Pratik Sharma Lamichhane / Mahima Devkota

With the advent of Corona Virus, we have been hearing that the aged-people, people with multiple conditions, are at greatest risk and need support with the activities of daily living. Buying groceries, taking medicines, preparing food, bathing, taking old-age allowance, communicating with family living remotely, and accessing health care monitoring, are facilitated by care-givers, an immediate family member or a more distant relative.
But these vital, routine matters have been thwarted by our recent lockdown in Nepal. With so many aged people dependent on others, particularly in care homes, growing number of aged people- living in care homes in both urban and rural areas, reduced funding, services, and limited space, further marginalises the safety of their daily life. Further, during the recent lockdown, aged people's immobility, their lack of awareness of and access to current technology and allowances, seriously compromised their mental, physical and financial health.
Older people are more vulnerable to severe diseases in our post- COVID-19 world. Europe, where the largest percentage of the world's aged people live, has been greatly affected by the pandemic. Over 95 per cent of European deaths occurred in those older than 60, with more than 50 per cent of all fatalities involving people aged 80 years or older. Reports show that 8 out of 10 deaths are occurring in individuals with at least one comorbidity factor, in particular those with cardiovascular disease, hypertension and diabetes, but also with a range of other chronic underlying conditions (WHO, 2020).
With their dependency on others, ranging from minor support to prompt access to healthcare facilities, our aged population is more likely to face dire outcomes from COVID-19. What happens when the dependency is cut off? Can they survive on their own, both during and after the pandemic?
In Nepal, due to migration of the younger generation, family conflict, impoverishment and disengaged inter-generational reciprocity, many aged parents are living alone or in old- aged homes. Their day to day interactions and activities are severely obstructed, leading to their increasing social isolation. These impacts are increasingly compounded for aged people who do not use today's internet and smartphone technologies and indeed more so with limited access to even simple phone calls. Exacerbating this further is income disparity geographical isolation and inequality in Nepal. Unawareness of home-delivery systems, phone payment, and the inability to make phone calls to doctors, are likely to take a toll on their health.
Local bodies and government, can and must work on programs and services that help to meet older people’s needs for home care, nutritious food, toiletries, medicine, social support and information for mental and emotional well-being. Accurate tallying of the number and situation of aged-people, assisting them when health care is needed, making them understand that this pandemic will end and counseling them to follow daily routines are likely starting points.
Similarly, every experience in life is constructed through the social, economic, and knowledge capital of human beings, all of which have a profound impact on access to resources. For example, the other day while grocery shopping, I saw an old man selling vegetables, rather than resting at home, thus increasing his risk of contracting COVID-19. And, on the same day, I saw another aged person going for a routine check-up in hospital. The difference in experience is surely due to differences in economy.
Many families are surviving on the edge, and when survival itself is the biggest challenge, then it overrides diets, supplements, and even health care! However, a lot of potential problems do not exist in our health care system alone. Things like widening access to the federal Supplemental Nutrition Assistance Program, addressing food deserts, and supporting returning citizens in the workforce, all relate directly to health, but we don't always think that way.
Here, we can help aged people, by practicing social distancing not social isolation, by prioritising and promoting their health and by keeping them out of hospital. At an individual level we can help by giving them phone calls, helping them run errands and stocking up on medical supplies, checking up on them, leaving notes, and connecting through the terrace or virtual media.
Similarly, reducing the risk to care-givers (formal and informal) must increase, although the lack of protective clothing is a constraint. If a family care-giver has a job that requires them to come in close contact with people, then they may decide to not closely approach aged people. However, this will alter normal family routines and habits, with those elderly who cannot walk, being unlikely to be able to feed and bathe themselves.
In the meanwhile, aged people having delirium, Alzheimer's, and other mental health conditions, need constant care. But, lack of home nursing care, further marginalises them. We can only imagine how much more so the case is if that person is living alone.
Thus, of course, a major limitation is that there isn't enough personal protective equipment right now, necessary facilitation of health services, immobility and lack of engagement. So we have to weigh the risks and benefits of tapping into a finite supply of protective equipment by checking up their status, by providing necessary emotional, financial and health support and services ensuring they get all that they need. We need to support and provide care to the elderly living in our community and our care homes. We should respect and treat older people empathetically during these difficult times.

(Sharma Lamichhane is a Ph.D. Scholar at the Department of Social Work, TU. Devkota is a Masters in Social Work specialising in Gerontology.)