Situation analysis of ‘institutionalized’ and ‘homeless’ elderly widows abandoned in India’s pilgrimage centres: insights into their living conditions and available infrastructural facilities

INTRODUCTION

Today, India is known as a progressive country with multicultural heterogeneity, yet it is nevertheless firmly anchored in religious sentiments, traditional beliefs, and cultural conventions. In a traditional society, family was very much considered the backbone, but in recent times there has been fragmentation of the joint family dynamics owing to migration of the younger generation from rural to urban to metropolitan cities due to lucrative opportunities. The sad reality that accompanies this phenomenon is the question of “what happens to the elders of these families in their absence?” They are perceived as a burden by their own family members and are thus, forced to confront life's most grim reality of being left alone. In general, widows are more frequently confronted with these appalling circumstances due to absence of a life partner who could have provided love, care and assistance to them in their later life.

Upon the demise of husband, some widows are often left destitute, ‘dispatched’ to religious places to spend the rest of their lives. This is a common practise in India, but in actuality, they are compelled to live in ‘homes’ meant for them, surviving on alms (begging) and charity.¹ While some of these widows are tricked into coming to the religious places by their family and ends up being dumped and abandoned, others are kicked out of their own home by their family members, who eventually travels to these religious places in search of living opportunities by begging alms or finding a place in shelter homes mushrooming in these cities.Without family support, elderly people are more vulnerable, and institutional care should only be used as the very last alternative when personal circumstances make it essential for them to reside in an old age home. The concept of “old age homes” or “homes for the elderly” is unfamiliar to Indians in spite of that the number of people living in OAHs is rising as the population of the aged increases.²

The old age homes are sheltered housing facilities for the impoverished who are abandoned by their respective families in society. In the last decade, these homes have proliferated in India's main cities, as more and more elderly people are getting abandoned by their families. The old age homes and shelter homes offers mere accommodation and a few spectrum of personal care, economic and health care services to the elderly who are abandoned and do not receive care and support from their family, but these homes are largely unencumbered, severely lacking infrastructural facilities and has poor living conditions. In India, there are primarily two types of old age homes for the poor elderly: free homes and paid homes.^3,4 Most of the OAHs and shelter homes in India that provide free housing facilities are typically financed by the government or charitable organisations, whereas others that provide paid services are predominantly privatized, for-profit agencies. In India, about one percent of the elderly reside in old age homes, and the number of such facilities is growing.⁵

There have always been reservations regarding the lack of adaptability of what an OAHs may require in aspects of elderly-appropriate infrastructure. The advanced western nations have an adequately well-organized structure of establishments for the care of the aged; nevertheless, the expansion and development of these facilities in India, which commenced about in 1901, remains insufficient.⁶ Previous study has indicated that one of the most serious issues in elderly care is the discordant living environment for the elderly who are physically and psychologically weak.⁷ It was imperative to understand the infrastructural facilities and amenities in OAHs/shelter homes where these vulnerable marginalized abandoned elderly widows spent their lives in destitution. The present study provides some insights into the current status of old age homes/shelter homes in Varanasi and Vrindavan, the two major religious pilgrimage cities in India, where elderly widows over the past few decades have considered it as a favourable destination to spend the rest of their lives in abandonment. This paper simultaneously also highlights the lives of those who somehow ends up living a life as a “homeless” on the streets, outside the temples and on the ghats of river Ganges in the city of Varanasi.

METHODS

Data source

The study was based on the primary data collected from the old age homes, shelter homes (run by government or private Organization or NGOs) which are giving shelter to these abandoned widows and also from those who are living on the streets, outside temples and ghats (in absence of a place to live), after their families and friends have dumped them.

Study area

The study was conducted in two pilgrimage sites-Vrindavan and Varanasi in the state of Uttar Pradesh, India. Several media documentations have presented these places as to be the centre where most of the widows, disowned by their families come to live after abandonment in the later stage of their life.

