HelpAge India Report 2021, ‘The Silent Tormentor: Covid 19 & the Elderly’, assesses the impact and challenges of the pandemic on lives of elderly living in households (informal settings) and old-age homes (informal settings). It unravels some deep-seated fears of the country’s elderly. It also examines the new culture of ‘work from home’ of family caregivers and its implications as well as concerns of caregivers in both settings to understand their behaviour and circumstances.

While on one hand Covid-19 brought out some hard challenges faced by old-age homes (formal setting) during the pandemic, the findings also says a large part of the elderly surveyed in household settings felt lonely and wanted someone to talk to them.

The report says that old-age homes have been struggling to stay afloat during the pandemic and having access to basic service goods and services proved difficult. As many as half of the old-age homes faced scarcity of funds during the pandemic and 37% had no isolation or quarantine room if any elderly was infected.

For those in household settings, despite 58.6% elderly having family members who worked/studies from home and living in close proximity with them throughout the day, 20.5% elders wanted some company with them, 35.7% wanted someone to just call them to talk and 13.7 % felt trapped and frustrated.

Of 20.8% elders who lost either their family members or friends due to Covid-19, when asked what could have been done better to save their lives, 50.8% said better medical/health infrastructure, 44.4% said availability of vaccine and 38.7% said availability of medicines and injections on time.

As many as 42.1% elders were most worried of being hospitalized if infected with Covid and 34.2% were worried of being isolated. 11.5 percent had fear of dying.

As many as 73.9% of these elders lived with their family, 9.4 percent with spouse and only 9.9% lived alone. Some 41.1% elders were financially dependent on their family members, out of whom 70.2% were in age group of 80-89 years. About 52.2 percent elders said their income has been impacted due to Covid. Job loss (34.9%) and pay cut (30.2%) of family members emerged top reasons.

The survey also found misinformation about vaccination among elders. As of the 58.2% elders who were aware of the Covid-19 vaccine, 61.2% felt that they will be completely immune to the disease after taking the vaccination. But 41.8% elders were not aware of the vaccine.

Some 15.6 percent elders said they are victims of abuse, 45.6% complained of disrespect and 23.1% said beating /slapping were the main forms of abuse. About 62.1 % felt risk of getting abused during the pandemic had increased; 43.8% blamed their son as main abuser and 27.8% said it was the daughter-in-law. In 14.2% cases daughters turned out to be the abuser. Emotional abuse (60.1%) was the main form of abuse followed by financial abuse (61.6%) and physical abuse (58.6%).

The survey conducted across six tier-1 cities (Delhi, Mumbai, Bangalore, Hyderabad, Kolkata and Chennai) covering Sec  A, B, C & D also found that 48.1% caregivers in household setting faced difficulty in managing their expenses as many had lost their jobs and were coping with decreased salary. As many as 36% found it difficult to give full attention or dedicate time to elderly members in their family. The caregivers said that need for more attention (37.4%), behaviour of family members (33.6%), financial insecurity (26%) and inability of the family members to understand needs/emotions of the elderly (18.3%) were major challenges faced by the elderly during the pandemic. Nearly 98% caregivers were family members with son (27.3 %) followed by spouse (21.5 %) as main caregivers.

“The pandemic has brought about fear and ambiguity, especially among older adults. It is important to not only pay attention to the elders’ physical wellbeing but also their emotional wellbeing. What is interesting to note is that while 61.4% said that the ‘work from home/study’ affected their day-to-day routine in a negative way, this sharply contrasts with the caregiver perspective as 71.6% said it did not affect the elders’ day-to-day routine. This has exposed a distinct gap by the younger members in the family in understanding the elders’ needs,” said Prakash N. Borgaonkar, head – Maharashtra and Goa, HelpAge India.

In old-age home settings the measures taken by old-age homes to ensure social distancing guidelines are met by elders. They included conducting counselling sessions for the elderly to make them understand about social distancing (74.1%), encouraging elderly to make video calls to their family members instead of meeting them physically (62%) and sanitization of groceries, medicines, daily essentials etc. procured from outside the old-age home (58.3%). About 93.5% respondents said that regular sanitization/fumigation process was put in place to protect the elderly from Covid-19.

TV (95.4%), radio (36.1%) and phone call (30.6%) were the sources of information on Covid-19 for the elderly in old-age homes. The findings further say that 67.6% staff of the old-age homes do not have a health insurance cover, 34.3 % old-age homes consistently faced the problem of staff shortage during the pandemic, 56.1% of staff at old-age homes feel stressed due to shortage of caregivers/attendants during pandemic and 50.9% of caregivers feared getting Covid-19 while taking care of them.

Further, the findings say that while 67% old-age homes had PPE kits, 37% did not have PPE kits available to their staff. Nearly 51.9% of staff members/caregivers of the old-age home are not worried about elderly being infected with corona virus. About 61.1% old-age homes had patients who needed extra care for their daily activities like those suffering from dementia and Alzheimer’s or are bed-ridden etc.

Among the elderly living in old-age homes, 60.6% elders were most worried about isolation and quarantine, 62.2% feared hospitalization and 22.9% abandonment by caretakers/ family members in case they got infected with Covid-19.

Like elders in household settings, elders in old-age homes felt loneliness and isolation and loss of communication with their loved ones. Of them, 58.5% elderly felt that pandemic has affected their communication with their loved ones. At the same time, 59.3% caregivers said visitors were not allowed in the old-age home to meet their parents or grandparents.

“It was clear that old-age homes are struggling to stay afloat during the pandemic. The future is uncertain but we must ensure that elder needs are addressed so they can live their later years with dignity and hope,” added Borgaonkar.

“We received more than 1,000 calls on our Elder Helpline relating to elder abuse, violence and disputes in the Second Wave – an increase of 18% from the first wave. The helpline received almost 20,000 calls in total in the Second Wave, which is a 36% increase since the first wave with calls about counselling increasing by 111 % and requests for income support by 54%,” said Dr Imtiaz Ahmed, mission head, Agecare, HelpAge India.

“The report clearly brings out the sense of fear, worry and loneliness our elders are facing and the increased risk of abuse due to growing dependency. The report also addresses the urgent need now more than ever for building a strong and responsive eldercare system. The elders’ needs must be given the priority, attention and resources they deserve and even as family caregivers do their best, despite challenges, government, community and private sector must work together to support caregivers and bring in elder friendly policies and programmes,” said Rohit Prasad, CEO, HelpAge India.

The survey was conducted by Ipsos Research Private Limited with participation of 3,526 respondents.