old age home case study

Lifestyle Changes and Perception of Elderly: A Study of the Old Age Homes in Pune City, India

Priyanka v janbandhu 1 , santosh b phad 1 , dhananjay w bansod 2.

1 Research Scholar at International Institute for Population Sciences, Mumbai, India

2 Professor, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India

* Corresponding author Priyanka VJ , Research Scholar at International Institute for Population Sciences, Mumbai, India

Received Date: 13 October, 2022

Accepted Date: 10 November, 2022

Published Date: 15 November, 2022

Citation: Janbandhu PV, Phad SB, Bansod DW (2022) Lifestyle changes and perception of elderly: A study of the old age homes in Pune city, India. Int J Geriatr Gerontol 6: 138. DOI: https://doi.org/10.29011/2577-0748.100038

The increase in old age homes and its residents mandates attention to the living condition of elderly at these institutions. The study is based on the information collected from 500 residents of 23 old age homes of Pune city in India. A multistage random sampling used for the selection of samples. A semi-structured interview schedule was adopted to gather the information from the respondents, the interview schedule was approved by the research ethical board of the institute. To strengthen the study qualitative insights are also gathered using case studies and key informant interviews. About half of the respondents were having issues while adjusting at old age home and similar percent has reported that their life has considerably changed after joining the old age home. Over half (52%) of these have experienced negative impact, such as homesickness, feeling of left alone (abandoned) by family members, feeling of staying at a hostel, follow certain schedule, elderly have to adjust in their daily life, and so on. Due to family attachment, many respondents feel lonely. For instance, 56 percent of the respondents perceive that they are being left out by their family members. While, two-thirds of respondents perceive that other elderly who are staying with their family members are having a better life than themselves. Hence, many respondents would like to go back to their families. Despite the fact that more than half (54%) of respondents know that they will spend their remaining days at the old age home. Whereas, 42 percent of the respondents said they are not certain about their future stay and 2 percent believe that soon they will return to their former homes among family members. Although many respondents experienced positive outcome after joining the old age home. Yet, the issues of uncomfortable living, loneliness, or similar unpleasant feeling is present among some of the respondents. These experiences are mostly due to the absence of family members in surrounding.

Keywords: Adjustment; Living condition; Old age home; Family; Elderly

Introduction

Population ageing is considered to be one of the biggest challenges of demographic transition in the twenty-first century [1-3]. Decreasing fertility rates and increasing longevity have resulted in a higher population of elderly people (aged 60 years and above) compared with the younger and adult population than ever before [4-6]. Although developed regions were the first to witness the phenomenon of population ageing, now the developing regions are witnessing a rapid growth of aged population [7, 8]. The share of persons aged 60 years and above in the world is expected to increase by 56 percent between 2015 and 2030. [9]. As per United Nations Population Division estimates increase the share of old age population from 5.7 percent in 2019 to 7.6 percent in 2030 in lower middle income countries [10]. As per 2011 census [11], India’s older population aged 60 years and above is 103 million and it is expected to increase 319 million by 2050 [12].

Increase in the proportion of older population due to shift in the age structure from younger population to older population create various challenges for policy makers and create burden on younger generation and increase demand for social and economic support care for elderly [13]. Before advancement of demographic transition in India, traditional family system was providing care for elderly especially in joint family system. In the past several years, as a result of advanced demographic transition along with socioeconomic development and urbanization, a large chunk of migration has occurred. As skilled professionals have moved to developed countries and from rural to urban areas for better opportunities, leading to reduction in family size and the erosion of traditional families. It led to growth of nuclear families, reduced socioeconomic support and care for elderly, and increased the demand for old-age homes in India [14].

With increased longevity, many of the elderly would require some form of long-term care, the cost of which needs to be borne by their families. This might result in family members withdrawing from school or employment to care for the elderly member. Hence, older people are viewed as a burden [15,16]. Traditionally, within the familial hierarchy elderly people have enjoyed a high status [17-21]. However recently, with the increase in age, several elderly people experience eroding status. In addition to other factors, it contributes to the behaviour of the elderly towards their families and their living arrangement [22,23].

According to BKPAI report [24] marriage of children is and other reasons such as include death of spouse, family conflicts, and migration of children are reasons for elderly to live alone. In addition, the demand for old age homes increased. Some evidences indicate that the increase in old age homes was seen largely in the southern regions of the country, particularly in Kerala and Tamil Nadu, then in the western state of Maharashtra [25-28], due early demographic transition, urbanization and migration led small family norm compared to other states. There has been changes in the social and family structure which affected the culture and norms of the society. The process of modernization and search for better standards of living and job opportunities forced children to move away leaving their parents behind. In This study we assess the lifestyle of elderly and their perception who live in old-age homes in Pune city of India.

Data Source and Methodology

A list of old age homes was obtained from Help Age India, Pune office [29]. This study was conducted in 23 old age homes of Pune city, India. From these old age homes, a total sample of 500 respondents was selected using the lottery method. The researcher used the purposive sampling technique and limited the sample size to 500 elderly respondents from 23 old age homes. The study includes old age homes which have completed at least 2 years of functioning, avoiding all those old age homes which were established or in function not more than 2 years. The study includes only those elderly who were aged 60 years and above, living in old age homes at least for one year. Elderly persons have experience of living in old age home for less than a year are not considered in this study. Those elderly who was unable to respond to the question or who had any psychological issues (diagnosed by a medical practitioner) are not considered for the study.

Participants

The study population was comprised of 500 elderly people, residents of old age homes. Those elderly who are physically mobile and capable of conducting interviews on their own behalf the respondents should have stayed in the old age home for one year so that they can give a better understanding of the facilities provided in the particular old age home where they are staying. A semi-structured interview schedule was developed for the data collection. This interview schedule received approval for data collection from the ethical board of the institute. Data was coded and analysed with STATA (v.14.0) software.

Sample characteristics of elderly population who are living in old-age homes

Table 1 presents the sample characteristics of elderly living in old age-homes in Pune city, Maharashtra. Among respondents, over three-fifths (63%) are women and 37 percent are men. Higher proportion (42%) of respondents are aged 70-79 years, followed by aged 80 years and above (31%) and aged 60-69 years (26%). Percentage of elderly living in the old age homes increases with the up to certain education level. For instance, 13 percent of respondents live in the old age homes have never attended school, whereas 24 percent of respondents have completed 8-10 years of schooling. Share of female respondents is higher with no schooling than the male respondents (16% against 9%). According to marital status, higher proportion (62%) of respondents are widowed/widower compared to 23 percent are never married, 8 percent are currently married and 7 percent are divorced/separated. Share of elderly men who are never married is higher than the never married elderly women (28% against 19%). While, share of elderly women who are widowed is higher than the widowed elderly men (67% against 54%). With regard to social groups, majority (79%) of the respondents does not belong to Scheduled Caste (SC), Scheduled Tribes (ST) or Other Backward Caste (OBC). While, 12 percent of respondents are belonging to SC and 7 percent are OBC. According to the type of family, higher larger share (73%) of respondents were living in nuclear family and 26 percent came from joint family. Since, women tend to have lower social status compared to men, they are more likely to depend on the male person of the family either father, husband or son. Hence, women are inclined to have lesser significance in the family. In line with other several factors, women are more likely to join the old age home compared to men.

Table 1: Percentage distribution of women and men aged 60 years and above by selected background characteristics, Pune, Maharashtra, 2017.

Lifestyle of the elderly living in old-age homes

Elderly respondents were asked about whether they have experienced any changes in their personal lifestyle and either positive or negative changes after joining the old-age home. The changes in personal lifestyle of the elderly covers various dimensions such as adjusting with the environment of old-age home, feeling loneliness or left alone, home sickness, health issues as chronic and psychological health problems. While, some respondents have experienced positive changes such as improvement in health condition, received good care at old-age home, good social networking as mingling with other old age home residents, peaceful environment, engagement in various activities which is also a part of entertainment for them.

Table 2 shows the percentage distribution of elderly with significant changes in their personal life style. Over half (52%) of the respondents have experienced negative changes after joining the old age home, while about two-fifths (39%) have experienced positive changes and around one-tenth (9%) have neither experienced any positive nor negative changes in their lifestyle at old age home. Share of elderly women with negative changes in higher than the share of elderly men (56% against 35%). Similarly, among widowed elderly more 54 percent have experienced negative changes and 38 percent have positive changes. Whereas, respondents who are from rural areas are more likely to experience negative changes (57%) compared to respondents from urban areas (44%). Share of elderly with experienced negative changes decreases with increase in number of sons (71% elderly with no son to 33% elderly with 3 or more sons). While, percentage of respondents with experienced negative changes increases with increase in number of daughters (48% elderly with no daughter to 81% elderly with 3 or more daughters).

Mr. Singh (name changed) shared - “I could not afford the cost associated with the required health treatment. In order to receive health treatment and basic care, I have joined the old age home. As a result, my health improved after joining the old age home. At old age home, I have been receiving health care services, the availability of care-taker is an additional advantage. Eventually, my health started recovering at old age home.”

Table 2: Percent of elderly with significant changes in their personal life and positive change in their life after joining the old age home of Pune city.

Perception of elderly

The results presented in (Table 3) shows the percentage distribution of elderly’s perception who live in old-age homes about the others (elderly who lives at home with their family) are better-off compared to them and they feel lonely or left out at oldage home, which varies with different demographic and social characteristics. Perception among elderly staying at old age home that other elderly (who are not staying at old age home) are betteroff than themselves is higher among widowed/widower elderly (69%) compared to never married elderly (65%) (χ2 p-value <0.05). According to type of family, perception of elderly from joint family who live at old age homes that other elderly (who are not staying at old age home) are feel better-off than themselves is significantly higher (74%) than nuclear family elderly (64%) (χ2 p-value<0.05). Similarly, perception of elderly whose residence is abroad and lives at old age homes that other elderly (who are not staying at old age home) are feel better-off than themselves is significantly higher more (71%) than whose earlier residence is same district at local (64%) (χ2 p-value <0.05).

Mr. Ganpat (named changed) never married respondent said “Many elderlies have children and still they are staying in the old age home with me. After watching them suffering like this, I feel that it’s better I am not married and I don’t have a family (children). What is the use of having such children who cannot take care of their parents in their last stage of life? Because, in the end, we (never married and ever married elderlies) are sailing in the same boat.”

Higher percent of widower / widowed elderly who live at old age homes perceive (60%) that they feel lonely or left out than never-married elderly (55%) (χ2 p-value<0.1). According to type of family, the joint family elderly who live at old age homes perceive (60%) that they feel lonely or left out is significantly higher than nuclear family elderly (55%) (χ2 p-value<0.05). Other demographic and social characteristics of elderly perceiving those other elderly persons are better –off who are not living in the oldage homes and feeling loneliness who are living at old age homes are not shown significantly.

Radha (named changed) a widow respondent said “An old age home is unable to provide a warm and welcoming environment like home. My family is always on my mind. Being away from them, and the realization that I will never get a chance to return to them, makes me more uncomfortable at old age home. I feel being isolated by my family members, which makes me feel lonely.”

Table 3: Percentage distribution of the elderly perceiving that the other elderly person is better off and the feeling loneliness at old age homes, Pune city.

