JA­MAICA: not a place for OLD PEO­PLE

Jamaica Gleaner - - IN FOCUS PLUS - Peta-Anne Baker & San­dra Lat­i­beaudiere Guest Colum­nists

It is in­deed un­for­tu­nate that Ja­maica’s Vi­sion 2030 theme makes no men­tion of Ja­maica be­ing the place of choice where per­sons can re­tire and en­joy old age. The signs of this be­ing pos­si­ble for the sub­stan­tial ma­jor­ity of older per­sons are very poor.

Up to 2007, some 80 per cent of all Ja­maicans did not en­joy universal health care, de­fined as re­ceiv­ing “the health ser­vices they need with­out risk of fi­nan­cial ruin or im­pov­er­ish­ment”. Our eco­nomic tra­vails over the years would sug­gest that this sit­u­a­tion has not changed.

The 2012 Sur­vey of Liv­ing Con­di­tions Age­ing Mod­ule Re­port states that while poverty among older per­sons is lower than for the gen­eral pop­u­la­tion, only about a third of older per­sons re­ceive a pen­sion of any kind, and al­most 50 per cent of this num­ber re­ceive less than J$10,000 per month. Fur­ther­more, while al­most half of all house­holds with older per­sons re­ceive re­mit­tances from abroad, only about a third of the poor­est of these house­holds re­ceive re­mit­tances any at all.

In fact, it is safe to say that many older Ja­maicans are too poor to re­tire, but in our cur­rent youth-ori­ented pol­icy en­vi­ron­ment, and with a sig­nif­i­cant per­cent­age of per­sons hav­ing lit­tle more than a pri­mary-school ed­u­ca­tion, em­ploy­ment op­por­tu­ni­ties are lim­ited to largely low-pay­ing oc­cu­pa­tions.

Ja­maica is in de­nial about the ex­tent of pop­u­la­tion age­ing that is oc­cur­ring. Our plan­ners, pol­i­cy­mak­ers, and the wider so­ci­ety seem un­aware of the fact that the coun­try is al­ready ahead of the curve, with al­most 13 per cent of our pop­u­la­tion be­ing aged 60 and over (that is close to 400,000 peo­ple).

It is pro­jected that the num­ber of per­sons aged 80 and over will in­crease by al­most 60 per cent by 2030 (a mere 14 years from now!). One-third of house­holds in Ja­maica con­tain at least one per­son 60 years of age or older. In most in­stances, these per­sons are ac­tive mem­bers of the house­hold, of­ten pro­vid­ing care to younger and older mem­bers and ma­te­rial sup­port from mea­gre re­sources, in­clud­ing for the 23 per cent of per­sons re­ceiv­ing it, from their PATH ben­e­fit.

It should not come as a sur­prise that a sub­stan­tial mi­nor­ity of older men (30 per cent) and a slightly smaller (25 per cent) group of older women are not sat­is­fied with their qual­ity of life (although they do have a higher sense of achieve­ment). The lev­els of dis­satis-

fac­tion are greater (over 40 per cent) among the poor­est mem­bers of this pop­u­la­tion. The fact that lev­els of dis­sat­is­fac­tion seem to de­cline with in­creas­ing age should of­fer no com­fort as this could rep­re­sent a spirit of res­ig­na­tion to one’s lot rather than ac­tive sat­is­fac­tion.

The re­lease of the World Alzheimer’s Re­port 2016 on Septem­ber 21 as part of a month of at­ten­tion to a dis­ease, which is still not com­pletely un­der­stood, en­cour­ages us to fo­cus on those per­sons and their fam­i­lies who are strug­gling with this prob­lem. (The re­port can be found on the Alzheimer’s Dis­ease In­ter­na­tional web­site at www.alz.co.uk/re­search/worl­dreport). To be con­fronted by the grad­ual ‘dis­ap­pear­ance’ of a per­son one has known and loved for many years is an in­de­scrib­ably painful ex­pe­ri­ence for fam­ily and friends alike. Pro­vid­ing ad­e­quate care can prove to be costly, and sup­port ser­vices are few.

De­men­tia, which is a de­cline in men­tal func­tion­ing in a man­ner that im­pacts one’s mem­ory and sub­se­quent abil­ity to per­form rou­tine daily tasks, af­fects a small but grow­ing mi­nor­ity of older per­sons world­wide and in Ja­maica.

