The burden of old age — abandonment, abuse, neglect

Elderly persons need a proper home, financial assistance, treatment for mental health and medical issues related to aging such as Alzheimer’s or dementia, which would often lead to the need for nursing care. And being old does not mean that they do not need to socialise.

Director of the Division of Aging Dr Jennifer Rouse said in Trinidad and Tobago, 11 to 12 percent of the population fits into the category of senior citizens, of which the fastest growing cohort within older persons is the “oldest old”, that is, persons 85 years and over.

Many of the illnesses that afflict senior citizens are usually chronic incommunicable illnesses, which do not essentially prevent them from having an active social life, unless they are amputees because of diabetes or paralysed because of a stroke.

Rouse noted that although more women have chronic diseases, such as diabetes, hypertension, heart disease and chronic respiratory disease, they were living longer than men.

She said for some caregivers, taking care of the elderly was sometimes a burden as culturally, senior citizens were kept at home.

“Government, however, would prefer that they are kept in their own homes than in homes for the elderly. Cabinet has looked at restructuring the Patient Care Assistance Programme, which was started years ago but has since been stopped. A curriculum is being drafted to be sent to Cabinet,” Rouse said.

She said all persons, including those from the TT Retired Nurses Association (TTRNA), who would be involved in patient care, must go through accredited institutions, which would be standardised.

Rouse added that they must also be trained in mental care, such as Alzheimer’s, which she said was increasing.

She said that younger people were now being afflicted with Alzheimer’s disease, which is the most common form of dementia. This is an incurable, degenerative and terminal disease that is generally diagnosed in persons 65 years and older, but this is no longer the case.

“People with Alzheimer’s are living longer, but the challenge is early detection. It cuts across all barriers and has no finite blueprint of what triggers this disease,” Rouse said.

There are 130 homes for the aged in TT, according to Rouse, who said legislation must be put in place to protect the elderly.

The Ministry of Social Development gives subventions to nine homes which they “inherited” in the “early 20th century”. These were referred to as poor houses.

Others are privately run or are supported by charity and donations, such as the Missionaries of Charity in Laventille.

Although the Sunday Newsday was able to speak with one of the Sisters, who was Asian, she was not very forthcoming with information, saying that they did not “speak with the newspaper”.

But, she did admit that they were not funded by Government.

“We have people who do not have any homes or families, so they do not get any visitors,” she said.

Asked how they were able to run the home, which was burgeoning with orchids, roses, bougainvillea and other shrubs and plants, the Sister replied, “Through God’s grace and intervention.”

This was the same home that 102-year-old Rosa Nanton was taken to when she was removed from what could barely be called a shack on a hill in Morvant. She was marooned with no food, running water or electricity...and totally alone.

Rouse said the majority of the homes were privately owned and therefore were operated for profit, but subventions were geared toward charitable-non-profit organisations.

“Government has to revisit the policy issues that would come out of this legislation because we do not want to create a society of dependency,” she said.

Rouse said if Government was providing financial assistance to every home for the elderly, then everyone would want to open a home.

She said while most senior citizens receive a pension, Government was taking into consideration the rise in cost of living and food and did not want the elderly to be “fleeced”.

Rouse said the issue had to be looked at from all the various ministries involved, including Social Development and Health, but they had not reached “around the table” about subsidising private homes for the elderly.

“We have a model home for the young people, so now we are looking at whether to have a model home to project what a home for the elderly should look like,” she said.

Rouse said the standard of care for senior citizens must not be compromised and families must also come up with innovative means to take care of their elderly.

She added there were costs that were incurred by persons who wanted to operate homes for the elderly, such as making it accessible for the elderly and insurance which was a must in order that the resident’s safety was a priority.

Rouse said raising the incomes of the elderly was not the only panacea, but their social lives must also be taken into account

“There has to be a holistic approach and it must be done in a planned manner. Their social lives have to be stimulated. Theirs is not an economical issue, but a psycho-social one where their needs must be met.

“Adult daycare is another option where the senior citizens can stay during the day when their caregivers are away. That way they can mix with other people. They want to converse, not be locked up in a room. They can be in their own home, but be lonely.

“Another thing is to allow children to visit them in these centres, encourage sing-alongs. This way they can keep their minds alert,” Rouse said.

Once a man, twice a child

Supervisor for DATTA Homes for the Elderly in Arima, (operated by the DATTA Welfare Federation, affiliated with the Adventist Church) said caring for senior citizens was “no easy thing.”

“First, to begin with, you have to have love for them. If you don’t have love you cannot do the work,” said the woman who requested that her name not be used because she “did not like the publicity.” She did it out of love. (We shall call her Annie.)

“We as caregivers or as managers, we have to have a greater interest in senior citizens in order to take care of them. What we saw in the past, the government did absolutely nothing to assist senior citizens then. The average citizen decided to look after the senior citizen, in other words we are going to give something to the community, to those around us,” she said.

She said that there are 38 elderly pay-to-stay residents at Torecilla Gardens and Church Street in Arima, with an average of 18 staff members.

The elderly in their care, she said, were there because families could not care for their loved ones due to various reasons.

“There are those who are too busy, those who don’t have the heart because seeing your mother or father or uncle or aunt in that situation, it hurts you knowing that they were once bright and sprightly and now look at how they are.

“So, we decided we are going to care for them, which the church provides for. Caring for senior citizens takes an extra effort. Some have Alzheimer’s and that is a special care.”

She admitted that one had to be trained in that area.

