.8
3.5

52.1
21.8
45.4
9.2
4.2
3.4

62.7
15.0
33.5
15.5
5.2
0.9
0.9
3.4

16.7

17.6

17.2

0.9
9.6

11.8
0.8

6.4
5.2

 Religious leader/organization
Trustee
Neighbors/friends/relatives
Family doctor
Social worker/employer etc.
Cannot say
Total

8.8
6.1
54.4
2.6
4.4
0.9
100.0(114
)

7.6
3.4
55.5
4.2
100.0(119
)

8.2
4.7
54.9
1.3
4.3
0.4
100.0(233
)

+ Percentages may add to more than 100 because of multiple responses.

Health and Illness Management

Health and illness are important concerns in old age. Visual, auditory,
dental and mobility problems, weakening of muscles, loss of appetite,
anemia, sleeplessness, and minor gastric disorders are some of the common
afflictions of ageing. In this regard, the study has explored the various health
problems or illnesses experienced by the elderly at the time of the interview.
Data on this aspect is presented in Table 10. As is evident, while the list of
varied types of illnesses or health problems is fairly long, the proportion of
elderly currently suffering from some of them is not very large. In fact, about
14 percent of the elderly men and women have reported that they do not
have health problem or illness. The major health problems reported by the
respondents are arthritis/joint pain (50 percent), followed by visual problems
(31), back pain (29), anemia/weakness (21) and sleeplessness and mobility
(20 percent each). About 17 to 19 percent have reported auditory problems,
hypertension, muscular weakness and lapses in memory. Asthma and
respiratory problems have been reported by 14 percent while cataract has
been mentioned by 13 percent. Gastric problems/acidity and constipation,
which are often more associated among the elderly due to weakening of the
alimentary system, are reported by just 3 percent each of the respondents
(Table 10). Sex wise differentials can also be noted from Table 10. Overall, 89
percent of the elderly women have reported at least one current health
problem or illness as against 83 percent of elderly men. Problems of back
pain, mobility and joint pain/arthritis are noted more among women (38,24
and 57 percent respectively) than among men (20,17and 43 respectively).
Anemia/ weakness has been reported by 28 percent of the women as against
13 percent of men. Sleeplessness and hypertension each were reported by
24 percent of women and by 13 and 24 percent of men respectively.
Asthma/respiratory problems have been reported by a greater proportion of
elderly men (20 percent) as compared to 8 percent of women. Thus, it seems
that morbidity among women during old age is relatively more than among
the men.
The aspect on health and illness was further explored with regard to
treatment seeking, for those reporting a health problem or illness. This
information, which is presented in Table 11, looks at treatment for current

illness as well as that, which occurred, in the recent past. Of those who had
reported a current health problem, about 28 percent of them had not sought
any treatment for the same. The majority of the remaining had resorted to
allopathic treatment (64 percent), followed by ayurvedic (9 percent) and
homeopathic (7 percent) treatment, while about 3 percent had resorted to
home remedies (Table 11). The results on treatment taken for illness in the
recent past (one week, one month and one year prior to the survey) also
indicate that of those elderly who had such an illness/health problem, the
majority (90 to 95 percent) had sought treatment. Finally, the opinion of the
elderly about their health in general was sought. As can be seen from Table
11, about 23 percent considered themselves to be very healthy while 62
percent felt they were fairly healthy. It is heartening to note that no major
sex differentials are noted on this aspect of health and illness management,
indicating that both men and women equally are seeking treatment for their
health problems.

