By Dr P Vyasamoorthy, Hyderabad

1. Introduction

As per National Policy of Older Persons (NPOP) enacted in 1999 by the Central Government, the number of Older Persons in India is 6.8% according to 1991 census and that it would raise to 17% in 2002.  Population of Hyderabad is estimated to be about 6.5 million and the State of Andhra Pradesh currently has about 77 million population. An estimated 8 per cent the number of older persons is likely to be about 6.2 million. At present in 2005 we have nearly 8 million seniors in AP. The projections of the United Nations reported that Hyderabad would assume the status of becoming the 23rd largest mega city of the world by 2011 when the population is likely to cross the 10 million mark. There will be about 1 million people over 60 years in the city while in the entire country the number is likely to be over 110 million. The increasing population of elderly needs urgent mechanisms to address issues associated with elders.

1.1 NPOP and Andhra Pradesh

As a part of implementation of NPOP in Andhra Pradesh, the government of Andhra Pradesh has set up in February 2003 ”the State Council for the Elderly” with 18 members. Besides representatives from government departments like health, police, housing, finance, food supplies, transport, railways, Disabled welfare etc, there are representatives from NGOs (Hospitals, Old Age Homes etc) too. Andhra Pradesh State government lays emphasis on the following aspects of Senior Care:

Ø      Covering more persons under Antyodaya Scheme for distribution of food to poor

Ø      Reservation of 10% of houses for elders

Ø      Protection of life and property of seniors

Ø      Pre-retirement counselling programs

Ø      Encourage NGOs to set up Day Care Centers & Old Age Homes

Ø      Develop a career bank of resumes of persons willing to be hired under second-career program

Ø      Set up Helplines for Old Persons

Ø      Permit PHC & school buildings for the use of NGOs and Senior Citizen Associations

Ø      Set up geriatric wards in tertiary hospitals

Ø      Conduct surgical camps specially for cataract

Ø      Encourage NGOs/trusts/voluntary agencies to provide concessional medical treatment by offering government land

Ø      Engage retired medical professionals in organising health camps

Ø      Provide Old Age Homes in areas not covered; for women exclusively.

The governmental efforts are not sufficient to tackle all the problems. The role of NGOs and voluntary organisations can not be undervalued. Some details are in next section.

1.3 NGOs in Andhra Pradesh

As in other states a number of NGOs, Voluntary organisations and Senior Citizens Associations have jumped in to tackle the problems faced by elders.  As per the directory of Old Age Homes in Andhra Pradesh brought out by FAPSCO (Federation of Andhra Pradesh Senior Citizens Organisations) there are 310 Old Age Homes in AP as of September 2004. Some 60 Day Care Centers are also in operation.  About 120 Old Age Homes get some grants from the government. Rest are managing by them-selves. Some NGOs running Old Age Homes, are also engaged in elders welfare in other ways. These are listed in the appendix.

2. Volunteerism in Elder Care

As already said, depending only on governmental efforts would lead us nowhere. Rest of the country – private agencies NGOs, corporate entities, religious trusts and political parties, Senior citizens Associations etc must chip in. Quite a lot can be achieved by voluntary efforts with of course the back up by government.

2.1 Definition

Quoting from Wikipedia, Volunteerism is the willingness of people to work on behalf of others, without pay or other tangible gain. Volunteers may have special training as rescuers, guides, assistants, teachers, missionaries, and ham radio operators and in other positions. However, the vast majority of volunteers do their work on an impromptu basis, recognizing a need and filling it, from those who search for a lost child to someone who gives directions to a lost visitor. In this paper we are concerned with Volunteers as care givers for seniors.

2.2 Characteristics

Volunteering may be formal or informal. Formal volunteering specifies the boundaries, defines the scope and responsibilities, and provides a formalised mechanism for achieving results. Usually an organisation is behind it. Whereas, informal volunteering involves sporadic attempts often prompted by one or two influential individuals. They do not last long as they lack formal structure and scope.  Volunteer work can be totally government supported, partly funded, guided and monitored by government or be totally in the realm of private bodies. Again the benefits of voluntary services may flow to the beneficiaries free of cost or the recipients may be charged a small fee for the services they enjoy. Moreover voluntary activities may involve delivery of services through the employment of physical resources or by dispensing soft / social skills. Donating Clothes or giving a massage to relieve pain are examples of the former; Listening to a distressed individual is an example of providing ‘soft’ service.

2.3 Volunteering for Seniors

When we think of seniors and their problems we can categorise volunteering activity into several slots.  Main areas of concern for elders have been identified as: Accommodation (shelter), health, finance, legal and security. Following table lists some typical activities where volunteers may be useful.

