Older People Sharing and Caring Project

Project Proposal Prepared by

Keshari Kansakar

Submitted by
Child and Women Development Center
Swasthya Sewa Tatha Shanti Ashram
Sankhmul, Lalitpur
Tel. 977-1-5550037
Email:cwdcepscc@wlink.com.p

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Background:

Older People Sharing and Caring Project, implemented as a pilot project since April 2001
by Child and Women Development Center, has completed two years and is well into the
third year. The project started in collaboration with the Council of Ex-Civil Servants
with a goal to improve the status of older people and increase their feeling of
‘inclusiveness’ in urban areas of Lalitpur and Kathmandu districts. The target of the
project was mainly the older people of Wards 9 and 22 from Lalitpur sub-metropolitan
area. About 12 to 13 percent of the population of those wards consists of older people 50
years and above (approx. 2,000 older people) and comprise of different castes mainly
Maharjan, Shrestha, Sakya, Deula and Khadgi. Those are traditionally farmers,
government and non-government service holders, business people, artisans, sweepers
and butchers by occupation. Now all of these communities have diversified their
occupation and unlike their grandfathers’ generation, all the children attend schools and
are well educated.

Rapid urbanization, education and diversification of occupation have brought about

unexpected changes in lifestyles, attitudes and behavior among younger generation
while older people are very much traditional in their thinking and behavior and
nostalgic about their past lives. The result is the generation gap—the lack of
understanding between the older and the younger generation. Today’s grandchildren
are much more exposed to outside world than their grandparents whose world then was
confined to home life and hard work as they recall. They did not have opportunity to
attend schools and had to struggle for survival when quite young. Today’s children are
in a better position as they have more opportunities to receive education, and enjoy
various means of travel and communications which all may contribute to widening their
thinking and adapting new values and customs. which are different to the customs and
values older people grew up with.

Today’s older people feel ‘social isolation’. In many families older people do not have
much interaction with family members nor have good terms with them. The younger
generation has many interests and concerns and they care less about the older
generation, their interests and needs. As a result, older people feel neglected and spend
most of their time alone, with limited interaction, for example, when they meet their
contemporaries for a short time during the day. The health of older people is the lowest
priority in the family and, unless seriously ill, older people are not taken to the doctors
or cared for. Older people do not receive proper care and respect from the family. In a
number of cases, older people are physically weak and have few if any, options; they
accept their condition as it is. They feel happy and comfortable when they find that
younger generation love and support them, listen to them and respect them in some
ways.

As is common in Nepal, the majority of older people in the project area live with families
—at least one son and his family. But increasing numbers of older people are found to
be living alone or with only their spouse despite having a son or sons. This suggests
that traditional systems of taking care of older people within the family may be slowly
breaking down. Even for those living with the family, the care and support do not seem

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to be adequate and the life of older people may be more difficult than it seems from
outside. Today’s older people do not enjoy the same respect and care that the older
people in the past used to receive. The widening generation gap is the major source of
unhappiness for older people in the family.

Those older people who stay alone have harder time in sickness and even for day-to-day
survival. The older people may not be that poor in the sense that they have house, land
and some savings but for the lack of proper care and service they feel poor. Among
those living in the family also, they cannot spend their savings according to their will.
For many older women when their husbands died all of a sudden, they even faced the
problem of survival if sons refused to take care of them. Older women who had never
worked outside home were then forced to find work. This is equally difficult in that
employers are usually reluctant to hire older women.

Women and children’s issues have received much attention of policymakers lately but
older peoples issues hardly even come into discussion. Policymakers and the general
public are unaware of the situation of older people in Nepal—the difficulties they face,
their rights, the support services needed for them including basic health services.
Moreover, the issue of older people is ‘hidden’ since the general conception is that older
people are respected and taken care of by their family, so there is no need for outside
intervention while in reality, most older people spend the rest of their life in difficulty,
pain and in silence.

The achievements in the first and the second year:

Child and Women Development Center has carried out many activities during the two
years of its project implementation. Qualitative research undertaken with selected
communities of older people has helped us to understand the situation of older people
in those communities. It has addressed some of the major issues identified by the
research. In order to bring older people from exclusion, weekly religious programs are
taking place regularly. About 60 older people attend twice a week religious programs
regularly and listen to religious sermons and songs, watch religious movies, etc. and
thus spend time with their companions. Spending their time in religious activities such
as visiting temples, worshipping, singing religious songs is one of the favorite pastimes
of older people in Nepal.

In order to alleviate medical problems of older people, a monthly health camp is held on
the last Saturday of every Nepali month and many older people who could not afford to
buy medicines on their own have been helped in those camps. Special camps are also
held occasionally. This has been one of the major attractions for old people as they get
free medicines for minor diseases that are otherwise ignored by family members.