Table
10:

Experience of Various Health Problems Reported by

Elderly Inmates at the Point of Survey, Gujarat, 2003

Current health problem/illness

Percent distribution+
Men
Women

Total

None

17.5

10.9

14.2

Visual

29.8

31.9

30.9

Cataract

12.3

14.3

13.3

Auditory

19.3

16.8

18.9

Dental

15.8

18.5

17.2

Mobility

16.7

23.5

20.2

Arthritis/Joint pain

43.0

57.1

50.2

Weakness of muscles

15.8

21.8

18.9

Back pain

20.2

37.8

29.2

Anemia/Weakness

13.2

27.7

20.6

Loss of appetite

5.3

9.2

7.3

Sleeplessness

15.8

23.5

19.7

Lapse in memory

18.4

16.8

17.6

Depression

0.9

10.1

5.6

Speech difficulty

2.6

5.0

3.9

Partial paralysis

2.6

0.8

1.7

Respiratory/Asthma

20.2

8.4

14.2

Urinary

7.0

6.7

6.9

Prostate

3.5

2.1

Hernia

3.5

1.7

2.6

Hypertension

13.2

24.4

18.9

Low blood pressure

3.5

6.7

5.2

Cardiac

9.6

8.4

9.0

Diabetes

7.9

8.4

8.2

Gastric/acidity

1.8

4.2

3.0

Constipation

2.6

3.4

3.0

Skin disease

0.9

1.7

1.3

Others

3.5

9.2

6.4

Total number of inmates

114

119

233

+ Percentages add to more than 100 because of reporting more than one illness/health
problem by the respondents.

Table
11:

Treatment Availed by Inmates for their Current and Past

Health Problems/Illness, Gujarat, 2003

Treatment for current & past

illness

Men

Percent distribution
Women
Total

Type of treatment for current

health problems/ illness
No treatment taken

27.7

27.4

27.5

Allopathy

63.8

64.2

64.0

Ayurveda

12.8

5.7

9.0

Homeopathy

6.4

6.6

6.5

Home remedies

2.1

Treatment currently availing:

Total

100.0*(94)

3.7
+

100.0*(106)

3.0
+

100.0*(200)+

Illness during the recent past

and its treatment
Illness during last one week

7.9

8.4

8.2

Treatment taken

88.9

90.0

89.5

Illness during last one month

14.0

17.6

15.9

Treatment taken

93.8

95.2

94.6

Illness during last one year

14.9

28.6

21.9

Treatment taken

94.1

94.1

94.1

Very healthy

23.7

21.8

22.7

Fairly healthy

61.4

61.3

61.4

Not healthy

14.9

16.8

15.9

Inmates opinion about their

health in general

Total

100.0

100.0

100.0

Number of respondents

114

119

233

* Percentages may add to more than 100 due to multiple responses.

+ Includes only those who are currently availing treatment for their health problems.

Psycho-emotional and Social Aspects of

the Elderly Living in Old Age Home
The final aspect studied provides an idea of the psychological,
emotional and social aspects of the elderly living in old age homes as
reflected by their satisfactions and dissatisfactions with various services
provided and the advantages of such institutional living arrangement as
against the disadvantages as well as their sense of isolation (being away
from children and family) or whether such an arrangement provides the
much needed comfort, solace and companionship of age- mates and the
freedom to pursue their own activities without constraints. This section ends
with an exploration of the opinions of the elderly regarding children as old
age support and who they feel should care for the elderly, in the context of
changing familial values. Findings on these varied but related issues are
presented in Tables 12-14.
Satisfaction with Service Provision
As is evident from Table 12, the majority i.e. 86 percent of the elderly
respondents has reported their satisfaction with the various services
provided in the old age homes. The major reasons reported for expressing
satisfaction are because of good services and good behaviour of the staff (58
percent), food being palatable and wholesome (32), accommodation being
satisfactory (27), and they have the freedom to pursue and participate in
religious activities (15). A few have also mentioned about the good medical
facility available at the institute (10 percent) and that the entertainment and
library facilities are also good (2 percent). In addition, about 5 percent have
stated that they have to be satisfied with the services as they have no choice
and that they have accepted and are resigned to this way of living (Table 12).
This last view is also voiced by a large majority of those who expressed their
overall dissatisfaction with various services in the old age homes. As can be
seen from Table 12, about 14 percent of the elderly had expressed their
dissatisfaction out of which 58 percent stated that they felt this way as they
had no choice but to live here and had therefore resigned themselves to this
way of life. A few among this group also refused to gave any comments and
were found to just turn away from this line of questioning, indicating the pain
they felt with such an arrangement. The other reasons reported for
dissatisfaction were the inadequacy of basic facilities of light, fan,
entertainment and staff (16 percent), followed by food not being to their
liking or not suiting their health (13 percent) and loss of freedom to live the
way they want and restrictions in their movements because of the rules of

the institute (10 percent). Just 3 percent have expressed their dissatisfaction
with medical and health care facilities provided (Table 12).

