Rotational Living Arrangement: Evidence from rural Barddhaman and - - PDF document

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Rotational Living Arrangement: Evidence from rural Barddhaman and - - PDF document

Rotational Living Arrangement: Evidence from rural Barddhaman and Bakuda Author: Arpita Paul PhD Scholar, International Institute for Population Sciences, Mumbai, India Email: parpita19@gmail.com Introduction Elderly are often considered as burden


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Rotational Living Arrangement: Evidence from rural Barddhaman and Bakuda Author: Arpita Paul PhD Scholar, International Institute for Population Sciences, Mumbai, India Email: parpita19@gmail.com Introduction Elderly are often considered as burden in most of the developing countries where social security systems are non-existent or poorly developed and elderly are mostly supported by family for their sustenance. Income derived from savings, accumulated assets or private pensions are negligible for most of the elderly in developing countries. Hence, providing food, shelter and health care to the elderly becomes burden for the earning members of the family. At the same time, with the changing societal and familial norms there is sharp increase in nuclear family even in developing countries. In this scenario the living arrangement of elderly plays an important role in determining their health and well-being (Agrawal, 2012; Velkoff, 2001). As evidences suggest, the share of elderly who live alone has increased sharply in the recent decades in South-East Asian countries like Japan, China, Republic of Korea, and India (UN, 2005). India is a demographically diverse country where different states are at different stages of demographic

  • transition. Indian states like Kerala, Tamil Nadu, Maharashtra, Punjab, West Bengal etc. have

significantly high proportion of elderly whereas states like Uttar Pradesh, Bihar, Madhya Pradesh have large share of young population. And because of the age-structural transition and changing familial norms, the living arrangement of elderly is also facing transition in most of the states. Traditionally, in India, majority of the elderly live with their son though slowly but steadily this culture is changing. Many studies suggested that the proportion of elderly who are living alone or with their spouse has increased significantly (Paul & Verma, 2016; Rajan & Kumar, 2003). Although this trend is mostly experienced in urban area, especially, in the metro cities, rural areas are not untouched by it. Structure of the family is largely influenced by the needs and resources to fulfill those needs of the family members. Also, the attitude of taking up responsibilities plays a very crucial role in defining the family size. It‟s a difficult task to measure the attitude but the size of the family explains a lot about it. Numbers of sons, married children, age, health status, etc. are the various factors that determine the living arrangement of elderly. Rotational Living Arrangement Although the previous investigation clearly indicated that parents preferred to live with their children, the difficulties in modern societies (such as Westernization) sometimes disappointed elderly parents may raise various concerns in daily living and health care. Therefore, an alternative living arrangement for

  • lder people has been initiated in India to meet the traditional expectation of family virtue from elderly

parents and the living conditions of modern societies, which is rotational living of parents with their adult children especially son‟s family in Indian context. As the number of nuclear families has increased sharply the responsibility of taking care of elderly parent is like a liabilities which is shared among the

  • children. This particular system is termed here as „rotational living arrangement‟ which is a very new

phenomenon, particularly, in Indian context and it is also not much explored in other countries. We have found merely two studies which talk about the rotational living arrangement in context of few provinces

  • f China (Kao, Chang, Huang, Tsai, & Chen, 2013; Thøgersen & Anru, 2008).
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The preference of living arrangements for older people depends upon the family resources and social

  • participation. The lack of appropriate family resources to fulfill the intention for older people to live with

adult children may result in elders living alone in their communities. The adverse health impact of solitary living for older people has been well recognized, but the health characteristics and benefits of rotational living with family for older people remained uncertain. In a rotational living arrangement, adult children may share their responsibilities of providing direct care for their parents to prevent them from living alone, but rotational living per se may cause some new stresses and challenges of care related to frequent changing living environments and unstable social networking (Kao et al., 2013). Therefore, the main

  • bjective of this study aimed to evaluate the social and health well-being of older people who were

rotationally living with their family in India. This paper is a very first attempt of this kind for Indian

  • context. This study will contribute to the existing literature of elderly living arrangement with exploring

the social implications and motivations for the emergence of rotational living arrangement in elderly. Materials and Methods The data for this study was collected during May to November 2015 in two districts of rural West Bengal,