Sample size

A total of 360 respondents were selected purposively depending on the location specific scenario, time availability and accessibility of the respondents. Out of this, 280 respondents (Varanasi- 100 and Vrindavan- 180) were staying in OAHs (ashrams)/ shelter homes and 80 respondents (Varanasi- 40 and Vrindavan- 40) were ‘homeless’ staying near the temples, on streets and outside ghats of river Ganga. An overall fourteen (14) OAHs (ashrams)/ shelter homes from the two cities were managed to be included in the study. For the purpose of selecting the samples for the study, a list of old age homes/shelter homes were obtained for each city where widows were currently staying after their abandonment. From this list, old age homes/shelter homes were approached in order to reach the desired sample size based on the permission received and accessibility.

Methodology

As it was intended to be an exploratory cum descriptive study, the methodology used was an investigative one using research tools such as questionnaire for interviews, case studies and key informant interviews (KII). Univariate and bivariate analysis has been used for the analysis. In the paper, we have used a composite index measure “overall infrastructural facilities index” constructed based on the level of satisfaction as opinionated by the respondents in this study for the infrastructural facilities and services being provided during their stay. It is based on 10 basic facilities such as: food quality, residential facilities, infrastructural facilities, recreational facilities, staff availability, medical services, proper space availability, overall maintenance, lighting and ventilation and safety (flooring, stairways, protection). The reliability test of the index was performed, and the Cronbach’s alpha score was 0.79 that indicate a good reliability of the index. The index was further classified into three categories: ‘poor facilities, ‘average facilities and ‘good facilities’.

In the study, term- ‘OAHs/ shelter homes’ and‘ashrams’ are used interchangeably denoting the same meaning. Similarly, the term ‘homeless’ is used interchangeably with the term “abandoned elderly widows staying on the streets/outside temples /on the ghats of river Ganga.” denoting the same meaning.

Ethical considerations

Ethical approval for conducting this research study was granted by the Research Ethics Committee of the Institute. An informed consent form was formulated and prior consent was taken before starting the interview. The purpose of the interviews was explained to all participants, and they were assured that the information collected would be utilised purely for academic purposes.

RESULTS

Out of the total 360 respondents, majority of them were in the age group of 60-70 years (44%), followed by 71-80 years (34%) and then over 80 years (22%). About 38% of the abandoned elderly widows were from the other backward castes, followed by general category (32%) and SC/ST (31%).

*N=259 as only these respondents ever had children

In Varanasi, majority of the abandoned elderly widows in OAH/shelter homes were from general category (48%) while about 42% of the homeless belonged to SC/ST caste. In Vrindavan, majority of the abandoned elderly widows belonged to OBC category (OAH/shelter homes: 40%; homeless: 43%). Most of the respondents were from the rural areas (66%) and could not read or write (89%) themselves nor could their husband read or write (77%). Illiteracy could also be one of the determining factors for the vulnerable conditions of these elderly widows as these could be the reason for their general lack of awareness in the society. More than 55% of them have been living in abandonment for more than 10 years, 24% for more 6-10 years and 21% for less than 5 years. These years of abandonment shows how lonely their life had been. Thus, from the table it clearly shows us how the widows had lived their life being illiterate, poor and living in rural areas and how for so many years they had been lonely after becoming an abandoned widow. It was essential to understand the family dynamics of these widows because it would allow us to better understand their past life conditions. The majority of the abandoned elderly widows (63%) lived in a nuclear household. In both Varanasi and Vrindavan, a similar pattern was seen among homeless abandoned elderly widows and those residing in OAH/shelter houses, with the remaining 37% belonging to joint families. Parents go to great lengths to ensure the happiness of their children and hope to receive the same love and care in their later years, but few people achieve their dreams, and widows are especially vulnerable. The majority of them (46%) had more than two children, 26% had two children, 14% had one kid, and 15% had no children. The majority of people (47%) had both a son and a daughter, while 31% had only a son and 22% had only a daughter. Similar patterns were noticed in Varanasi and Vrindavan. The majority of them admitted to having a bad relationship with their children even before widowhood (49 percent), 36 percent admitted to having an indifferent relationship with their children, and just 15% admitted to having a good relationship with their children (Table 1).