Table
12:

Satisfaction and Dissatisfaction Expressed by the

Inmates with the Services Provided at the Old Age
Homes, Gujarat, 2003

Satisfaction/Dissatisfaction with the services

Satisfied with services
Not satisfied with services
Reasons for satisfaction

All services are good/good behaviour of the staff

Services are free/at low cost

Food is good/wholesome food/find food suitable

Accommodation satisfactory

Good medical facility/medical care is good

Have freedom/facility to participate in religious

activities
Entertainment/library facility is good
Have no choice/have to be satisfied with
services/accepted the way of living

Total
Reasons for dissatisfaction

Have no freedom to live the way want/have to follow

institutes rules/restriction in movement
Food does not suit health/food is not good
Accommodation is not adequate/lack of
space/sharing room with other inmates who are not
like-minded or not accommodative
Not satisfied with medical/health care service
Basic facilities like light, fan, staff to clean utensils &
clothes and entertainment are inadequate

Percent
distribution of
Inmates
85.8
14.2
57.5
14.0
31.5
26.5
9.5
15.0
1.5
4.5
100.0*
9.7
12.9
9.7
3.2
16.1

No comment/No other option but to live

here/resigned to circumstances

Total

58.1
100.0*

* Percentages may add to more than 100 due to multiple responses.

Advantages and Disadvantages of Institutional Living

Regarding the various advantages and disadvantages of living in an old
age home, presented in the Table 13, it is noted that mental well being
associated with institutional living (33 percent) and all basic needs taken
care of by good and caring staff (49 percent) are the major advantages
reported. It is interesting to note from Table 13 that a much higher proportion
of elderly men (40 percent) than elderly women (25 percent) have stated
that they consider the stress free environment, peace of mind and absence
of conflicts (with children) as the major

Table
13:

Opinions and Attitudes Regarding Institutional Living

Expressed by Inmates , Gujarat, 2003

Opinions / Attitudes
1
Advantages of institutional living
Stress free environment/ no
conflicts/ peace of mind
Looked after very well/all needs
taken care of /services of low or
no cost / staff is good and caring
Free from responsibility of
maintaining a household at this
age
Can pursue religious activities
as desired
Company of other age-mates
Personal security/safety
No choice/have no one to care
for us/can not look after self
Cannot say

Total

Disadvantages of institutional
living
No disadvantages
Have to live according to
institutes rules/ it is like living in
a jail
Away from family and
relatives/feeling of being
isolated/minimum interaction
with out side world
Inadequate medical care/lack of
cleanliness of rooms, bath-rooms
and toilets
Sharing accommodation with
unknown people
Food is not suitable/palatable
Loss of self respect/living on
charity/ institutional living is
painful
Cannot say/no comments/dont
want to say

Total

Given a choice, preferred place

of stay/ arrangement in ones old

Percent distribution
Men
Women
Total
2

40.4

25.2

32.6

50.9

47.9

49.4

19.3

12.6

15.9

15.8

21.8

18.9

12.3
13.2

14.3
5.0
10.9

13.3
2.6
12.0

8.8
100.0*

6.7
100.0*

7.7
100.0*

68.4
4.4

58.8
8.4

63.5
6.4

15.8

19.3

17.6

2.7

0.8

1.8

5.0

2.6

1.8
2.6

4.2
4.2

3.0
3.4

8.8

5.9

7.3

100.0*

100.0*

100.0*

age
Old age home
With family
Either arrangement, depending
on the circumstances

Total

1
Reasons for preferring old age
home
For self respect/peace of
mind/away from familial
conflict/more freedom/this is the
best option at this age
Lack of affection in family/no
familial support
Lack of economic support
Do not want to be a burden on
any one
Have no one to take care/absence
of close family members
Fulfillment of all
needs/requirement/do not have to
depend on any one
Can pursue religious activities
without disturbance/can live our life
of Sanyansin (Sainthood)
Other (such as company of
others/low cost of need fulfillment)

