Choice or Imposition? Factors that Influence the Receptivity of the Elderly in Lucknow

Towards Staying at Senior-Living Homes

Mahi Agarwal

mahi-agarwal@outlook.com

The International school Bangalore

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Abstract

In an increasingly urbanized society of India, the phenomenon of the elderly spending their twilight

years in senior-living homes is gradually becoming more prevalent in big cities like Delhi and

Mumbai. A senior living home is a home for elderly people where they are provided all the amenities

they may need to stay healthy and comfortable. Urbanised in the context of Indian cities means that

the city is much more technologically and socially advanced than the rest. This trend has

concomitantly been accompanied by the rise in the number of such institutions to meet the demand.

Hence, the present research study focuses on whether a trend was also representative of other parts of

India by conducting an online survey among 70 elderly citizens of Lucknow, belonging to the age

group of 65 years and more living in urban/rural areas of Lucknow. Besides this, interviews were

conducted with few respondents to generate more in-depth knowledge of the topic Thematic analysis

revealed sociocultural characteristics, factors specific to Lucknow. Nonetheless, the study shows that

the reluctance of Lucknow elderly to stay at senior-living homes may be a situation that could change

in the not-too-distant future. With the convergence of their aging and the movement of social trends

away from joint families and home-based care services, the elderly in Lucknow may have to prepare

themselves for the prospect of living in these institutions. A social trend is a term used to describe

events that society as a whole follows or considers correct. Senior-living home industries and

policymakers in Lucknow could benefit from the current study to enhance the quantity and quality of

these homes to make them an attractive alternative for the elderly to want to move there.

KeywordsSenior-living homes, Social trends, Urbanized

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Introduction

In traditional India, the joint family typically cared for the aged (Panday & Kumar, 2017). However,

such an arrangement has begun to disintegrate due to the increasing urbanization of India. With the

migration of young couple to cities to look for work and the concomitant breakdown of joint families

into dispersed nuclear families (Akbar et al., 2014), the elderly are left on their own to care for

themselves (Devi et al., 2013; Hegde et al., 2012; Kumar et al., 2012; Mishra, 2008; Mudey et al.,

2011). Those who struggle to look after themselves in the event of medical emergencies and are

unable to get home-based care would require institutional support. All these interrelated trends have

made senior-living homes appear more relevant than ever within the Indian setting (Panday & Kumar,

2017).

Senior-living homes refer to accommodations that are dedicated to the aged population (Panday &

Kumar, 2017). It ranges from a place where the elderly can stay only during the day time to fully

services 24-hour care (Panday & Kumar, 2017). In senior housing, special attention is given to safety,

accessibility, and diversity. These qualities are essential to allow the elderly to have a ‘home away

from home’ experience (Panday & Kumar, 2017).

Today, there are over 1000 senior-living homes in India, with the majority offering free settlement

(Panday & Kumar, 2017; Akbar et al., 2014). These places accommodate the old people who are

uncared for and ensure that the elderly have access to the basic necessities of life (Panday & Kumar,

2017; Akbar et al., 2014). Paid versions of such homes have now become increasingly popular due to

the growing demand, with fees that vary according to the specific types of services provided. For

instance, other than the bare essentials, additional activities can include yoga classes (Panday &

Kumar, 2017). Although they live in these senior-living homes, residents can still stay connected with

family and family by phone, etc. (Panday & Kumar, 2017).

Senior-living homes in states like Delhi and Kerala can boast of high-quality senior-living homes with

adequate medical care families and quality meals; they are not widely embraced as a desirable

alternative in many smaller cities (Panday & Kumar, 2017). Rather, the stigma that senior living

homes are meant solely for senior-living citizens who have been abandoned by their families and are

difficult to care for lingers on. In fact, several research studies on elderly have identified several

factors that contribute to the elderly’s preference to stay at senior living homes in their old age. They

include: economic hardships (Bansod et al., 2006; Bharati, 2009; Mishra et al., 2008); the absence of

adequate family support (Gupta et al., 2014); poor treatment by the family (Gupta et al., 2014; Lalan

et al., 2014); and the ill health of the elderly (Akbar et al., 2014). Whether these factors constitute

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reasons that influence the elderly’s willingness to contemplate living in senior-living homes in

Lucknow was one of the focuses of this research study, as these institutions had not gained much

traction to date. A more nuanced examination of this issue was also conducted to identify additional

influencing factors in order to produce a complex picture of this phenomenon.

