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“Preparing for the elderly nightmare” (FT 15/2/2020)

16/02/2020

Preparing for the elderly nightmare (FT 15/2/2020)

Professor Wadan Narsey

 

Why is it that Fiji taxpayers spend a hundred times more on children who have yet to contribute a cent to society, while totally ignoring the needs of the elderly, who have already worked all their lives for society?

Why is it that most of our NGOs and religious organizations who for decades pooled their money and efforts to build schools all over Fiji, have not built Old Peoples’ Home to look after their elderly?  (perhaps with one exception?).

Indeed, which organisations are preparing in the coming decade for the elderly tsunami that is about to hit Fiji?

How many families with the real elderly preparing to make sure that their elderly age in dignity with families coping reasonably well, instead of being buffeted by an aging nightmare?

Is the Fiji public and parliament even discussing how the burdens of looking after the elderly will be shared between the households, community organizations and the state, or some combination of the three?

Not planning for the elderly at the household level

Those of us who live with aging parents and other family members soon realize how we never planned to build homes suitable for the really elderly.

When I built my own home some thirty years ago I put in (with great consideration I then thought) a second floor flat downstairs for my parents.

I made sure there was an internal staircase so that they could come up whenever they wanted to, and my children could go down to visit their daada and daadi when ever they wanted to, with both having their own space.

But I never envisaged that one day my father would not be able to walk up the stairs, even with railings to help.

I suspect that most of us building our own homes never thought about

* having a completely level floor without a single step which old people often trip over.

* making sure that our bathroom doorways were wide so that our old people could go through easily with their walkers, and eventually be wide enough for wheelchairs.

* making sure that toilets were open plan so that old people could be wheeled there in the wheelchairs and moved on to the toilets by carers.

* making sure that the bathrooms were similarly open plan to enable carers to be able to wash the elderly in comfort.

* making entry and exit to the house via wide level footpaths without steps or huge slopes which the elderly could not traverse with safety and ease.

Throughout Fiji houses are still being built with not a thought being given to the elderly who will one day, without fail, be living in them, and irony of ironies, may even have built it originally.

How many architects are there in Fiji who make it a point of informing their clients about the needs of the elderly. On the contrary how many architects are there who throw in split levels all over the place to give fancy effects?

But fundamentally, the real tragedy is that while we as parents bend over backwards to make our homes safe for the kids, we are totally short-sighted and often simply uncaring of the needs of our parents and the elderly.

The eventual dementia and bedbound

Most elderly want to grow old in their own homes.

But when the elderly have become forgetful with Alzheimer’s and forget to use their walkers, it is so easy for them to fall, often resulting in multiple fractures which can take years to heal.

Despite families’ best wishes, the safety of their elderly force them to look for the greater safety of old peoples’ homes, where there is 24/7 care by trained nurses, in safe environments.

Many families have already experienced their elderly really becoming totally helpless and bed bound 24/7.

Meaning that they basically lie in bed all day and night running the risk of bed sores; they have to be fed in bed; they do their toilets in bed into nappies if the families are well enough to afford them; and the carers have to wash them in bed.

I doubt if there are too many beds in Fiji where the head of the bed can be raised by a motor so that the elderly person can at least sit up for a few hours each day, perhaps to watch TV.

I doubt if too many families have lifting facilities for taking the bed-bound elderly from the bed to the bathroom or toilet.

I doubt if too many families have proper wheel chairs in which the elderly can be regularly taken out for an airing.

Sometimes the elderly slowly develop dementia or Alzheimer’s disease (the two are slightly different) and to their own horror and that of their families, they cannot remember what took place half an hour ago.

They will repeatedly ask their carers for meals or to go to the toilet when they have already done so half an hour previously; they fail to recognize their children or partners or even their daily carers.

Very few of the people looking after their elderly in this sad state will think back to the time when these same elderly people, usually the mothers, did exactly the same for their totally dependent children when they were babies and infants.

Very few people will generously think: “no big deal. I am only returning the favor they did us”.

They might not even want to think about how much their frugal parents saved all their lives so as to give their children a head start in getting an education and owning their own homes.

We are an ungrateful lot.

Why few Alzheimer’s cases in Fiji?

I was originally puzzled why we in Fiji do not encounter more cases of Alzheimer’s disease or  dementia, until I compared Fiji data on aging with that of Australia.

Life expectancy in Australia for males is around 82, while in Fiji it is about 65.  For females, life expectancy in Australia is around 84, while in Fiji it is about 67.

The Graph shows what a small proportion of Fiji people live to be 75 years or older.

In Australia, some 7% of the population lives to the age of 75 or more; while in Fiji, only  2%.

The reason why we in Fiji do not encounter more cases of dementia or Alzheimer’s disease is because our elderly die before they can develop these two conditions, which generally become worse with age.