An overall fourteen (14) OAHs (ashrams)/ shelter homes from the two cities were managed to be included in the study. It provides general information of these institutions which provided shelter to the elderly widows abandoned in the city. The OAHs/shelter homes (also termed as “ashrams” interchangeably) in our study has been further categorized into three different types- Government based OAHs (public ashrams), those managed by charitable organizations/NGOs and private OAHs/shelter homes (managed by private entity). Out of 14 ashrams in our study, there was one government based OAH in Varanasi and five in Vrindavan; there was four charitable ashrams in Varanasi and one in Vrindavan and two private ashrams in Varanasi and one in Vrindavan. All the six government OAHs/shelter homes in both the cities were getting government aid/funds; all the five charitable organizations and one of the private ashrams were dependent on public donation and some of their own funding and two of the private ashrams in Varanasi were relying on their own fund to operate and meet all the expenses to manage these OAHs/shelter homes (ashrams). Only the government ashrams were getting financial support from government to manage their institutions and a charitable organization in Vrindavan getting support from NGOs; whereas the rest had to depend on their own funds or public donation (which is not dependable source of financial assistance) to manage their institutions.

All the government and charitable organization-based ashrams had their own building obtained with the help of government or gifted a long time back to the charitable organization to support the elderly widows coming to the cities after being abandoned. Two of the private organizations were using rented building to manage their shelter homes and supporting the elderly widows abandoned in theses religious cities. Out of these two, one of the private ashrams in Varanasi was renting a private building and the other one in Vrindavan was renting a residential building to run these ashrams. All the ashrams which were government based had government buildings while the rest of the charitable ashrams had either private or the residential buildings. Talking about the structures of the building in which these ashrams were running, all of them were double storied except for two of the ashrams in Varanasi which were single storied. The government run ashram in Varanasi was located near the main road and the rest of the government run ashram in Vrindavan was slightly away from the main road. The charitable organization who were supporting such ashrams for abandoned elderly widows in Varanasi were mostly located far from the main road. The only charitable ashram in Vrindavan was located near the main road and was easily accessible to all the amenities of the city. The private ashrams in both the cities were located slightly away from the main road as they managed to find a building away from the cities to run these ashrams. Most of the ashrams in both the cities which were located far away from the main road had calm and peaceful surrounding, while those which were situated near the main road were crowded and noisy. The government ashrams in both the cities reported that the supplies of their day to day needs are met by the government funds which was irregular in Varanasi but was received monthly as reported by the ashrams in Vrindavan. Most of the charitable organization reported that they were receiving funds from public donations which was not fixed and had usual delays. Two out of the three private ashrams reported that they depended on institutional private funds and used it as and when required in the management of the daily supplies while running the ashrams. The third private ashram was dependent on public donation and had no fixed frequencies of supplies (Table 2).

Note: *Public/Govt. Ashrams: Ashram 1-6;**Charitable Org. Ashrams: Ashram 7-11;***Private Ashrams: Ashram 12-14

Note 1: wherever ‘0’ (absence of facility) is applicable it has been marked with ‘Ο ’ and wherever 1 (presence of facility)is applicable it has been marked with ‘’. Note 2: Ashram 1-6 :Public /

Govt. Ashrams; Ashram 7-11: Charitable Org. Ashrams ; Ashram 12-14: Private Ashrams.