Methodology

The aim of this study was to identify the factors that influenced the attitude of the elderly in Lucknow

towards spending their post-retirement years in a senior living home, as well as the extent of their

influence. A mixed method research design is used. Quantitative as well as qualitative research

approaches were adopted to examine this phenomenon. Senior citizens stated their attitude towards

their desire to live in a senior living home after retirement by rating their level of willingness to do so

– the dependent variable. The factors that were identified as possible predictors of their attitude

towards living in a senior living home after retirement were as follows – the independent variables:

● Demographic variables of age and years of education

● Non-demographic predictors that comprise self-reported levels of:

o financial independence,

o quality of family life,

o closeness of family unit,

o post-retirement assistance needed,

o quality of health,

o familiarity with the concept of a senior living home

Sample

A sample of 70 senior citizens in the age group of 65 years and above residing in Lucknow, Uttar

Pradesh, were part of the study. Informed consent was taken and the participants were briefed about

the questionnaire as well as the interview.

Tools Used

The tools used to gather this data are interviews and a questionnaire. A questionnaire was circulated to

senior citizens out of which 70 senior citizens filled out the form. Besides this,five elderly citizens

were interviewed. The question asked to them was “What are your views on senior-living homes and

could you picture yourself living in one?”

Hypothesis

The hypotheses are set out below:

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Null Hypothesis: The aforementioned factors have no effect on the willingness of the elderly in

Lucknow to spend their post-retirement years in a senior living home.

Alternative Hypothesis: The aforementioned factors have an effect on the willingness of the elderly

in Lucknow to spend their post-retirement years in a senior living home.

Informed consent an ethical considerations

Data Collection Procedure

An online survey for elderly respondents living in Lucknow, aged 65 and over, was used to gather

both quantitative and qualitative data. From the quantitative standpoint, the elderly respondents’

attitude towards spending their post-retirement years in a senior living home was represented by their

self-reported rating of their willingness to do so. As for the predictors, the following variables were

chosen due to the following reasons:

● Age: To determine a specific age group that might be more inclined or not inclined at all

towards the idea of an old age home.

● Years of education: To determine whether or not education level plays a role in the elderly’s

mindset towards senior-living homes.

● Level of financial independence: To determine whether or not the level of financial

independence affects the elderly’s willingness to stay at a senior-living home

● Quality of family life: To determine the importance of the quality of family life, and how it

impacts the decision of the elderly.

● Degree of closeness of family unit: To determine what kind of atmosphere at home to do the

elderly tend to leave more to live in a senior-living home

● Amount of post-retirement assistance needed: To determine the relationship between help

required and willingness to stay for an elderly, to judge what the most popular condition is in

which the elderly come to stay at a senior-living home.

● Quality of health: To determine how the quality of help influences the elderly’s decision to

stay at a senior-living home.

● Familiarity with the concept of a senior living home: To determine the awareness levels of

senior-living homes among the elderly in Lucknow , and see how it influences their decision.

Responses to an open-ended question about their willingness to spend their post-retirement years in a

senior living home allowed the respondents to elaborate further on their ratings. In addition,

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interviews were conducted with five respondents to seek out data about the kind of norms and beliefs

of the elderly living in Lucknow towards senior living homes, which may be deterring them from

wanting to live there. Additional queries also covered the kind of facilities they would want and the

quality of life they would expect out of a senior living home. Together, the data offered a rich and

complex examination of Lucknow's elderly citizen’s perceptions towards living in senior living

homes.

Data Analysis

A regression analysis was conducted to identify which of the variables were statistically significant in

influencing Lucknow’s elderly citizens’ willingness to spend their post-retirement years in

senior-living homes and their relative levels of influence.

Moreover, for qualitative data thematic analysis was carried out for respondents from the survey, to

produce additional insights.

