Something really scary to think about as our parents (and we) get older...
and the added worry... how will we handle it financially, we stay at home and take care of them, or work and pay for them to be taken care of somewhere else??
Asian parents in care homes
Some Asian people are turning their backs on tradition and putting their ageing parents into a home rather than within the extended family. Sarfraz Manzoor visited Aashna House in London to find out why
Manjula Shah and her husband ran a newsagent's in Thornton Heath, Croydon, for 12 years – rising every day at 4am to ensure that local children did not steal the papers from the pavement then spending 12 hours behind the till. On the morning of 15 May 1995, Mr Shah dropped dead because of a heart attack. It was his 55th birthday.
When their daughter subsequently married, Manjula began to feel extremely lonely. "And that was when my daughter said she had found this place where I would not be alone," she says.
On 13 August 2009, Manjula moved into Aashna House, a residential care home for elderly Asians, in south London. Manjula is one of 34 residents at the home, supported by a team of 30 people also of Asian origin.
Aashna House is not unique, but it's unusual in offering culturally specific care. Everyone who works with the residents is fluent in Gujarati and Hindi, the food is prepared according to religious requirements, and the television in the common room is permanently tuned to Asian channels. I recently spent two days at Aashna House, and on my first visit I met Manjula.
"My daughter is in Canada and she has been there since December," she told me, "but she phones me regularly." I asked her what it was like when she first came here. "I was scared," she said, "but I had no choice."
What does she do all day?
"It's very boring just sitting watching television. We do exercise sometimes. I am 65 and there are very old people here, but there was no choice for me – I had to come so my daughter could have peace."
In Asian tradition, parents look after children who, in turn, look after parents: elderly relatives being cared for inside the family is something that Asians have taken great pride in, something that separated them from the supposedly heartless western custom of throwing mum and dad into a home. I remember my father saying once that the British treated their pets better than their parents; to men and women of his generation, care homes were nothing less than a moral obscenity. In this sense, Aashna House should not exist. The fact that it does is evidence that times are changing. Some British Asian children are, reluctantly and gradually, realising that they can no longer care for their parents at home.
It is a decision few take lightly and it is rarely reported – which is what makes Fozia Khan's Channel 4 documentary, Asian Gracefully, to be shown on 4 March, so revelatory and compelling. Khan lost both her parents during four months in 2009, and that colossal loss coupled with being pregnant at the time led her to reflect on how her generation of young British Asians was dealing with its ageing parents.
"I remember my dad used to joke about it," she recalls. "It was seen as the ultimate betrayal because they had done everything for you."
Khan befriended the residents of Aashna House and for six months followed their lives. The day usually begins with a cup of tea in the communal dining halls. That is followed by personal care in the morning – bathing and grooming – before tea and biscuits and a series of religious readings. Around noon, residents return to their rooms before a communal lunch then a sleep and television until a cup of tea at 4pm. The afternoon ends with memory exercises, medication and dinner at 6pm, after which the residents are free to return to their rooms for the evening.
Manibhen Ramjee, 85, is sitting with her son Dinesh, a 57-year-old retired head teacher, when I meet her. She looks much younger, thanks to 40 years of teaching yoga. "We made the decision to put Mum here after she suffered a heart attack and stroke and lost her short-term memory. We realised she needed 24-hour care," Dinesh told me. The children visit regularly, and when I ask what she thinks of the home she tells me it is excellent.
Not everyone finds the home sociable. Among those lunching alone is Egbert Sen, a 78-year-old Christian Pakistani. He is a tall, dandyish man with a square face and amused eyes. He hands me two photograph albums. I expect old family pictures but they feature Sen with, among others, the Hollywood stars Charlton Heston, Steven Spielberg, Harrison Ford and Christopher Reeve. Sen is a retired actor who appeared as an extra in an extraordinary range of films, including Octopussy, My Beautiful Laundrette and Raiders of the Lost Ark. He arrived in Britain in 1957 and quickly became well-known as one of a tiny number of Pakistani actors. In the album, Sen has a luxuriant Jack Lord-esque hairstyle and stands beside a succession of young women.
In conversation, he's a little vague: he says he married in either 1970 or 1980. But he is certain that his wife was white and that they had five children.