Our abil­ity to live longer in­creases the like­li­hood that the in­ci­dence of de­men­tia, in gen­eral, and Alzheimer’s, in par­tic­u­lar, will in­crease. Pre­cise num­bers of per­sons with de­men­tia are dif­fi­cult to ob­tain. Rates of di­ag­no­sis in mid­dle-in­come coun­tries such as ours run at less than 10 per cent. Cur­rently in Ja­maica, de­men­tia data are rolled in to data for men­tal ill­ness. Many per­sons liv­ing with de­men­tia are likely to be ex­pe­ri­enc­ing other chronic con­di­tions such as di­a­betes or hy­per­ten­sion.

The high-level spe­cial­ist US group work­ing on this dis­ease states that the ob­jec­tives of clin­i­cal care for per­sons with de­men­tia (of which Alzheimer’s is a type) are: “Pre­serv­ing, to the max­i­mum pos­si­ble ex­tent, cog­ni­tive and func­tional abil­i­ties, re­duc­ing the fre­quency, sever­ity, and ad­verse im­pact of neu­ropsy­chi­atric and be­havioural symp­toms, sus­tain­ing the best achiev­able gen­eral health, re­duc­ing risks to health and safety, and en­hanc­ing care­giver well-be­ing, skill, and com­fort with man­ag­ing the pa­tients with de­men­tia in part­ner­ship with health-care providers.”

In­sert into the pic­ture painted above per­sons suf­fer­ing from, or try­ing to pro­vide care for, per­sons with Alzheimer’s – a dis­ease where the main med­i­ca­tion can cost $31,000 per month if one is allergic to the stan­dard meds, or is not reg­is­tered on the Na­tional Health Fund (some 50 per cent of older per­sons are not), or doesn’t know the sys­tem well enough to en­sure that their pre­scrip­tion is writ­ten on a gov­ern­ment letterhead.

The lat­ter may seem un­usual but should be con­sid­ered in the con­text of the find­ing that onethird of those in­ter­viewed in A se­nior ci­ti­zen is spot­ted of­fer­ing a ride to a young­ster on his bi­cy­cle in Green­wich Town on Thurs­day, Jan­uary 7. Lack of ac­cess to pen­sions has had a de­bil­i­tat­ing ef­fect on older Ja­maicans in their re­tire­ment years.

2012 were not Na­tional In­surance Scheme con­trib­u­tors be­cause they did not know how to be­come con­trib­u­tors.

For the fam­ily care­giver, the pos­si­bil­ity of tak­ing a break from care­giv­ing is avail­able only to those with fam­ily or friends will­ing to take up the re­spon­si­bil­ity or who can af­ford to pay for sub­sti­tute care (if they can get over the feel­ing of guilt at even ac­knowl­edg­ing this need) and can af­ford the trip abroad or week­end in the coun­try.

The ab­sence of respite care and other ad­e­quate sup­ports are them­selves con­trib­u­tors to the risk of abuse.

Among the paid care­giv­ing pop­u­la­tion, de­spite legislation re­gard­ing hours of work and wages, most of these per­sons, es­pe­cially those work­ing in the home set­ting, work 14- 18-hour days and go for weeks with­out time off. Of course, in both the for­mal and so-called in­for­mal sec­tor, the vast ma­jor­ity of care­givers

are women, many of them mid­dle-aged or older.

LIT­TLE IM­PROVE­MENT IN NURS­ING HOMES

Most nurs­ing homes no longer smell of urine, but in far too many, lit­tle else has changed. Reg­u­lar ac­tiv­i­ties aimed at achiev­ing an ob­jec­tive such as one of those men­tioned above, “pre­serv­ing, to the max­i­mum pos­si­ble ex­tent, [the] cog­ni­tive and func­tional abil­i­ties” of res­i­dents, are rarely in ev­i­dence. As in the case of child­care, the tele­vi­sion set seems to be the pri­mary source of ed­u­ca­tion and en­ter­tain­ment.