“I don’t disagree with that, but if you read a little more on that and are guided by the spirit of God, you’ll be able to do a better job. Senior citizens tend to tell you, ‘I forget this here, I forget that there, this person take this, this person take that’ and nobody is taking anything from them, it just that they are just ‘going’,” she said.

Annie said elderly diabetics needed special care as well, especially with their diets.

“As we all know, some diabetes is hereditary and some can be as a result of what we eat, lifestyle. In order to care for that, you have to make sure they are well geared. They cannot walk barefooted, they have to eat a balanced meal, they have to take their medication, whatever the doctor prescribes they take it and they’ve got to take it on time, which is most important,” she said.

Taking care of the senior citizens, Annie said, can be like taking care of a child.

“We give them things to keep them occupied and active, but how long will they keep active?

Maybe for ten or 15 minutes, like a child because they are once more children. So this is why when you are caring for the elderly, you have to study child care to be better able to take care of the elderly because they are once more children,” she said.

Looking at these gentle, innocent faces, one can’t help pause to share a kind word, but, according to Annie, beware... Especially if the senior citizen has Alzheimer’s or dementia.

“They abuse you too you know. They really abuse you. They even hit you. They abuse you in all different ways. They curse you and you’ve got to take all of that because you dare not hit them back, you’re not supposed to. They tear your clothes and fight you.

“You’ve got to treat them with love and as I’ve said before, if you don’t have love, you cannot do this job. You must compassion, endurance, not patience because you have to ask the Lord for that. They need extra, extra care,” she said.

Diet is especially important for the elderly since their bodies, some of them frail, have special requirements. But it is not always easy getting them adjusted to the new meals.

“Sometimes you cook the food and I mean good food, not any old rubbish, a balanced meal. Some of them aren’t accustomed to that so they don’t want it. They’re accustomed to eating junk food so that when you give them this balanced meal, you have to sit, make sure that they eat it and you have to explain to them, why you want them to eat this, like a child again.

“They don’t like water. Water has no taste. They want juice and soft drinks and these things are not good for them because remember they are not active and eventually what they eat and a drink breaks down into carbohydrates and eventually they suffer with diabetes,” Annie said.

She said they tried to follow the basic rule of a drink a half hour before they eat or half hour after they eat.

“Eating and drinking is not good for them because the food takes too long to digest,” she said.

Annie said she and the staff tried to keep the residents interested with activities such as crocheting, but it was difficult to hold their interest for long periods.

“I remember buying thread for them. They would do it for about half an hour, and then they would drop it down. They get fed up so your eyes have to be on them all the time. We try to get them to walk for exercise and I remember today I told one of the men, ‘Get up and walk for me, please.’ He looked up and said, ‘Mmhm, I will, mmhm’, and he sat right there and never got up,” she said. Annie said exercise was important for the elderly, even a leisurely walk, especially when they were diabetic.

She added that they did not like water “on their backs” because they felt cold.

“As a human being, the change in your metabolism as you get older, it gets weaker and weaker, so their bodies cannot withstand the cold. We bathe all our residents in warm water unless it’s a foot massage or something like that,” she said.

Taking care of elderly patients who are senile or suffering from dementia is a trying job, but it is one that the staff at DATTA has to deal with.

She said running the homes was a difficult task as by law, the ratio was five residents to one nurse.

“I mean, that is a bit ridiculous in the sense of when you have to pay people and you have a three shift system, you have a lot of money to pay people and doing a service like this for the community, you have to put out a lot. Our homes are being run by a group within the Adventist Church, which has been in operation for the past ten years,” she said.

Their’s are establishments where people bring in their elderly to live for a fee, but, according to Annie, it did not always work out.

The two houses were rental properties, so that, tied in with the cost of food, utilities and salaries for staff, has proven to be difficult to handle.

“Food is very expensive and we have to make sure that our residents are given proper meals to suit their dietary needs. Every Monday morning you go to the grocery you tend to wonder, ‘Would this home survive?’

“What we need to see is a little more interest shown by the Government, not just to make rules. You have to show that these people have done their part in the society and we need to compensate them in some way or the other.

“Yes there is the pension and we are thankful for that, but we get a lot of trouble from some of the family members in getting our money at the end of the month,” she said.

This caregiver said there was one resident whose family had not payed for her room and board since January, this year. In fact, they only paid one month’s allowance.

“We took this person off the streets and as women we don’t like to see our people on the streets. We took the lady in and the family came, made arrangements and so on. They visit when we call and she has about nine children. I shouldn’t say ‘they’ because just one of them comes. We’ve asked why don’t they all pull all their resources together to pay for their mother’s stay here. We’ve asked that over and over,” Annie said.

She said sometimes the only time they saw family members was at the end of the month when they came to make payments. “Some of them come to pay and they don’t even ask to see the parent. Not all of them. You can’t label them, you can’t take a brush and paint all of them,” she said.

Annie said there was also a doctor on call 24 hours a day, who reacted to their calls very promptly.

She noted that some of the residents felt that they had been deserted by their families and often questioned why they had been “abandoned” and put in homes.

“We hear patients talk about desertion and abandonment all the time. ‘I mind my children for so many years and look how they just drop me in a home. I missing my family.’

“Senior citizens love their home. They don’t like to be taken out of their home. They always say they want to die in their home. I have to remind some of them that their children have lives of their own, but we have to also remind the children that they still need to love their parents. Bring a little flower or small gift to show them you love them and let that bond continue so they won’t feel deserted,” Annie said.