Results and Discussion

A regression analysis was conducted to identify the factors that influenced the attitude of the elderly

in Lucknow towards spending their post-retirement years in a senior living home, as well as the extent

of their influence. The regression analysis showed that the predictors did not produce a statistically

significant effect: F(9, 60) = 1.31, p = 0.25 (Table 1). Even though, one of the factors, the level of

assistance required, b = -0.45, t(60) = -.21, p =.04, with a p value below .05, its t statistic is below the

t critical value of 2.00.

Table 1Regression Analysis of Factors Influencing Willingness to Stay in Senior-Living Homes (N=70)

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Table 2

Thematic Analysis of the interview responses

THEMES EXAMPLE

1. Lucknow’s Socio-Cultural Beliefs and

Norms: Double Stigmatization

1) their bond with their children is weak;2) their children have abandoned them/they are

being a burden3) They are troubled or unhappy

2. Accessibility of Professional Home-Based

Services

“It is important to point out that the tradition ofhaving a family doctor has been prominent inIndia for many decades and is a trusted source

of service by many.”

3. Psychological Deterrents “Along with just the environment factor, I alsohave my own routine, one that I enjoy and ispractical for me. I am free to do whatever I

want. I value my freedom greatly…”

The aim of the research is to identify the factors that influence the attitudes of the elderly in Lucknow

towards spending their post-retirement years in senior-citizen living homes. The quantitative results

were insignificant however in contrast based on the thematic analysis it was found that quite a

number of the predictors were commonly identified as factors that would compel the elderly to join

senior-living homes, particularly individual vulnerabilities, it would seem that there were overarching

factors that superseded the respondents’ concerns at the individual level. One overarching factor could

be the specific socio-cultural beliefs and norms of the Lucknow community.

Another factor relates to the elder community’s perceptions of senior-living homes in Lucknow in

terms of: 1) the prevalence and quality; and 2) the elderly respondents’ knowledge of such

institutions. It is possible that a description/ image of senior-living homes may have acted as an

example so that the participants who were unaware could have answered on the basis of the

description.

The following sections will thus provide a thematic analysis of the aforementioned factors and

additional unidentified factors raised by the respondents in their responses to the open-ended

questions. The themes to be presented are as follows:

● Lucknow’s Socio-Cultural Beliefs and Norms: Double Stigmatization

● Accessibility of Professional Home-Based Services

● Psychological Deterrents

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Lucknow’s Socio-Cultural Beliefs and Norms: Double Stigmatization. Based on the

interviews with respondents who were living with their children or family relations, the belief that the

elderly should live with their children or family relations is deeply entrenched. It is premised on the

fact that India is a collectivist culture country wherein family members assume the responsibilities

and share them with each other of them looking after one another. Within such a traditional paradigm,

elderly citizens of Lucknow feel that staying with their family for the rest of their lives is their only

option. As the interviewees remarked, society’s judgemental attitude towards elderly citizens who

may wish to stay at a senior living home is a restrictive factor:

Even if some citizens wish to stay at a senior living home, the majority of the population is likely to

decide against it due to the influence of society. They may feel ashamed of how society will view

them. These are a few of the many things that society believes if an elderly stays at a senior living

home: 1) their bond with their children is weak; 2) their children have abandoned them/they are being

a burden; and 3) They are troubled or unhappy etc.

Mostly it is thought that if a senior citizen were to move into a senior-citizen home, they probably

couldn’t afford staying at their house anymore. So they had to make a compromise and settle for less.

Furthermore their social standing, as well as the respect that was once paid to them, suffers a decline.

Essentially, the decision of a senior citizen to stay in an old-age home can be stigmatizing, as it is

accompanied by negative associations of difficulties at both the individual and familial levels. In a

highly collectivist society that places a strong priority on the reliance on the family unit, senior

citizens’ selection of a senior-living home to spend their twilight years would be cast in an

unflattering light.

Quality of Old Age Homes in Lucknow. The comments also reflect the stigmatization of

old-age homes. The respondents commented that senior-living homes are also often perceived not as

‘luxurious’ places to live, but rather as ‘hostels for the elderly’ — a place of last resort. In fact, this

kind of thinking in India is reinforced by sources and studies that say old age homes are meant for

senior citizens who are unable to stay with their families or are destitute (Panday & Kumar, 2017). For

older people who have nowhere to go and no one to support them, senior-living homes provide a safe

haven (Panday & Kumar, 2017).