Total

Reasons for preferring familial

living
Home is home/it is more
comforting/you are with your own
people/can share joys and sorrows
together/better to die in presence
of family members
Have rights over family
members/no obligations
It is more respectful to live in
family
Can live as we wish/easy to adjust
with own family members/have
freedom
To enjoy grandchildren/great
feeling to live with grandchildren
No substitute for home in old age

Total

60.5
32.5
7.0

58.8
31.1
10.1

59.7
31.8
8.6

100.0*(114) 100.0*(119)

100.0*(233)

44.9

37.1

41.0

26.1

25.7

25.9

8.7
14.5

8.6
10.0

8.6
12.2

24.6

24.3

24.5

30.4

28.6

29.5

5.8

10.0

7.9

7.2

2.8

5.1

100.0*(69) 100.0*(70)

100.0*(139)

73.0

70.3

71.7

10.8

8.1

9.5

5.4

10.8

8.1

8.1

10.8

9.5

2.7

2.7

2.7

10.8
10.8
100.0*(37) 100.0*(37)

10.8
100.0*(74)

Reasons for those who would opt

for either (old age home or family)
arrangement, depending on the
circumstances
Individual should stay where they
have self-respect
Being bachelor/spinster/having no
family or children, can not
opine/might have no option
If there is no income/economic
support, then institutional living is
better
If children are affectionate and
take care, then one should opt for
familial living, otherwise old age
home/if there is no conflict in the
family, then familial living is better
Others

Total

1
Whether inmates feel lonely living
in an institute away from children
and relatives
Yes
No
Cannot say
Reasons for feeling lonely in the
institute away from children and
relatives (Yes group)
It is natural to miss children and
family/ feel isolated from social life
Have brought up children with
love and care and would like to be
with them
Affection and care of children is
absent/ despite ill treatment by
children we miss them
Others

Total

Reasons for not feeling lonely in

the institute away from children
and relatives (No group)
Dont miss children because they
have no love or respect for us/they
are self-centered
We are in contact with children
and relatives/ children and
relatives come to visit us and we

37.5

25.0

30.0

12.5

33.3

25.0

8.3

5.0

33.3

35.0

8.3
100.0*(12)

10.0
100.0*(20)

37.5

12.5
100.0*(8)

17.5
81.6
0.9

26.1
73.9
-

21.9
77.7
0.4

65.0

45.2

52.9

15.0

29.0

23.5

25.0

25.9

25.5

5.0
6.4
100.0*(20) 100.0*(31)

5.9
100.0*(51)

11.8

14.8

13.3

6.5

12.5

9.4

can also go to visit them

Have no close family/used to
living alone, not having married
Have come to terms with our
life/have made our life/this is our
home
Have made friends here/have
company here
Staff takes care of us/staff is
good to us/services and facilities
are good
Have freedom to do what we
want
Living with spouse
Cannot say

Total

Whether the inmates are happy

about their stay in the old age
home
Very happy
Happy
Some what happy
Not happy
Not at all happy
Cannot say

10.8

8.0

9.4

14.0

18.2

16.0

30.1

31.8

30.9

8.6

11.4

9.9

19.4

13.6

16.6

8.6
1.1
7.5
4.5
100.0*(93) 100.0*(88)

29.8
33.3
30.7
3.7
1.8
0.9
100.0*(114)

Total
* Percentages may add to more than 100 because of multiple responses.

