Aging in Community Project in Sri Lanka

Together with people with good heart, skills, knowledge, and passion, we challenge to change the elder care from institution to community approach.

Please let me know if you would like to join us!

Sometimes, I encounter a question from my friends that

“Why are you so passionate about improving elder care?”

Each time I tried to answer the question in a past, I always fail to articulate my feeling, although I knew that I had a strong motivation for this issue deep in my heart.

When I was in Sri Lanka eating curry with my friends, I suddenly had a strange feeling about why I was in an unfamiliar country to learn about elders’ lives. Then, I questioned myself why I am interested in elder care so much that I lived in a nursing home, coming to Sri Lanka , and studying almost ten years in graduate school that is far away from my family.

At that time, again, I still could not articulate my feeling, and was struggling to come up with an answer for myself until I encountered a scene in the movie “the freedom writers.”

In that movie, an elder woman, who helped Ann Frank during the Nazism era, came and spoke to high school students in the USA . When a student told her that she would be his HERO because of her noble and brave action to protect Ann Frank under the frightening situation, she answered to him that  “I am not a HERO. I just did it because it was the right thing to do.”

Her comment brought me back the memory of talking to Jude and Bill Thomas for the first time. When I asked them why they chose the hard path to start the Eden Alternative, they said that “We are doing this because it is the right thing to do…”

It was such a great moment for me to realize myself the reason why I am doing what I am doing. It was clear that the simple concept of “doing the right thing,” has always been the guide for my path. Throughout my journey, I also learned that all the people in the culture change movement are the heroes because they are trying hard to “do the right things for elders”. Some people are nationally and internationally recognized as s “movers and shakers of culture change,” however, the real heroes are those who take care of elders in long term care facilities everyday.

I would like to always remind myself that every one of us can turn on a small right to make a brighter and better place for all of us to live together.

Despite the limited access to elderly care services in Sri Lanka , most of the elders are able to live with their family at home.  I was wandering why and how they can do this. Based on the interviews, site visits, and discussions with locals in Sri Lanka, I found that following are the factors which enable elderly people to age in their own home in the community in Sri Lanka . Unfortunately, accessibility issues are not yet addressed by any parties, while social policy report published by UN suggested for government of Sri Lanka to take immediate action.

• Buddhism tradition (Respect elders, taking care of parents)

   

• Dana (sharing and donation)

   

• Not only family members, but also relatives and neighbours share responsibility of care

   

• Inexpensive and easy access to bus transportation

   

• Availability of different transportation bus, 3wheelers, train, riding bike

   

   
(left:Our team members, right: Delicious Sri Lankan dishes at lunch)

I safely made it back to the US. This trip to Sri Lanka was quite a life changing experience for me in many ways.

The trip gave me a wonderful and unique opportunity to think about the “real meaning of happiness.” In modern societies, people are so exhausted because they need to work hard to earn money in order to purchase the things that other people have. Many of us may believe that having a nice car, a big house, or take luxury vacations will bring happiness to our lives. When we achieve these “things”, however, their value quickly fades away. Then, we start all over again; chasing more and better things to buy without knowing if they will ever bring happiness in our lives. Although these “things” may delight us, this pleasure is rather temporary and do not come with deep sense of satisfaction.

Despite the limited access to comfort, convenience, and financial resources in people’s life in Sri Lanka, I found that their lifestyles were so much more genuine and meaningful. Many people I met appeared to know that real happiness comes from inside, from the satisfaction that one gets from giving and sharing, honoring friendships, or being grateful about what one is given. The sense of happiness is not something that we can purchase. It may require a continual action of giving and sharing with others. People in Sri Lanka diligently find opportunities to share with others, even though some may only have very limited resources. This practice seems to help them find a meaning for their lives, and ultimately bring the sense of true happiness in their lives.