Future intention of elderly to length of stay in the old-age homes

(Table 4) presents percentage of elderly and their future intention to length of stay in the old-age homes in Pune city, Maharashtra with different demographic and social characteristics. Percentage of elderly and their future intention to length of stay in the old-age homes is significantly associated with educational level. Length of stay in the old-age homes till death is decreases with increasing educational level. More than half of elderly population with no-schooling (55%) have future intention to length of stay in the old-age homes till death compared to graduation and above educational level (46%). The 44% of elderly have no idea about their future intention to length of stay in the old-age homes with no-schooling compared to graduation and above educational level (47%) (χ2 p-value <0.1) The higher percentage of elderly population whose childhood residence is rural and their future intention to length of stay in the old-age homes till death (58%) compared to others (51%) and lower percentage of elderly population whose childhood residence is rural and they did not have idea about their length of stay in the old-age homes (35%) compared to others (45%) (χ2 p-value<0.1). Percentage of elderly people who had no children with them with length of stay in the old-age homes till death is significantly lower (72%) than others who were having children (44.2%) and percentage of elderly who had no idea about their length of stay in the old-age homes is significantly lower (50%) compared to other who were having children (24%) (χ2 p-value<0.001). Other demographic and social characteristics of elderly such as age, sex, martial-status, religion, social groups (SC, ST, and OBC), family type (nuclear and joint family), having sons and daughters have not shown significant association with their length of stay in the old-age homes in Pune city.

Table 4: Percentage of the elderly with future intentions to stay in the old age home, Pune city.

Discussion and Conclusion

The gender difference is quite prevalent in living in oldage homes as elderly women are more likely to live in the oldage homes than elderly men. Majority of widowed/widower elderly and elderly who came from nuclear family live in the oldhomes due to lack of care and support and death of their partners, especially women have prolonged widowhood due to longer life expectancy than men [38]. Previous evidence shows that increasing urbanization and globalization lead toward nuclear family and migration of children for their job leads to unable to care for their aged parents [30]. For elderly persons, without support of their children, caring themselves is very difficult [30,31].

Most of the elderly have experienced negative change in their life after entry in the old age home as they felt home sickness, health issues as chronic and psychological problems, feeling lonely or left alone, need to adjust with environment of old-age homes and responded that neutral as neither satisfied nor felt bad living at old age homes. Many of previous studies have shown similar evidence that elderly who live olde-age homes suffer from Socio-psychological health problem such chronic health issues as stress, loneliness, depression, anxiety and other health and social issues as loneliness and lack of familial relationship. Especially staff of old-age homes lack caring for elderly, empathy, insufficient understanding of aging issue and skill to take care of elderly in old-age home led to worsen the lifestyle of elderly [3236]. Among these elderly persons, widowed/widower and elderly from rural areas have not satisfied much about their life compared to their counterparts. Widowed/widower elderly are forced to join in the old-age homes due to lack care and socioeconomic support, death their partners, and for being from nuclear family. Majority of the women respondents have spent most of their time with family members and taking care of the household chores. While men have played part in both indoor and outdoor activities. As a result, compared to men, women while staying away from home or family members have shown more disappointment [37].

Important emerging finding of this study is that share of elderly who have experienced negative changes decreases with increase in number of their sons, whereas it increases with increase in their number of daughters. Only few of the elderly have experienced positive changes after joining the old age home such as improvement in their health, received good care at old-age homes, good social networks as mingling with other friends and peaceful environment. Old age brings several issues, and health problems and lack of care and support are the key issues for the elderly. At the old age home, elderly receive health services, care and support which are important needs of the elderly. Hence, several respondents stated that their health condition has improved or they received appropriate health services at the old age homes. While many respondents have unpleasant experiences with their family members and old age home avoids such unpleasant events.

Majority of elderly’s perception who live in old-age homes about the others (elderly who lives at home with their family) are better-off compared to them and they feel lonely or left out at old-age home. Of these, perception of widowed/widower elderly and elderly from joint family about other elderly is that they are better-off and they also feel lonely or left out at old age home is significantly higher than their counterparts as never married and nuclear family. A large part of the respondents covers never married elderly or those who never intended to join the old age home. So, this group considers other elderly who are living with their family members having better life than themselves. Majority of elderly’s intend to stay at old-age home till death and some have no idea that how long they will stay at old age home. Of these, the elderly who have no children have more likely to stay at old-age home till death compared to those who have children.

The study mainly suggests that situation of elderly living in old age homes need attention, as several elderly are experiencing homesickness, unable to cope up at old age home, and feel lonely or left out, irrespective of availability of all required facilities at old age home.

• Chen F, and Liu G.(2009). Population aging in China. In International handbook of population aging (pp. 157-172). Springer, Dordrecht.
• Davies A, and James A.(2016). Geographies of ageing : Social pro cesses and the spatial unevenness of population ageing. Routledge.
• Dyson T. (2001). A partial theory of world development: The neglected role of the demographic transition in the shaping of modern society. In ternational journal of population geography, 7 : 67-90.
• Bongaarts J. (2009). Human population growth and the demographic Philos Trans R Soc Lond B Biol Sci. 364: 2985-2990.
• Bloom DE, Canning D, and Fink G.(2010). Implications of popula tion ageing for economic growth. Oxford review of economic poli cy, 26 :583-612.
• Wu L, Huang Z, and Pan Z.(2021). The spatiality and driving forces of population ageing in China. Plos one,16 e0243559.
• Herrmann M.(2012). Population aging and economic development: anxieties and policy responses. Journal of Population Ageing, 5: 23
• Giridhar G, Subaiya L, and Verma S. (2015). Older women in India: Economic, social and health concerns. Increased Awarenes, Access and Quality of Elderly Services. BKPAI (Building Knowledge Base on Ageing in India), Thematic Paper, 2.
• United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Ageing 2019: Highlights (ST/ ESA/SER.A/430)
• United Nations, Department of Economic and Social Affairs, Popu lation Division. (2015). World Population Ageing 2015 (ST/ESA/ A/390).
• Office of the registrar general of India. Census of India-2011. Ministry of home affairs, Government of India.
• The Hindu.(2021). Number of India’s elderly to triple by 2050.
• Subaiya L, and Bansod DW.(2011). Demographics of population Aging in India: Trends and Differentials,BKPAI Working Paper No. 1. New Delhi: United Nations Population Fund (UNFPA).
• Bhattacharya P.(2005). Implications of an Aging Population in India: Challenges and Opportunities. Orlando, Fla. Presented at: The Living to 100 and Beyond Symposium Sponsored by the Society of Actuar
• Lancet, T.(2012). Ageing well: A global priority. Lancet 379:1274.
• Rajan IS, and Aliyar S. (2008). Population ageing in India. Institutional Provisions and Care for the Aged, 39-54.
• Chiu S, and Sam Y. (2001). An excess of culture: the myth of shared care in the Chinese community in Britain. Ageing and Society, 21:681
• Chen X, Liu M, and Li D. (2000). Parental warmth, control, and indul gence and their relations to adjustment in Chinese children: a longitu dinal study. Journal of family psychology, 14: 401-419.
• Dowd J J.(1975). Aging as exchange: A preface to theory. J Geron tol, 30: 584.
• World Health Organization. (2015). World report on ageing and health. World Health Organization.
• World Health Organization.(2001). Health and ageing: A discussion paper (No. WHO/NMH/HPS/01.1). World Health Organization.
• Malhotra R, and Kabeer N.(2002). Demographic transition, inter-gen erational contracts and old age security: an emerging challenge for social policy in developing countries.
• Perlman D, and Peplau LA. (1981). Toward a social psychology of Personal relationships, 3:31-56.
• (2012). Report on the Status of Elderly in Select States of In dia, 2011. UNFPA.
• Dyson T, and Moore M. (1983). On kinship structure, female autono my, and demographic behavior in India. Population and development review, 9:35-60.
• Anderson S, and Ray D.(2012). The age distribution of missing women in India. Economic and Political Weekly, 87-95.
• Ratcliffe J.(1978). Social justice and the demographic transition: les sons from India’s Kerala State. International Journal of Health Ser vices, 8:123-144.
• Sudha S, Suchindran C, Mutran EJ, Rajan SI, and Sarma PS. (2006). Marital status, family ties, and self-rated health among elders in South J Cross Cult Gerontol, 21:103-120.
• HelpAge India.
• Johnson S, Madan S, Vo J, and Pottkett, A. (2018). A qualitative analy sis of the emergence of long term care (old age home) sector for se niors care in India: Urgent call for quality and care standards. Ageing International, 43: 356-365.
• Cohen-Mansfield J, Hazan H, Lerman Y, and Shalom V.(2015). Corre lates and predictors of loneliness in older-adults: a review of quantita tive results informed by qualitative insights. International psychogeri atrics, 28 :557-576.
• Shivarudraiah M, Ammapattian T, Antony S, and Thangaraju, (2021). Views of the elderly living in old-age homes on psychoso cial care needs. Journal of Geriatric Mental Health, 8: 113-114.
• Adhikari P. (2017). Geriatric health care in India-Unmet needs and the way forward. Archives of Medicine and Health Sciences, 5:112-114.
• Indu PV, Remadevi S, Philip S, and Mathew T. (2018). A qualita tive study on the mental health needs of elderly in Kerala, South In Journal of Geriatric Mental Health, 5: 143-151.
• Raj D, Swain PK, and Pedgaonkar S.(2014). A study on quality-of-life satisfaction & physical health of elderly people in Varanasi: An urban area of Uttar Pradesh, India. International Journal of Medical Science and Public Health 3:616-620.
• Viveki RG, Halappanavar AB, Joshi AV, Pujar K, & Patil S.(2013). So ciodemographic and health profile of inmates of old age homes in and around Belgaum city, Karnataka. J Indian Med Assoc 111:682-685.
• Rajan SI, and Kumar S.(2003). Living arrangements among Indian el derly: New evidence from national family health survey. Economic and Political Weekly, 38:75-80.
• Janbandhu PV, and Bansod DW. (2022). A Study on social and psychological conditions of elderly living in old age homes of Pune city in Maharashtra. (Unpublished doctoral dissertation). International Institute for Population Sciences, Mumbai, India.

© by the Authors & Gavin Publishers. This is an Open Access Journal Article Published Under Attribution-Share Alike CC BY-SA : Creative Commons Attribution-Share Alike 4.0 International License. With this license, readers can share, distribute, download, even commercially, as long as the original source is properly cited. Read More .

International Journal of Geriatrics and Gerontology

• About Journal
• Aims and Scope
• Board Members
• Article in Press
• Recent Articles
• Articles Search
• Current Issue

We use cookies for a better experience. Read privacy policy . Manage your consent settings:

Manage Your Consent:

Rethinking architecture of Old age homes

An old age home is a place intended for the elderly where they can live when there is a problem to stay on their own or their children or sometimes destitute. Most of the time senior citizens cannot be alone as they will become dependent and require care and attention for their wellbeing. Old age is an inevitable part of human life and the required care and affection from family may not be given all the time. 

In a lot of cases, aged people who require another person to provide care are often sent to old-age homes. An old age home is a multi-facility centre with housing facilities for senior citizens. It is designed to create a home for the elderly but more often than not due to lack of funds or irrelevant design old age homes become more like a healthcare facility with poor infrastructure. 

Here are some points you need to consider while designing old age homes:

1. User-Friendly Design | Old Age Homes

For people who have lived independently or with families all their lives, living in an old age home could be challenging. Adapting to rules and new people will take time. To make this process smooth and convenient the atmosphere and ambiance of the place play a major role. The design of the old age home should concentrate on comfort and a user-friendly experience. There are several thumb rules and standards followed while designing a space for senior citizens. 

Some common problems with some of the existing old-age home designs are narrow entrances and staircases, which make accessibility with wheelchairs difficult. When stairs are narrow and steep and bathrooms aren’t easily accessible or inconveniently located. Often these possible design oversights do not consider the needs of older people or for people with disabilities. 

