TAKE CARE WHERE YOU AGE

 

AGED CARE – BETTER HERE THAN THERE?    

 

                    

Australian politicians like to parade their nation’s welfare and medical credentials, claiming a world-class government-funded system ensures the disadvantaged get the attention they need.

That was the story in the years BC (Before Covid).  It’s different now. The pandemic has exposed policy flaws – particularly with aged care.

If the quote ‘the measure of a civilization is how it treats its weakest members’ often attributed to Indian statesman Mahatma Gandhi (1869-1948) remains apt, then Indonesia is doing better than its Ozzie neighbour.

Here in Indonesia looking after retirees is not a big government responsibility.  Only former public servants, the military and employees of major corporations get pensions, and they’re small.  Just two per cent of the national budget goes on social welfare, while Vietnam and Thailand allocate five per cent. To fill the gap families are expected to protect, watch and provide, and to do so as their cultural duty. 

Readers familiar with kampong and village life will know traditional communities are a mix of newborns, those soon to depart and everyone in-between, students, parents, workers, retirees – every cohort of humanity together.

About 40 per cent of Indonesians live in rural desa (hamlets).  Come dawn the old folk can be seen easing the younger generation’s workload with cleaning and cooking, washing and bathing, much of it in public.

They move slowly, can be forgetful and maybe need a stick for support.  But they’re essential, wanted, not a nuisance.  Those too weak to labour can nurse a babe and expand the littlie’s day with lullabies.

They see neighbours readying kids for school, the mums checking uniforms and satchels. Be tidy, be polite. Never be ashamed. 

  In this mystical mix of ancient traditions, Indonesians show respect for age, the place where we’re all heading.  A quarter of Australians are reported to be lonely. Chance are there’d be only a few Indonesians suffering solitude.

 

 

When the old-timers breathe no more, the houses they inherited are passed to the next generation. They’ll lie at the edge of the desa alongside those who’ve shared their lives, like Australians once did in village church graveyards, not a huge and distant impersonal urban cemetery run by a government department.

There are downsides.  The elderly can get grumpy and annoying, especially when criticising young parents’ modern childcare techniques. The facilities are often sub-standard. Most desa have electricity but not potable piped water, leaving rivers to wash, bathe and defecate, which is how President Joko Widodo spent his early years in Solo. 

These villages are nothing like the newer suburbs Down Under where homes commonly house working parents and a couple of kids.  So where are the Grans and Gramps?

In ‘clean, modern, well-supervised residential care’, more commonly known as Old Folks’ Homes.  These began mid last century as a response to women entering the workforce, so no longer available to help aging parents.  At first, the OFHs were small and run by non-profit organisations, often associated with churches and staffed by untrained volunteers.

Then commercial operators moved in. Eldercare has now become big business – and costly. Entry and exit fees, maintenance charges and other imposts often drain savings despite government subsidies. 

Now the dangers are physical.  In one Queensland facility, 100 residents and 82 staff caught the virus. Although the Federal government says victims with other ills are dying ‘with Covid, not from Covid’ the crisis is so bad Army medics have been called in to help with OFH staff shortages.

In Australia Omicron has killed 566 old people and infected 30,000 OFH staff and residents since the first case last November. More than 145,000 coronavirus-related deaths have been reported in Indonesia since the pandemic began two years ago, but we don’t have age data.

We’re all living longer. The numbers of Indonesians over 60 increased from 4.5 per cent in 1971 to 9.6 per cent in 2019. World Bank stats show Indonesian women’s life expectancy is now 74 years and men’s 69.4. Add a decade for the Australian figures.

The Medical Journal of Australia reports Australia has ‘the highest proportion of older people living in institutional care compared with 11 other nations.’

In Australian residential homes, the workers are a rapidly diminishing force. Many are migrants, carers from cultures vastly different from the cared, taking the low-paid jobs Australians reject. So the occupants are much the same age.

A few Indonesians who’ve lost contact with their families sometimes complete their span on earth in ‘nursing homes’. Sounds caring, but a 2020 report from Yogyakarta’s Gadjah Mada University said the term has become ‘embedded in Indonesian society as a place to live for elderly who are poor, are neglected, and do not have families, so it shows unfavourable stigma.’  In brief – putting elders in care is considered shameful in Indonesia.

Maybe this should happen in Australia as Covid reveals the wrongs. A two-year Royal Commission found shocking deficiencies in residential aged care prompting Commissioner Lynelle Briggs to write:

"Life is to be lived. No matter how old we are, how frail or incapacitated we might be, how rich or poor, we all have the fundamental right to wellbeing, enjoyment and fulfilment as we age.

‘In order for this aspiration to become reality, our aged care system must be founded on the principles of unfailing compassion — care, dignity and respect.’

In Indonesia, these necessities are provided by families, not agencies. Maybe something Australians need to accept if their Lucky Country is to be fortunate for all.

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First published in Indonesia Expat 4 March 2020:  https://indonesiaexpat.id/outreach/observations/aged-care-better-here-than-there/

 

 

 

 

WHAT TO DO WITH THE OLDIES? HERE THERE'S ONLY FAMILY CARE

 

Doing aged care differently

Our street in Indonesia has 70 households. Many are mixed generation families.  With few nursing homes or retirement villages, and those far away, families have two options: The kids do the caring, or employ a carer.  Either way Grandpa or Grandma stays home.