26.0
37.0
33.6
1.7
1.7
100.0*(119)

5.0
6.1
100.0*(181)

27.9
35.2
32.2
2.6
1.7
0.4
100.0*(233)

advantages, probably indicating that women may have been better able to
cope with the emotional upheavals of familial living. For women, the
proportion reporting the freedom to pursue religious activities as desired (22
percent), is a little more than the same reported by the men (16 percent),
again indicating the basic difference between the sexes on their interests
and pursuits.
Not surprisingly, almost equal proportions of the men and women (4851 percent) have reported that they consider the low or no cost of
services/all their basic needs being taken care and being well looked after to
be the major advantages of living in an old age home. In addition, almost
equal proportions (11-13 percent) have also reported that such a living
arrangement is of benefit to them as either they cannot look after
themselves or they have no one to take of them. In fact, this is, on a way, a
forced choice, as reported by this proportion of the elderly respondents
(Table 13).
With regard to the perceived disadvantages of living in an institute, 64
percent of the elderly (68 percent men and 59 percent women) do not
consider any disadvantages with such an arrangement. The feeling of
isolation living away from family and friends and the outside world, in

general, is the major disadvantage reported by 18 percent of the elderly.

Other disadvantage, which arises out of the restrictions, as reported by
about 6 percent, is that they feel they are living in a jail and the resentment
they feel having to live according to the rules of the institute. Surprisingly,
more women (8 percent) than men (4 percent) have reported this loss of
freedom as a disadvantage of living in an old age home (Table 13). Some of
the other disadvantages reported by about 2-3 percent each of the elderly
are the lack of cleanliness of accommodation, bathrooms and toilets, sharing
accommodation with unknown people, unsuitable food and the loss of self
respect and the feeling of living on charity (of such an arrangement) which
causes than pain.
The respondents were therefore asked about their preferred living
arrangement. As evident from Table 13, three-fifths of the elderly men and
women (60 percent) have reported that they would choose to stay in an
institute, 32 percent reported that they would prefer to stay with family and
the remaining opined that either institutional or familial living arrangements
would be acceptable to them, depending on the circumstances, i.e. if they
have someone who would look after them they would prefer to live with
family, otherwise institutional arrangement, is better. Among the reasons
reported for preferring institutional living arrangement the major ones
reported are for self-respect/ peace of mind/absence of familial conflict (41
percent), followed by fulfillment of all basic needs/requirements and not
having to depend on the whims of family members (30 percent), lack of
familial affection and support (26 percent) and absence or no close family
members to take care of them as reported by 25 percent of the elderly (Table
13).
Among about 32 percent of the elderly who had opined that given a
choice they would prefer to live with family members in their old age, the
major reason reported by as high as 72 percent of them, being the feeling of
comfort and belongingness with ones own children, being able to share the
joys and sorrows together and finally the sense of security of dying in the
presence of loved ones. About 10-11 percent each have also reported about
the rights they can exercise over family members, the respect they would
have (in society) living with family members and the ease of adjusting with
ones own family than with strangers. Of those who stated that either
arrangement would be acceptable, depending on the circumstances, about
35 percent reported that familial living arrangement is preferable if children
are affectionate, take care of older parents and there is no conflict between
the two generations, while 30 percent of the elderly reported that a person
should stay wherever they have self respect. Another 25 percent stated that
since they had not married and had no children, they were not in position to
voice their opinion (Table 13).

To further understand the emotional state of the elderly, the

respondents were asked whether they felt lonely living away from their
children and the reasons for the same. An overwhelming 78 percent replied
in the negative indicating that they did not feel lonely living in an institute
(Table 13). A closer examination of the reasons for expressing this view
reveals that about 31 percent said that they have made friends at the old
age home, about 17 percent reported that they now have the freedom to do
what they want, while 16 percent stated that they have come to terms with
their life and consider the institute as their home now (Table 13). About 9
percent have stated that they are in touch with their children and relatives
and they visit each other while an equal proportion reported that they do not
experience loneliness as they had no close family and were used to living
alone before coming to the old age home. Once again, the void created by
the absence of close family members is filled by the good care taking
provided by the staff of the institute as reported by 10 percent of the elderly
respondents (Table 13).
While more than four-fifths have stated that they do not feel loneliness
living away from children, their answers and justification, however, reflect an
artificial armour which they have created around themselves to protect
against the emotional pain meted out by children. Only 22 percent of the
elderly admitted that they did experience loneliness living away from their
children. Among this group, 53 percent replied that it was natural to miss
children and that living in an institute isolated them from social life. Another
26 percent stated that despite the ill treatment meted out by children (the
elderly being forced to live in an institute), they missed them and their love
and affection. The remaining almost one fourth of the respondents reported
that since they had invested emotionally in the upbringing of children, they
would like to spend their life with them. (Table 13). All these reasons reflect
the pain that is associated with the severing of the strong familial bond that
these elderly parents are experiencing in the last stage of their lives.
An overall indicator of the emotional state of the elderly can finally be
assessed from their response to how happy they are about their stay in the
old age home. As revealed from Table 13, about 63 percent of the
respondents are very happy or happy while 32 percent are somewhat happy.
Just 4 percent expressed the view that they are not happy with this living
arrangement while less than 1 percent reserved their opinion on this aspect.