[Statistical note: I compare Australia with indigenous Fijians in Fiji, excluding Indo-Fijians who, because of the emigration of their young families, today have an artificially higher proportion of the elderly than indigenous Fijians.]

The sad reality is that there is no training of our communities and families to cope with the problems of dementia or Alzheimer’s of their elderly in the home, even for the few cases that are diagnosed.

Can community organizations help?

We are all aware of the hundreds of schools built throughout Fiji by the Catholics, Methodists, Sanatan Dharam, the Arya Samaj, the Muslim Leagues, etc. etc. to educate the young.

Of course, that was decades ago when our communities really worked collectively, the rich and poor alike, to save and pool their money for the collective good.

That communal spirit is sadly gone as well-off members of the families  and communities have emigrated and those remaining behind have become selfish wealth accumulators sending their profits abroad

Sadly, the vast majority of Fiji people have become dependent on governments which have often deliberately fostered the hand-out mentality in order to get votes in elections.

It is a bit ironic that Ministers like Dr. Mahendra Reddy are today pleading with farmers to do more to help themselves (see FT 11/2/2020) when other government ministers have been handing out cash everywhere.

Why is it that few of our community organizations have built facilities for their elderly who without doubt will have contributed decades of their personal time and money to help build the schools that have educated their children?

These same elderly have also worked hard throughout their lives and paid the taxes that governments use to fund the education and health of their children.

But what do these elderly get in return from their governments, when they cannot work any more, and many have no savings left in the FNPF or the banks?

It is good that some communities are now teaching age care courses at their colleges but I suspect not in sufficient numbers to cope with the coming elderly tsunami, but age care workers need homes to work in.

Where is the government support?

Every one in Fiji knows about the massive “record” amounts of taxpayers’ funds that are being devoted to education of children, amounting to in excess of $300 millions annually for teachers’ salaries and school running costs.

For children, there are no private school fees, or textbook fees or school bus-fares.

There are even full TOPPERS scholarships and TELS loans paying not just for tuition but living expenses, with many graduates emigrating soon after graduation.

In contrast, how much is government spending for the needs of the elderly, such as a basic living allowance, or building homes for the elderly and training and employing carers?

You would be lucky to reach a figure of $10 million per year, a pittance compared to what is being spent on the young.

In total contrast, over the last ten years, more than $2 billion dollars (that is right two thousand million) have been spent on roads infrastructure, with much being wasted through inefficiency (witness the disputes between Fiji Roads Authority and private contractors).

Much of this of course, has been “paid for” by increases in Public Debt which now hangs over Fiji’s head like the “Sword of Damocles”.

Remember also that many graduates educated at taxpayer expense emigrate to greener pastures in Australia, NZ and Canada and only a few would send money home to help look after their elderly.

The political paradox of ignorant voters?

So here is a political puzzle.  Those aged 5 to 18 who receive the massive amounts of education budgets, cannot vote while every one of those elderly or those who are about to become elderly in Fiji, do have the power of the vote.

So why have the elderly not agitated for more taxpayer resources for themselves?

Why have the major political parties not placed the needs of the elderly on their elections manifestos?

Why governments who keep boasting that “we are all equal as Fijians” not treated the elderly as equal to the young when it comes to taxpayer funds?

Work Opportunities Locally and Abroad

Fiji age care workers are renowned the world over for their warmth.

Indeed, there are many expatriate families in Fiji who move their elderly to Fiji where the cost of 24/7 care is far less than that in Australia and the elderly feel at home.

I have previously pointed out that the Australia population is aging rapidly and there are grave shortages of trained carers all over Australia.

I know that Pacific TAFE runs age care courses with their qualifications supposedly acceptable in Australia but reviews indicate that only a very small proportions of Pacific Tafe graduates are obtaining employment in Australia.

But there is little doubt with Australian salaries for carers around A$50 thousand a year (F$70 thousand) Fiji’s age care graduates could very profitably target niche markets in Australia, looking after the Australian elderly, including former Fiji citizens.

Surely, such movement of age care workers could well be part of the trade agreements between Australia and Fiji, as a “Win Win” situation for both countries.

A recent Report for Australia’s Royal Commission into Age Car Quality and Safety (May 2019) noted:

“the demand for culturally appropriate services is likely to increase considerably in the future and this demand will change over time as the different ethnic populations continue to age at different rates. One of the challenges of ensuring the provision of culturally appropriate care is the changing makeup of the overseas born population which may present difficulties in finding an appropriate workforce.”

Those interested in Fiji’s aging problems might wish to read all  the reports coming out of this Royal Commission.

In particular, readers might wish to examine how Australia is coping by a mix of strategies including state owned age care homes, some built by religious organizations like the Uniting Church, some providing subsidized services in the homes of the elderly as much as possible, and individual families privately looking after their own elderly- a horribly expensive affair which few families can afford.

These could well be models for Fiji even if rural isolation would be a massive challenge.

The religious organizations and NGOs need to start national dialogue urgently.

 

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