Throughout this trip in Sri Lanka, I was constantly looking for the reasons why elders are highly respected and being cared for by family members and neighbors at home. Among the many possible reasons, I believe is that their cultural values of “selflessness” and “sharing” may be the most important grounds upon which the supports for elders to age in place within the community is founded.

Again, my trip was wonderful, and I have learned so much from this experience. I hope my diary was somewhat helpful ….

Since I have learned so much about elder care issues in Sri Lanka this time, I will keep posting my thoughts as well as the progress of our design project in this blog space.

This village incorporates the ideas of:

• Developing strong community ties among residents
• Creating a sustainable living environment

This village also encourages the idea of sustainable lifestyle. Technologies, such as solar panel and water system were installed to provide resources, and each household utilize compost for managing their waist as well as for fertilizing organically grown products.

We have spent several hours for talking to people and walking around the community. While we were there, there were so many activities happening; children were running around on the street, elders were cleaning houses, and women were doing laundry. Many were willing to show their houses to us--these were small two bedroom houses usually occupied by 5 -7 people in three generations.

….Can we purchase a sense of community?

As a part of this project, we are planning to do some renovations/ historic preservation work on a donated property in a rural area of Sri Lanka . This property belongs to the family of the landowner for generations, and he decided to keep the name and legacy of his family by using this land to offer social services to the people in the community. The house is located in a small village in the central part of Sri Lanka, so all of our team members spent 4 days at the site after driving 6 hours from Colombo . We measured the house, visited local elders’ houses in the neighborhood, and interviewed the elders during our stay.

When we were working in that house, many elders and children came in to greet us. Among the visitors, a 79 years old, former chief of the village gave us such an intriguing comments. When I asked him whether or not he thought young people in the village would be willing to help elders in need, he looked at me with strange look. Then, asked me to repeat the question, so I did.

The old man looked at me again, and said:

“I don’t understand what you are trying to ask me. Is it a question? Yes, young people will come and help.”

I was a bit embarrassed to realize that I was foolishly trying to understand the elder care situation of this village through the lenses my past experiences. The old man also said that it was a great idea to have an aged care in the vicinity, so that he can visit elders and help them. Other villagers also said that they would welcome aged care facility in the community so that they have opportunities to help elders.

Their comments made me realize how self-centered I have become…I have never thought that elder care facilities could be perceived as a place that provide opportunities for others to give. While the villagers are relatively poor, they definitely know the real meaning of “happiness” in life.

Left: 104 years old man is singing a traditional song for us

Right: a women's room in an aged care outside of Colombo

It takes so much effort to help elders to remain their own homes in our society today. I thought that some countries that respect elders may have easier situation for providing care at home with the help of others. However, the problems and concerns that family caregivers face everyday seem to be the same everywhere… Most of the elders in Sri Lanka are still taken care of by family, relatives, and neighbors. Moreover, due to the modernization and urbanization of our society, the concerns which are addressed by caregivers Sri Lanka are almost identical to the those in Japan and USA.

The main concerns of Sri Lankan are:

“Women have professional careers and do not have time to care for elders.”

“Children live in urban area due to their jobs, and it makes it difficult for them to care for their parents who prefer staying at their own homes in rural area.”

“There are not enough services available that benefit middle income Sri Lankan to care for their parents at home.”

“There is not enough space available for elderly parents to live in a small house.”

At this moment, people in Sri Lanka do everything they can do to take care of their own parents. While they mentioned how difficult it is to care for their parents at home, they also said "it is not easy, but we just have to find the way and do it. I cannot imagine anyone who can refuse to take care of their parents, becuase that is what we have to do."

In order to approach these issues, Sri Lankan should come up with their own solution. When we spoke to the social policy strategists, I felt that they would  welcome the idea of providing long term care to elders who do not have family members with whom they could live. Since this country has such wonderful values of “always looking for the opportunities to help and share with others,” I hope that they will choose a different path in the future to avoid the problems that the United State and Japan have experienced through “institutional care,” which deeply disturbed social ties to family, friends, and communities as well as social roles and respect of elders.