A list of total thirty available facilities and amenities was used in the study to understand the basic standard of facilities available in these OAHs/shelter homes, where these elderly widows lived after their abandonment. All the thirty available residential/infrastructural/recreational and medical facilities were listed and on the absence of these facilities- a value of “0” was given against the listed facility and a value of “1” if that was present in the respective OAHs/shelter homes. The following table gives a clear representation of the available facilities with respect to the OAHs/shelter homes (ashrams) at present. These listed facilities in the table will depict the adequacy of these elderly homes at present and to what respect they meet the required standard to make their living satisfactory. The only charitable organization run ashrams i.e. ashram 11 in Varanasi had the best facilities among all the other ashrams in the study and had a score of 26 out of 30 with only few facilities missing which were handholds and grab bars, separate prayer rooms and lacked 24 hours ambulance facility and the proximity to nearest government hospitals. The private ashrams (ashram- 12 and ashram- 14) and government ashrams (ashram- 1, ashram- 2, ashram- 3 and ashram- 4) in both the cities had mediocre scores between 15 to 19 stating that the facilities available at the se OAHs /shelter homes had average facilities which mostly lacked a proper room for themselves, a separate sick room, generators, fire safety measures, any help to manage their laundry, a proper dining space, handholds and grab bars, personal cupboard storage etc. Two of the government ashrams (ashram- 5 and ashram- 6) in Vrindavan scored 13 out of 30 which was somewhat okay in terms of standard residential environment for the elderly widows abandoned. Rest of the ashrams which was mostly run by charitable organizations (ashram- 7, ashram- 8, ashram- 9 and ashram- 10) and one of the private ashrams (ashram-13) in Varanasi was scoring poorly between 6 to 9 out of 30 and had inadequate facilities to cater to the needs of the elderly widows living in isolation (Table 3).

Furthermore, these facilities provided by Ashrams to these abandoned elderly widows living at their respective institutions was analyzed by generating a composite index- “overall infrastructural facilities index” based on the level of satisfaction as opinionated by the respondents in this study. In Varanasi, it can be seen that the abandoned elderly widows were somewhat satisfied with the quality of the facilities being provided to them. About 54% of the respondents stated that the ashrams had ‘good facilities’ while 10% of them stated that the facilities were ‘average’ and about 36% felt that the facilities were ‘poor’ in the OAHs/shelter homes. In contrast, abandoned elderly widows staying in Vrindavan reported poor (41%) to average (37%) facilities being provided by Ashrams. Only 22% felt that the quality of services and facilities were good in these institutions in which these abandoned elderly widows were seeking shelter. Thus, on an average from the two cities (i.e. Varanasi and Vrindavan) where these abandoned elderly widows were seeking shelter in old age post their abandonment, it was disclosed that about 39% were not satisfied and rated the quality of services and facilities being provided to them as ‘poor facilities’, while 28% felt an average facilities were being provided and rest 33% of them felt it was somewhat ‘good’ in terms of services and quality of facilities available at these Ashrams (Figure 1). One of the key informants who was the caretaker of one of the ashrams of Vrindavan stated that “the funds we receive are minimal, and it is quite difficult to give adequate meals, good-quality clothing, mattresses, and other necessities to the widows who come to seek shelter. We do our best to accommodate their demands, but the facilities are inadequate due to lack of resources”.

The study also demonstrates the living conditions of the abandoned elderly widows who were homeless. Majority (60%) of the widows said that they lived outside the temples in the absence of shelter, place of living. Approximately one-fourth of them (24%) reported that they lived on streets and 16% said that they lived near ghats. More than half of the widows (54%) revealed that they preferred living independently. About 36% were not taken in when approached to the ashrams and 10% did not even know where to go to. The high percentage of widows wanting to live independently denotes that they do not want restrictions to be imposed on them in their last days of life. About 65% of the widows were unhappy of their current dwelling place. It was obvious as these widows live on streets and definitely want a better life for themselves. Approximately one-fourth of them (26%) were somewhat satisfied but not happy with their dwelling place and only 9% were those who were happy. Two third of the widows (66%) (Varanasi- 45%; Vrindavan- 53%) had no willingness to enter shelter homes/ ashrams. About 49% of them manage to get two meals a day; 44% of them even manage to get three meals a day but 8% of them only get one meal a day. For majority of the widows (46%) begging was the source of their daily need management. Most of the widows (70%) informed that they slept on street sides during the night. About 20% of them slept outside the temples and 10% slept in other places (parks/gardens, etc.) Majority of the widows (78%) had to defecate openly. Only 6% used public toilets/bathrooms and 15% used community toilets. More than half of the widows (55%) managed medical expenses of pharmacist. About 10% depended on free medicines and the same percentage of them were depended on other sources. One-fourth (25%) of them requested other to provide them some help for their medical facilities (Table 4). One of the case studies (94-year-old abandoned widow begging near one of the famous Ghats of Varanasi) participants elaborated-“sometimes I sleep on streets, sometimes in front of temples, sometimes near some park. I do not have a place to go. I spend my days begging and my nights sleeping wherever I can find a spot that feels safe. From the money that I earn by begging, I somehow manage my meals and some of the medicines that are less expensive, other than that I am unable to afford anything. Nobody wants to live such a life. Every day, I have to worry about my meals and there are times when I even sleep empty stomach. It’s depressing but I have no choice”.

