When care comes with a price

Increasing life expectancy, a growing disease burden and nuclear families make professional caregiving for the elderly inevitable. But, the lack of a well-trained force and high rates for quality care make the service out of reach for many. When Maria (name changed), a 25-year-old working professional, was looking out for professional caregivers, for her ailing grandmother, she had only a few options. Expensive and with a set of clauses, she reluctantly settled for one, coughing up almost Rs 12,000 per month. 

“They said we had to pay a caution deposit of one month’s fee. It cost as much as Rs 700 for nurses on two shifts per day. There was also a non-negotiable commission of one month if the person dies. It was a lot like business and less of care.” She added that she had to put up with irregular nurses.

Raghuraman A, a resident of Nanganallur, had a similar experience. His ailing father needed care and he had to pay as high as Maria did. “That male nurse used to keep smoking beedis and when I hired a caregiver for my mother-in-law who was recovering from a spinal cord surgery, we had a substitute nurse who charged us Rs 7,000 for three days, even as we paid Rs 25,000 for round-the-clock services per month,” he explained.

Dr Ravi Samuel, psychotherapist, said that there a lot of circumstances and conditions that ascertain the services rendered.  These could be regular or part time services, or for psychological support. While regular services are required 24x7 for illnesses like dementia, stroke, parkinson’s disease, etc., part time is for those with arthritis or with problems with mobility. “There is also a category with sensory deprivation and the professional caregiver gives them the much needed support, as the family is clueless about how to deal with them. In all these cases, professional caregiving becomes mandatory,” he said. 

Father of geriatric medicine, Dr VS Natarajan, added that the services of caregivers have assumed significance of late. “Growing life expectancy, increasing disease burden and the burgeoning of nuclear families have triggered a demand for these services. The quality of these caregivers, however, is questionable,” he said. The agencies provide nurses who have just basic education, he pointed out. “They are given a training of three months in care and sent to the homes. They should undergo rigorous training in geriatric wards to rise to the occasion,” he said.

Service providers say that while they work around the limited resources available with basic qualification of the caregivers being 8th pass, they ensure quality.  Dr Renuka David, MD, Radiant Medical Services, which has been in the field for over 11 years, said, “They are made to undergo training and the whole team is supported by the able guidance of ex-servicemen from the Army, insisting on discipline. They are trained for three months to six months and 1 year and above depending on the kind of services from basic care to medium to high range of services like complete care and administering injections” said Dr Renuka. Similarly, the cost of these services may vary depending on the kind of services. 

“Basic care costs Rs 500-600 per shift to the more intensive care costing Rs 1,200 per shift,” said Dr Renuka ANEW, which has been training several batches across categories including peadiatric and geriatric, has tied up with six hospitals in the city, including Dr Mehta’s Hospital and the Sundaram Medical Foundation for hands on training for a month before giving them assignments. Dr M Annalakshmi, treasurer of ANEW, said, “There is an exam for the personnel to clear before they undertake assignments. The minimum charge is Rs 10,000 per month for these caregivers.” 

The service providers admit that the home care market is not alluring for qualified nurses, despite incentives. Dr Renuka said, “80 per cent of the candidates are women and most of the nurses want to go for hospital duty, even if it means half the salary provided in homecare as it is highly demanding,” she said. Jayasudha, a nurse with more than seven years’ experience explained why nurses don’t prefer homecare roles. 

“Such a service doesn’t add weightage to our experience, even if it pays better when compared to hospital services. But, a part-time service like dressing wounds can supplement the existing experience,” she said. 

On the other hand, Norah, a middle aged woman and widow, who worked an export factory earlier, now earns about Rs 800 to Rs 1,000 per day, working as nursing aid for the elderly. She said, “I underwent basic training for a few months before being employed at homes. I don’t have a stable income because assignments are for short duration, but it gives me just enough to support my daughter who now has a job.” 

While the earnings may be high, Dr Samuel said that one cannot overlook the inherent challenges for the caregivers and the elderly in such an arrangement. “I have heard of cases of the elderly misbehaving with nurses. There are also instances of the elderly being exploited by the nurses. There is a GO that says nursing aid should not administer injection. But how do we ensure this is followed in the home set up? Moreover, when the elderly have problems with their own family, the nurses may indulge in unprofessional counselling,” he said. 

Dr Samuel also raised the question of monitoring and audit for elders and nurses. 

“I have seen the agencies rendering excellent services in the beginning. After a few months they change the person and the services turns mediocre. I have stopped recommending any agency due to these experiences. It is like a racket,” he said. With Tamil Nadu having a huge section of elderly population in the country, R Sathianathan, vice-chairman of Alzheimer’s & Related Disorders Society of India (ARDSI), said there is an urgent need to bring down the costs. 

“In future, there will be a multi-fold rise in the number of dementia patients. For professional care to percolate at all levels, we need to bring down the costs,” he said.