What make people happy? ( more money? comfort? covenience?)

(left: residents' room, right: these are everything that residents own)

I have visited one of the oldest elder care housing in Sri Lanka today. This facility was founded in 1917 and  providing care to 7 elders. Currently, 150 elderly people over 60 years old are living in this place, and 8 nurses currently provide the care with 5 administrative support staff members. They receive very little support from government due to the lack of social policy that help elderly care in Sri Lanka . The government’s support is 300 rupee ($3) a month per person, which provides only one day meal. The rest of the income is covered by the donations from community. Most of the meals served to the residents are donated (DANA) in two ways: one way is to bring home cooked meals and serve it to elders, and the other way is to donate cash ($30-$40 to cover one meal for 60 elders and all staff members).

Amazingly, people have already pledged to provide more than 98% of the meals that would be served in the coming three months. In Sri Lanka, it is common for people sign up to provide meals for elders (Dana -donation) or do a charitable act on special holidays, birthdays, memorial days of a family member, instead of receiving gifts from others. While many people in Sri Lanka do not have much access to comfort, convenience, or financial resources like in developed countries, they still practice giving and helping others. When I learned of this practice, I was quite embarrassed by my greed and selfishness.

The physical environment of this facility was quite shocking for me, because 12 elders share the same room, a dementia resident was isolated and locked in a small room, and more than 50 elders were sharing the same bathroom facility. Moreover, the culture of this organization was very much institutional, a nurse talked only about medical treatment and proud of her skills and career, and managers valued efficiency of staff members. In spite of all of these setbacks, elders in this facility seemed to be relatively happy about their lives, because they have a safe place to sleep, foods to eat, and given medical care if they need. In fact, most of them had a peaceful face with beautiful smile. One lady told me that “I am happy in any situation because I practice Buddhism. I have everything I need here, it could be better if I lived with family. But I am satisfied with living here and my life.”

After the visit, I thought that the elders in the facility might have such strength and wisdom to detach themselves from materialistic desires, and reach their inner peace to be grateful for what they have. When I saw the peaceful facial expression of the elders in this facility despite the low quality of their physical environment with the institutional operation, I was puzzled by the real meaning of the “quality of life of elders.” While developed countries such as Japan or the United States can afford to provide comfort, convenience, and safety for elders in beautifully designed living environment, I do not recall seeing anybody with such a peaceful facial expression in any elderly care settings in both countries.

It is quite ironic to learn that elders, who do not have access to a comfortable and convenient living environment, have more peace within themselves for their lives. I hope that we can do something to improve the quality of their living environment to fit with what they really deserve to have.

Buddhism philosophy heavily influences on current caregiving situation in Sri Lanka. Caring for older parents is one of the most important duties as human being in this philosophy. Not only children, but also relatives provide care for elders. Neighbors do not provide direct care, however, they do involve in other types of support, such as bringing foods, helping house keeping activities, or visiting elders to be a company.

Traditionally, youngest son takes care of parents’ house, but caregiving responsibility would be shared by other member of family as well. If children migrated into urban setting and financially stable, they bring their parents to their houses to care for them. This situation occurs due to the limitation of job opportunities for young people. Once people get a job, they have to keep it for a long time because there may not be another job opportunity available anywhere in Sri Lanka . The people do not have enough resources or stable job, they move back to rural area to care for their parents. If this arrangement does not work out, elders move into aged care homes which are usually caring for elderly women without any family or relatives.

Because Sri Lanka provided free education and free healthcare for over 60 years, elderly population in this country are much healthier and more educated. These educated baby boomers are eager to provide opportunities for better education and job for their children. As a result, they do not expect their children to take care of them in the same way that they did to parents, because they do not want to be a burden for their children. Many of the middle class baby boomers are more acceptable to the idea of moving to aged care setting when they need care. In fact, some social policy analysts and government official mentioned that they would like to encourage the development of long term care industry for elders because of the rapid growth of elderly population in next 30 years. I was a bit surprised to learn that they did not seem to worry about the potential consequences that may be caused by the institutional care.