2. Landscape Design

A place with a landscape often tends to relax and calm one’s mind. A stroll through a garden or a park is one of the most common activities old people do. This also helps them to keep them active and fit. Slow exercises also help increase the well-being of their physical and mental health and doing them along with fellow residents would add fun to the activities. 

Most of the time senior citizens feel like they are cooped up in their houses. So, introducing landscape design in the old age home architecture would be a key factor that will be a tremendous change in the environment for the elderly. Being close to nature is proven to have a healing effect on people. Adding natural landscape elements will boost their mood and provide rejuvenating energy. 

3. Entertainment and Recreation Space

During old age, people feel like they have a lot of time in their hands. Passing time seems to be a very general issue amongst senior citizens. Boredom leads to lethargy and their presence of mind is seldom lost. Having hobbies is one way of spending time. Making time for lost hobbies like reading books, watching movies or knitting will add to their daily activities. 

For entertainment and recreation, games are played where the senior citizens interact and have fun and relax. Having a common activity for every week is a strategy adopted in old age homes for recreation purposes. When this is considered in the design, the main requirement for this cause to be able to function would be a large gathering space accessible easily from their homes. Multifunctional closed or semi- open spaces must be designed to cater to the needs of the people. 

A few common old age problems are weakness in limbs, vision, and memory loss. Whatever the issue, physical or mental old people tend to become vulnerable and susceptible to danger. Without supervision, they tend to get lost easily. Due to irresponsible design and infrastructure , they often tend to trip or slip which could be a minor issue for young people but could be more dangerous for old people who take longer to recover. 

So, designing spaces with a clear viewing range so that it becomes easy to spot people from across the room or halls. Blind spots and negative spaces must be avoided to reduce confusion. Clear signage must be provided at common spots like gardens and gathering areas in case the senior citizens get lost. Levels and steps are not recommended as a design rule as old people often have weak limbs and it becomes hard to climb up.  

5. Health | Old Age Homes

During old age, it becomes uncertain as to when and what kind of health issue may arise. Medical support becomes essential for the elderly. Sudden and severe health issues require immediate care and treatment. If not a hospital at least the old age home must be equipped with basic treatment facilities and equipment. 

Easy access and sufficient beds must be provided for care. Equipment and medicine must be available to be transferred to the house of the patient in case of emergencies. Wide lobbies, interconnected blocks, and ease of movement through transition spaces become crucial for the design of healthcare facilities in old age homes. 

6. Good lighting 

Good lighting is another essential design feature that has to be introduced in old age homes. An ample amount of light must be provided and the places must be well lit to have free movement and good vision. Lights are often provided in nooks and corners like table tops, cabinets , above switches, etc. 

The lighting provided must be warm colours and nothing jarring to the eyes. Lighting fixtures in lawns are also important during the evening. All the spaces must be well-lit with no shadow areas and glare must be avoided.

7. Personal space | Old Age Homes

Despite living along with several other senior citizens who are strangers and sharing space with them, they must be provided personal space. It is essential for them to feel that the old age home can be their home where they are free to do what they want. 

For this, as a design solution , they can be provided with personal rooms where they can carry out various activities individually and not as a group. A design must aim to reach the people on a subjective level so that they can relate to each space differently and feel as if it’s their own. 

Designing old age homes is a great challenge as the mind-set of the users is not fixed and often requires a fresh perspective. An old age home design must achieve to create a place to instill hope and energy and not just as a shelter for old people who are often abandoned by their families. 

The natural dynamic of the public design must be tweaked to be adjusted to the requirements of the old age home design. Simplicity and dignity in spaces for the design must be followed in an attempt to create a place for the senior citizens to have a better and healthier lifestyle. 

A Plus Topper. (2021). Old Age Home Essay | Essay on Old Age Home for Students and Children in English . [online] Available at: https://www.aplustopper.com/old-age-home-essay/#:~:text=An%20old%20age%20home%20is%20a%20shelter%20that%20is%20home 

Dengarden. (n.d.). Elderly Care House Design for Our Old Age – Elderly Care Home . [online] Available at: https://dengarden.com/safety/Home-Design-Ideas-for-Our-Old-Age.

ArchDaily. (2018). How To Design for Senior Citizens . [online] Available at: https://www.archdaily.com/900713/how-to-design-for-senior-citizens.

JK, B. (2010). Guide to Designing Old Age Homes . [online] Architecture Student Chronicles. Available at: http://www.architecture-student.com/design-guide/guide-to-designing-old-age-homes/.

Spandana is an architecture student with a curious mind, who loves to learn new things. An explorer trying to capture the tangible and intangible essence of architecture through research and writing. She believes that there is a new addition to the subject everyday and there is more to it than what meets the eye.

Architects in Winston – Salem – Top 30 Architects in Winston – Salem

10 examples of secret underground cities in the world

Related posts.

Transitioning from Architecture Student to Practicing Architecture

What does art as a technique in architecture mean?

Industrial revolution and the Architectural community

Emotions in the peaceful border design

Sacred Landscape: The Concept of Human-Environment Interaction

What can we infer about a space from its design and architecture?

• Architectural Community
• Architectural Facts
• RTF Architectural Reviews
• Architectural styles
• City and Architecture
• Fun & Architecture
• History of Architecture
• Design Studio Portfolios
• Designing for typologies
• RTF Design Inspiration
• Architecture News
• Career Advice
• Case Studies
• Construction & Materials
• Covid and Architecture
• Interior Design
• Know Your Architects
• Landscape Architecture
• Materials & Construction
• Product Design
• RTF Fresh Perspectives
• Sustainable Architecture
• Top Architects
• Travel and Architecture
• Rethinking The Future Awards 2022
• RTF Awards 2021 | Results
• GADA 2021 | Results
• RTF Awards 2020 | Results
• ACD Awards 2020 | Results
• GADA 2019 | Results
• ACD Awards 2018 | Results
• GADA 2018 | Results
• RTF Awards 2017 | Results
• RTF Sustainability Awards 2017 | Results
• RTF Sustainability Awards 2016 | Results
• RTF Sustainability Awards 2015 | Results
• RTF Awards 2014 | Results
• RTF Architectural Visualization Competition 2020 – Results
• Architectural Photography Competition 2020 – Results
• Designer’s Days of Quarantine Contest – Results
• Urban Sketching Competition May 2020 – Results
• RTF Essay Writing Competition April 2020 – Results
• Architectural Photography Competition 2019 – Finalists
• The Ultimate Thesis Guide
• Introduction to Landscape Architecture
• Perfect Guide to Architecting Your Career
• How to Design Architecture Portfolio
• How to Design Streets
• Introduction to Urban Design
• Introduction to Product Design
• Complete Guide to Dissertation Writing
• Introduction to Skyscraper Design
• Educational
• Hospitality
• Institutional
• Office Buildings
• Public Building
• Residential
• Sports & Recreation
• Temporary Structure
• Commercial Interior Design
• Corporate Interior Design
• Healthcare Interior Design
• Hospitality Interior Design
• Residential Interior Design
• Sustainability
• Transportation
• Urban Design
• Host your Course with RTF
• Architectural Writing Training Programme | WFH
• Editorial Internship | In-office
• Graphic Design Internship
• Research Internship | WFH
• Research Internship | New Delhi
• RTF | About RTF
• Submit Your Story

Looking for Job/ Internship?

Rtf will connect you with right design studios.

• Hispanoamérica
• Work at ArchDaily
• Terms of Use
• Privacy Policy
• Cookie Policy

To Design for the Elderly, Don't Look to the Past

• Written by Matthew Usher
• Published on October 30, 2018

When the world undergoes major changes (be it social, economic, technological, or political), the world of architecture needs to adapt alongside. Changes in government policy, for example, can bring about new opportunities for design to thrive, such as the influx of high-quality social housing currently being designed throughout London. Technological advances are easier to notice, but societal changes have just as much impact upon the architecture industry and the buildings we design.

The same is true of changes in demographics, and we are in the midst of a monumental shift. In 2015, 8.5% of the population of the world was aged 65 or over (617 million people). This is predicted to grow to 12% of the population by 2030, and to a staggering 16.7% of the population by 2050 [1]. Historically, this percentage has steadily grown but dramatic advances in medicine are allowing people to live longer, creating aging populations across the globe. This problem is compounded in countries where the birth rate is also incredibly low, as is the case with Japan. We must reevaluate how the elderly are treated within society.

When thinking about the impact of these statistics, the natural assumption within the context of architecture is to think about medical care, hospital design, and accessible cities. However, this overlooks an emerging and serious problem: loneliness and social isolation. Within the UK, 51% of those aged over 75 live alone, and 11% of older people are in contact with friends and family less than once a month [2]. Similar results are present across Europe.

Chronic loneliness within the elderly population is incredibly prevalent and a significant number of studies have been conducted looking at the measurable health impact it has, such as creating a higher risk of disabilities, heart disease, strokes, and dementia. Architects can help tackle loneliness at the source and dramatically help increase the quality of life for a portion of the population who are often isolated. This article explores how good design can help further this cause, how architects have combated this previously, and what the industry leaders are doing now.

In recent years, architects and developers alike have begun to rethink how housing for the elderly should be treated. Multiple panels discussing and studying the needs of the modern older person have been held, including with RIBA and New London Architecture . The new approach features light, modern and very sensitively designed property - the exact opposite of the traditional image. In these schemes, part of the solution is making the housing desirable to residents regardless of perceived or traditional tastes. Living in modern retirement communities provides an opportunity for engagement and interaction while beginning to shed this stigma, and allowing residents to retain their independence.

The Housing our Ageing Population Panel for Innovation (serendipitously acronymed HAPPI) was originally held in 2009, and their reports have since become industry standard. The original 2009 report featured multiple high-quality case studies from throughout Europe, and subsequent issues featured not just the panel's findings but guides for implementation. Advice includes ranges from the architectural  (generous space standards, daylight, and adaptability for ‘care readiness’) to the social (engaging positively with the public.)  It is the latter part of this range that is most crucial and can be combined with architectural standards. 

PRP have become leaders within this field and heavily draw upon this advice from the HAPPI reports. Their Pilgrim Gardens project won multiple awards between 2012-2014 and features several of the design features advised by HAPPI. Double-aspect flats encircle communal garden spaces of hard and soft landscaping, and a shared colonnade acts as a slow circulation space. In-built sliding glass doors to allow the use of the balconies year round.

While focusing more on those requiring care, Dietger Wissounig Architekten’s nursing home in Austria employs a similar effect internally and is incredibly light, liberally using timber and wood within to create a soft and caring environment. Double-stacked corridors are again avoided, allowing the circulation to be inhabited socially as inviting spaces.

The report also highlights the need for multipurpose space where the residents can meet and which could possibly act as a hub for the local community. At The Architect in Utrecht, residences for the elderly requiring care are stitched into the building with the rest of the housing alongside communal spaces and the nursery. Similar projects by Haptic in Norway and Witherford Watson Mann’s almshouse in London also stress the need for social connection. These projects share spaces between neighbors, school children, and the local community through gardens, allotments, shops, and public squares.

Cities have begun to acknowledge the changing needs of an aging population. The ‘Campaign To End Loneliness’ has established a framework of three methods in order to address the multifaceted issue: individual intervention, neighborhood action, and a whole system approach. To help combat the wider scale challenges, the city of Manchester has become the UK’s first ‘age-friendly city’ [4], a World Health Organisation initiative which several forward-thinking cities across the world have subscribed to. The key priorities of the initiative include known benefits such as improvements in transport, housing, and health services, but also highlights the need for civic participation.

