Elderly care - a lesson from China

The Time magazine, in one of its issues, before Barak Obama was to visit China in 2009, made a mention of a few things that he could learn from the Chinese. Among them were the Chinese habit of saving and the care that they take of the elderly. Chinese have not given up these traditions in the euphoria of accretion of untold riches. Both are twined together, as one becomes the enabling element for the other.

The magazine expected Obama to harangue the Chinese to spend more, consume more and, “believe it or not, to become more like Americans”, forgetting the irreversible Chinese habit of saving. Imprudence and profligacy, with not a thought ever given to the idea of saving for the future, have been the hallmark of Americans, i.e. until around 2005 when the personal-savings rate in the US hit zero. The sub-prime crisis changed all that. The shockwaves that emanated from the crisis reverberated around the world but taught a lesson to the Americans which they are unlikely to forget in a hurry. It prompted them to snap-shut their wallets, inducing them to be more careful with their money. The consumer spending plunged with rising unemployment, “heavy debt loads” and credits that became tighter. For the first time in many decades Americans became prudent spenders. The savings rate lifted itself from 0% to a high of 6% late in 2009.

Although China has come a long way during the last 60 years, it has not shed many of its traditions and saving is one of them. When the Communists seized control in 1949 China was a poverty-stricken basket case. Mostly an agrarian country, it was ravaged by food shortages and famines. From Mao’s collective farms, hidden from the world behind a “bamboo curtain”, China today has emerged as the “world’s factory” and is now readily acknowledged as the world’s fastest growing economy, an industrial and military superpower. Unabashed capitalism adopted by Mao’s successors converted a once-peasant society to one that is modern and is virtually aping the West in all respects. With a couple of trillions in foreign currency reserves, China has become the world’s third largest trading country and soon it is going to become Asia’s largest economy. While during the last twenty years its poverty rate has fallen from 53% to just 8%, its middle class has progressively become richer and some of the rich are aiming to become “big rich”.

And yet, the Chinese have not given a go by to their traditional practices. Personal financial prudence, for example, has for centuries been held in high esteem in China and hence it has a high saving rate – above 20%. Saving for the future for the Chinese has all along been necessary for the simple reason that they have to take care not only of their children but also their aging parents. This is a cultural norm which has not undergone any change despite the perceptible transformation in their living standards. Regardless of the fact whether one is a wage-earner or a billionaire real-estate agent, across the socio-economic hierarchy care for aging parents has remained the norm and has for long been accepted as a familial duty. Looking for its reasons outsiders may attribute it to the absence of publicly funded pensions or healthcare systems. The absence of such social security nets may have, according to them, even incentivized the practice. Whatever the reasons, the fact, however, is that for the life of them, the Chinese are unlikely to ever think of going and parking their parents in homes for elders or nursing homes. It is not in their ‘system’ and the practice, apart from being abhorrent, is just not acceptable and is likely to remain so regardless of the new initiatives, if any, that the State takes.

This is in direct contrast to what obtains in the United States. The American nursing homes are so chockful of the elderly that soon there may not be enough space in them for fresh arrivals. By 2030 their number is likely to soar to 70-odd million. The explanations given for the large scale use of these homes by the elderly are many and varied. While it is contended that three generations living together was virtually a norm once upon a time in America, all this witnessed a break-down during the last century when Americans became more mobile, and, in the process, rootless having to move from state to state in search of better economic prospects. Caring for the aging parents from two or three time zones away, thus, was stated to have become difficult. Nursing homes provided a very viable alternative for proper care and treatment of the elderly by personnel who were professionally trained. The practice, nonetheless, is likely to undergo a change for reasons that are patently economic. Nursing home services being frightfully expensive, with the progressive cutback on personal expenses the emphasis may eventually come on home-care for the elderly – even if it eventually has to be subsidized by the State.
In India, however, the situation in this respect happens to be dismal. Despite the traditional respect and care for the elderly, the elders largely find themselves in an unenviable situation. As long as the concept of joint family remained intact, they, apart from being cared for, wielded considerable authority within the family. No major family decision would ever be taken without their approval. However, the system progressively faded away with modernization, industrialization, urbanization, education and ever more ‘nuclearisation’ of families. Simultaneously, the values that invested the elderly with respect and authority also got largely eroded. No wonder, the tradition that demanded care for the elderly also melted away into thin air.
The problem in India gets compounded because of the huge population, almost 33%, that survives in abject poverty (below the poverty line). The elderly in such families, generally, have to be left to their own devices. Often when younger ones migrate to towns looking for employment the infirm elders are left behind in the villages to fend for themselves. Worse, 90% of the labour force in the country is in the unorganized sector of the economy where post-retirement benefits are mostly absent. While the traditional system broke down nothing new emerged in the shape of social security or safety nets for the elderly, barring a few attempts by some states. Pitiable and utterly inadequate, they are more in the nature of an exercise in tokenism.

Indians are also great savers. The current household saving rate in India continues to be high – above 20%. And, yet Indians are increasingly becoming selfish and are reluctant to support their elderly in the manner they should. Some, in metropolitan towns, happened to indulge in behavior with their own parents that was utterly un-Indian, unethical and not in keeping with the country’s traditional values. Parents were, reportedly, driven out of their homes by their own progeny. Even some murders of the elderly were reported in order to secure ownership of parental property. In view of the increasing hardships inflicted on the elderly by their own offshoot, the government, shamefully, had to bring in an enactment for the welfare and maintenance of parents and senior citizens. Parents can now demand from their progeny food, clothing, allowances, medicines and a place to live in accordance with law.

Clearly, it is not the US alone that needs to imbibe from China some of its social mores. Even India, despite its rich traditions and culture but somehow having lost its way, would do well to imbibe some of them.