It is important to note that the information above may only be applicable for the people are in the middle class. Low-income families still rely so much on social capital among family, friends, and neighbors. In the last several days, I have been hearing the concept of “social class/status” so many times from various people. This issue needs more investigation to since “living with similar background together, yet well-mixed interactions” seems to be a desirable/comfortable condition for the people in Sri Lanka .

Why? Why is it so hard for people to move away from institutional care?

I have been quite impressed by the high standard of human value and generosity among Sri Lankan since I arrived here. Today, however, I was simply shocked to discover that the “culture of institution” rooted deeply in this country. I am sure that the people who are involved in the culture change movement would be so frustrated to hear the term “inmates” when people refer elders in long term care settings. The individuals, whom I was talking this afternoon, kept using the term “inmates,” which absolutely made me crazy!!! I repeated to refer them back as “elders” for many times, however, they did not seem to sense the implicit way of telling my discomfort. So, I finally told staff and owner of the organization that “I would appreciate if you could call these elders as “elders” rather than “inmates”, because inmates sound as if they are prisoners.” Some people thought my comment being offensive, because they were proud of providing a “good enough care” for elders who are in need of care.

There is a clear social status in the society of Sri Lanka . There is countless number of people including children begging foods on streets. The people seem to accept this situation and live their lives without questioning serious about this situation. I felt that people are eager to share whatever they have to help others. The attitude toward age care is also based on their sharing culture. The elders who are living in age care settings are mostly women who do not have any family or relatives. Some are elderly homeless people from street. Charity organization operates these settings with donation from general public or NGO such as Helpage. The residents of the facilities pay as much as they can afford to give to the organization. People from surrounding community sometimes donate money, but most of the time, serving foods for elders. The donors feel that bringing the home cooked meals for the elders will give opportunities for elders to enjoy variety of home-cooked meals. It seems that many practice this way of sharing at least once a month.

When we visited an aged care for 27 “elder orphans,” I could not hide my sad feeling. There were four beds in a each room, and one shared bathroom for all of the residents, except for the bedridden residents. Elders seem to be relatively satisfied with their living environment, and staff members were proud of their operation. In fact, all of the 6 staff members live in this facility. Their rooms are located right next to residents room and the quality of the room was as same as other residents’ rooms. They were sharing a room with 2 or 3 other staff. Each staff member gets 4 to 5 days off every month. The Staff trainings are provided by HelpAge and anyone can be certified as a caregivers after 1 year program. Although I do respect staff dedication and the mission of this organization, I still could not satisfy with the environment, especially the fact that people think it is OK to have 4 elders living in the same room. When I asked them question if they are considering to make the room private, their answer was “no we cannot afford it, and also four people in the room is good enough for them.”

Since staff members as well as owners and some scholar were very happy with this environment, I asked them simple question that “Can you recommend your mother to live here?” They looked at me strange and paused, then said “we are not in the same social status. This is not appropriate for her.”

……………. Am I just a naïve idealist from Japan who just cannot understand why anyone can comment other people’s right in this way?

I, then, asked another question that “Can you share a room with three other elders, when you need care?” Their answer was that “Well, we have a different type of lifestyle from them. I definitely need my private bathroom with my own bedroom.”

………….. GOOD ENOUGH. I heard this term so many times today, and it made me depressed. Good enough is a relative concept, and means different level of life style. However, I strongly believe that we should not intentionally design the lower standard living environment than the ones in which we ourselves would be willing to reside.

Sri Lanka has so much to offer to teach rest of the world in terms of “Sharing with others,” because the concept is embedded in their everyday life. They are quite expert at helping each other in many ways. I would like to see this good quality of culture being integrated into elderly care for people in various social groups.

Should we be happy about providing “good enough care” for elders?

My answer is “Absolutely NOT!!!”