Architects can take a leading role in the design of new policy. In Manchester, the ‘Age-Friendly Design Group’ assists with designing local parks to be more age-friendly, listening to the elderly to inform good practice, and publishing of design guidelines. Stephen Hodder, a previous RIBA president, said that such groups open up a “much-needed debate on how we can start shaping the landscape of our built environment for our older age”.

Outside of the city-scale, architectural solutions can also provide for a range of needs. Public ‘day-stay’ centers, such as the Casa del Abuelo in Mexico seem particularly popular (especially in Spain and Portugal.) The design of centers such as these is often strikingly modern and open, blurring the distinction between inside and out. This can partly be attributed to the temperate climates these projects are located in, but the prevalence hints at an emerging approach.

The Guangxi senior center in China , serves an atypically large population and features a range of activities and spaces to accommodate this. The undulating form, clad in wood grain aluminum louvers, includes everything from game courts and gardens to an indoor swimming pool and table tennis rooms. This haven of activity attempts to engage the elderly in physical activity alongside social spaces.

Particular success can be found when positioning these centers as hubs for the local neighborhoods rather than simply as single-purpose structures. This method is similar to The Architect in Utrecht, This can include proximity to other types of housing (such as The Architect) but can also be integrated with libraries or universities. A successful example of this is Sant Antoni - Joan Oliver Library , by Pritzker Prize-winning practice RCR Arquitectes .

The project is nestled within one of Barcelona’s city blocks, wrapping around a central courtyard. The library forms the public face of the building and primary programmatic element, appearing to be suspended between two apartment buildings. The community space then occupies one wall of the courtyard and overlooks the public space. This maintains the perceived ‘safe space’ but places it firmly around a local hub, unifying the project into a coherent block.

A final method is to promote interaction between the young and the elderly. These may seem to be an odd combination of programmes, but significant research is being undertaken into this and the centers which currently subscribe to these ideals and offer them in a safe and secure way.

At the beginning of this article, Japan was noted to be one of the countries most impacted by aging populations going forwards. Increasing life expectancy and societal changes (leading mothers to work outside the home) has meant the numbers both nurseries and senior centers/retirement homes are increasing. There is clearly an opportunity to restructure the way care is delivered for both young and old - something Japan has already been doing for over 40 years. Kotoen, a “yoro shisetsu” (facility for the children and the elderly) in Tokyo, is the oldest age-integrated facility in Japan, having opened in 1976. Here, interaction cuts both ways: seniors can volunteer in the nursery, children visit the communal areas of the care home, and both join together for special events. 

When adjoined to care homes, the benefits of this arrangement make sense. Both share basic needs: the provision of meals, physical activity (in the case of the elderly, to keep them active and fit), and communal spaces for socializing. The benefits for the elderly are fairly obvious. The arrangement provides company and activity, bringing life into a space which can often become mundane. But there are notable social and developmental benefits to the children as well: it helps to promote a healthy and positive view of aging and helps counter any preconceptions about the less able.

Mount St. Vincent, a care home in Seattle, runs an ‘Intergenerational Learning Centre’ and endorses similar benefits, stating that it helps to provide a broader perspective of family life for the children who do not have grandparents active in their life.

Surprisingly, there is a dramatic and measurable impact of this upon the physical and mental health of the elderly. St. Monica’s Trust in Bristol housed a study into these benefits, measuring the impact upon the residents over a six week period. At the end of the study, 80% of the residents had improved their mobility and grip strength, and 70% has reduced their score on the scale of depression.

So how can architects begin to promote and further this idea? The impact upon loneliness of aligning these programmes together is dramatic, but the majority of the examples across the world are activity and event-driven. There is the opportunity to develop a new building type to house this program and best suit the needs of the young and old, rather than attempting to retrofit existing spaces. Neither senior citizens nor children want to live in a dull environment, so adapting the design creatively to suit the characteristics of their users is a wonderful opportunity rarely given.

• Sustainability

世界上最受欢迎的建筑网站现已推出你的母语版本!

想浏览archdaily中国吗, you've started following your first account, did you know.

You'll now receive updates based on what you follow! Personalize your stream and start following your favorite authors, offices and users.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Geriatr

Dignity and the provision of care and support in ‘old age homes’ in Tamil Nadu, India: a qualitative study

Vanessa burholt.

1 School of Nursing/School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Room 235B, Level 2, Building 505, 85 Park Road, Grafton, The University of Auckland Private Bag, 92019 Auckland, New Zealand

2 Centre for Innovative Ageing, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales UK

E. Zoe Shoemark

R. maruthakutti.

3 Department of Sociology, Manonmanian Sundaranar University, Tirunelveli, Tamil Nadu India

Aabha Chaudhary

4 Anugraha, Swabhiman Parisar, Kasturba Nagar, Shahdara, Delhi India

Carol Maddock

Associated data.

The datasets generated and/or analysed during the current study are not publicly available as restrictions apply to the availability of these data (intention of data analysis included in participant information forms) and sensitivity (i.e. human data) but are available from the corresponding author on reasonable request. Data are located in a controlled access repository at the University of Auckland.

In 2016, Tamil Nadu was the first state in India to develop a set of Minimum Standards for old age homes. The Minimum Standards stipulate that that residents’ dignity and privacy should be respected. However, the concept of dignity is undefined in the Minimum Standards. To date, there has been very little research within old age homes exploring the dignity of residents. This study draws on the concepts of (i) status dignity and (ii) central human functional capabilities, to explore whether old age homes uphold the dignity of residents.

The study was designed to obtain insights into human rights issues and experiences of residents, and the article addresses the research question, “to what extent do old age homes in Tamil Nadu support the central human functional capabilities of life, bodily health, bodily integrity and play, and secure dignity for older residents?”.

A cross-sectional qualitative exploratory study design was utilised. Between January and May 2018 face-to-face interviews were conducted using a semi-structured topic guide with 30 older residents and 11 staff from ten care homes located three southern districts in Tamil Nadu, India. Framework analysis of data was structured around four central human functional capabilities.

There was considerable variation in the extent to which the four central human functional capabilities life, bodily integrity, bodily health and play were met. There was evidence that Articles 3, 13, 25 and 24 of the Universal Declaration of Human Rights were contravened in both registered and unregistered facilities. Juxtaposing violations of human rights with good practice demonstrated that old age homes have the potential to protect the dignity of residents.

The Government of India needs to strengthen old age home policies to protect residents. A new legislative framework is required to ensure that all old age homes are accountable to the State . Minimum Standards should include expectations for quality of care and dignity in care that meet the basic needs of residents and provide health care, personal support, and opportunities for leisure, and socializing. Standards should include staff-to-resident ratios and staff training requirements.

In recent decades India has witnessed significant improvements in public health, with increases in life expectancy and longevity alongside declines in infant mortality and fertility rates. As a result, the age structure of India’s population has changed with increases in the proportion and absolute number of older adults (60 + years) in the population. Overall, the proportion of older people has increased from 5.4% in 1950 to 9% in 2020. However there are variations in the age structure across Indian states: in 2020, around 14% of the population in Kerala were 60 + years compared to 7% in Assam [ 1 ]. Although there have been gains in increased life expectancy and healthy life expectancy in India, there have also been increases in the proportion of the older population spending more years living with a disability. This is related to the impact of infectious diseases, malnutrition, and the rapid growth in the prevalence of non-communicable diseases (e.g. diabetes, cardiovascular disease, and hypertension), with many older people requiring long-term care and support to manage their daily activities [ 2 , 3 ].

There are a variety of family forms in India, however, the notion of a normative traditional mutigenerational household and extended family prevails [ 4 ]. There is a social expectation that the traditional family will uphold filial piety (respect and obligations towards parents) and familism (prioritizing family needs above all others) [ 5 ] and meet the social, instrumental, economic and emotional needs of older people [ 2 ]. Indeed, this expectation is formally constituted in law. The Maintenance and Welfare of Parents and Senior Citizens Act mandates children, grandchildren and other relatives with sufficient resources to provide support to older people who are unable to maintain themselves. In situations where support is not provided, older people can take relatives to a tribunal to obtain a maintenance order. Non-compliant relatives may be fined or imprisoned. However, this is not a common course of action because there is a lack of awareness of the Act [ 6 ]. Furthermore, older people are reluctant to pursue legal action which could bring shame on the family and criminalise family members or result in a court order requiring the older person to transgress social norms and live with relatives other than sons [ 4 ]. Additionally, not all older people have access to family care: some do not have an extended family and/or have care needs that exceed family care-giving capabilities [ 4 ]. To cater for an increasing number of older people who need extra-familial support in later life, a new ‘old age home’ sector has emerged in India. We use the official terminology ‘old age home’ throughout this article when we refer to the sector in India. We use the expression ‘inmates’ to describe residents of old age homes. We do not condone the use of this term, but use it to illustrate the widespread adoption of the English language word (and meaning) in Indian academic, policy, media and public discourse.

The old age home sector comprises not-for-profit and private homes. The private sector caters predominantly for ‘middle class’ older people, that can afford them [ 7 ] and the charitable (not-for-profit) sector provides for older people without financial assets. The Integrated Programme for Senior Citizens provides basic amenities for older people without access to support (e.g. food, shelter and medical care) and is administered through grants at the state level that are paid directly to providers of registered old age homes and day centres [ 8 ]. Only 310 homes were funded through this scheme in 2018–2019 across all states in India [ 9 ]. There are no accurate records of the number of old age homes in India, nor of the number of residents in facilities, as homes that do not receive funding are not obliged to obtain a license, register, or to be inspected [ 10 ].

In 2016, Tamil Nadu was the first state in India to develop a set of Minimum Standards for old age homes that are delivered by not-for profit organisations [ 11 ]. These focus on physical elements of the facilities (e.g. the size of room, presence of CCTV), access to basic services (e.g. productive activities for residents, housekeeping and assistance with daily activities) and medical services. Although there are no standards relating to the quality of care, the guidance specifically notes, that “each inmates [sic] right to dignity and privacy should be respected” [ 11 ]. This statement is aligned to Article 1 of the Universal Declaration of Human Rights (UDHR) [ 12 ], that all human beings are born free and equal in dignity and rights. However, the concept of dignity is complex and contestable, and is undefined in the Minimum Standards.

There are two main definitions of dignity which distinguish between inherent dignity and status dignity. The Kantian notion of inherent dignity is conceived as equal moral status and personhood which is grounded in humans’ sentience, rationality and capacity for autonomy [ 13 ]. Some authors suggest that this definition excludes people who lack cognitive capacity or autonomy (e.g. older people with severe dementia) from equal respect and dignity [ 14 , 15 ]. Furthermore, many argue that inherent dignity is built on metaphysics or theology concerning the moral standing of human beings in relation to their ‘gods’ versus the rights of other animals [ 16 ], while others have argued that it is concerned with the worth of the individual in relation to other people [ 17 ]. The controversy concerning the concept of inherent dignity tends to detract from the political function of the UDHR which are intended “to protect individuals against the consequences of certain actions and omissions of their governments” [ 18 ]. Consequently, in this article, the concept of status dignity is used to describe the relationship of residents in an old age homes to the State and the agents of the State (staff in old age homes) [ 19 ].

Valentini [ 19 ] defines status dignity as “a status a human being possesses, comprising stringent normative demands” (p. 865). From this theoretical perspective, the duties to ensure the dignity of citizens (and that human-rights are fulfilled) primarily falls on the State and its agents. However, in order to explore whether the state is fulfilling their primary duty requires a definition of ‘normative demands’ essential for dignity [ 20 ]. In this respect, Nussbaum [ 21 ] has posited that governing bodies should secure for all citizens a threshold of ten central human functional capabilities (CHFC). CHFC are “opportunities that people have when, and only when, policy choices put them in a position to function effectively in a wide range of areas that are fundamental to a fully human life” [ 22 ].