"Why are you here?" I asked him. "Climbing was a problem where I used to live," he says. "There was no lift and the tower block had six storeys."
Fozia Khan herself found it hard talking to the families while she was making the film. "It is considered a shameful thing to put your parents in a home," she says.
It is clear that Sen doesn't feel right where he lives now. "I have no friends here so I am not happy: the Gujaratis keep themselves to themselves; the Patels do the same. I wish there were more Pakistanis here."
I am struck by the fact that most residents are Indian Gujaratis. The British Pakistani population is far more traditional than the Indian community. It is still largely unthinkable for most Pakistanis to send their parents into places such as Aashna House.
"There are not too many Pakistanis because their children have been brought up with different values – their children would be too ashamed to put their parents in a care home," says Fareeda, who is from Lahore and has worked as a full-time care officer at Aashna for the past seven years.
"The people here like the fact that we speak their language and cook their kind of food," she says.
"How would you feel if your children sent you to a place like this?" I ask. She laughs nervously. "I would not like that – the way I have brought them up, I am keeping my fingers crossed. I hope they will look after me."
My father died in 1995. Since then, my family has worried about our mother. She is now 78 and reasonably healthy but very lonely. My sister lives with her and my brother lives next door, but everyone works and so my mother is largely alone during the day, and consequently very bored. I have tried to encourage her to visit a weekly lunch club that caters for older Asians but after one visit she refused to go again, arguing that everyone else in the club was Indian, not Pakistani. It is unthinkable that we would put her in a care home, but we are fortunate that there are four of us to share the load. Not everyone is so lucky.
In the first-floor dining room of Aashna House, a 91-year-old woman slowly eats lunch. She is tiny with straw-yellow hair. "It is very sad, her story," one of the care assistants tells me. She was born in 1919 and came to Britain in 1967. Her husband died in 1977, which plunged her into a depression.
It was hard to talk to this lady and I could do little more than shout questions, which were met with an uncomprehending glare. I found being in her presence almost unbearably sad. It was impossible to not look at her and see something of my own mother. I found myself feeling angry at her son – how could he do this to his mother?
I soon had the chance to ask him. "My dad died which threw my mum into a depressive state and she developed schizophrenia," he said. He explained that he had had to inject his mother with drugs to calm her down; these put her to sleep 24 hours a day. The demands of looking after her took a toll: when he was trying to study, his mother's schizophrenia worsened. "I spent 30 years of my life looking after my mum," he said. "I had not married and I was not making progress with work, and I was feeling suicidal."
He decided he could no longer take care of her. "She is paralysed and she suffered a stroke," he said. "She also has type-two diabetes, glaucoma, manic depression and schizophrenia."
Does he feel guilty? "Of course I feel guilty," he said. "I would love to have her back home, but I cannot provide the care that she is getting now. I don't like her being here but what other choice do you have? I am trapped."
This family's story highlights just how knotty the issue of elderly care can be. Speaking to her son has given me a strong sense of the dilemmas children face before deciding to put their parents in care.
In many ways, Aashna House is an unusual place that caters for exceptional cases. Most Asians in Britain still would not contemplate putting their parents in such a home. Residents here are, on the whole, middle-class – I am surprised at how even 85-year-old Mrs Ramjee speaks perfect English – and it is striking how many residents I speak to have only one child – most Asian families are larger so there are more people to share the responsibility. The residents of Aashna House were pioneers as the first wave of postwar Commonwealth immigration and now they are pioneers again: it seems inevitable that in future more and more elderly Asians will find themselves encouraged to go into care homes.
Homes that offer culturally specific care are hugely valuable for today's Asian elders, but I suspect the coming generation will spend their last years in a more racially mixed environment. To my generation, it will matter much less to be surrounded only by fellow Asians.
Before my visit, I expected to find Aashna House dispiriting. The truth is more complex. I am glad I don't need to think about this kind of option for my mother, but what it does, Aashna House does very well indeed. The residents are treated with great respect and dignity. It was perhaps inevitable that times would change and that the tradition of Asian children looking after their parents was doomed. That is something to mourn. The only comforting thought is that while Manjula, Egbert and the others may feel lonely living apart from their families, they have the consolation of being lonely together.
First Cut: Asian Gracefully, Friday 4 March, 7.30pm, Channel 4