Seniors’ concerns and areas of Volunteer activities

Having seen important aspects of volunteering, let us look at how it is being practised or organised in various parts of the country with special reference to Hyderabad .  

3. Volunteering for Elder care: Sketchy Scenario in India .

3.1 Mysore

Mysore has a Helpline for Elders. It is organised by Elders Council and Trust, Jayalakshmipuram, Mysore . They have a list of Volunteers and their areas of specialisation with phone numbers. Apparently people in need of help have to contact different people for different problems. General Contact number is: 2416725

3.2 Delhi

In Delhi the Police department has set up a Helpline: 1091 and 1291. They have collected details of nearly 4700 seniors in Delhi who are living alone who may require emergency care or help. This database helps speedy help. It is also useful in investigation of crimes when they occur.

3.3 Bangalore

The Bangalore based Helpline for seniors is organised as a part of Nightingale Medical Trust. 1090 is the centralised phone number. Volunteers offer help by manning Helplines, visiting orphanages and in imparting group therapy. Other activities include: Medical referrals, legal advice, counselling etc. Bangalore Helpline also (like Delhi ) maintains a database of seniors who may need emergency care. One speciality of Bangalore Helpline is that it caters to seniors afflicted with Alzheimer’s disease. They have helped a number of seniors who have lost their way due to memory impairment, to get back to their families.

The parent body – Nightingale Elders Enrichment Center in Bangalore provides facilities for seniors to get together and entertain themselves. Several activities like: Yoga, Language Learning, book reviews, discussions, chat services, music appreciation courses, painting, gymnasium, library are offered. Such activities make the life of lonely seniors liveable and enjoyable.

4. Hyderabad & Secunderabad

Twin Cities of Hyderabad and Secunderabad and Ranga Reddy District have a number of NGOs and Voluntary Agencies and Associations or Societies fully or partly engaged in caring for the aged persons. Let us look at a few of such institutions and their activities now.

4.1 Sri Satya Sai Ashram, Kondapur

Sri Satya Sai Seva Ashram in Kondapur, Ranga Reddy District in Andhra Pradesh runs an Old Age Service Home for the past thirteen years. Besides providing food shelter and clothing to 25 seniors, the ashram provides services to elders in many ways. Being a religious oriented venture, Bhajans and prayers are important activities. Outsiders are also invited. Twice a week a voluntary physician attends to health problems. The service includes diagnosis, prescription and distribution of medicines too. The local community elders get preference in treatment. The residents are chosen if they are active and are capable of taking care of them-selves. All services and facilities are free while contributions are welcome. (Ms Shanti Kumar 23005634 and 23000478)

4.2 Society for Aged and Women, Secunderabad (SAW)

SAW: (Society for Aged and Women, Ishaq Colony, Secunderabad is a three year old registered Voluntary Agency with about twenty members – of whom six are active. They have adopted an Old Age Home in Jeedimetla, near Hyderabad . Specific Requirements of the residents are catered to on case-to-case basis by collecting donations, purchase and supply. They also collect rice from various volunteering houses on a daily basis (Popularly known as “Pidi Arisi Thittam” in Tamilnadu) and hands over the collection to the Old Age Home. One physician organises a monthly camp for ascertaining the Bone Mineral Density (BMD) of seniors and women. This helps diagnose osteoporosis early and take suitable preventive or supportive actions. Nearly 250 to 300 persons benefit in every camp for a nominal fee of Rs 100/-, which in turn is ploughed back to SAW activities. (Dr Kumuda Raghavan, 27801544)

4.3 Solivar Care Senior Citizen Resort

Solivare Care Senior Citizen Resort. Ameerpet, Hyderabad . This is senior service center set up by a software company as a part of fulfilling their social obligations. No old age home is maintained. Free training programs for elders in Yoga, Meditation, Spoken Sanskrit etc are given. For instance the present batch of 8 ‘students’ attend weekly-thrice classes in spoken Sanskrit. A free lending library with about 500 books is also available. A small gymnasium with thread mill, cycling etc is also available for those who would like to exercise regularly. They also conduct pilgrimage tours. It is start-up NGO planning to provide medical care, counselling etc. (Ms Madhavi Latha. 55779839)

4.4 Heritage Helpline for seniors

Heritage Hospital is an exclusive hospital for senior citizens established in 1994. The hospital offers free health screening at Moinabad Village near Hyderabad . It also offers bedside assistance program for seniors who are bed-ridden or otherwise immobilised due to accidents. Girls and boys from poor households are given training in Elder Care provision methods and deployed to serve elders at their homes. The training course in “Care of the Older Persons” is a six months course conducted in association with the Ministry of Social Justice and Empowerment, Government of India, Delhi . Heritage also maintains a database of jobs available for retired employees and helps seniors contact potential employers. The second-careers center recently conducted a seminar on this. It publishes “Senior Heritage Selections”, a quarterly magazine devoted to seniors affairs especially health. They also distribute clothes to the needy by organising a cloths bank .

