There are many constraints commonly voiced by NRIs when they are discussing ways to take care of their ageing parents back in India, especially after some medical event has made their parents less independent than before. Many of these constraints do not take into consideration ground realities and what is best for their parents.  This article lists some of these contraints raised in order to highlight the fact that it is important for the NRIs to understand that the situation has changed and they and their parents need to adapt to the new circumstances.

1.  My parents don’t want to leave the house/area they are currently living in.

This is one of the commonest requests.  “My parents have always been independent and capable of looking after themselves.  However, since my father had his operation/ has become bedridden, things have become very difficult for them to manage on their own.  However, they don’t want to move out of their house“.

If one or both of your ageing parents are living in an independent house or even an apartment and are no longer capable of managing their daily living activities, and there is no one else to help them, then you should have all options on the table, including the possibility of moving into a care centre (if available).

2.  We don’t want a full-time live-in person as it will impact their privacy. Is it not enough for someone to come only for the morning/night?

Having someone around 24 x 7 is absolutely essential if your parents’ capacity to look after themselves is diminished.  If you have someone during the day and no one at night, what happens if your mother needs to go to the bathroom in the middle of the night?  Or has breathing difficulties?  Or requires water to drink? Or has some other medical emergency?

If you have someone at night but not during the day, who will help them bathe, eat, and perform other daily living activities.

3.  We don’t mind having 2 shifts one coming in the morning and one coming in at night, but they should bring their own food and not use our bathrooms.

If you have two people working round the clock, then you are talking about two 12-hour shifts.  So let us say, one comes in and stays from 8 AM to 8 PM, and the other comes in at 8 PM to 8 AM next morning. It is going to be extremely difficult for them not to have at least one meal and some coffee/tea during their 12-hour period. Or use the rest room for that matter.  Would you work under such conditions?  And even if somebody is willing to, do you think they will be able to give the kind of care you expect for your parents?

4.  Not understanding recovery periods.

“My mother broke her hip and has had her operation.  I am here to look after her.  I am sure she will be back on her feet in a month and I can go back.  Nothing needs to change“.

Yeah! Right!
As people get older,  recovery takes longer.  And even after they recover, they are unlikely to get back to their old independent self. At least not in the majority of the cases.  Face the facts. Things have changed.  You have to deal with it.

5. My parents only eat what they have cooked.

Well, if they are no longer able to cook, then they have no other option but to hire a cook or order food from outside. Can you think of any other option?

Well, we aren’t here to dismiss your constraints and worries.  You are far away from your parents and neither party can move in with the other.  These are ground realities.  Everyone knows you as an NRI would find it extremely difficult if not impossible to uproot yourself from home, family and career to come back to India to look after your parents.  Just don’t let that guilt stop you from making other hard decisions.  Put your foot down where you need to, and make the changes that you have to. If it costs you more, well, just figure out a way of taking care of it.  The well-being of your ageing parents is still your responsibility.

Every week we get calls from around the world asking us the same question. “Can you recommend someone who would look after our ageing parents back in India?”.

Unfortunately, in most cases the short answer is “no”.

While India may be the head quarters of outsourced services for the software and back-office industries, we are as yet unable to find high-quality service providers for looking after ageing parents.

This is not just because there are so few such home health care agencies ready to take on such a role, but is also because of the myriad constraints that the NRIs and their parents put on the potential service providers.

Ideally what you are looking for is a continuing care facility or a multi-level care facility such as those found in the west which provide all the services necessary to an ageing resident, whatever be their physical and mental condition, now and in the future.

Such establishments are rare in India, at this point in time, though a few are coming up in various parts of the country.

Realistically though, for now your best option is to find an immediate family member or a close relative to look after your parents and arrange for a home healthcare service provider to assist the family member/relative in the care giving process.

Options

If an immediate family member or close relative is not available, look out further for a relative, who because of financial reasons, would be willing to stay with your parents and look after them for a monthly salary. This would be a win-win situation for both parties as it gives you a dependable and trustworthy resource to be your representative at home while providing this relative with boarding, lodging and a certain amount of financial independence. Of course, it may not be fair to have them look after all aspects of caregiving (depending on the condition and needs of your parents). So, you can arrange for professional home care service provider to assist this person in the routine aspects of caregiving.

In the next article we will see what are the common constraints people face and how some of those could be tackled.

There is an article in Wired about 23AndMe’s quest for Parkinson’s.  23AndMe, as you know is a company that is decoding the human genome in search for patterns to help us understand diseases.