DISCUSSION

The main objective of this study was to obtain a better knowledge of the existing institutional resources available for those seeking support in their state of isolation in old age. Their sufferings in abandonment is only eased by the fact that they have proper roof over their head but that does not solve all the other issues which already tends to enhances their traumatic experiences in life. The poor environment does not ease out their other physical and mental issues related to old age abandonment. Some of the facilities like separate bathrooms and toilets, prayer rooms, helpful furniture, personal storage/cupboards, dining hall, small garden, television, prayer room space, training rooms were not very common and present in all the ashrams. Generators and fire security system was absent from all the ashrams except for one in Varanasi. Help with the laundry and personal care are some of the services not present in most of the OAHs which is very important help for the elderly widows struggling physically and mentally. None of the OAHs/shelter homes had handholds and grab bars in staircases and corridors to help with elderly-appropriate environment in their assisted living space.Those who were ‘homeless’ and abandoned in these religious cities seeking shelter, on the other hand, had a different perspective on the institutional setup. Many of these abandoned elderly widows were hesitant to move into these old age homes/shelter houses, fearful of losing their independence as they grew older. They were ready to spend their lives on the streets and outside temples, on their own terms and with their own volition.

CONCLUSION

With the growing incidence of elderly being abandoned in major cities and religious places, these cities are crowding with migrants from all around making it difficult for the management (government) to look out for them all at once. So, a balance could be maintained if there is OAHs/shelter homes in each district across all the states providing equal benefits to the vulnerable destitute making it easier to manage and provide help to the needy. As the elderly, especially the old widowed women face severity of homelessness post abandonment, it becomes very essential to create a regional level task-force comprising a group of representatives, who specifically address this issue and tries to manage and provide the services to these vulnerable group of population. In absence of enough standard OAHs/shelter homes catering to the needs of abandoned elderly especially widows, there should be certain policies and programmes drawing attention toward those who become homeless and live in isolation in our society.

ACKNOWLEDGEMENTS

We are grateful to the local authorities, managers and staffs of the old age homes/shelter homes (ashrams) of both Varanasi and Vrindavan, NGO Workers, and locals for their assistance in conducting the data acquisition in these two major cities.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Srivastava V. Women ageing: Social work intervention. 1st edn. Jaipur: Rawat Publications; 2010.
2. 2. Kumar S, Gupta A, Mazta SR, Sharma D, Chaudhary A, Chamotra S. Assessment of facilities and reasons for settlement in old age homes of Himachal Pradesh, India. Int J Community Med Public Health. 2020;7:2588-94.
3. 3. Gupta A, Mohan U, Singh SK, Manar MK, Tiwari SC, Singh VK. Home away from home: quality of life, assessment of facilities and reason for settlement in old age homes of Lucknow, India. Indian J Community Health. 2014;26(2):165-9.
4. 4. Tiwari SC, Pandey NM, Singh I. Mental health problems among inhabitants of old age homes: a preliminary study. Indian J Psychiatr. 2012;54(2):144.
5. 5. Liebig PS. Old-age homes and services: old and new approaches to aged care. J Aging Soc Policy. 2003;15(2-3):159-78.
6. 6. Kashyap SN. Extent of infrastructure facilities available in old age homes of Uttarakhand, India. J Dairy Foods Home Sci. 2008;27(3 and 4):226-9.
7. 7. Choi MK. A study on the analysis of housing environments of the elderly households and its suggestions in preparation for aging society. J Architect Inst Korea. 2000;16(9):29-38.