Besides the above, Heritage also offers a Helpline for seniors. The contact number is 23390000. The local Police Commissioner co-operates in preventing elder abuse, counselling and arbitrating in the case of family disputes etc.  Heritage Helpline is for the seniors in distress. It offers the resources available according to the needs, which may vary from emotional to physiological to grievances with the government machinery etc.  Heritage Helpline goes to the aid of elderly, even those who may not be able to reach the center. Elderly who have difficulty in sharing their problems with their family members and friends and need somebody to talk to and provide a listening ear to them. In all such cases the Helpline can be useful. It serves as a source of information dissemination on the resources available in the community. For example, one may wish to know the addresses of Old Age Homes and Retirement resorts in the twin cities. The Helpline operates for 12 hours from 8:00 am to 8:00 pm on all days except Sundays and national holidays.

Trained Volunteers supervised by professional staff, man the Heritage Helpline. Most of the volunteers are seniors themselves with multilingual skills and can speak at least three dialects. Volunteers co-ordinate with the Government departments (like the Police and healthcare departments) and establish rapport with private sector companies and senior citizens associations. They are trained in basic counselling skills, understanding older persons, community services and resources for older persons, communication skills, death and dying etc.

Elders facing abuse at home are helped by house visits, arbitration and counselling of family members. Police assistance is sought where needed.

Senior citizens who cannot pay for expensive treatment in private hospitals and nursing homes are guided with information and assistance on healthcare facilities that offer cheaper services.

4.5 Senior Citizens Forum, Secunderabad

Senior Citizens Forum, Secunderabad is a Voluntary association of Seniors (above 55). Col NA Kumar is our President. We have about 250 members. SCF runs a Day Care Center which is open everyday except Sunday between 10:30 am to 1.00 pm. Day Care Center offers news clippings of interest to seniors, indoor games facility like Chess and Caroms. The Forum members meet every First Monday and fourth Monday at 4:30 pm. Lectures of interest to seniors are arranged. Members devote one Monday to internal lecturers and another Monday is for External lecturers of eminence. Topics like health, yoga, law, investment, spirituality, and alternate therapy are discussed.

The philosophy of the Forum is:

‘We have benefited by the society all along. Now let us give back to the society in whatever manner we can’.

Members also go on several heritage tours both local as well as out-station trips. SCF has adopted Mehaboob College Centenary High School . Members offer voluntary teaching assistance. Children are given financial assistance. They are included for tours and trips. An Education fund has been started last year.

Annual Days are also celebrated. Seniors are felicitated for their achievements. A monthly newsletter called “Abhilash” is brought our regularly. AP Govt seeks the advice of SCF on matters of interest to Elders welfare. SCF has its own Cap, Logo, Badge (ID Card), Song etc. House / Hospital Visits are made when other members are sick or hospitalised. Such visits offer a sense of companionship and a feeling of wanted-ness to those who are lonely dejected or otherwise unhappy.

Visits to Old Age Homes: Several Volunteers visit routinely many Old Age Homes and distribute food, clothing etc. Many members celebrate their birthdays or ‘remembrance-day’ of the passing away of their parents etc in this fashion. They also collect old clothes and distribute too.

Professional volunteers: Among the members are qualified doctors, chartered accountants, lawyers, bankers, dieticians, IT specialists, police officers, judges, Engineers of different disciplines and consultants. These too offer their services to the members and outsiders free of any charges. However the volunteerism is not organised or formalised.

For example, a physician offers voluntary consultancy, free of charge daily, for one hour for 5 days a week. The physician’s regular presence helps in getting unbiased Second Opinion, or free diagnosis and prescription. He checks BP, Temperature and the like. School children of the attached school also benefit. An IT Expert helps seniors on issues like Email, choosing & setting up computers, sorting out minor problems in computer usage etc. A retired judge proffers advice on writing wills and similar legal issues.

Advise via web: As many as fifty members exchange advises, opinion and suggestions through the Internet based discussion forum and pass on the information to others. This Discussion forum is at: http://www.yahoogroups.com/groups/scf-secunderabad

While privileges of the SCF is available to members only, the web based discussion forum is open to all those interested in seniors’ affairs. Topics such as budget–impact, health insurance, and alternate therapies are discussed. This discussion list appears to be the only active web based forum in the country. The Web forum was started in Jan 2002. It has fifty members exchanging about 70 messages per month.