Table
14:

Opinions of the Inmates Regarding Children as Old Age

Support and Who Should Care for the Elderly in the Context of
Changing Familial Values

Opinion

Percent distribution
Men
Women

Whether the elderly agree with the view

that children are the main support for
parents in old age

Yes
67.5

No
28.9

Cannot say
3.5
Total
100.0(114)
Reasons for considering children as
main support in old age (Yes group)

Parents have given birth to children/

57.3
children are expected to support parents/
why else do people have children

It is a tradition/customary for children

37.7
to look after elderly parents

When children are young parents look

5.2
after them, so in old age children should
care for their ageing parents

Only sons are expected to support

parents in old age, but not daughters

Others

Cannot say
3.9
Total
100.0*(77)
Reasons for not considering children as
main support in old age (No group)

Children have become selfish/want to

30.3
live their own lives without responsibility
of parents/ children forget sacrifices
made by parents

In pursuit of economic and professional

6.2
growth children dont want to care for
the elderly

God is our only support

12.1

Son may be willing but daughter-in-law

9.1
may not be willing to look after the
elderly

If parents have money, only then

21.2
children will look after them in old age

Others
15.2

Cannot say
12.1
Total
100.0*(33)
Who should care for the elderly in the
context of changing traditional family
values and ties

The elderly themselves

13.2

Son(s)
41.2

Daughter(s)
2.6

Both sons and daughters

26.3

Government

Spouse
39.5

Cannot say
7.0
Total
100.0(114)
* Percentages may add to more than 100 because of multiple responses

58.0
41.2
0.8
100.0(119)

Total

62.7
35.2
2.1
100.0(233)

63.7

60.3

31.9

34.9

4.3

4.8

2.9

1.4

2.9
100.0*(69)

1.4
2.1
100.0*(146)

38.8

35.4

12.2

9.8

20.4
12.2

17.1
11.0

6.1

12.2

12.2
6.1
100.0*(49)

13.4
8.5
100.0*(82)

6.7
45.4
4.2
23.5
34.5
3.4
100.0(119)

9.9
43.3
3.4
24.9
36.9
4.7
100.0(233)

Are children still considered the main support for ageing parents?
In view of the fact that many of the elderly respondents living in the
old age homes are doing so despite having children of their own, whom they
had probably expected would care them in their old age, it was thought
pertinent to find out whether they still consider children as the prime support
in old age. As evident from Table 14, a large proportion of the elderly, 63
percent reported that they still consider children to be the main support in
old age. Among this group, three fifths of the respondents reported about the
reasons such as it is natural for children to look after ageing parents, it is
expected role/duty of children to care for parents and is the main reason why
people have children. Another 35 percent replied that it is customary for
children to look after parents. These reasons reflect the values adhered to by
ageing parents who invest heavily in children for securing a better future
when they themselves are unable to fend for themselves. Table 14 also
shows that 35 percent of the elderly men and women reported that they do
not consider children to be their main support in old age. Their reasons for
expressing this view indicate their pain and feelings of betrayal by children.
As can be noted from Table 14 about 35 percent reported that children have
become selfish and do not want the responsibility of ageing parents. About
17 percent opined that only God is their support, 12 percent indicated a
reason which points to the greed and selfishness of children i.e. that children
will only look after parents if the latter had money while 11 percent reported
that the son may be willing to look after the elderly parents but the
daughter-in-law would not like this responsibility.
In view of these responses, the elderly were therefore asked who they
feel should care for them in the context of changing traditional family values.
It is interesting to note from Table 14, that children still feature largely in the
care of ageing parents since 43 percent reported that sons should care for
the elderly and 25 percent felt that both sons and daughters should take
care of the elderly. About 37 percent reported that the spouse should care for
them, probably forgetting that the spouse is also getting old or that one of
them would probably die earlier than the other. Surprisingly, not a single
respondent has voiced the role of the government in providing the much
needed support in the care of this group of the population, whose numbers
are going to increase in the future.