The capability approach refers to the opportunities and freedom to undertake the activities necessary for survival, to avoid or escape poverty or serious deprivation and achieve a life that is  “not so impoverished that it is not worthy of the dignity of a human being” [ 23 ]. For example, bodily health (a CHFC) is partly underpinned by nourishment. Nourishment in turn requires resources to prepare meals (i.e. access to food products that are culturally or religiously acceptable and an energy source to cook upon) and the personal ability or external support to undertake the functions of cooking and eating. The capability approach resonates with other authors’ descriptions of the conditions necessary to support dignity in organizational and clinical settings [ 20 , 24 , 25 ]. All ten CHFC are relevant to supporting the dignity of residents in old age homes, however, this article focuses on four: life, bodily health, bodily integrity and play which correspond to Articles 3, 13, 25 and 24 of the UDHR (Table ​ (Table1 1 ).

Correspondence between four central human functional capabilities [ 21 ] and articles of the United Declaration of Human Rights [ 12 ]

In India, there has been very little research within old age homes. The research that has been published has tended to focus on the private sector [ 7 ]. The available evidence suggests that a majority of homes require residents to be ambulatory, continent, and cognitively able at the time of admission [ 7 ]. Whether the CHFC are supported for residents that become unable to self-care because of physical or cognitive impairment is unknown. Presently, it is unclear as to the extent to which staff in old age homes, as agents of the State, uphold the dignity of residents. To explore human rights issues and experiences of old age home residents in India, this article addresses the following research question:

To what extent do old age homes in Tamil Nadu support the central human functional capabilities of life, bodily health, bodily integrity and play, and secure dignity for older residents?

Sample location

Tamil Nadu state is situated in the south India and covers 130,060km 2 . Tamil Nadu had a population of 72 million in 2011 of which 88% were Hindu. One-tenth ( n ≈ 7.2 million) of the population were age ≥ 60 years.

Sampling procedures

Old age homes were purposively selected from three southern districts in Tamil Nadu: Thoothukudi, Tirunelveli, and Kanyakumari (Fig.  1 ). Forty-three old age homes were located through a mapping exercise: 13 in Thoothukudi, 11 in Tirunelveli and 18 in Kanyakumari. The ratio of fee-paying to free old age homes in each district, and the size of the homes were used to inform our sampling strategy. Participants were randomly selected from lists of residents in 10 facilities, to obtain (as far as possible) a gender-balanced sample of 10 people in each district (Table ​ (Table2 2 ).

Map of the states of India showing the location of Tamil Nadu, and map of Tamil Nadu showing location of selected states

Characteristics of old age homes in sample

a Purports to be for destitute older people: of those interviewed, all participants either paid themselves or had relatives that paid ‘donations’

b Also role as care attendant

c Also role as nurse

d Also role as cleaner

Data collection

Face to face guided interviews (17–70 min; M  = 34 min) were conducted in Tamil with 30 residents (15 male, 15 female, age range 60–83 years) and 11 staff in old age homes, between January and May 2018 by three experienced female interviewers who were PhD scholars at Manonmanian Sundaranar University. To standardise approaches to interviewing, training was provided by the first and third author.

Interviewers explained the purpose of the study and established relationships with the residents and staff before the study commenced. All participants were interviewed in a private place where they could not be overheard or interrupted.

Semi-structured interview guides were used for residents and staff. Open-ended questions explored how residents came to be living in the old age home [described elsewhere, 4] and experiences of the old age facility. Examples of questions included: “Tell me about your typical day”, “What is the best thing about living here?” “What is the worst thing about living here?” “If you need help here, does anybody help you?” “What do you do with your time?” Staff were asked questions such as, “What services are provided to residents?” “How are residents’ needs assessed, if at all?” “What happens if a resident becomes sick?”.

The first three interviews were used to pilot the interview guide, and to check the quality of interviewing. Interviews were recorded, transcribed, and translated by a professional translator into English and anonymised. Pseudonyms are used throughout the article.

Framework analysis was used to analyse the data [ 26 ]. Five distinct but inter-connected phases (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) provided a rigorous methodological structure. Familiarisation, conceptual and cultural understanding of the interviews were clarified during team meetings (first and third author with interviewers) in Tamil Nadu. The second author created a list of a priori codes from the interview questions (e.g. support for each activity of daily living, discriminatory practices, food and nutrition, religious practices, leisure and recreation, worst and best things in the home). She applied these codes to transcripts (in NVivo 1.5.1), and while reading through the transcripts simultaneously created a new series of a posteriori codes, in an inductive thematic analysis. The first author read through the transcripts and coding to check validity. She then systematically applied a second coding index based on the capability approach: some thematic nodes became wholly subsumed in the ‘family’ nodes (e.g. ADLs were subsumed under ‘bodily health’) whereas others were relevant to more than one CHFC (e.g. worst thing in home). The first author charted the data into a framework which provided a decontextualized descriptive account of the data in relation to each CHFC.

The first author undertook the preliminary interpretation of data in three steps. First, taking an outcome-oriented approach, examples where each CHFC had/had not been secured were juxtaposed, providing an insight into the breadth of experiences of old age home residents. Second, residents’ and staff interviews were grouped by home and particular attention was paid to exceptions, contradictions and disconfirming excerpts. Third, experiences were contrasted between types of facilities (registered versus unregistered). All other authors (in India and the UK) were used as a sounding board, to check the persuasiveness of the analysis and to provide different ways of interpreting the research phenomenon [ 27 ].

‘Life’ refers to being able to live a normal life-span and not dying prematurely or before one's life is reduced as not worth living. This CHFC is closely related to bodily health. Participants referred to the ceiling of care available to them, if a resident was ill, or unable to carry out activities of daily living. In some cases, this was also referred to as the ‘worst thing’ about the old age home.

The first quote highlights the practical and ethical difficulties of deciding what ‘a life not worth living’ comprises. In this example, the resident perceived that the facility would judge that a sick older person’s life had no quality and would not be worth saving. Maalia explained what would happen if she became ill in the old age home in which she lived:

They will put me in the back room [sick room]. You may get a bath or you may not. You will have to lie there and die… If I become sick, the Sister will pour coffee and porridge. They will do that only when you become too sick. When you are going to die, they will pour water and bid farewell. That’s all. (Female, 65 years, widowed, H11 unregistered)

In other facilities, residents believed that if their health deteriorated to a point at which they were unable to take care of themselves they would be cared for by their children. For example, Rishi who had four daughters and lived with his wife said:

If we become too old and unable to do things, they [daughters] will only take us back. Now we are able to do things. So we are here. If we fall sick, these people will inform them and they will come and take us with them. (Male, 83 years, married, H14 registered)

Similarly, Hitendra said:

What if I become sick in the last stage of my life? Luckily I joined here when I was healthy. The facilities here are good. So, I want to be here for some time... I told my son that I would go to his house in [city > 200 miles away] if my health deteriorated. (Male, 83, separated, H10 unregistered)

The expectations for support at the end of life maybe unrealistic, as the residents were living in the facilities because their families were unwilling or unable to provide support. If support did not materialise, then this would not be problematic for Rishi, as the old age home he lived in provided life-long support. Diya, another resident in H14 noted:

If we are not well, the doctor will immediately attend. All medicines will be provided immediately. These three people [the doctor, the manager and the assistant manager] take such good care. One should have done punniyam [meritorious deeds in previous lives or in the past] to come here. (Female, 77, widowed, H14 registered)

However, there was no health care, personal support, or palliative care in the facility where Hitendra resided, and the manager noted:

The residents should take care of themselves. If they cannot take care of themselves, we cannot help. We do not have any attendant here. (Manager, H10 unregistered)

The Tamil Nadu Minimum Standards note that “each Old Age Home should ensure that the inmates [sic] should continue to receive care till the end of his/her life or up to natural death” [ 11 ]. Despite, mandatory care obligations, the Standards were only enforceable in registered facilities. Consequently, with one exception where a nun provided some personal support (see section on bodily health below), there were no care attendants to support residents in the unregistered facilities (Table ​ (Table2 2 ).

Bodily health

This theme incorporated examples of supporting residents’ bodily health through medical and personal care (i.e. support for activities of daily living), adequate nourishment and shelter. Some difference between facilities in the availability of staff to provide health and personal care were mentioned above concerning CHFC life.

Residents in unregistered facilities were more likely to have to retain the ability to self-care or to provide support to each other than those in registered facilities. Dev and other residents in the same facility noted:

Here we don’t have anybody to get help. That is the rule here. One should eat oneself, one should wash oneself, one should sleep oneself. They are strict about it. Suppose you cannot walk by yourself, they, your co-residents may help you. That’s what happened to me for some 10 days. My roommates helped me. They would bring food for me. (Male, 72 years, never married, H15 unregistered)

However, this was not common to all unregistered facilities. Although there were no ‘paid’ attendants, in one facility a nun helped residents with personal care tasks, as Deepak said:

This Sister [name] takes me all by herself from the bed to the wheelchair. Takes me to the toilet for evacuation and cleans, gives me a bath, towels and brings me back here, dresses me and makes me lie down. She helps me eat food. She does everything in a good manner. (Male, 68 years, widowed, H16 unregistered)

In the only unregistered facility with a care attendant (the manager) the ratio of care attendants to residents was 1:20, whereas in the registered facilities, it was around one person for every four or five residents. The difference in levels of staff between registered and unregistered facilities was particularly stark for the largest facilities: whereas the registered facility had 19 staff for 65 residents, the largest unregistered facility had only three staff (one manager and two cooks) for 110 residents. In this facility the manager explained that “ we give work to those who are able among the residents” . Many of the manual jobs described by the manager, such as sweeping and cleaning rubbish are associated with lowest castes in India and are considered degrading [ 28 ].

We assign the older among them such work as making brooms with coconut leaflets. If they are young, we assign cleaning and gardening work. But we rotate the tasks. For the mentally retarded elders [sic], I ask them to take the firewood... I will give the vegetables to them and ask them to handover to the cook… They do such things as sweeping and removing cobwebs. They clear the dustbins. We ask them to help their fellow residents who are bedridden. (Manager, H11 unregistered)

In registered facilities, residents were more likely to receive support with personal care and medical or health care, even if this involved making clinical appointments outside the facility. In one facility some difficulties with personal support were noted: Pratik and Padma highlighted issues associated with assisting men and women to dress appropriately and with dignity.

There is a lady nurse. She takes me to the bathroom and gives me a bath and helps me dress. But she is a woman, and she does not know how to tie the veshti. Other men around will come to help at such times. (Male, 60 years, separated, H18 registered) That nurse gave me this petticoat without any saree. She is a nurse. Doesn’t she know that this petticoat is only suitable for a saree? (Female, age unknown widowed, H18 registered)

To support the nourishment of residents, most facilities had a set weekly menu. Residents in most facilities were satisfied with both the quantity and quality of the food that they received and Hitendra’s comment was typical of many “ The food is good. Even at home we will not get such food”. There were only two facilities in which residents indicated some dissatisfaction with the availability of food and drinks. In the first facility, this was mainly in relation to ‘snacks’ that had to be purchased. This was problematic for residents such as Varsha and Udit who had insufficient income.