  • India. Total sample of 322 elderly men and women were interviewed in 2 districts of West Bengal. 14 in-

depth interviews were conducted to analyze the health and work status of elderly along with their living arrangement. Results and discussion A new trend in living arrangement of elderly was found in rural area of West Bengal, commonly known as the „Pali‟ (in local language) which means eating or living rotationally with son‟. This arrangement can be understood as a system where elderly‟s needs and requirements are taken care of by all his sons on rotation basis. The duration for which each son will provide food and other financial needs is pre-decided among children. The periods usually vary from one week to more than three months duration. In this arrangement, elderly may stay alone but eat rotationally with each son‟s family, or the elderly will be staying and eating alternatively with each son‟s family for a specified period of time. The basic characteristics of the elderlies in rotational living arrangement are mentioned in different tables which one can refer from APPENDIX section to understand the study population. This study found that those elderly who were living in this arrangement were not very happy or satisfied with it. Out of 14 elderly 8 said that they feel unwanted but since they are financially dependent on their children their decisions doesn‟t matter on the type of living arrangement. Elderly also told that their children took this decision for them and they were informed after the decision was made. This observation reflects that elderly does not have much decision making right. Some elderly said that they are treated like burdens by their children. On the other hand, six out of fourteen elderly who said that rotational living arrangement was good as they can have chance to live with their sons alternatively. One of them said “It is a good system as I get to eat different food every week”. The study found that the elderly were also satisfied with this arrangement as the financial needs were equally fulfilled by their children. This study also found that the financial support for meeting any health care need of the elderly was shared by all the sons. If elderly was suffering from any illness the expenditure incurred in the treatment will be divided equally among the

  • children. Other basic needs of the elderly will be met by the child he or she is living at any given time.
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Almost 30 percent of those who are not living in rotational arrangement said that they will prefer this living arrangement. Out of this 30 percent majority said that they will prefer this system because then they would not be left alone in their old age. Approximately 66 percent of those who said that they will not prefer rotational living arrangement, about 33 percent of them specified the reason was that this arrangement was not good. To know the perception about rotational living arrangement among elderly question was asked that “Do you think that they (who are living in rotational living arrangement) are happy?” to those elderly who are not living in rotational living arrangement. About 76 percent think that those who are living in rotational living arrangement are happy. Although India has a long history of joint family but family structure has been rapidly changing which may cause for the emergence of the rotational living arrangement. The study found that rotational living arrangement though doesn‟t affect much on the health care aspect but takes a toll on the emotional well- being of the elderly. A paucity of literature suggests that this is an untouched issue and need further investigation to explore its pros and cons in the lives of elderly. Some insight from in-depth interviews During field visit of the study area, I came across a system called “pali” ( a local Bengali term) meaning as turns or rotation system of living arrangement. One of the respondents said “you do not know about it? I am living for last 20 years in this arrangement.” "What is this pali system?" I probed further. She responded “I will eat with each of my sons alternatively for a specific period of time. Since all my sons live together in the same compound with a different kitchen, so for each term, I stay with the family I help their family in doing kitchen chores and help my daughter-in-law when and as asked.” This study is an attempt to understand and explore the rotational living arrangement in Indian context based on 14 case studies through in-depth interviews. The entire 14 sample of elderly were living with their male children in a rotational arrangement. Interestingly, they do not prefer to live with their

  • daughters. One of the male respondents said that “How can I live with my daughter. She is a daughter and

not son. Even if my daughter-in-laws do not like me but this is impossible that I‟ll go and live with my daughter in rotational living or in any other form of living arrangement”. Another female respondent said, “If my sons will not look after me I might live a poor life but this is not a rational decision to live in the house of your married daughter.” Another respondent pointed “taking good care of me at old age is the responsibility of my sons not daughter. My sons have to take care of me because there is no other way around.” On enquiring about their decision of entering into rotation living one of the respondents said “I, no it was not me. When I became a widow my sons came and told me from now you will be living on 15 days rotational basis with two of us. I was in a shock with their decisions. I tried to convince them that I just need a place to stay why they want me to go eat at one house for 15 and another for next 15 days. But they were firm on their decision. So here I feel unwanted among my loved ones.” Another male respondent told that “since I get some government monetary benefit as I am physically challenged I asked my elder daughter-in-law and younger son that I‟ll rotationally live with them for a period of 15 days. This way I‟ll be able to live with both of them and both of them can have some monetary help from me.” Though, this arrangement reduces the burden of health care or any other kind of expenditure on elderly as the children share the financial expenses equally among themselves. One female respondent told that “last

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winter I was very sick and was living with my 2nd son and in 2 or 3 days I have to start sharing food with my youngest son family. My 2nd son uses to buy medicine for me. On the day when my “pali” (rotation) came to live with my youngest son I realized that my second son has bought enough medicines for me so that there will be no disturbance in my medication due to their decisions.” Another female responded said that “She suffered a lot because of this system none of my sons bought me medicine and would always believe that the other one was giving me the required care and medicine that I was in very need at that time”. Further looking deep into their lives it was very clear that their social contacts have not limited or affected because of this living arrangement. Although they visit their friends and relatives as they use to do before going into a rotational living arrangement, their decision-making power has become very limited. One of the male respondents said “I have not chosen my life, nor the way and people I will be living with so what makes it a difference if my son does not take any advice from me regarding any of their family matters. One female respondent said “I never made any decisions. Just after my marriage, my mother-in-law was the decision maker later my husband took all the decisions though he would ask me about my opinion. Now my son and his wife take all the decision. Sometimes my son will ask me ma should I do this or do that but my decisions do not affect much on his prior decisions.” The study further looked into the abuse faced by the elderly living in a rotational living arrangement. One