SUMMARY AND CONCLUSIONS

The present study was undertaken with the overall objective of

understanding the existing institutional facilities available for the care of the
elderly and to obtain the perspectives of the elderly men and women living
in old age homes regarding institutional living, in the state of Gujarat. A
sample of 25 old age homes, government aided and NGO managed, from
various parts of Gujarat was selected to obtain information on institutional
facilities from the managers of these homes. A further sample of 233 elderly
men and women (about 9-10 from each home) was also drawn to obtain
perspectives of the elderly. Interviews with the managers of the old age
homes has revealed that a little over half of the old age homes have been in
existence for more than 15 years while just five institutions are relatively
new as they had been established during the last 5-6 years. All the surveyed
homes are residential in nature and since most of them are NGO supported,
their major source of funding is either through individual donors or by the
trust that has established them.
Almost fifty percent of the homes surveyed either do not charge
anything for accommodation and other services from inmates or waive the
charges for those who cannot pay, less than half require compulsory full
payment from all inmates whereas just two managers reported that they
charge a nominal amount from the
inmates. The intake capacity of the
homes varies from 25-100 and more and most of them accommodate both
men and women. Very few homes are for only men or only women.
The results of interviews with the heads/managers of the old age
homes has also revealed that they are unable to meet the growing demand
for old age homes as reported by more than two-thirds of the institutional
heads. Furthermore, despite charging the elderly for accommodation and
other services, the institutions are not adequate with respect to various
services and staff for care taking due to inadequacy of funds. Yet another
important limiting feature of the old age homes surveyed, pertains to their
criteria for admitting an elderly person. Majority (four-fifths), of these
institutions, do not admit the elderly who have any diseases, especially
infectious diseases, are unable to take care of themselves or are not in good
physical and mental health. In fact, this is the group most likely to be in need
of good health and medical care. Regarding the difficulties of managing such
an institute is the inadequacy of funds for medical care and other service
provision as well as in employing sufficient number of staff for care of the
elderly.
The perspective of the elderly living in old age homes sheds light on
their socio-economic and other characteristics and attitudes towards
institutional living. It is noted that the majority are not highly educated,
particularly elderly women, and were in lowly paid jobs with meager savings
to meet their requirements during their old age. The background
characteristics further reveal that about 29 percent of elderly men and 8