In order to create awareness on the plight of older people and to bridge

intergenerational gap, a modest start has been made. Preliminary discussions were held
with older people, and their family members including children. This helped us to let
families know about the project objectives, understand their views regarding older
people and generally helped to raise awareness of the importance of older people at the

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family and community level. There is a good rapport built with the community—the
older people, their families, elected ward officials, and local volunteers.

The above-mentioned activities—mainly weekly religious programs and health camps—

will be carried out with the intention of making them sustainable in the future. We have
gained more experience at the community level and now we need to put our experience
to strengthen the relations between younger and the older generation as well as raise
awareness on the plight of older people at the national level. There is a need to create an
environment for the increased interactions between younger and the older generation so
that there is better understanding between them and thus harmony in the family for the
well being of both the generations.

With the experience gained in the first and the second year, Older People Sharing and
Caring Project will continue through the third year with the following goal and
objectives.

Goal: Improve the status of older people and increase their feeling of 'inclusiveness' in
the society.

Specific objectives:

 To help reduce intergenerational gap through increased interaction between

different generations and enhance each other's understanding;
 To study the best health care model for the older people;
 Advocating for increased access to quality care services to older people through
appropriate policy and program interventions by the government and concerned
agencies;
 To make the project activities as sustainable as possible with the creation of older
people forum at grassroots level to carry out the programs and advocacy
independently.

Proposed activities:

Besides continuing with the activities from the previous years mainly religious and
health programs, the focus will be more on the increased interaction between older
people and the young generation, raising awareness at the local and the national level
on the plights of older people in general, and advocating for increased access to health
care services for older people in particular.

Interaction programs: There is a need to create awareness among younger generation of

the importance of older people in the family and the community, the problems they face
and increase the level of understanding between the two generations so that older
people have homely environment and are properly treated by their families.

One way to reduce the intergenerational gap is to open dialogue between older people
and the younger generation so that they understand each other better. For this rapport
will be built with children’s groups from different communities/localities and
preliminary discussions regarding older people will be held with them. A modest start

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in this direction has already been made in the second year of project implementation.
Children’s room has been set in the same building where religious activity takes place.
There are reading and playing materials for children there to come and spend their time.
Children and the older people will be brought together in weekly sharing forums. They
will also be brought together in interaction sessions during workshops/training.

Moreover, older people and their family gathering program and a special program respecting
local older people will be organized to bring older people and the family members together
and make the younger generation aware of the contributions of older people in the
society. From this we expect better understanding between different generations and
improved condition of older people in the community.

We expect better caring and loving environment for the older people at home as an
outcome of this program. Moreover we expect older people to understand the younger
generation much better. Children below 14 years of age will be the main targets of this
program.

Advocacy: Besides the community level, there is a need to raise awareness on the
particular issues of major concern to older people such as health care, medical treatment
at discount prices to older people, problem with old age and widow allowance at the
national level as well. Within a year at least two local level and one national level
workshop will be organized involving different audiences including media,
policymakers, and influential people. The media will include radio, newspaper and TV
journalists. People who can influence the policy for older people will be invited from
time to time in weekly forums to raise awareness on the issues of the older people.

Essay and debate competition regarding older people and their lives will be organized
among children’s groups at local level. Series of publications will also be brought out in
local papers on the major issues of older people.

There is a need to create a strong forum of older people at the local and possibly regional
level for undertaking various activities and for lobbying. Selected older people will be
given training to build their confidence and inform them of their rights. They will take
the lead in organizing different programs and also encourage them to participate in
different older people forums at national level.

Weekly sharing forums: Weekly religious sermons by Buddhist monk and the Hindu
priest as well as religious singings, and occasional screening of religious movies, health
education will be carried out as before. A ten-member committee of selected older
people has already been formed to carry out the weekly religious programs so that the
program will be continued with little supervision of CWDC staff. This team will be
strengthened through training and local volunteers will also be included in the team.
This way, older people will also gain self-respect and self-confidence and young people
start respecting older people more. These programs provide an environment for older
people to meet friends and neighbors regularly and be happy in each other’s company
and at peace.

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At the demand of older people weekly religious program will be extended from two
days a week to four days a week. Besides Sunday and Wednesday, there will be
religious program on Friday as well. On Tuesday there will be literacy class for a limited
number of older people by a volunteer.

Monthly health camps: Health care is one of the most basic needs of older people. Being
sick is one of the major sources of unhappiness for them. Older people suffer from
various diseases such as weak eyes, knee pain, back pain, leg pain, gastric, chest
problem, high blood pressure, etc. The monthly health camp has been a great help to
many older people who cannot afford to go to the doctor and buy medicines on their
own. So this service will continue for the third year as well. However, an effort will be
made to make this program sustainable.

Community health care support system: As mentioned above, older people feel lonely
and isolated and need companionship. Moreover, there are also older people who
cannot go out of their house. There is a need for some voluntary service to give some
company (or counseling in some extreme cases) to those older people who lack mobility
and who do not have family support.