  • f the female respondents who thought that she was neglected among her children said that “How much

more they will abuse me is this system of living. Rotating among my sons every week is kind of emotional abuse I am going through each week.” Another female respondent told that “my eldest daughter-in-law is a bad woman. I feel as if abusing me verbally and mentally is all that is left in her life. Staying with my eldest son‟s family becomes painful all because of her. I even asked my younger son to keep me with his but he thinks it is too much to ask. This is destiny I have to accept it. And I wish that I do not have to face such situation for a long time. The study also found respondents who do not have to face any abuse as their financial need was not one son responsibly and this has improved the relations between mother-in-laws and daughter-in-laws. In conclusion, at the preliminary stage of this study and with initial findings, one can have a mixed sense about the social and psychological effects of the rotational living study on the elderlies living in this

  • system. Although this system is very new kind of phenomenon arising in India as whole but in West

Bengal, this particular arrangement is still at very low level but observed to be rising with different

  • reasons. The final analyses with some additional case studies will definitely give a broader picture.

References Agrawal, S. (2012). Effect of living arrangement on the health status of elderly in India: Findings from a national cross sectional survey. Asian Population Studies, 8(1), 87-101. Kao, Y. H., Chang, L. C., Huang, W. F., Tsai, Y. W., & Chen, L. K. (2013). Health characteristics of

  • lder people who rotationally live with families: a nationwide survey. J Am Med Dir Assoc, 14(5),
  • 331335. doi: 10.1016/j.jamda.2012.10.024
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Paul, A., & Verma, R. K. (2016). Does Living Arrangement Affect Work Status, Morbidity, and Treatment Seeking of the Elderly Population? A Study of South Indian States. SAGE Open, 6(3). doi: 10.1177/2158244016659528 Rajan, S. I., & Kumar, S. (2003). Living Arrangements among Indian Elderly: New Evidence from National Family Health Survey. Economic and Political Weekly, 38(1), 75-80. doi: 10.2307/4413048 Thøgersen, S., & Anru, N. (2008). 'He Is He, and I Am I': Individual and Collective among China's Rural Elderly. European Journal of East Asian Studies, 7(1), 11-37. doi: doi:http://dx.doi.org/10.1163/156805808X333901

  • UN. (2005). Living Arrangements of Older Persons around the World. New York: Department of

Economic and Social Affairs Population Division, UN. Velkoff, V. A. (2001). Living Arrangements and Well-being of the Older Population: Future Research Directions: United Nations, Department of Economic and Social Affairs, Population Division. APPENDIX: Table1: Rotational Living Arrangement of elderly in rural West Bengal

Descriptions Percent (Sample) Total Sample N=322 Are you living in rotational living arrangement? Yes 4.4 (14) Elderly currently living in rotational living arrangement N=14 Number of children you live with? 2 Children 71.4 (10) 3 Children 14.3 (2) 4 Children 14.3 (2) How many years are you living in this arrangement? 1 year 28.6 (4) 2 to 5 years 28.6 (4) 6 to 10 years 28.6 (4) More than 10 years 14.3 (2) What is the duration of stay with one child? 1 week 14.3 (2) 15 days 42.9 (6) 1 month 35.7 (5) More than 1 month and less than 6 months 7.1 (1) Are you Satisfied with this type of living arrangement? Yes 42.9 (6) If yes, Reason. Get to live with all sons 33.3 (2) Less burden on children 50.0 (3) It is a good system 7.1 (1) If No, Reason. Fell unwanted 75.0 (6)

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No proper care by any children 12.5 (1) No definite place to stay 12.5 (1) Elderly currently not living in rotation living arrangement N=308 Would you prefer to live in a Rotational Living arrangement Setup? Yes 30.8 (95) If YES, reason Get to live with all sons 20.0 (19) All the needs will be met 23.2 (22) Would not be left alone 33.7 (32) Less burden on children 22.1 (21) It is a good system 1.1 (1) If NO, reason. System is not good 33.8 (72) Want to live with one son 3.8 (8) Will rather live alone 10.3(22) No respect 3.3 (7) Have only one son 25.8 (55) Other 23.0 (49) Do you know anyone who is living in this rotational living arrangement setup? Yes 61.5 (198) Do you think that they are happy? Yes 76.8 (152)