The lack of popularity of senior-living homes amongst the citizens of Lucknow could be a result of

the small number that exist. Although there are 1000 senior-living homes in India (Panday & Kumar,

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2017), in Lucknow, only seven are functional(Panday & Kumar, 2017) . The majority are in very poor

financial health, some are run as semi-charitable organizations as well. Considering the income group

of the respondents, which range from 37,500 thousand – 500,000 thousand, the standard of a

semi-charitable senior-living home would not be up to scratch for them.

Based on the aforementioned realities — the dearth of quality senior-living homes that can cater to the

elderly from the middle and upper classes, the perception that senior-living homes could offer a

desirable alternative may not have been fully acknowledged. Perhaps, had this research study been

conducted in a metropolitan city like Delhi, which boasts of more quality senior-living homes (Akbar

et al., 2014), the results would be radically different, thus highlighting the significance of this research

study in revealing particular results of interest for industry professionals and policymakers of

Lucknow.

Accessibility of Professional Home-Based Services. Another key reason that the

interviewees cited as their lack of interest in senior-living homes in the existence of a ‘family doctor’

system. Each family has a friendly physician who conducts home visits to treat the unwell. Besides

offering medical attention, a doctor can instil a sense of security and confidence with pleasant words

of encouragement.* Most elderly citizens still turn to their family doctors for any kind of medical

advice. When asked about this, the interviewees stated:

“[so long as] the concept of family doctors is alive, it will always beat [...] going to a senior-living

home.”

“It is important to point out that the tradition of having a family doctor has been prominent in India

for many decades and is a trusted source of service by many.”

Apart from family doctors, affordable house help is also easily available in Lucknow. Between 1991

and 2001, there was a 120 per cent increase in the numbers of domestic help (Hanu, 2018). This is still

the case all over India.

Based on this discussion of the availability of viable alternatives that can furnish both specialized and

general home-based assistance, it is understandable that the elderly in Lucknow have no real incentive

to move out of their homes. At the end of the day, opting for a lifestyle that includes house help and

family doctors is cheaper than living at a senior-living home, with the concomitant benefits of

maintaining one’s respectability in the eyes of society.

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Psychological Deterrents. More than just a physical relocation from one physical space to

another, living in a senior living home constitutes a drastic transformation of one’s way of living,

which can impinge on one’s overall sense of well-being. Thus, such a decision is not one that the

elderly can take lightly, especially within a sociocultural context that discourages such a practice. This

theme certainly plays a prominent role for all respondents In particular, a respondent was articulate in

pointing out multiple reasons for his attachment to his home. The first factor is the sentimental value:

“I have been living in my house for the past 30 years. All my memories with my family are from this

house. I have seen my children and my grandchildren’s journey growing up in this home. My wife and

I are so closely attached to this home that we could never think of residing elsewhere no matter what

the benefits may be.”

A second factor is the freedom to pursue one’s way of life that is characterized by preferred routines,

freedom and privacy:

“Along with just the environment factor, I also have my own routine, one that I enjoy and is practical

for me. I am free to do whatever I want. I value my freedom greatly…”

“I also enjoy spending time with myself alone, privacy is a very important factor to me and I feel that

it will be lost amidst the hustle- bustle.”

The also revealed a third factor that captures very well the common fear of the effects of

institutionalization that can lead to the erosion of freedom, the ceding of control and individuality:

“I don’t think I would be a fitting candidate to follow a fixed routine. I like to feel that I am in control

of everything around me and being bound to a regime would not suit me well. It would invade my

freedom to practice my hobbies and furthermore, create a tension between my old habits and the new

routine […] I am also scared that the regime and environment may shape me into a different person

and I may lose sight of myself in the process.”

Although these factors may depend from person to person and situation to situation, it is likely that

some of these factors take a toll on a proportion of the elderly citizens of Lucknow when it comes to

relocation. Studies have revealed that for the elderly, moving away from their own homes with

attached sentiments, comforts and property holdings, and a fairly happy life, to new environs in the

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cities is tough. In fact, sometimes the “social and psychological effect” from relocation can be

“lethal”. Thus, the respondent’s concerns should be considered.