percent of elderly women had never married. The proportion of widows was
much higher (64 percent) than widowers (35 percent). With regard to their
familial background, it is interesting to note almost one fourth of the elderly
had lived alone prior to coming to the old age. Among them, more men (28
percent) than women (20 percent) had reported that they had lived alone.
The picture with regard to living arrangements in the old age homes shows
that the majority of the elderly have to share a room and toilet facilities with
other age mates in the institute, which often causes conflict among them.
Some have also reported on the dissatisfaction with the quality of meal
provided. Regarding experience of health problem or illness, the results
indicate that the majority i.e. 86 percent have reported the common
problems of ageing such as failing eye-sight and hearing, arthritis, dental
problems, weakness, sleeplessness, lapses in memory, asthma,
hypertension, problems in mobility and back pain. Relatively more women
(89 percent) than men (82 percent) have reported about a current health
problem. There opinions regarding satisfactions and dissatisfactions with the
various services indicates that the majority are satisfied with the services
provided and with the care taking of the staff.
Among the reasons for choosing institutional living arrangements, the
absence of close family and relatives to take care of them coupled with their
own ill health or that of their spouse is the foremost reason reported by the
elderly. This is, in fact, further supported by their background characteristics
wherein 18 percent of the elderly had never been married, while about 57
percent were either widowed or divorced.
Most startling are the results, which indicate that the demand for
institutional living arrangements in the face of weakening traditional familial
support has increased as grown-up children find it difficult to simultaneously
care for their own children and ageing parents. This virtually compels the
elderly to move out of the care of the family to such impersonal
arrangements, where they are struggling to make a new meaning of their
lives, seek solace and comfort in age mates, adjust to the discipline of
institutional living and to unfamiliar living arrangements including the
peculiarities of age mates. Such familial conflicts as a cause for choosing
institutional care finds confirmation from the fact that more than fifty percent
of the elderly had been living in a joint family before coming to the old age
home. In addition, about one third have reported that they choose such an
arrangement due to familial conflict, about 11 percent stated that such an
arrangement enabled them to live a life of dignity and self respect and a
little less than one-fifth had chosen institutional living as they did not want to
be a burden on family members.
Finally, the results suggest that while the physical ties of the elderly
men and women with their adult children have weakened or snapped
completely, their psychological and emotional bond with them remains

strong. This is reflected by the fact that more than sixty percent of the
elderly living in old age homes still adhere to the view that children are the
main support for parents in old age. It is therefore a sad reflection that these
expectations of the elderly for the care and comfort from their children
remain unfulfilled. The results therefore suggest that the state should be
prepared to meet the need for good institutional living arrangements for the
elderly as the demand for such care is likely to rise in the future.
Simultaneously, some sort of counseling services will also need to be
developed and incorporated in the larger programmes for the elderly to
address their psycho-emotional health in addition to the service provision for
their physical health.

REFERENCES
Dandekar, K. 1993. The Aged, Their Problems and Social Intervention in
Maharashtra. Economic and Political Weekly, Vol. 27(23), June 5,
pp.1188-94.
Das, N.P. and Urvi Shah 2001. The Social and Health Status of the
Elderly in India: Evidence from Recent National Level Data. A
special report prepared as a part of the research initiative at the
Population Research Centre, Baroda for the MOHFW, New Delhi.
Government of India. 1991. Socio-Economic Profile of the Aged Persons: NSS
42nd Round (July, 1986 June 1987). Sarvekshana. Vol. 15. No.2,
Issue No.49, Oct. Dec. 1991, National Sample Survey Organization
(NSSO), Department of Statistics, Ministry of Planning, New Delhi.
Government of India. 1998. The Aged in India: A Socio-Economic Profile,
NSS Fifty-Second Round, July 1995 June 1996, NSSO, Department of
Statistics, Ministry of Planning and Programme Implementation.
Government of India. 2000. Elderly in India Profile and Programmes
2000. Central Statistical Organization, Ministry of Statistics and
Programme Implementation. New Delhi.
Rajan I.S., U.S. Mishra and P. Sankara Sarma. 1999. Indias Elderly Burden
or Challenge. Sage Publications, New Delhi.

Rao, V.A., P.M. Vasudevan and T. Madhavan. 1982. Psychosocial Aspects of

Geriatric Population. In A Kiev and A. Venkoba Rao (eds.), Reading
in Transcultural Psychratry, Madras: Higginbothams.
Sharma, S., 1999. Elderly in India: Their Mental Health Poblems. In Arun P.
Bali (ed.), Understanding Greying People of India, Inter-India
Publications, New Delhi.
Sharma, S.P. and Peter Xenos. 1992. Ageing in India Demographic
Background and Analysis Based on Census Materials.
Occasional Paper No.2, 1992. Office of the Registrar General and
Census Commissioner, Government of India. New Delhi.
United Nations. 1987. Population Ageing: Review of Emerging Issues, Asian
Population Studies, Series No.80, Economic and Social Commission
for Asia and the Pacific, Bangkok, Thailand.
1