CARING for the elderly is expensive business.

With costs rising every day and the working world becoming increasingly hectic for Jamaicans, many family members, who are faced with the task of tending to elderly relatives, are being forced to choose between putting these older family members in nursing homes or risk keeping them at home where regular (and sometimes round-the-clock) attendance to their needs is not guaranteed.

Health sector experts say the option of the nursing home is greatly increasing in popularity resulting in improved business for the sector. Unlike past years, they say, nursing homes islandwide have been attracting full capacity.

But Head of the Department of Community Health and Psychiatry at the University of the West Indies (UWI), Mona, and former Chairman of the National Council for Senior Citizens, Dr Denise Eldermire-Shearer, is not as upbeat about the growing trend as some of her colleagues. She believes that despite the myriad of challenges that the present generation faces, putting an elderly relative in a nursing home should be a last resort. According to Eldermire-Shearer, the primary intention of relatives should be to keep the elderly relative at home, especially in this West Indian culture, which is essentially against the practice of putting people in institutions.

“The thing that most family members need to realise is that most of these elderly persons can stay at home. In fact, in Jamaica, we have less than two per cent in institutions and looking at our projections in terms of the dementias and chronic diseases, such as hypertension and diabetes, we estimate that probably only 10 per cent will need intensive care. By intensive care, I don’t mean hospital care, I am referring to round-the-clock care. Besides, going the route of a nursing home is far more expensive and the prices go up every year,” she told the Sunday Observer.

“Importantly, you also have to remember that the majority of older people in Jamaica are not on a pension. About 75,000 are getting an NIS pension and it’s only about 16 per cent that are on a private pension in Jamaica. The majority of older Jamaicans are not on a pension, and younger Jamaicans are not learning their lesson either. I don’t know how we are going to make people realise that you have to prepare for old life. You have to prepare financially and otherwise.”

Eldermire-Shearer pointed that by way of categorisation, there are several groups of elderly people living in Jamaica including ‘Well Older People’ whose basic financial needs are the same as everyone else’s: food, clothing and shelter; and ‘Frail Old People Who Are Well’ (usually over 80 years) who need help with the activities of daily living, hence demanding the “additional cost of a caregiver, not necessarily a nurse.” She said other categories include the ‘Sick Older Person’ (someone who has had a stroke or has Alzheimers’; someone who needs constant care).

“Many years ago, that caregiver was automatically a female family member. I mean in the 1960s and ’70s if you were a girl in a family, you knew you were going to have to help take care of granny or grandpa one day,” Eldermire-Shearer explained.

“Families are much smaller now. When there were 10 children, one could stay home. Somebody would support him or her. We are now down to that little family size of two and three. Education has played a tremendous role in the change.

According to Eldermire-Shearer, the ‘stay-at-home mom’, is a thing of the past as more women are educated and have jobs.

“So the challenges for providing for older people is not only a financial situation. That is the message,” she said.

“With all the money in the world, if you don’t have somebody to help grandma to the bathroom or to the shop, your money not going to be of any use to you,” she remarked.

Nursing homes in Jamaica

A nursing home serves as a permanent residence for elderly people who are too sick or frail to live at home, or as temporary facilities during a recovery period. Nursing homes are designed for people who are chronically ill or need around-the-clock medical care. Some patients go directly to one after being discharged from hospitals because they need intensive care from a licensed nurse or therapy to recover from an injury or a disabling illness.

Other seniors are in nursing homes because they can no longer manage daily activities, such as bathing, eating, dressing, and taking care of their toilet needs. But, in truth, all nursing homes are not alike. Certain facilities are equipped to provide different levels of attention while others specialise, depending on the needs of the individual.

Here in Jamaica, the Ministry of Health lists 49 recognised residential nursing homes on its website, with the majority located in the Corporate Area.

“I believe nursing homes are doing well in Jamaica because there is a high demand for them nowadays,” said Joan Wint, long-serving operator of the Golden Years Home for the Aged in Palmer’s Cross, May Pen.

“Part of the reason why they are doing well is because the Ministry of Health ensures that the quality of health care provided by these homes is more than acceptable. Also, we have an ageing population and it is becoming increasingly difficult for relatives to get good people to care for the relatives at home.