Yet another huge concern is the loss of the immediate social circles that constitute the foundations of

the lives of many elderly individuals. This is particularly the case for a collectivist society like India in

which fitting in with social groupings is so important to an individual’s sense of well-being (Sinha et

al., 2004). They pointed out that they all have their own closely-knit “social circles'' of friends and

family, with whom they would like to spend their twilight years. These are their comments:

“My friends and I meet almost every day. We like to play cards every night and it’s a great way to

pass the time. I could never give up this contact. It is a blessing to have them by my side!”

“My wife and I live with our son, our daughter in-law and their two children. The house is always so

lively and we are so happy to be a part of our grandchildren’s lives. Our son and his wife both work;

so we take care of the kids, while they are gone during the day time. Our friends also live in the same

complex with us and we go on a morning walk with them every day. We are very happy and would

not like to be separated from our children and our friends.”

“My wife and I take part in many charities and galas. We are very social and enjoy going to social

events! We also like to watch movies in theatres and occasionally dine outside with our friends.

Although our children are settled in the States, we do not feel alone. Our friends always keep us

company and we them. We are living our best lives and are very free-spirited individuals. We would

not want to leave our friends or our current kind of lifestyle.”

This final set of comments clearly show that respondents are enjoying an ideal lifestyle for the elderly

— one that is characterized by a vibrant social life and dynamic activity. Nonetheless, they do reflect

a temporary state of affairs that will inevitably change with the passage of time, leading also to an

accompanying need to determine whether the living arrangements need to be adjusted. As such, the

option of senior-living homes should not be dismissed.

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Conclusion

In conclusion, the results of this study provided some particular insights into the factors that influence

the decision to stay at a senior-living home for the elderly from Lucknow. Based on the thematic

analysis, it was found that the in-depth interviews with the respondents to the survey and responses to

the qualitative questions in the survey were thus extremely helpful in identifying insights regarding

the particular factors associated with the sociocultural characteristics of Lucknow, which are not the

same as the situation facing the elderly in other Indian cities. This finding thus illustrates the need for

future research on senior-living homes to pay attention to the unique socio-cultural attributes in

different cities of India in order to ensure that they cater to the specific populace they serve.

Nonetheless, the respondents’ vocal articulation of their reluctance for the moment to contemplate

staying at a senior-living home does not mean that such a prospect may not arise in the future. In fact,

it was pointed out that this status quo could change over time. With the erosion of the nuclear family

structure and the trend of adult children studying/working abroad, as well as the shift away from

home-based doctors, senior living homes may need to be put forth as a viable option.

Implications for future research

In order to help adjust the mindset of the elderly at Lucknow and transition them towards a more

receptive state, the quality of senior-living homes in Lucknow will need to be enhanced. Several

recommendations are presented below:

1. For a start, the local government and related industry should focus on increasing the number

of senior-living homes in Lucknow focusing on changing the mindset. Their availability will

help to normalise this concept so as to reduce the stigmatization surrounding these homes.

2. Periodic open houses and the provision of day activity programs are effective ways for the

community to get acquainted with the physical space and gain exposure to the types of

interactions that are available. This is all part and parcel of the adaptation process.

3. To increase the allure of senior-living homes, the management needs to go beyond providing

basic amenities like tables and beds to pay attention to making them more homely, rather than

clinical. The residential spaces should feel like home for the residents.

4. While many senior-living homes like to advertise that they have services and activities as a

positive feature, it is also important for the staff to recognize that the loss of privacy and a

private space could be a concern for the elderly residents. Therefore, it will be important to

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find the balance between attention/activity and privacy/quiet time. Ultimately, they can take

part in recreational and leisurely activities if they wish to or not if they don’t want to.

5. Similarly, the preservation of some routines can help the residents to feel comfortable in their

new home. They should be allowed to ease into a preferred routine, which can ensure that

they do not feel that they have sacrificed their freedom.

Limitations of the study

No other criteria except the need to be above 65 needed to be met to be eligible to fill in the

questionnaire. Further criteria like a predetermined income bracket or family configuration could have

been further applied to get more specific and conclusive results.

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