The wider com­mu­nity and pub­lic pol­icy as­sume that care­giv­ing is a fam­ily re­spon­si­bil­ity and is, there­fore, not wor­thy of much pub­lic dis­cus­sion and sup­port. One im­me­di­ate con­se­quence of this is that fam­i­lies deal­ing with de­men­tia of­ten find their ex­pe­ri­ence a lonely and de­bil­i­tat­ing one. When older per­sons be­come the re­cip­i­ents of care, they be­come more and more vul­ner­a­ble to the loss of their in­de­pen­dence, as well as to ver­bal, emo­tional, fi­nan­cial, and

phys­i­cal abuse. Un­like the sit­u­a­tion of chil­dren, there is no pub­lic ed­u­ca­tion or ad­vo­cacy about elder abuse and the en­vi­ron­ment could be de­scribed as hos­tile to the par­tic­i­pa­tion of older per­sons in de­ci­sion mak­ing.

While progress has been made, the au­thor­i­ties have a great deal more to do in the area of set­ting and mon­i­tor­ing stan­dards of care in res­i­den­tial fa­cil­i­ties for older per­sons. Our churches and civic or­gan­i­sa­tions could play a sub­stan­tial role in help­ing to de­tect abuse in the home, and the banks and other fi­nan­cial in­sti­tu­tions need to equip their staff with the knowl­edge and skills to de­tect elder fi­nan­cial abuse.

Ja­maica has no legislation that al­lows per­sons to set out their wishes for care in the event of their be­com­ing un­able to ex­press them. This deficit af­fects not only per­sons with de­men­tia, but is com­pli­cated in the case of de­men­tia be­cause of its pro­gres­sive na­ture. A per­son may be un­able to man­age their fi­nances but still be able to de­cide on where he or she wishes to live.

De­spite the talk of par­tic­i­pa­tion and in­di­vid­ual choice the ten­dency to equate old age with di­min­ished de­ci­sion-mak­ing ca­pac­ity of­ten de­nies this group the en­joy­ment of their right to self-de­ter­mi­na­tion.

In­ter­est­ingly, a sub­stan­tial per­cent­age of older per­sons, 33 per cent of those 80 years of age and over and more than 40 per cent of those 60-79 years, con­tinue to be ac­tive in so­cial or civic or­gan­i­sa­tions. How­ever, the high­est level of in­volve­ment is in the Church and is most likely re­lated to spir­i­tual and so­cio-emo­tional needs. Par­tic­i­pa­tion in other groups, even those in­tended for older per­sons such as se­nior cit­i­zens’ groups, does not reach five per cent in all but one in­stance (5.3 per cent of the high­est-in­come group of older per­sons are re­port­edly ac­tive in a com­mu­nity or­gan­i­sa­tion).

Sixty-four per cent of per­sons 60 and over voted in the 2011 elec­tion, with the high­est turnout be­ing among the poor­est. Re­gret­tably, it ap­pears that this group of vot­ers is not yet us­ing its power to en­gen­der greater at­ten­tion by pol­i­cy­mak­ers to its con­cerns.

It is clear that in ad­di­tion to sig­nif­i­cantly ex­pand­ing its or­gan­is­ing ef­fort, the Na­tional Coun­cil for Se­nior Cit­i­zens needs to in­clude train­ing in ad­vo­cacy for the groups with which they work. Agen­cies such as the So­cial Devel­op­ment Com­mis­sion, the ODPEM, and the Red Cross need to fo­cus more on the in­volve­ment of older per­sons in their own right and on pro­mot­ing their abil­ity to speak on their own be­half in re­la­tion to poli­cies and pro­grammes to serve older peo­ple and sup­port their care­givers.

There is an ur­gent need for older per­sons them­selves to come to­gether to strate­gise and de­mand at­ten­tion to their con­cerns. Pro­fes­sion­als and other con­cerned per­sons have a role to play in speak­ing to the needs of older per­sons, but per­haps our great­est task is to find ways to en­gage older per­sons them­selves, the ma­jor­ity of whom are com­pe­tent and ac­tive, to speak to their own needs and the needs of those among them who are con­fronting de­bil­i­tat­ing dis­eases such as Alzheimer’s.

I

FILE

Se­nior cit­i­zens line up to re­ceive food pack­ages at an an­nual west Kingston treat in Tivoli Gar­dens on De­cem­ber 22, 2014. One-third of house­holds in Ja­maica con­tain at least one per­son 60 years of age or older. SEPTEM­BER 25, 2016

JER­MAINE BARN­ABY/PHO­TOG­RA­PHER

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