Economics of elder care: How to balance love, duty, and practicality while caring for aged parents

Economics of elder care: How to balance love, duty, and practicality while caring for aged parents



I met her at the retirement home. She and her husband had quit their jobs in Singapore and moved in with her 80-year-old mother, who was afraid of living alone after her husband passed away. They were scared after her father’s unexpected demise following a brief illness, before the children could arrive. We, a group of cousins spending a weekend there, were divided in our approval of this selfless act.

Caregiving is not easy. We can argue about why it is important. We must be grateful to our parents; we must support those who cannot contribute anymore; we must love and care for someone who has given so much to us when they need our help; we cannot abandon those who are weak and dependent; we must set a good example by being kind to the elderly, and so on. The standard for responsible behaviour by the next generation has been set in the society, where abandoning aged parents is near criminal. Taking care of parents is what loving, virtuous, dutiful and grateful children do, we tell ourselves.

However, we have enough examples around us showing that such selfless acts do not come easily to most of us. We have done our best for our parents, but we know the toll it took on us. Being appreciated for being the caregiver felt good, but not good enough to ease the burden of caregiving. We deny the hardships, graciously do not bring up the sacrifices, and bury the resentment deep inside. We turn around as we age and tell our children that we won’t burden them similarly. That is a clear acknowledgement of the burden of the task. Retirement homes that have sprung up all over India offer the choice of old age comfort for a price. Why do we find it difficult to accept that caregiving is a service that can be outsourced and paid for in a marketplace?

Women have been the traditional caregivers in the household. They cook, clean, and care for the children and the elderly. When a marketplace for work opened up to include women, we discounted these caregiving services even more. Women who stayed at home to nurture the family were seen as less accomplished than those who went to work, for caregiving services did not earn an income. Women had to make a choice between work and home, and were judged whichever way they chose.

At the same time, the struggle to balance work outside home and caregiving responsibilities impacted the lives of most women. Women stretched themselves or took a career break, quit their jobs, or chose suboptimal jobs, to care for children, the elderly and the home. Markets for caregiving came up in response. Households began to engage workers to help with the chores. Childcare services offered hope for women who went to work. Today’s working woman can also outsource her kitchen. Why should care for the elderly be seen differently?


We tend to paint a generalistic and unkind picture of these developments. Most of us don’t grow our own food anymore. We have long outsourced it to the point where many of us have no clue how our food is produced. Faced with the threat of metabolic diseases, we are still arguing for our rights as consumers in the marketplace for food. We have not taken direct responsibility to do it ourselves. Nor is it practical for the world to go back to a life along a river, growing food in the farm, where we live with our livestock. This extreme example is only to illustrate that markets for caregiving services will continue to emerge. Caregiving for the elderly need not be an exception. It only takes acknowledgement that this task is tough for most of us and we need help.We, perhaps, frame the problem differently. Many elders of earlier generations continue to view moving into a retirement home as abandonment. They worry about what others will say and how their children will be judged. We place a premium on what the elders’ preferences are, and give in to unrealistic assertions rooted in denial. Everyone in their 60s knows first hand, or from friends, stories of our parents wanting to live in a house they have occupied for years, among friends they have known so long, unwilling to move into elderly care facilities, or where feasible, to their children’s home with outsourced caregivers. The burden this places on their well-meaning children is usually discounted.The elderly are treated with respect and deference in our society. Even if their demands are unreasonable, we heed. They are not amenable like little children, who would willingly walk into daycare, or husbands who would eat a meal prepared by a cook. Both sons and daughters, and their spouses, take on a mandate they can’t shrug off. Between feelings of genuine love and gratitude for parents, and the cold refusal to take responsibility, we have many shades of grey.

Money, as always, is the villain of the piece. We dislike markets taking over our lives. We don’t want to put a price on and outsource what we know are acts of love and nurturing. We see ourselves diminished as a society when we reduce these to services with a price tag. We continue to hope that the goodness in us will flow enough to remain selfless for the other. Or we see ourselves as driven by duty and dharma to do what has to be done, without protest.

Being torn in this manner about caregiving seriously diminishes efficiencies in the marketplace that have emerged for these services. After so many years of women being in the workforce, and the disproportionate caregiving responsibility after child-bearing, they have not been able to demand mandatory daycare services at their workplace. Household help remains an unregulated and exploitative marketplace. The packaged and outsourced food industry has grown with alarming disregard for the health of its consumers. But we continue to believe that all these services are somehow bad for society because they monetise services a household must offer altruistically.

We can do better. These choices can coexist. We can build these services such that they provide the support we need, while layering our ability to nurture and care. We need conversations around these choices. So many households’ choices around income, spending, saving, investing and giving are impacted by these decisions. Our circle of what we care about must expand and get real so that the trade-offs are better informed.

The Author IS CHAIRPERSON, CENTRE FOR INVESTMENT EDUCATION AND LEARNING



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