4.6 Care for the Aged

Care for the Aged is a unit of: Medical, Educational and Natural Services (MEANS), located in Moula ali, Hyderabad.

MEANS was started in 1994 and the special geriatric care unit called Care for the Aged was started in 2000. This organisation specialises in providing healthcare for the elderly. Nearly 40 seniors are accommodated for geriatric care. Residents are given food, shelter and healthcare. Seniors who require constant health care nursing and medication under supervision are admitted. Six doctors work voluntarily along with four sisters and many ward boys. They provide consultancy, diagnosis, and medication and carry out minor surgeries. Physiotherapy is a routine facility. They also refer cases to government hospitals and private nursing homes for treatment. Most of the services are free to the poor and some user charges are collected from those who can pay.

They are affiliated to Twin cities Association of Old Age Homes. Patients are referred to other Old Age Homes too when there is no vacancy. They get co-operation from local nursing homes and manage to get occasional help from corporate houses and pharma companies.  They collect old clothes for distribution. Left over medicines etc from nearby colonies. They do not get ay funds from government or foreign agencies. It is self supporting through donations from volunteers.

Most important problem of present day elders is social neglect due to selfish children depriving elders of any concern, care, love or comforts. Some inmates are left to die without anyone coming to claim the body!

They conduct health camps especially cataract camps. They create awareness among rural masses about:

Ø      good health and necessity for preventive medical check up

Ø      cancer and its care

Ø      Aids , prevention measures

Ø      Community Health measurers etc

According to Dr Prakash, Head of MEANS center in Moula Ali, the main problems are:

Ø      Space. Rented building does not allow changes to be made suitable for geriatric wards.

Ø      Old persons have peculiar health problems. Most general practioners and even senior doctors in Govt & private nursing homes do not know or appreciate problems of old persons – due to lack of specialised geriatric knowledge.

Ø      Diagnostic equipments are not available for the poor in Govt hospitals. Corporate hospitals are unaffordable even for diagnosis leave alone treatment.

The AP State government awarded MEANS last year for its excellent work for the seniors. A Helpline for Elders was started last year but did not pick up due to infra-structural problems.

4.7 Association of Senior Citizens, Secunderabad

The Association of Senior Citizens runs a Day Care Center in Secunderabad.  The Association concentrates on healthcare aspects. They have four meetings a month during which internal and external lecturers, discussions etc are held. They have adopted an NGO running an Old Age Home and provide support by subscribing to newspapers and magazines. Annual seminar on health Insurance, acupressure, second career planning etc have been conducted.  They have also created a directory of Hospitals, nursing homes, doctors and medical shops that offer discounts on the services/products sold by them to Elders community. Here elders volunteer to help other elders in an informal way.

5. Some Observations and Summary:

When we look at the volunteering activities obtaining in some of the NGOs and Voluntary Agencies mentioned above, it may be said:

5.1 Sporadic versus Formal attempts

The Voluntary efforts in the twin cities taken towards elder care are unorganised (except in the case of Heritage Hospital) and informal with no proper planning; no priorities have been worked out; no specific budget allotment or ways of generating funds have been well though of. They are in bits and pieces started with the interest of some individual or the other. Some seem to be half-hearted attempts. They are sporadic attempts not envisaged to be sustainable in the long run.  Many attempts were started and given up or closed down – for instance Elder Care Services Private Limited, Nest, Samaritans etc. In the case of MEANS, while activities relating to providing services to the sick are excellent, the Helpline started last year is non-functional. Even in the case of Heritage Helpline, they suffer from want of people to manage the Helpline – though other areas of senior care on the whole are taken care of systematically.

Elder Care Services P Limited was started four years ago on commercial lines. They could get volunteers (free & fee based) and enlist a good number of customers as well. But they had to close down due to social stigma linked with purchasing paid counselling services. The actual recipients of Care were ready to pay but their wards (sons/daughters) would prevent them from accepting help upon payment (or for that matter even free) basis!

Even in the case of Old Age Homes where certain fees are charged depending upon the paying capacity of the residents (intended to be run on semi-commercial basis), most such homes are running under ‘loss’ – the occupancy ratio being very poor.  However the demand for Old Age Homes is high, unmet and growing. The same holds good in the case of all other services voluntarily offered for Elders. When we try to find out the actual conditions, the situation turns dismal. This indeed is a paradoxical situation.

