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Calls grow to regulate elders’ homes as Lanka’s elderly population increases
View(s):By Mimi Alphonsus
As Sri Lanka’s population ages and the economic crisis drives young people abroad, the elderly are increasingly left without traditional family support networks.
While charitable elders’ homes are underfunded, a Sunday Times investigation reveals that the private retirement home industry is barely regulated, leaving seniors worried about how they will spend the last stages of their lives.
When Dinushi Abeyratne (name changed) decided to migrate for work in 2021, she searched for an affordable elders’ home for her mother, who suffered from dementia. When she first admitted her, Dinushi paid Rs. 40,000 a month, higher than the standard price, to account for her mother’s condition.
But she soon started to hear from a friend that her mother’s situation was not good. Dinushi said that within five months of admission, her mother had lost so much weight that her rib cage was showing.
“The home was understaffed, and the staff were not trained. Even the girls who were handling the medication were just recent O/L pass-outs,” she said.
She said it was not uncommon to employ fewer staff in elders’ homes. There was also a tendency to hire less qualified people, paying them low wages. One charitable home in Colombo houses nearly twenty residents and only four staff, none of whom are medically trained. “I am the doctor, I am the nurse, and I am the caretaker all in one,” lamented a worker who requested not to be named.
Senior care in Sri Lanka currently falls under the Protection of the Rights of Elders Act, which created an Elders Council and Secretariat with powers to register and revoke registration of homes. However, the law does not regulate elder care, and while guidelines exist, they neither cover the training of staff nor the home’s obligations to guardians.
“We know this is a gap, so we are going to amend the act,” the Secretariat’s Director, K. G. Lanerolle, said, adding, “We have a draft, and I think it will be presented to Parliament within 2-3 months.”
According to Mr. Lanerolle, the Secretariat recommends that elderly homes be inspected every month by elder rights promotion officers, but this was not the case last year due to its officers being recruited to conduct Aswesuma [the new social welfare scheme] enumerations. The Secretariat did not have data for when the last inspection of Sri Lanka’s 349 elders’ homes took place.
One elder rights promotion officer, who requested not to be named, said that she must inspect the elders’ homes in her division and visit more than 5,000 seniors living alone or with children. “The Secretariat assigns me only one extra person to help if they deem it necessary,” she explained, “so I find it difficult to cope with the task.”
Furthermore, an advocate working for an elder rights NGO said elder rights promotion officers often did not have the correct subject knowledge to deal with the complexities.
When Dinushi found out that the home had failed to inform her about bedsores and only told her that her mother had gone into a coma hours later, she decided it was time to transfer her mother to a new home.
Because her mother was bedridden due to her complications, Dinushi paid more than Rs. 100,000 a month for the new home, in addition to medical expenses and special items the home requested.
Dinushi herself works in the care industry, and she claims the home quickly became wary of her educated questioning. “When she got sick again, they did many blood tests, but I only got a few of the results,” she said. “I asked for the report book [which records food and water intake, urine output, etc.], but they refused to share that with me and started ignoring me. Once, I could not talk to my mother for a week because the home didn’t answer my calls.”
Dinushi was frightened by the lack of transparency. “I didn’t know what was going on, and I felt they were taking advantage of the fact that my mother had dementia and did not remember whether she had been fed or cared for,” she explained. “They knew I was helpless because I was abroad.”
Her mother finally passed away in 2023, at the age of 81. “Doctors made me feel guilty for going abroad, and the elders at home treated me like a cash cow,” Dinushi said. “I work hard and sometimes don’t eat myself to be able to afford all the medicines and extra charges they sent me, only for them to be misused and for my mother to end up suffering. I know she could have lived for longer if not for the poor care.”
F. Shabnam, whose 84-year-old father spent time in two different elders’ homes, echoed Dinushi’s sentiments. “They asked us to pay a lot of money for small things, and I know for a fact that it wasn’t worth the money,” she said, “but I was afraid to complain because there simply aren’t other options.”
Elders’ homes have also been beset with a lack of standardised practices. At a private elders’ home in Colombo, an official said they required guardians to get involved if hospitalisation should occur, but often guardians avoided such obligations. He claimed that 90% of guardians did not make the payments on time, creating difficulties for the home when paying staff salaries and bills.
Still, for-profit elders’ homes can rely on a somewhat steady flow of income.
At an elders’ home in the Northern Province, a manager explained the difficulties she faced in procuring funds. “We primarily support our residents through donations, and for now we have managed to make it work,” she said. “Additionally, the government provides a monthly allowance of Rs. 500 per resident, but to get this money, we have to go through so much bureaucracy.”
The manager explained that the cost of food and medicine had increased, and as a trained nurse, she often had to assess whether it was possible to settle for cheaper alternative medicine. “Moreover, many of our patients have psychological issues due to war trauma,” she said, “and the Department of Social Services sometimes pressures us to take new residents even if handling them is beyond our capacity.”
Elders' home in Moratuwa. Pic by Indika Handuwala
According to the National Secretariat for Elders, Sri Lanka has an elderly population of 3.5 million. By 2050, each working adult is projected to have twice the number of elders to care for as they did in 2020, according to the Asian Development Bank. Despite the urgent need, the budget allocated by the Treasury for the National Secretariat for Elders has not been increased for the year 2024, though it distributes financial assistance to poor elders and is responsible for ensuring seniors are cared for in institutions and outside.
Prof. Lakshman Dissanayake, a demographer and member of the National Elders Council, is a proponent of home-based care instead of institutionalization. “To do this, we need a programme similar to the midwife system where elders can be regularly visited and their well-being assessed.”
Until such a programme is implemented, elders’ homes will continue to be a popular option among migrating children or families where both partners work.
| Economic crisis worsens elders’ plight Most elders live by themselves or with their children. Due to the economic crisis, the situation of such elders has worsened. K. Sarathamby, 82, travels to the clinic 2.5 kilometres away, nearly every week, by bicycle because buses do not come into his small village in rural Mannar. He worries about how he can continue taking care of his health once he is no longer fit to cycle. Many others in his village make the long walk to the clinic, only to be faced with daunting lines and the news that they have to procure their medicine outside for prices that many cannot afford. “Many of us seniors in the village relied only on our vegetable gardens to eat and make a little money,” explained Mr. Sarathamby, “but now, because of flooding, that is gone, so we have no money to spend on medicine and no vegetables to eat either. The government provides Rs. 2,000 to more than 500,000 poor people above the age of 70, but more than 200,000 are stuck on a waiting list. The Secretariat provided medical assistance, devices, housing schemes, and self-employment support to about 10,000 elders in 2023. K. Rajeshwary, 72, lives on her own as her children have moved to India and Colombo. She is on the elders allowance waiting list but is hesitant to ask her children for support. “How can I beg them for money when they too are struggling so much? We are old now, and our lives are coming to an end, but they have small children to feed.” | |
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