Pushpa Mohan Sakri, a petite and soft-spoken 36 year old mother, used to work in an essence and syrup packaging unit in Bhiwandi. A ninth standard pass out, she is now employed at the posh Hiranandani area as a caregiver to a woman in a semi-coma state. “She can’t move and she behaves like a child,” is how Pushpa describes her client.
As she watches over the bedridden client, feeds her and bathes her, the busy people of Mumbai are on the lookout for more such Pushpas who can give daily, round-the-clock care to their ailing family members. Add to the ailing those such as specially-abled children and the elderly.
With the absolute number of the elderly (over 60) population in India set to rise to 137 million in 2021 (as opposed to 76 million in 2001), more families will need trained caregivers for patients who are totally or partially dependent.
Pushpa is one of the 50 caregivers who are part of Aaji Home Care, a for-profit founded by Prasad Bhide in 2012. Bhide, formerly an IT professional working in New Jersey, felt the acute need for such caregivers when his own grandmother was hospitalized back in Mumbai.
His parents, who were stepping into old age themselves, were short of an able hand to take care of the ailing grandmother’s non-medical needs. Bhide realised that the next time someone’s aaji fell sick, there would be better care professionals available.
Leaving his IT job and equipping himself with a diploma in homecare assistance, Bhide started Aaji in Powaii. Currently, the organisation caters to clients in Powai, Thane and Andheri with plans to start in Bandra soon. The women who work at Aaji hail from places such as Kalyan, Vikhroli and nearby Kanjurmarg. The difference between dusty Kanjurmarg and sanitised Powaii is telling about the caregivers and the clients.
“Aaji’s clients are mostly the higher middle class. Our caregivers are lower middle class women, many of whom worked for daily wages earlier. At Aaji, they have a pink-collar job and it is a win-win situation for clients and caregivers.”
Bhide is critical of many of the caregiver bureaus in the city which provide untrained carers in the manner of daily wage earners and a lack of accountability. Bhide chose to overcome these challenges with Aaji by providing accountability of the caregivers, a monthly salary for the caregivers and consistency of service by the caregivers.
“The current market of caregivers is unorganized in India. Home carers are usually seen as another in the list of manpower providers such as drivers, labourers and domestic helps. To be an efficient caregiver means understanding what your client’s needs are,” says Bhide.
Ajay Pillai, a physiotherapist who works as care-manager at Aaji, believes that some of the key values for caregivers are knowledge about hygiene, listening skills and trustworthiness. The Aaji women have basic education, since the job demands literacy. Pillai trains newly recruited caregivers to discern symptoms of diseases, daily care and the problems of the elderly, especially those suffering with diabetes, dementia or Parkinson’s.
“Sensitive awareness is crucial is in this business. For example, a caregiver must know that a patient suffering from Parkinson’s takes medication that works like a battery. When the battery is down, symptoms may shoot up. At these times, it is important not to shout at the patient.” A nursing tutor trains the recruits and also teaches them basics of stomach feeds and nasal feeds.
Prior to recruitment, Bhide and Pillai do what is called as resource mobilization and become part time detectives. Unlike the bureaus, where background verifications are not done, Aaji does a mandatory police and background verification on the women they employ. Moreover, the client’s health situation is also checked.
Pillai states, “If the client has been recently discharged from hospital, we consider if Aaji can or should provide support. Since we handle only non-medical care, we take up extreme cases only when we know adequate medical care is already in place.” Once employed, if a tiff arises between the caregiver and her client, the good news is that Aaji steps in for resolutions. Such progressive action may not be always found with daily wage caregivers in the unorganized sector.
Every Aaji caregiver has a little chart with a list of daily tasks for each client. Bath, walk, medication and so on are boxes on that list. All those boxes need to be ticked by the end of the day. Reminiscent of the daily task schedule seen with many domestic helps in the organized sector, do women line up to take this job?
Bhide says, “There is a lot of stigma attached to those who work in other people’s homes. They fear that you could get treated like a servant. I have heard some of my employees’ parents say that they should rather work as salesgirls in malls, for there is more dignity in that.”
Pushpa luckily disagrees. She is happy that she knows quite a bit about assisting the elderly. “This knowledge will be of use to me when I need to take care of my family members when they are really old,” she says. There is, of course, the opportunity for organizations to aim at home care assistance for those who can’t afford a Pushpa or an Aaji.
Bhide says, “The more the number of such organizations enter the market, there will be surely ample scope for even the lower middle class families to afford a caregiver at subsidised rates.”