CWDC had already initiated this concept of voluntary service with local volunteers.
During the first year of the project, five young local volunteers from different localities
were selected to conduct once a week home visit of older people in their community.
But now only two local volunteers are still continuing this activity once a month. They
were given minimum incentive of Rs100 per visit after submitting their visit report to
CWDC. Since this concept is new, there is a dearth of trained volunteers who can deal
with older people. So local volunteers and concerned persons from the government and
non-governmental organizations will be trained in providing support to older people in
the community. They will be appointed in different localities to keep in touch with
older people especially those living alone, to give them company, listen to them and
remain abreast of their problems and help them solve in possible ways. They will be
provided minimum cash incentive per visit and a training opportunity locally and
nationally as they become available.

For this activity CWDC has received limited funds from the Ministry of Women,
Children and Social Welfare. Under this activity, a regular staff nurse and local
volunteers will carry out home visits and give company and medical advice especially to
older people living alone and those without mobility.

Study of best health care model for the older people: Review literature from other
countries that have similarity with Nepalese culture with older people as Nepal health
care and other service providers (public, private and voluntary organizations) will be
sensitized on the health situation, needs, concerns and capacities of older people
through interaction programs including older people themselves and solutions and
recommendations will be sought. This will be tied with awareness raising program
mentioned above.

Networking: With the experience gained in the initial project areas, project activities will
be extended to other nearby localities. We will be encouraging other local NGOs to

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undertake such activities by themselves in their localities. CWDC will provide technical
support to carry out such programs in different localities. One local NGO from the
nearby area has already contacted CWDC and shown keen interest in the activities and
the staff has been involved in the training. Other NGOs also will be contacted and the
sharing forums with like-minded organizations will be held to learn from each other’s
experience.

Expected results:

- General public and policymakers will be aware of older people's concerns and there
will be pressure for better action;
- Older people will have self confidence and feel less isolated;
- Older people are better respected at home by family members;
- Better understanding developed between older people and younger generation
especially children.

Monitoring and evaluation: Monthly review meetings will be held with the project
staff, advisory committee and the older people themselves. Frequent review meetings
will be held with actual beneficiaries, i.e. older people themselves who attend the
programs to monitor the progress and get their feedback and suggestions to improve the
program. At the end of the program, stakeholders themselves will undertake an
evaluation of the project activities.

Sustainability: The project has been able to save the rent and other expenses. The Ex-
staff Council has provided the rooms for office and for religious program. A children’s
room has also been set up there. CWDC membership drive will be launched to collect
funds. Different local sources and international donors will also be sought to raise
money for older people programs.

Staff: Besides the current staff of project coordinator, there will be full-time research
cum administrator, who will carry out the discussions with older people and the
younger generation on the issues of older people at different localities. Local volunteers
with some training and incentive will be appointed to carry out home visits of lonely
and sick older people.

Constraints: How to create a homely environment for the older people within the family
is quite challenging. Since it is a very sensitive issue, we have to be careful not to
antagonize family members. The proposed interaction program however is expected to
create positive impact in this respect. For those older people living alone, how we can
help them is also a major issue. In this respect we want to have a modest beginning by
training local volunteers to undertake this task. Since there is a misconception that older
people are taken care of by their families, there are no special services for older people
such as counseling, treatment, day care, etc. But since there is considerable number of
older people living alone, we have to learn through our experience of such services.

Budget

Older People Caring and Sharing in Nepal

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Budget Breakdown
Exchange rate $1 = 75 NR
Description Cost Cost (US
(Nepal Dollars)
Rupees)
Salary costs
Programme Coordinator 130,000 1,733
Research & Administrative Assistant 78,000 1,040
Staff Nurse 65,000 867
Office Assistant 39,000 520
Project Advisor (30 days per year) 45,000 600
Programme costs
Weekly interaction programs (refreshment expenses) 25,000 333
Intergenerational programs (interaction programs, essay
and debate competitions) 30,000 400
Health camps and home visits to housebound older
people 70,000 933
Training of volunteers for 5 days (fee for resource
persons, snacks and stationary) 70,000 933
Training on leadership, confidence building, counselling
for older people and local volunteers 50,000 667
Study of appropriate healthcare models (stakeholder
analysis, literature review, and interactions between
older people and health care providers) 50,000 667
Advocacy workshops: 2 local level and one national level
workshop for different stakeholders on health needs of
older people 70,000 933
Travel costs 10,000 133
Office Costs
Communications 15,000 200
Stationary 5,000 67
Repair and maintenance (computer, furniture, etc) 10,000 133
Audit fees and bank charges 10,000 133
Staff meeting costs (refreshments) 8,000 107
Total Project Cost 10,400
Global Giving Administration (10%) 1040
Grand Total 11,440