The forever quarantine of the aged people
Contributor: Mahima Devkota
The rise of the frustration of people due to Nepal lockdown- lack of movement, access to resources, and social distancing because of Covid-19 pandemic is palpable. However, this has been the reality of the everyday life of most aged-people. Aged-people are the ones who are 65 years and over, and they are one of the most at-risk demographic whose situation might worsen if and when this pandemic hits Nepal hard. There is a dire need to be involved in retaining the healthy and active aging with the involvement of family and community for the total well-being and also as the preparedness for sudden changes.
Recent data related to the death of aged-people in Italy and China shows that the fatality rate for aged-people over 80 from COVID-19 is almost 15%. According to the 2011 Population Census of Nepal, the elderly population constitutes 8.13% of the total population, which is more than the population growth of the country itself. The life expectancy of Nepalese which was 54 years in 1991 is 71 years, as per the census. It can be inferred that life expectancy has increased by more than one year (1.3 years) in every 2 years. However, health care facilities, social security benefits, age-friendly initiatives, family-based and community-based care system, and the social ties are the weakling in Nepal for the security of these people.
In the social context of Nepal, the family used to be the center in the lives of every Nepali people compared to what it is today. The elderly and toddler were given special care, love, support and respect. There was a sense of mutuality and altruism between individuals and inter-generational bond and support in our society. However, with the advent of modernization, this previous social structure is now shifted and geography has become the deformity in people lives, reforming the traditional based bonds and agronomic culture into industrialized means and services. Presently, society has changed due to the changing context of the world, desire for small family, poverty, and need for a comfortable living. Moreover, with the advent of a severe lack of employment opportunities in the country in-migration and out-migration rate has increased dramatically. Nepal’s emigration rate for 2011 is estimated at 10.77 per 1,000 population. The augmentation of migration results in the old-aged people living alone and in the old-aged home. As per a study on the health status of elderly living in Briddaashram (Old Age Home) conducted by Chalise and Shrestha in Kathmandu, it was found that 5.6 percent male and 11.6 percent women are living alone(Mishra S1 and Chalise HN2,3*). The living arrangement of the elderly shows 39.4% elderly were living alone before they join the old-aged home. Currently, a number of 11,500 of aged people are living in registered old-aged organizations in Nepal.
In this uncertain circumstance of potential calamity, aged-people living alone has information and mobility challenges. Due to lack of information, they might be unaware of what to do and what not to do which increases the risk of getting infected with this novel Coronavirus.
Despite increment in life-expectancy rate, and decrement in mortality rate there is still a required call for demographic and epidemiological transition, and shifting need towards the aged-based care. Every country in the world has crossed the first stage of the demographic transition where the traditional agricultural shift has mortared into the modern and industrial era. However, in the context of Nepal, we are still unaware of the status of aged-people living alone and in an old-aged home when unexpected life events and financial expenses occur.
Furthermore, in Nepal, social security benefit to the old-aged is a mere monthly allowance of Rs.3000, provided for the purpose of basic sustenance. However, when this potential pandemic is realized and impacts aged-people, especially ones with multiple health conditions, the situation for these people will be a crisis. In times when food availability is uncertain, medical help is scarce, and social isolation might bring mental health challenges this only allowance is nowhere close to alleviate the problem that aged-people might face. Moreover, the shortage of assisted health care, palliative care, and hospice care during pandemics will push this aged-people beyond any help and support.
Numerous old-aged people living in old-aged homes might get infected with viral diseases due to proximity with each other and lack of a healthy and active life. In a recent scenario, of Covid-19 transmission, the aged-people are likely to suffer from lack of food, mobility, and health services.
It is a question to ask government bodies that what they have planned and completed from the individual, group, community, and governmental levels? Recently, India and Australia are providing allowances to aged –people and free home delivery of foods and utensils. In America, food delivery in a home is assisted by firefighters for aged people. In Italy, health care is focused on extenuating pre-health conditions of aged people to sustain the transmission of Corona –Virus. Looking at the per capita is 1,034USD dollar in July 2019(World Bank, 2019), GDP per capita based on PPP for Nepal was 3,318 international dollars (World Data 2019). The federal budget on fiscal year 2018/2019 for senior citizens is 0.14% of the total budget, which is very low in amount though the most vulnerable age groups are senior citizens. So, out-of-pocket spending is the largest health funding source in Nepal. The epitome of crisis would impact on employment opportunities, herby reducing the income in the country. The rampant unemployment decrease the purchasing power parity leaving Nepali citizen mostly old- aged people in susceptible state. Though the government has decided to give incentives of Rs. 10,000 to old-aged homes. The hardest question right now is an economy of $28.813 billon sustain in the time of crisis?
Nepal’s most cherished armored in a difficult time is the family. Looking at the world crisis now, the family institution is being the back-bone in every home. So, the focus should be made on promoting family and community-based organizations like in India, Japan, and Canada. The first step that the government can do is to prioritize the needs of aged people with the preset mobilization of resources. On an individual level, we can facilitate aged people living near our homes by checking up on them, giving information and helping in sustaining the basic substantial needs. During the pandemics, the state-level government should make the free and universal delivery of food services to aged-people and also should cut the cost during health hazards. At the local level, the smooth flow of medicine and food services should be made available to be aged-people. Let’s be the helpline and make the helpline available to the old-aged people.