Here they make coffee occasionally. It is black coffee. We don’t get it daily. They give biscuits rarely. If we give money, we can ge t. (Female, 75 years, widowed, H11 unregistered) I would like to eat some snacks like biscuits and omappodi. But I cannot get these. (Male, 80 years, separated, H11 unregistered)

In the second facility (H18, registered), the quality and range of food provided did not suit Padma’s food preferences or intolerances, she said:

Sour dosai. I don’t like it. If I eat this I will get leg pain. I don’t eat curd. I was advised not to eat sour things. They give just four idlies and they too will be sour. I will eat wheat dosai, but they will not give me any. (Female, age unknown, widowed, H18 registered)

In terms of providing shelter the cleanliness of the unregistered facilities varied, and this is contrasted in the following quotes from Maalia and Hitendra. Whereas Maalia had to clean faeces from the bathroom before she bathed, Hitendra was very satisfied with the cleanliness of the old age home in which he lived.

It [the bathroom] is befouled with urine and faeces. I clean it up with water and then, if I can tolerate it, I take a bath or wash clothes. I keep the clothes on my thigh and apply soap. What else can I do? Where can I go? (Female, 75 years, widowed, H11 unregistered) The rooms and the beds are neat. They change the bed sheet every month. They sweep daily. Bathroom and toilet are clean. (Male, 83 years, separated, H10 unregistered)

Bodily health is underpinned by opportunities to have good health (i.e. access to health and personal care), to be adequately nourished, and have adequate shelter. The Tamil Nadu Minimum Standards for old age homes specify the services that should be provided to residents. These include three meals (breakfast, lunch and dinner), two refreshment breaks (tea, coffee and snacks), and weekly visits by a medical officer. Furthermore, in-house staff should include a nurse, counsellor, cook and helpers (care attendants). While these services were more likely in registered homes there was still variability in terms of the quality of the services provided, an issue that is not addressed in the Minimum Standards. Overall, unregistered old age homes were less likely to provide opportunities for bodily health for residents: only one unregistered old age home in the study attempted to cater for the personal care needs of residents.

Bodily integrity

Bodily integrity refers to moving freely from place to place, secure against assault. The themes ‘abuse’ and ‘leaving the premises’ (i.e. freedom to move within and beyond the old age facility to the community) were incorporated in this family node.

Residents in H14 (registered) and H10 (unregistered) were permitted to leave the premises if they gave written notice and were accompanied by an attendant. Special occasions such as weddings and birthdays often warranted longer trips away from the facilities, and Joti noted that residents could be accompanied by their relatives. Avinesh also mentioned that residents were permitted to go to local places if they were accompanied by a member of staff:

If a resident wants to go out, like attending a wedding, the person who brought the resident here should come and take the resident. (Female, 84 years, widowed, H14 registered) The reason is that we are all old and if anything happens it will become difficult. If we request and if it is a nearby place, they will send us with an attendant. (Male, 78 years, married, H14 registered)

Only Dev mentioned being permitted to go out alone.

I can go and come alone. They allow for it. But one should go and come back properly. If we do anything unwanted, they will not allow. When they have confidence in us, they allow. (Male, 72 years, never married, H15 unregistered)

H11 (unregistered) particularly stood out in terms of denying residents freedom of movement. In this facility, most residents talked about their desire to leave and lamented the fact that they were not permitted to do so. Aanav’s reaction to a question about access to the local community was typical of residents in this facility, who expressed a desire to leave the old age home for good.

I am only thinking of when to leave this place. Even if I have to beg for food… I want to go somewhere. I don’t want to be here … If you raise the walls and put a tiger alongside, we cannot escape. Now I am with that tiger [the manager] here. (Male, 60 years, widowed, H11 unregistered) .

However, it was not only unregistered facilities that failed to support bodily integrity for residents. Padma noted that she was denied access to other areas of the old age home and said ‘ here we cannot move from one room to another’. She also cited an example of abuse by staff when she was initially left at the home, deserted by her family and distressed:

They first kept me on the staircase. As I kept on shouting, ‘Father Yesappa, save me!’ they took a plastic tea cup and gagged me. I fainted. Madam [the manager] went to her home. When I became conscious, I started chanting a prayer. The woman in the other room informed them. Madam came and ordered, ‘Don’t sing. Don’t pray. Shut up your mouth and lie down’. (Female, age unknown, widowed, H18 registered)

Deprivation of freedom of movement was not only a feature of old age homes in Indian society. A summary of Maalia’s life history demonstrates how actions assumed to improve her life (and that of her daughter) diminished her freedom and subjected her to unequal relations (Female, 75 years, widowed, H11 unregistered). Maalia spent the majority of her life in various facilities run by the same charitable organisation. At a young age, Maalia admitted herself to a children’s home to avoid abuse at home. She left briefly to marry but was abandoned by her husband when she was six months pregnant. Maalia left her daughter in a children’s home, moved into a women’s refuge and worked in the kitchen of the orphanage that she had been raised in. She borrowed ₹3,000 from the organization to arrange her daughter’s marriage (despite the organisational commitment to find suitable grooms for female residents, and meet all of the associated costs), and later required ₹27,000 for hospital fees to treat a burn sustained while working in the kitchen. After the first ‘loan’, the proprietors retained her salary (₹500 per month) for more than two decades. Eventually, Maalia’s sight deteriorated and she needed eye surgery. Unable to work to pay back another loan, Maalia requested to move to an old age home for older people that was located within the cluster of facilities. Thus, Maalia’s experience in the old age home was the result of a cumulative sequence of events. Deprivation of freedom was coupled with coercion through indebtedness to the cluster of charitable facilities. She suggested that death was preferable, “ I want to pass away as soon as possible. I should hurry to vacate this place .”

With the exception H11 (unregistered), most residents were permitted to leave facilities if they were accompanied by a relative or care assistant. However, access to the community was not equal among residents. Padma (H10, registered) noted that she was not permitted to move around the facility, or to leave, whereas other residents in the same facility were able to go out if they were accompanied. Across all facilities, residents who were unable to walk (e.g. confined to bed) were rarely provided with sufficient support to move around the facility, and were not given sufficient support to leave the facility (see section on play). The Tamil Nadu Minimum Standards for old age homes have given scant attention to this particular facet of dignity for residents. The only reference to leaving the facility is in relation to ‘outings’ in which it is stated that “ The inmates should be taken out on local outings like temple, fairs, plays and places of tourist interests at least once in 3 months” . This suggests that old age homes should offer planned activities, rather than facilitating the freedom of movement for residents.

Securing dignity through play, concerns providing residents with the opportunity to laugh and enjoy recreational activities. Several old age homes provided residents with newspapers, books and opportunities to watch the television. One old age home (H14, registered) which provided accommodation and care for Brahmins, appeared to have the most ‘occupied’ residents. This facility provided residents with a range of religiously oriented activities such as chanting mantras, prayers, reading spiritual books, watching religious series on television, and singing devotional songs. On the other hand, residents of H10 (unregistered) were mainly reliant on the television and newspapers for recreational activities, as Hitendra noted:

We will get newspapers at 10 am. We get four newspapers... We also get magazines... Back at home, we had to walk some distance to go to a library… They put the TV on by 9.30 am, but I don’t have the habit of watching TV. I have to read all the four newspapers. (Male, 83, separated, H10 unregistered)

There was evidence that some old age homes (H11 unregistered and H18 registered) did not provide any leisure or recreational activities. Instead, in H11 the residents who were able to work were given jobs. For example, Varsha (Female, 75 years, widowed) said “ I sit at that gate [entrance of the home] and my work is to open and close it” . Saksham (Male, 84 years, widowed) said that residents who were unable to work were “ Sitting quietly… Nothing else” . Despite paying fees, there were no leisure activities for residents in H18, and Pratik noted:

Breakfast will be over by 9.30 am. Then I just sit. At 1 o’clock there is lunch. From 1.30 to 4 pm, we get time to recline. What else do we need at this old age? But we have to pay for all these. (Male, 60+ years, separated, H18 registered)

One old age home deliberately denied residents the opportunities for recreation, as described by Rajiv:

There is a TV in that hall. If we go there to watch it, they will switch off and say that there is no power supply, but if we come back to the room and put on the fan, it will work. So, they don’t like us to watch TV… Sometimes we get parcel food that is wrapped with old newspapers. I would carefully unwrap it and keep it for reading. I used to read the same paper again and again. You know, what they would do? They would select the food parcel with dampened wrapper and give it to me so that I cannot read it . (Male, 63 years, never married, H16 unregistered)

In other registered and unregistered old age homes, access to leisure activities was inequitable for certain residents. For example, there were few opportunities to participate in recreational activities for residents who were nonambulatory or tetraplegic, such as Deepak and Rina.

I can read newspapers. But there is no one to hold the newspaper for me. So, I don’t have anything else to do. It is just sitting or lying. If I am seated, I would keep on sitting until somebody comes and puts me to bed. (Male, 68 years, widowed, H16 unregistered) I cannot get up. I cannot sit… My only problem is that I don’t have anybody else here to talk to. I am always lying down. If they put on the TV, I will listen to the news. I don’t go to the hall and watch TV. Who will take me there? (Female, age unknown, never married, H18 registered)

The narratives indicated considerable variation in the extent to which residents in old age homes are supported to ‘play’. Whereas some homes met the Tamil Nadu Minimum Standards which stated that “games should be played in the evening singing songs (devotional) and other past time activities may be designed depending on the age category and health status of the inmates” and that recreational facilities (e.g. books, indoor games, radio, and television) should be made available, others failed to provide any facilities, or denied residents access to these.

Registration of old age homes is mandatory in Tamil Nadu. However, many remain unregistered. To date, Minimum Standards are only enforced in homes that are registered and receiving funding, as these are the only homes that the State is aware of. The results show that there is considerable variation in the extent to which the four CHFC life, bodily integrity, bodily health and play are met for older people living in these facilities. Furthermore, variation is not necessarily between old age homes that are registered versus those that unregistered. In essence, there is evidence that Articles 3, 13, 25 and 24 of the UDHR are contravened in both registered and unregistered old age homes in India. This suggests that the State (the Government of India) is not meeting its obligations under Article 1 to recognize that ‘all human beings are born free and equal in dignity and rights’ and has failed to mandate and implement safeguards for all older residents. In registered homes, it appears that Standards are not being regulated through inspection, nor is support offered to help maintain quality where old age homes fall short.

Considering the CHFC ‘life’ and Article 25 of the UDHR, in long-term care facilities and other healthcare settings around the world, routine clinical decisions are made about whether to treat older people at the end of life, or to prevent a life from being prolonged. The idea ‘that a life is not worth living’ is used to support these decisions [ 29 ]. However, in this study, in one unregistered home untrained, non-clinical staff (e.g. members of a religious order) were making judgements and withholding both curative and palliative care to residents. Furthermore, in four of the ten facilities, there were no health or support staff to secure appropriate and timely health care for residents, to ensure that they did not die prematurely.

A majority of older people requiring health care and support at the end of life in India – either living in the community or in old age homes—do not have access to services [ 30 ]. This is reflected in India’s poor global ranking on the 2015 Quality of Death Index, that places it 67 th out of 80 countries [ 31 ]. In 2014, the World Health Assembly passed a resolution to strengthen palliative care as a component of comprehensive care throughout the life course and urged national governments to carry out actions to develop palliative care (WHA67.19). In this respect, the education, clinical training, and competence of staff in old age homes are pre-requisites to facilitate dignity [ 24 ]. The State needs to ensure that old age homes are adequately staffed to secure health care for residents, and that staff are sufficiently skilled to uphold the rights of residents to a good life (and death).

