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October 9, 1999


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Who Cares For An Aging PIO?

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Raj S Rangarajan

You have no doubt heard of the Indian businessman or professional who has made it big in America, with his stable of swanky Mercedes cars in his multi-car garage in sprawling suburbia, whether in Princeton, New Jersey, Hempstead, New York or Sunnyvale, California.

With the Internet revolution spawning so many young Indian millionaires, you would have also heard that the Non-Resident Indian, now renamed Person of Indian Origin has earned widespread recognition among his peers at work, among his friends in the Indian community as also among his American neighbors.

You would have also heard that many PIOs invite their older parents to stay back in the United States to partake of the "American dream."

But how often have you heard stories percolating down the Indian community and the extended south Asian community, where old parents, who chose to emigrate to stay close to their children and grandchildren, feel forsaken, bereft of company and deprived of friendly chatter they were used to back home? Or, of the cases where older folk have fallen seriously ill here and are saddled with huge hospital bills and bruised egos?

Not knowing English and not being mobile are proving to be major handicaps for many Indian seniors and these stresses bring a sense of alienation since emotionally and psychologically they are unable to mix with their American neighbors -- white, black or brown.

It is time that Indian groups in different states of America started creating a dynamic mechanism to take care of our older folk here as also the 60-plus PIO on the verge of retirement. The centers could be profit-making recreational units where seniors would feel less lonely. Old age homes could be downright intimidating and insulting if the folks at the home are not old enough -- mentally and physically.

A small beginning seems to have been made in Florida and several other parts of America where such centers are being operated. With the PIO deciding to stay back sometimes out of necessity, he or she has to learn to adjust to the vagaries of American weather as also the tricky art of managing to adjust and live with two, sometimes, three generations with mutual respect and peace.

A major consideration is language. If the older folk at these recreational areas can communicate in a common language, half the problem is solved. It is a function of age that problems are getting more acute with older folk falling ill or are physically challenged. It will soon become difficult, if not impossible to grow old gracefully in America unless the Indian community takes immediate remedial action.

Rashmi Gupta, a professor at Hunter's College in Manhattan, New York, who wrote her thesis on Elder Caregiver burden in Southeast Asian families says: "The situation for the older Indian is grim on caregiving issues since the basic infrastructure and extended family concept do not exist here."

Vijayan K Pillai, a professor of Sociology at University of Texas at Arlington agrees with Gupta that a primary system has to be created for the benefit of the Indian senior and the graying middle-ager who now needs geriatric and emotional support.

Gupta cites several cases where the 60-plus PIO, retired in India, decides to move to the United States only to find that he or she is treated like a second-class citizen. The process of immigration and assimilation into a new environment with a new language, in some cases, "strange" customs and differing value systems do create stress, on occasion, with concomitant illnesses.

Sociologists believe that when people migrate to another country, they tend to lose their original value systems. However, for the most part, they seem to retain their original cultural values and food habits.

Traditionally, Indians have provided care for their elderly parents. The norm that the eldest son or other siblings would care for their parents in old age does not necessarily apply in the US. And, many of the old beliefs seemed to have vanished in India too.

Some became caregivers for their aged parents as they invited them to help in childbirth of the grandchild, and later decided to stay back permanently in the interest of "family unity", a category, America's Immigration & Naturalization Service recognizes. Some of the seniors have turned out to be baby-sitters unwittingly for the grandchildren and unpaid help at home.

Not all seniors relished the idea of having to "serve" in the autumn of their lives, albeit in their own son's or daughter's home. Adds Gupta: "In the interest of family peace, these respondents preferred, understandably, not to be identified by name or address even for research purposes."

Many seniors help in managing the household, the mother/mother-in-law helps in cooking and cleaning while their sons, daughters and their spouses go to work.. The seniors mostly taught their grandchildren cultural and spiritual values and rituals, the research revealed.

Overall, men rarely felt the burden, according to research studies. Daughters-in-law tend to feel the most pressure. Some of them found it frustrating and stressful to cook two kinds of meals for dinner, usually an Indian meal for the older folk, while children preferred American fare.

Some women complained in the survey that they had lost their sense of identity and privacy in a "nuclear family" situation, today's norm in America.

Even visiting a place of worship cannot be accomplished on a personal level by the aging PIO. It's not like the days in India, where a person could take casual stroll round the bend to the nearby temple or mosque for peace and solace.

Today, most senior citizens have to make appointments or plan a few days or weeks in advance since several people's schedules have to be carefully managed before a temple visit materializes.

Falling ill here could turn out to be expensive. Key questions arise when parents who are old and frail fall ill and need critical care. How do people cope when the parent suddenly becomes chronically sick or disabled? What kind of care do they provide and how do they manage? How much can the PIO afford?

Many of the visiting seniors are not used to the American way and encounter adjustment problems. Many elderly parents cannot communicate in English and are usually dependent on their adult children for transportation and fulfillment of their social and emotional needs. Even interacting with an American neighbor often becomes an exercise in gesticulation and guesses.

If admitted to a hospital or a nursing home, things could be worse. Hospital food at the best of times is tolerated, just passable. Many Indians who are vegetarians need home-cooked from home for sustenance, though these days even hospitals and old age homes provide veggie fare too. But the Indian taste buds are not satisfied by the often bland, overcooked greens and vegetables.

Most often, the attending physician's approval is needed for matching prescription diets with eating habits.

From a financial standpoint, after becoming naturalized American citizens, PIOs would qualify for benefits that the state offers like medicaid or medicare. But, not having contributed to the Social Service Administration, the PIOs will have to depend largely on the largesse of the son or daughter or the extended family.

Perhaps, it is time to pull the emotional strings of those philanthropically inclined specially in the Silicon Valley. Several groups have been raising funds for specific causes but none seem to be focused on the graying PIO.

There are a number of shelter homes for South Asian women in a few American cities; there are over a dozen Indian groups helping South Asian women. But there is hardly an organization devoted to the elderly.

Caregiving among some American communities is disappointing and heart-wrenching, and Indians in old-age institutions complain of lack of warmth and of problems unique to growing old here. Efforts are being made by Indian communities sporadically in cities like Dallas, Texas; Chicago, Illinois; Jersey City, and Edison, New Jersey to care for aging Indians who have made America their home.

But a basic and coherent game plan is needed for caregiving and for emergencies.

Many PIOs even after living here for more than 25 years have not been Americanized enough to accept the thought of an old-age home or a retirement community when it came to their own parents. The concept of the younger generation taking care of the older folk in America is not considered practical or desirable. It is perhaps so in India today.

With the number of Indian seniors on the rise in America, PIOs will have to start thinking in terms of setting up old-age homes or senior centers exclusively for Indian men and women. As of now, most health problems of seniors are being resolved by individuals and families on a personal level without too much help from the state or federal government.

But instead of depending on individual whims, senior citizens ought to have something planned for them independently. And they are certainly entitled to live a comfortable and meaningful life into the millennium.

Raj S Rangarajan is a New York-based freelance writer

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