Table 2: Socio-demographic characteristics of elderly living in rotational living arrangement in rural West Bengal

Socio-demographic characteristics Percent (Sample=14) Gender Male 21.4 (3) Female 78.6 (11) Age group 60 to 69 years 42.9 (6) 70 to 80 years 57.1 (8) Ever attended school No 35.7 (5) Yes 64.3 (9) Marital status Currently married 21.4 (3) Widow and other 78.6 (11) Exposed to substance abuse No 71.4 (10) Yes 28.6 (4) Caste Scheduled caste/tribes 14.3 (2) Other backward caste 28.6 (4) General caste 57.1 (8) Religion Hindu 78.6 (11) Muslim 21.4 (3) Monthly per capita expenditure Low 50.0 (7) Medium 35.7 (5) High 14.3 (2)

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Table 3: Work force participation of the elderly living in rotational living arrangement in rural West Bengal

Work participation Percent (Sample) Worked in last one year No 92.9 (13) Yes 7.1 (1) Reason for not working currently Never worked 57.1 (8) Health reason 35.7 (5) Ever worked No 57.1 (8) Yes 42.9 (6) Never worked reasons Housewife 87.5 (7) Disabled 12.5 (1) Main occupation Construction labour 16.7 (1) Vegetable hawker 16.7 (1) Carpenter 16.7 (1) Domestic labour 50.0 (3) Age at which stopped working Before 60 years 60.0 (3) After 60 years 40.0 (2)

Table 4: Health Status of the elderly living in rotational living arrangement in rural West Bengal

Health status Percent (Sample) Current health status (on Likert Scale) Very good 14.3 (2) Good 21.4 (3) Fair 57.1 (8) Bad 7.1 (1) Instrumental Activity of Daily Living Fully functional 35.7 (5) Moderate functionality 42.9 (6) Totally dependent 21.4 (3)

Table 5: Chronic ailment, treatment and average monthly treatment cost details of the elderly living in rotational living arrangement in rural West Bengal

Ailment Ailing person Percent (number) Receiving treatment Percent (number) Average monthly treatment cost (In INR) Suffering from any chronic diseases 71.4 (10) 71.4 (10) 522.2 Arthritis 50.0 (7) 21.4 (3) 110 Heart diseases 7.1 (1) 7.1 (1) 300 Asthma 21.4 (3) 21.4 (3) 233

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Hypertension 50.0 (7) 42.9 (6) 143 Osteoporosis 7.1 (1) 0.0 (0)

  • Renal or urinary tract infection

7.1 (1) 0.0 (0)

  • Cataract

42.9 (6) 7.1 (1) 112 Lost all teeth 21.4 (3) 7.1 (1) 300 Injury due to fall in last one year 7.1 (1) 7.1 (1) 300 Skin disease 7.1 (1) 7.1 (1) 100 Spondylitis 14.3 (2) 0.0 (0)

  • Essential tremor

7.1 (1) 0.0 (0)

  • Gastric/gastrointestinal disorder

57.1 (8) 50.0 (7) 160

Table 6: Out-patient and in-patient care of the elderly living in rotational living arrangement in rural West Bengal

Out-patient care Sample Fall ill in last 15 days 8 Episode of sickness Three 1 Two 4 One 8 Ailment Fever 5 Cough/cold 3 Dysentery 3 Gastric/gastrointestinal disorder 2 Period of suffering Started more than 15 days ago and still continuing 1 Started within 15 days and still continuing 4 Started and ended within 15 days 8 Place of treatment Pharmacist/dispensary 4 Registered Medical Practitioner 9 Average treatment cost per person ( In INR) 191 Average treatment cost per ailment (In INR) Fever 94 Cough/cold 283 Dysentery 40 Gastric/gastrointestinal disorder 20 In-patient care Hospitalized in last 365 days 2 Episode of sickness One 2 Ailment Heart attack 1 Breathing problem 1 Person assisted in hospital Son 1 Daughter-in-law 1 Duration of stay in hospital each ailment 5 days 2 Average treatment cost per person (In INR) 4000 Average treatment cost per ailment (In INR) Heart attack 3000 Breathing problem 5000

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Table 8: Sources of health care financing to meet various health care needs of elderly living in rotational living arrangement in rural West Bengal

Financing source Sample Total Treatment expenditure for any chronic disease Self or spouse 2 10 Children 8 Others 1 Treatment expenditure for outpatient care Self or spouse 4 8 Children 3 Others 1 Treatment expenditure for inpatient care Self or spouse 2 Children 2 Others