Turning to bodily health and the associated Article 25 (emphasising access to health care and personal support, food and shelter as the foundations of health, wellbeing and a dignified life), results indicated considerable variation between old age homes. In some facilities human rights were violated, with residents living in filthy conditions, while others were expected to help each other without any other provision for personal care or support within the facility. Elsewhere in the world, studies identifying risk factors for neglect have found that staff shortages, time pressures, staff turnover, and a high ratio of residents to staff contribute to care quality [ 32 , 33 ]. Thus, the dignity of care and support afforded to residents in some old age homes in India, suggests that the State needs to develop policies and strategies that regulate staffing ratios but also attend to quality of care and the maintenance of dignity.

Considering bodily integrity and Article 13: the right to freedom of movement, the study showed that most of the old age homes considered the safety of the residents and permitted them to leave accompanied by relatives or staff. However, residents are described as ‘inmates’ in policies (e.g. the Tamil Nadu Minimum Standards is published in English), programmes, and in research publications on old age homes emanating from India [ 34 , 35 ]. This is the language of incarceration. The term ‘inmates’ has been rejected for prisoners as it is derogatory, stigmatising, and dehumanising [ 36 ]. We contend that it is inappropriate to use ‘inmates’ to describe old age home residents for these same reasons, but also because it reinforces the notion that imprisonment, deprivation of liberty and segregation from the community is legitimate. While the deprivation of liberty of old age home residents is governed by legal codes in most European Countries [ 37 ], the decision to detain residents in India is arbitrary. The results showed that some residents were detained against their will, violating their human rights and undermining their capacity to live a dignified life.

The results of the study indicated that both bodily integrity (freedom of movement) and play are more frequently overlooked when residents have higher level needs, for example, are nonambulatory. Under these circumstances, some residents were denied their human rights with fewer (if any) opportunities to leave the premises or to engage in recreation. Elsewhere, studies have indicated that many care home residents spend a large proportion of the day inactive [ 38 ]. This is particularly salient for residents with dementia where there is evidence of restrictive practices, confinement and systematic breaches of human rights in care homes [ 39 ]. Severe physical or cognitive impairment is likely to incur greater demands on staff time to support freedom of movement and opportunities for leisure, when compared to the level of support required by residents who are less impaired. However, based on the concept of status dignity, it is the duty of the State (and its agents in old age homes) to uphold the human rights of all older people even if this requires additional staffing to ensure equity in securing CHFC for residents.

Limitations

The study was conducted in only one state in India, Tamil Nadu, and there may be variation in the quality and types of support provided in old age homes across India. However, we have no reason to believe that we would find a higher ‘standards’ of provision elsewhere. In 2019, the Ministry of Housing and Urban Affairs, Government of India developed a set of ‘model guidelines’ that are applicable to real estate developments intended for older residents who are ‘ willing and able to pay for accommodation services and facilities’ [ 40 ]. These model guidelines focus on services and physical aspects of the environment rather than the quality of care. The authors are fairly confident that the types of human rights violations observed in this study, would be found elsewhere in India (see also, [ 41 ]). As Tamil Nadu was the first state to introduce a set of Minimum Standards for old age homes in 2016, one may expect provision in this state to be ‘better’ than elsewhere as the standards have become embedded into practice over time.

This study was undertaken before the COVID-19 pandemic was declared a Public Health Emergency of International Concern by the World Health Organization in 2019. Globally, the pandemic has resulted in human rights violations for older people, especially in relation to the right to health and life [ 42 ]. Policy directives that were developed to protect the life of residents in care homes, have also impacted on bodily integrity and play [ 43 ]. Therefore, the experiences of residents in old age homes in Tamil Nadu are unlikely to have improved over the last two years. As old age homes are largely unregulated it is unlikely that the full extent of the impact of the COVID-19 pandemic on the human rights of older residents in India will be established [ 44 ].

Conclusions

Residents in old age homes can function effectively in the range of areas that are fundamental to a fully dignified human when policy decisions and the legal apparatus of the State provide them with the opportunities to do so. The concepts of status dignity, CHFC, and human rights have been used to describe the relationship of residents in old age homes to the State and the agents of the State (staff in old age homes). The results suggest that a new legislative framework is required to ensure that all old age homes are accountable to the State, regardless of the source of funding. We recommend that Minimum Standards include clear definitions regarding the expectations for quality of care and dignity in care, that meet the basic needs of older people (shelter, clothing and food) but also provide health care, personal support, and opportunities for leisure, socializing and access to the community. The legislative framework should also stipulate staff ratios, staff training and raising awareness of human rights. Standards should be regulated and support offered to help maintain quality. The study has highlighted incidents where human rights have been violated, but these illustrative examples have been juxtaposed with good practice, where residents’ human rights and dignity were protected. The research has demonstrated that it is possible to protect the dignity of residents of old age homes, but highlights areas where the Government of India and/or State Governments have a role to play in strengthening and developing old age home policies and strategies to protect older residents.

Acknowledgements

The authors wish to thank Dr R Anitha, Dr S Ponni, Dr R Hemalakshmi for contributions made to the research project. The source of maps for Fig. ​ Fig.1 1 is https://d-maps.com/carte.php?num_car=24853&lang=en

Abbreviations

Authors’ contributions.

VB: Conceptualization, Methodology, Project administration, Funding acquisition, Data curation, Formal analysis, Writing- Original draft preparation. EZS: Formal analysis, Writing- Reviewing and Editing. RM: Supervision, Writing- Reviewing and Editing. CAM: Writing- Reviewing and Editing. AC: Writing- Reviewing and Editing. All authors read and approved the final manuscript.

The cost of Open Access publication was supported by Health and Care Research Wales, Senior Research Leader fund.

Availability of data and materials

Declarations.

Ethical approval was granted by the College of Human and Health Sciences, Human Science Ethics Sub-Panel, Swansea University on the 20 th December 2017. Research was performed in accordance with the Declaration of Helsinki. Informed consent was sought from each participant prior to interview. All participants who were able (managers and residents) signed a consent form. Consent forms were read aloud to residents who were illiterate: residents who agreed to take part provided a thumb print rather than a signature on the consent forms.

Participant information forms indicated that de-identified data would be used in publications: participants consent forms indicated that they understood this information.

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Architecture Student Chronicles

Guide to Designing Old Age Homes

Design procedure for the old age homes.

But before we start with discussing our design consideration factors, it is very important to know what an Old Age Home is like and what is its purpose of construction…

One important thing to be kept in mind before initiating the design process is that, we should study the purpose of the construction and what they are like.

This will give us a clear idea of what we are actually suppose to consider in the design…

Apart from literature case studies, Live case studies are also very important…

In my previous articles, we have discussed eleven factors to be considered for a successful case study …

Old Age Homes

Old age homes are meant for senior citizens who suffer with a problem in staying with their children at home or are destitute. These homes are for older people who have nowhere to go and no one to depend on… These homes create a friendly and family like atmosphere for the elderly people where they can share their joys and sorrows and live happily. Old Age Homes are pretty developed in United States, United Kingdom and there is recent development seen in the construction of Old Age Homes in India.

These old age homes have special medical facilities for senior citizens such as mobile health care systems, ambulances, nurses and provision of well-balanced meals. So basically, it is a housing project for senior citizens of that country.

Old Age Homes have two main categories:

• Homes providing free Accomodation
• Homes working on a payment basis

Apart from food, shelter and medical amenities, old age homes also provide yoga classes to senior citizens. Old age homes also provide access to telephones and other forms of communication so that residents may keep in touch with their loved ones. Some old age homes have day care centres. These centres only take care of senior citizens during the day.

Location of Old Age Homes

• Studying the location of the structure is the most important factor. This will help us determine the climatic conditions of the place. Orientation of a building with respect to climatic conditions of the place.
• Location of an Old Age Home is of prime importance.
• It could be a part of the urban setting or it could be in a rural area. It depends on the kind of people that are going to stay in it.
• Some people prefer idyllic areas while some would like to live in close proximity to the quick facilities of the city.
• An Old Age Home should be preferably located in a calm, pollution free environment with all the basic necessities that are required for any comfortable housing project.

Design Concept for Old Age Homes

• Design of Old Age Homes depends on the social and economic status of the people who are going to reside in the homes.
• They could be the dormitary type, independent rooms or cottages…
• The rooms should be well-ventilated.
• Designing a ground Floor in an Old Age Home is of utmost importance. Possibly all the basic facilities in the home should be provided on the ground floor. If this is not possible and if upper floors have to be built then a sloping ramp has to be provided for facilitating easy passage of wheel chair and make movement of people with crutches easier.
• The toilets and bathrooms should have rough flooring so that the elders do not slip. Suitable railings should be provided for support.
• Recreation rooms and rooms for medical care should be built.

Working Staff in the Old Age Homes

• An administrator is must for the homes of the aged who will be responsible for the running of the home.
• Supporting staff such as clerks, cashier cum accountant, nursing staff, attenders, maids and a cook are the basic required staff for the efficient running of a old age home.

• A medical officer will be needed to attend to the health needs of the inmates. If the home is very close to a hospital where emergencies can be treated then, it may be enough to avail the services of a Doctor, who works there part-time.
• A nutritionist can play an important role by providing special attention to the nutritional requirements of the residents. At least a part-time nutritionist should be appointed.
• A professionally qualified social worker is an essential member of the team of personnel.
• Wherever possible nursing staff and health care workers trained in Geriatric care should be appointed.
• There is a need for helpers in the Old Age Homes who will take care of the Old people and help them move around…
• After figuring out the staff requirements for the Old Age Homes, we can determine the amount of space required for their offices and construction of quarters where they can stay while on job.

Medical Care Facilities in Old Age Homes

There should be a sterile store room where all medicines and medical accessories that may be needed for treatment of the residents are to stored as per the advice of a general physician.

• There are certain instruments that are necessary for the medical treatment such as Oxygen cylinders, suction apparatus and intra-venous sets should be readily available. Drugs should be replaced periodically, considering their expiry date.
• Transport facilities such as ambulances or any other vehicle that is similarly equipped as an ambulance should be available in case there is a need to rush them to the hospital for intensive care.

Recreational Facilities in an Old Age Home

• Provision of recreational facilities is must. Old people also need entertainment so that their mind does not remain idle. This will help their life become lively and happy and keep them away from any kind of depressing thoughts.
• Facilities such as small reading area, televisions, video players, newspapers and books should be provided.

• Not all old people like sedentary lifestyle…Depending on the extent of the physical activity of the residents other facilities for active sports such as: tennis, table tennis, squash can be provided.
• A small computer room could be provided for accessing the internet which is a must in today’s world. That will keep the residents mentally active and aware of the world outside…

From our discussion we can conclude some of the most important and basic Requirements in an Old Age Home

• Common Rooms
• Single and Double Bedrooms
• Pantry in every Bedroom
• Main Kitchen
• Dining Area
• Television Area
• Reading room
• Praying room
• Computer room
• Offices for the staff
• Common Toilets
• Sports Facilities for Tennis, Badminton etc.
• A Landscaped Garden with a jogging track

A lot of emphasis is being given on the design of Old age homes in the west especially in the UK. The importance of old age homes design has increased with the increase in the number of homes across the world.

35 thoughts on “Guide to Designing Old Age Homes”

Hello, It’s been nice to see regarding Old age homes, could you help any aspect related to Retirement Resorts- free independent houses for retired people

How much area is required to establish old age home? What may be the plinth area of construction? How far it shall be from the city?

what is the total area reqd if one wishes to have old age home for about 100 people

Hello, A minimum area of 2000 sqm would be required in order to accommodate 100 people in an Old Age Home.

Gud..I Appreciate It.. cos Is Our Semester Project.. I Have Learn So Many Things..