Parkinson’s is an incurable neurodegenerative disease that affects 1 million Americans. The biggest risk factor is age, but certain genetic mutations can increase risk too. 23andMe reports two of them to its customers, which each increase the chance of developing Parkinson’s between about 30 and 75 percent. (Sergey Brin, the Google cofounder and ex-husband of 23andMe founder and CEO Anne Wojcicki, carries one of those mutations, called LRRK2.)

But scientists don’t know how the disease works or even how much genetics play a role in its development and progression. Unlike Huntington’s or hemophilia, there’s no single genetic signal for Parkinson’s. 23andMe is betting that through brute-force pattern matching, it can map the constellation of genetic causes—and potentially inform new treatments.

To read the entire article go here.( https://www.wired.com/story/23andme-is-digging-through-your-data-for-a-parkinsons-cure/)

Joy, frustration, irritation, adjustment, finally happiness! Getting your parents to move in with you is a tough proposition. When they finally agree to move in, it requires a change in the mindset of everyone. The initial euphoria on both sides slowly moves through difficult periods of adjustment leading both sides to question the decision. But if you persevere and remain true to the reason as to why you want them to be with you, it is very rewarding in the end.  It is far more difficult for our parents to adjust since it means giving up ostensibly their independence.  Giving the limited space in our homes, it also means giving up prized possessions so as to accommodate everyone. It also meant making the home more secure, safer and comfortable for seniors.

Many conflicts arise during the initial phase – things to keep and throw away, finance, medical, the list goes on. When there are kids involved, the demands that are placed on us as parents often lead to what we perceive as interference from our parents. To them, we are still their kids who need to be spared physical and emotional demands. This often makes them intervene directly in delicate situations which make the grandchildren resent them and us. They miss their independence and their life and substitute that with trying to be a part of what happens at home. They constantly tell us when to be home, what to cook, how to buy our groceries and how to save. The conflict arises in how we raise our kids because of very different schools of thought about food, schooling and discipline.

Three generations of mood swings happen at the same time – old age, menopause and teenage. And you have to deal with the aftershocks. You navigate your way through treacherous waters filled with obstacles.

After you successfully navigate your way through these treacherous waters and lead your family successfully, it is richly rewarding to see your parents by your side through the joys and sorrows of everyday life. At the end, I am happy they are with me.

Most elderly ladies, especially in South India, have worn nothing but sarees all their lives.  While the saree is an elegant dress, it is quite a handful to drape, even for a normal person.  But to have to drape it on another person, that too someone who is confined to their bed is not only tedious but also difficult to manage for multiple reasons.  Just imagine having to change the saree every time there is a diaper ‘accident’ and you will understand some of the problems faced in such situations.

One such story involves an 89-year-old lady. This lady had been very active until she fell and fractured her hip a few months ago.  One thing led to another and now she is confined to her bed, and dependent on her daughter for everything.  A feisty lady, the perceived loss of control of the household and having to depend on others made her very difficult to deal with.

One of the things she refused to compromise on, in the beginning, was the saree.  She insisted that she had to be in a saree all the time.  And not just any kind of saree but one of the starched and iron cotton ones that she was used to all her life.  The daughter tried gamely for a few days but was unable to take on the additional burden of changing her mother’s saree two or three times a day.

She then bought nightgowns from us, but her mother refused to even consider them, even after she was given a wide choice of designs to choose from.  Finally, the mother and daughter had a big showdown at which time, the daughter reduced the choices to grey hospital gowns and our special design Cocoon nightgowns.  The mother finally relented and decided to go with the nightgowns, for she abhorred the dowdy hospital gowns, which she felt made her look and feel even sicker than she actually was.  Needless to say, the mood in the house subsequently went downhill.

We came to hear about this story when the daughter, the primary caregiver came to buy some more of our specially designed back-open nightgowns for her mother.

With dark circles around her eyes, hunched shoulders and a resigned look, she appeared to be at the end of her tether.  On gentle probing, she confided that she felt that she had let her mother down as she could not even meet the simplest of her wishes.

Once she narrated her story, we took a leaf out of another customer’ story (similar beginning, but a different ending), and suggested the following:

1. Have specific visiting hours for her mother during which time her friends and relatives can come and visit her.

2. Get the mother dressed in a saree for the those visiting hours, so she can receive her visitors the way that she liked – prim and proper in a starched cotton saree.

A few weeks later, the daughter came back for a few more of our nightgowns.  She seemed to be in a much better mood and was happy to share with us that our suggestion had worked very well and both mother and daughter were very pleased with the arrangement.

“Now that my mother has got used to wearing nightgowns, she finds them very comfortable and elegant.  She has sent me here to get some more, with clear instructions to get pastel shades because that is what complements her complexion”, she said with a throaty laugh.

On our part, we are very happy to have contributed in making the life of another care recipient and that of the care giver just a little bit better.