“An additional consideration is the fact that more and more Jamaicans are becoming professional people and they don’t have the time or someone to rely on to help out. So the only option left is to find a good place for your loved one.”

But Eldermire-Shearer noted that there is a lot more involved in the process than just finding a good nursing home.

“With the decision-making, it is not just money you have to take into account. Yes money influences it, but there are a lot of other things that you have to think about. Is the old person ready to go to a nursing home?”

Footing the bill

Sunday Observer checks revealed that depending on the part of the country, the average cost of nursing home care in Jamaica in 2007 ranges from about $30,000 to more than $80,000 monthly. A spokeswoman at the Rolph Grant Senior Citizens Home on Half-Way-Tree Road in St Andrew said the cost for accommodation and patient care starts at $35,000 per month, and increases depending on the level of need and attention the patient requires.

The Moravian Home for the Aged (Braemar Avenue, Kingston), which now accommodates a capacity 13 patients, said their prices start at roughly $30,000 monthly, while the Fairway Nursing Home (Fairway Avenue, Kingston) offer their services at a starting price of $40-$50,000 per month.

“A lot of people don’t have the time to care for their relatives, maybe because of the stress, so they rather pay to let a professional do it. Sometimes the patients stay here for months or for many years, depending on their situation,” said Miss Fuller, a supervisor at the Fairway Home.

“A lot of people who criticise nursing homes believe that the caregivers are abusive to the patients but that happens more in the US than anywhere else. It does happen in Jamaica, but not as bad as in the US. I know that for a fact,” she added.

Two Jamaican working women told the Sunday Observer that due to job commitments and having very young children to raise, they had no choice but to choose nursing homes for their elderly relatives. In both cases, the senior citizens had no other relative in the island. The women say it is a constant struggle to cover the nursing home cost and raise their children at the same time.

“I had no other choice because many weeks my job requires that I go out of town. It is really difficult because I am all she (her grandmother) has,” said Kimberly, 32, who works in the hospitality industry and has two small children.

“I don’t work a lot of money so I have to depend on my boyfriend for help, and from time-to-time one or two of my cousins in the States will send something to help us out. It really rough, but what can you do?” she said, with a heavy sigh.

Andrea, who moved from St Thomas to Kingston with her two-year-old daughter to live with an elderly uncle a few years ago is facing a similar dilemma.

“I think the government should start making nursing homes free-of-cost, or make them drop the prices because small income people like me are having it hard. If I could get some help to pay the bills right now that would be good because I don’t want to start owing, and then they put out my uncle. Very soon you are going to start hearing of old people being abandoned like young babies.”

A lesson to learn

Eldermire-Shearer believes Jamaicans need to start making long-term life plans to avoid many of the problems and pitfalls that currently plague the society, including the stress of properly caring for old people.

“Jamaicans need to ensure that they are making their preparations for old age because what is happening is that many people are being caught in the ‘sandwich generation’ of having young children to look after as well as old relatives, and they have a job to go to. So you have to give it some thought.

Government can’t stipulate and government can’t regulate for you. You need to know what you are going to do. In life, you need to foresee emergencies before they happen and have a plan. Long-term plans are important because it can be costly,” she emphasised.

“What my family did many years ago was that we called a family meeting and said: ‘Look, if Mommy or Daddy got sick tomorrow, what is our plan?’ We also need to start asking ourselves: ‘Who is going to look after me in old age? Which family member have I been close to, so that they can help me later in life?’

Eldermire-Shearer also pointed that the time had come to start “re-training boys” with domestic responsibilities.

“The whole domestic arrangements at home are changing. The thing is that the males were not brought up to do household chores because with many small families in Jamaica, the children are often two boys. Moreover, we assume that in old age our children will look after us.

In the meantime, she said “we have to get serious about pension”.

“We also need to recognise that NIS is a supplement. It is not going to give us enough money to live. So we have to make arrangements from early about our income. As soon as you get a job,” she said. “Yes, there are a lot of competing demands, but we have to inculcate into young people that they have to take their finances seriously. Families have to.”