Sawojajar is eight degrees under the Equator and a suburb of Malang, an East Java hilltown nudging one million.  Days start with the 4.15 call to prayer.  An hour later as the sun crests the mountains, the street’s five elderly and infirm men are wheeled out of the houses they once lorded, or shuffled into plastic chairs. 

There’s no sense of abandonment, more a welcome back. Parked in the shade of mango trees the old fellows expect to finish their days where they’ve lived among familiar faces, sounds, sights and smells. Here they’re obvious to all, spectators of the daily parade yet also participants.

With no public parks or pavement the bitumen is the community room, an oval, a market, an open-air hall, a thoroughfare.  There’s much to hear and see, and not one event has been organized by a social welfare consultant.

A quarter of Australians are reported to be lonely. No similar studies in Indonesia where mental health isn’t a front-page issue, but chances are there’d be only a few suffering solitude – and certainly not in this street.

Indonesians engage easily with strangers.  The watchers outside their wrought-iron fences advise reversing drivers of hazards, direct strangers to the right address, hold parcels for absent residents and act as human CCTVs.

The steps into familiarity start with asking where the visitor’s going, leading to questions about the family’s origins, age, the number of children and religion.  If privacy is precious, don’t retire in Indonesia.

This isn’t an attractive street, just rising above the average, middling middle class, homes mostly owned by the occupiers. The houses were badly built on a rice field in the 1990s so there’s much repairing and expanding.  Tradies weld, mix concrete and cut timber on the road.  Workers are always watchable and cheerfully accept unsought advice.

The live-in helpers (AUD 150 / a month) and grannies left behind when Dads and Mums head to work, shuffle around in shapeless housecoats caring little about their appearance for the black-top is their backyard.  They’ve already done the laundry; the clothes drying on the fence reveal who sports G-strings and fancy bras.

Now the plague has closed classrooms the kids have turned the street into a sports centre. They practise pushbike stunts, whack shuttlecocks, kick barefoot goals marked by flip-flops on the asphalt.   The granddads keep score and shout tactics.

Health is an issue for the elderly so there’s Ibu Jamu carrying a basket of bottles on her head, stirring a secret herbal mix to guarantee longevity and fix most moans - a sore back, inflamed throat, headaches and every ailment in-between.  Maybe even Covid-19.

She blends her patient’s personal supplement, revealing juicy news of others’ complaints while the customer drains the glass.  There’s a free health clinic a couple of km away, but Ibu Jamu is alongside.

So is a mobile shop.  A middle-aged woman pushes a four-wheel cart stocked with household necessities from soap powder to salt. Dad can get his ciggies, or the Jawa Pos without asking anyone to do errands.

Raps on a hollow log announce the bakso (meatball soup) cook.  He’ll boil a breakfast broth on his kaki Lima (five foot) pushcart and serve the retirees where they sit. 

Hawkers’ barrows are everyone’s news hub, the place to update on disputes and dramas, to plug into sagas of straying husbands, barren wives and wayward teens.  The oldies are always in the loop, in the rhythm of life.

There are no government home care packages.   Only former public servants, the military and employees of big corporations get pensions, and they’re small. 

A 2020 report by a team from Yogyakarta’s Gadjah Mada University claims only the government and a few non-profits provide residential care: ‘However, the term ‘nursing home’ has been embedded in Indonesian society as a place to live for elderly who are poor, are neglected, and do not have families, so it shows unfavourable stigma.’

Almost two thirds of Indonesian men smoke, with lung diseases taking an estimated half a million lives a year.  That was before Covid-19.   Four heart attack victims (three were heavy users) have recovered some speech. One seems to have dementia, but isn’t ignored.

When it gets too hot or wet (we’re eight degrees below the Equator) the seniors get pushed or steered indoors, hoping they’ll make it to the morrow. World Bank stats show women’s life expectancy is 74 years and men’s 69.4. Add a decade for the Australian figures.

Departure day comes with a black cross on a white flag. All go to the house, discreetly leave an envelope, console the widow across the open-coffined corpse in the lounge, praying together whatever the family’s faith.  The deceased lived with us, so died among us. He belonged.

What did he die from?  Only a foreigner would ask such a silly question:  Allah called.  More important to inquire the time of his passing and final words, because these can be interpreted to have special meanings.

This is neither Struggle Street nor Pleasantville. There’s nothing romantic or admirable about how the neighbourhood runs – it’s standard and the elderly don’t get shielded from the realities.

There’s a couple of snobs.  Parking sometimes causes mild friction. Real or imagined insults get stored and not all have a use-by date. The idle remember family scandals and religious conversions from last century and keen to update newcomers.

Semi-feral felines rip apart plastic rubbish bags for chicken bones. Scrumpers get lured by the mango trees, so some have been felled angering greenies.  Unswept leaves irritate the fastidious. Yet it’s rare to encounter threats to move.

The Great Australian Fear of millions of Asians fleeing their ghettos and swamping the empty land below does not apply to the Javanese.  Though their island is already one of the world’s most overpacked, they’re homebodies.

Sawojajar is where they’ve lived for decades and where they’ll die, not grouped apart by age or disability but mixing daily with the newborns, the itinerant traders, the kids growing up, the passers-by, the riches and routines, sad times and jolly events.  The idea they should be separated is abhorrent

First published in Pearls & Irritations, 9 March 2021: https://johnmenadue.com/australia-could-learn-a-thing-or-two-from-indonesias-personalised-approach-to-aged-care/