5.2 Training for volunteers

Volunteers need to be trained for rendering service suitable to customers. Training is essential in any field be it physiotherapy, secondary health care, providing counselling, offering listening services, manning help lines etc. In Hyderabad, Heritage hospital offers a six months course on serving the elders. Sweekar Upkar, Swayam Krushi are other agencies offering training for Care givers for Elders. At a higher level, University of Madras, University of Pune and IGNOU offer PG Diploma courses in Geriatric Medicine. For general counselling there are plenty of courses. Specific training facilities are few and need to be augmented.

5.3 Mapping expectations & requirements  

Volunteering becomes easy to one when his basic needs are fulfilled. When a person has enough to eat, stay and live a comfortable life, only thereafter he seeks name fame and recognition. He then volunteers to help others by offering money, physical efforts, goods, donations, support, consultancy, advice, time etc. We need people to carry our chores. Some may do it free of charge because they like to contribute their services which in itself is the reward they expect. Others may do it for money plus the satisfaction of social service opportunity. Some others may do only for money because money is more important at that point of time.

We need to combine all three kinds of people to achieve results. If someone is willing to donate money, use it to pay the volunteer who offers “hospital visiting services” who expects money. For example one may organize “listening services for the elderly” that may be free for the senior person who wishes to speak out, and remunerative to the volunteer who listens but the money may come from a corporate which sponsors the activity in a highly formalised manner. The success of volunteering depends largely in our ability to mix and match the requirements of Voluntary agencies on one side and the service-recipient (Seniors) on the other side.

Appendix

Addresses of some NGOs & Voluntary Agencies caring for seniors

(Organisations offering shelter alone to seniors (OAH) are not listed here.)

Care for the Aged (Unit of: Medical Educational and Natural Services),
Moula Ali, 6 Krishnanagar Colony, NFC Road, Hyderabad 500040
(Phone 93910 39990 Dr Prakash)

Association of Senior Citizens,
C/o Bharat Boys Scouts, SD Road, Secunderabad 500003
(Phone: Mr RN Mital)

Aravinda trust old age home , s.no-78,venkatramana coly b/s vasant
Nagar coly kphb,hafeejpet,hyd 500005. Phone: 23150005

Old age welfare centre , plot no28huda colony miapurvia chanda
nagar hyderabad 500138. Phone: 23049732

Pensioners old age home , plot no 48 ganesh nagar kuntloor village r r dist 501505. Phone: 24204025

Shanti old age home , 17-1-462/9 & 10 opp lake junction near
shivaganga theatre hyderabad 500060. Phone: 23449801/4

Shanti oldage home , 16-2-835 block d green view appartment
sankeshwar bazar sdb hyd 500060. Phone: 24169817

Helpline Orphanage Voluntary Organisatiom, 110 Sagar Road, South Nagarjuna Nagar Hyderabad 500079. Phone: 24093515

Elders Welfare Association. Plot 249 Vanaprashasramam Rampally
Hyderabad RR District 501301. Phone: 25502775

Senior Citizens Forum. Near E-seva VSP, Sachivalaya Nagar VSP
Hyderabad 500070. Phone: 24129737

Sevashram Home for Senior Citizens, Annavaram

Ranga Reddy District 500043. Phone: 255444

Senior Citizens Forum -Secunderabad
C/o Mehaboob College Centenary School, Near Tivoli Cinema, Secunderabad 500003. Phone: 27817597 Col NA Kumar, President

Solivar Care Senior Citizen Resort
609 Everest Block, Aditya Enclave, Ameerpet, Hyderabad 500036
Phone: 55779839

Heritage Hospitals, Somaji guda, 500082. Phone: 23379999
Mr KR Gangadharan, MD) Helpline: 23390000

Rashtriya Seva Samithi, Tirupathy. RSS maintains 9 Old Age Homes besides taking active part in Elder care.
Anurag Human Services Old Age Home, Qutab Shahi Tombs Opp Pro Agro Seeds, Hyderabad. Phone 23561157 Ms Rama.

Sai Seva Sangh Old Age Home, Plot 99 Road No 12, Vivekananda Colony, Satyasai Sritha Nilayam, Kukatpally 500072 Phone 23065796

Old Age Welfare Center, 3-22 Mayuri nagar, Survey No 28 HUDA Colony Miyapur Hyderabad 500049 Phone 23045261

Swayamkrushi Old Age Home for Mentally Retarded, Sivananda Punaravaasa Kendram, Kukatpally Hyderabad 500072. Phone 23057679 (Ms Manjula Kalyan)

Dr Pasupuleti N Hanumantha Rao Charitable Trust

Old Age Home, Sweekar Upkar U turn, Opposite: Jubilee Bus station Secunderabad 500003 Phone :

(Paper presented at the Workshop on Volunteer Groups by Longevity Center , Pune and NISD, New Delhi