Durvankur Starting constriction Old age Home In Thane Maharashtra with Donors support ple Help our 7 guide Ngo.

Hi, Can you/anyone tell us that where can we approach for funds for establishing an Old age Home in our city i.e Haldwani (Uttrakhand). We are working for old aged people since last four years. 63 old aged people have registered them with us. We are providing them day care facilitiestill date. One can go to FACEBOOK/HarishDhondiyal(Photos) to see some of our works done. Photographs are self speaking. We have Pan card, 12A certificate and 80G certificate of Income tax department with us with three years Audit reports and Annual reports. We have 4000 sq ft of land in the heart of the city with map/plan already prepared for it(OAH). But due to paucity of funds we are unable to do so till now. We approached to many but failed in sanctioning the amount. If anybody can help or guide, pls write a line to Secretary- Hem Memorial Society on [email protected] Will ever remain thankful and grateful for the same.We want to establish an Old Age Home for 25 people in first phase.

need some guidelines for setting up old age homes in India. I am looking to setting up in Chennai.

please i want to have a guide on how to design a hospital in your locality. i hope i will have some response

We wish to estabilish an old age home in our own building fo around 25 to 30 people. What are the govt. formalities required for it as we are doing it for the first time. We are not a registered trust or society but we want to help the old age people by donating our building and primary donation fund of around Rs. 5 to 10 lakhs. Please help.

Want to establish a mega old home project at Darjeeling Plain, international standard for multicultured people for joy happiness and liberate. Need your consultancy and advice. I am a Civil and Structural Engineer, M.I.E, F.I.V, AMASCE (USA)

Hi, I have a land of area 10000 sq.ft. I want to build an old age home in this plot- may be for around 50 people. Is it enough?

I have a donated land in west bengal to my trust. I want to get an oldage home. plz get me a full proof design to build it.

Can you plz suggest me some good old age and orphanage home in india for my thesis case study…

Does old age homes come in institutional building category??????

Yes. They could possibly fall under institutional building category.

hi, i want to know if there are any upcoming old age homes in Karnataka.

i wanted a live site for my thesis project..

Hello Shreegouri,

You will have to work on it yourself. I would advise you to get landuse maps of your city and study the scope of your proposal in different areas. Only after you can justify why your proposed building will serve the area in a positive way that you claim it will, your site selection process will be complete.

And also we are open to discussions. You can discuss how things come along with your thesis project. We look forward to hearing from you.

helo , i want to know suitable old age homes required for case study for my thysis project . site area of my project os 2.91 acres and also help me in suggesting the number of people which would be fine for my site area.

The idea of old peoples’ homes in Ghana has not catch up with us in Africa in general and Ghana in particular. This is basically because of our cultural setting where families take care of the elderly at home. Things are changing very fast now because of urbanization where the younger generation leaves the elderly at home to ‘fend’ for themselves. Moreover there are several elder generation who had live outside in Europe and America and would like to settle at home. There is therefore the potential for the development of these kind of homes in Ghana. Our organization has acquired large tract of land at water front which can be developed and are hereby seeking for financial support in this endeavor.

I wish you all the best with this endeavour.

SIR I WISH TO OPEN OLD AGE HOME IN OUR CITY .PRIME LOCATION IS THERE. WE HAVE AREA OF 3 ACRE NEAR RIVER AND MARKET ROAD.WE HAVE ALL STAFF FOR REQUIRED IN OLD AGE HOME. WE WISH TO PROVIDE FREE SERVICE AND FREE FOOD.NEEDY PEOPLE GET EXTRA BENEFIT

Dear Amrita,

I am happy to know of your well thought initiative to construct an Old Age Home. That is for a very noble cause. Let me know how I can help you.

Respected Sir, I want to open old age home in Maharashtra (India) So which things are required to open the old age home. How much investment needed in concern home

We wish to open a old age home in our village near Thanjavur District, Tamil nadu. Please send guidelines for the building design. Sairam. Moorthy

hello sir. I am an architecture student. I have taken my final year project as orphanage cum old age home. please can you tell me where is your site how big is it ?

I’m also architecture student and even my topic is same for thesis so i want to know that did u got any info abt it n where did u do ur case study? plz share some info and ur experience about ur case study and other aspects.

P. Gurumoorthy : Dear Sir. Sairam. We wish to open a old age home in our village near Thanjavur District, Tamil nadu. Please send guidelines for the building design. Sairam. Moorthy

i am going to start a old age home near malavalli, karnataka,if somebody is interested in joinining hands with me, they are welcome,some enterprenaur with ideas matching,

Dear Venkat Ram

I run a paid architectural design service. Let me know if you would like to get it designed by us… I shall send you all the details of our establishment. This initiative is for a good cause and I would be delighted to be a part of it.

sir, I want to start senior citizen/old age home near Dehradun for about hundred couples initially. How much expenditure should we expect. Also the ideal building design for the same.

Hello Ajai,

I would say keep 4 to 5 crores aside for the works…

In Bangladesh this is just start, as a social instability high demand in the old age level. I would like to request, if sent me the building design and others for 100 person and other facilities, will be highly appreciate for me. with regards

We would like to establish OLD AGE HOME. We want to prepare a PROJRCT REOPRT. Can you guide us?

I am going to start a old age home. so what are all requirement to open, how much investment needed and guidelines for building design.

Leave a Comment Cancel reply

You must be logged in to post a comment.

• Open access
• Published: 14 July 2022

Dignity and the provision of care and support in ‘old age homes’ in Tamil Nadu, India: a qualitative study

• Vanessa Burholt 1 , 2 ,
• E. Zoe Shoemark 2 ,
• R. Maruthakutti 3 ,
• Aabha Chaudhary 4 &
• Carol Maddock 2  

BMC Geriatrics volume  22 , Article number:  577 ( 2022 ) Cite this article

3116 Accesses

3 Citations

6 Altmetric

Metrics details

In 2016, Tamil Nadu was the first state in India to develop a set of Minimum Standards for old age homes. The Minimum Standards stipulate that that residents’ dignity and privacy should be respected. However, the concept of dignity is undefined in the Minimum Standards. To date, there has been very little research within old age homes exploring the dignity of residents. This study draws on the concepts of (i) status dignity and (ii) central human functional capabilities, to explore whether old age homes uphold the dignity of residents.

The study was designed to obtain insights into human rights issues and experiences of residents, and the article addresses the research question, “to what extent do old age homes in Tamil Nadu support the central human functional capabilities of life, bodily health, bodily integrity and play, and secure dignity for older residents?”.

A cross-sectional qualitative exploratory study design was utilised. Between January and May 2018 face-to-face interviews were conducted using a semi-structured topic guide with 30 older residents and 11 staff from ten care homes located three southern districts in Tamil Nadu, India. Framework analysis of data was structured around four central human functional capabilities.

There was considerable variation in the extent to which the four central human functional capabilities life, bodily integrity, bodily health and play were met. There was evidence that Articles 3, 13, 25 and 24 of the Universal Declaration of Human Rights were contravened in both registered and unregistered facilities. Juxtaposing violations of human rights with good practice demonstrated that old age homes have the potential to protect the dignity of residents.

The Government of India needs to strengthen old age home policies to protect residents. A new legislative framework is required to ensure that all old age homes are accountable to the State . Minimum Standards should include expectations for quality of care and dignity in care that meet the basic needs of residents and provide health care, personal support, and opportunities for leisure, and socializing. Standards should include staff-to-resident ratios and staff training requirements.

Peer Review reports

In recent decades India has witnessed significant improvements in public health, with increases in life expectancy and longevity alongside declines in infant mortality and fertility rates. As a result, the age structure of India’s population has changed with increases in the proportion and absolute number of older adults (60 + years) in the population. Overall, the proportion of older people has increased from 5.4% in 1950 to 9% in 2020. However there are variations in the age structure across Indian states: in 2020, around 14% of the population in Kerala were 60 + years compared to 7% in Assam [ 1 ]. Although there have been gains in increased life expectancy and healthy life expectancy in India, there have also been increases in the proportion of the older population spending more years living with a disability. This is related to the impact of infectious diseases, malnutrition, and the rapid growth in the prevalence of non-communicable diseases (e.g. diabetes, cardiovascular disease, and hypertension), with many older people requiring long-term care and support to manage their daily activities [ 2 , 3 ].

There are a variety of family forms in India, however, the notion of a normative traditional mutigenerational household and extended family prevails [ 4 ]. There is a social expectation that the traditional family will uphold filial piety (respect and obligations towards parents) and familism (prioritizing family needs above all others) [ 5 ] and meet the social, instrumental, economic and emotional needs of older people [ 2 ]. Indeed, this expectation is formally constituted in law. The Maintenance and Welfare of Parents and Senior Citizens Act mandates children, grandchildren and other relatives with sufficient resources to provide support to older people who are unable to maintain themselves. In situations where support is not provided, older people can take relatives to a tribunal to obtain a maintenance order. Non-compliant relatives may be fined or imprisoned. However, this is not a common course of action because there is a lack of awareness of the Act [ 6 ]. Furthermore, older people are reluctant to pursue legal action which could bring shame on the family and criminalise family members or result in a court order requiring the older person to transgress social norms and live with relatives other than sons [ 4 ]. Additionally, not all older people have access to family care: some do not have an extended family and/or have care needs that exceed family care-giving capabilities [ 4 ]. To cater for an increasing number of older people who need extra-familial support in later life, a new ‘old age home’ sector has emerged in India. We use the official terminology ‘old age home’ throughout this article when we refer to the sector in India. We use the expression ‘inmates’ to describe residents of old age homes. We do not condone the use of this term, but use it to illustrate the widespread adoption of the English language word (and meaning) in Indian academic, policy, media and public discourse.

The old age home sector comprises not-for-profit and private homes. The private sector caters predominantly for ‘middle class’ older people, that can afford them [ 7 ] and the charitable (not-for-profit) sector provides for older people without financial assets. The Integrated Programme for Senior Citizens provides basic amenities for older people without access to support (e.g. food, shelter and medical care) and is administered through grants at the state level that are paid directly to providers of registered old age homes and day centres [ 8 ]. Only 310 homes were funded through this scheme in 2018–2019 across all states in India [ 9 ]. There are no accurate records of the number of old age homes in India, nor of the number of residents in facilities, as homes that do not receive funding are not obliged to obtain a license, register, or to be inspected [ 10 ].

In 2016, Tamil Nadu was the first state in India to develop a set of Minimum Standards for old age homes that are delivered by not-for profit organisations [ 11 ]. These focus on physical elements of the facilities (e.g. the size of room, presence of CCTV), access to basic services (e.g. productive activities for residents, housekeeping and assistance with daily activities) and medical services. Although there are no standards relating to the quality of care, the guidance specifically notes, that “each inmates [sic] right to dignity and privacy should be respected” [ 11 ]. This statement is aligned to Article 1 of the Universal Declaration of Human Rights (UDHR) [ 12 ], that all human beings are born free and equal in dignity and rights. However, the concept of dignity is complex and contestable, and is undefined in the Minimum Standards.

There are two main definitions of dignity which distinguish between inherent dignity and status dignity. The Kantian notion of inherent dignity is conceived as equal moral status and personhood which is grounded in humans’ sentience, rationality and capacity for autonomy [ 13 ]. Some authors suggest that this definition excludes people who lack cognitive capacity or autonomy (e.g. older people with severe dementia) from equal respect and dignity [ 14 , 15 ]. Furthermore, many argue that inherent dignity is built on metaphysics or theology concerning the moral standing of human beings in relation to their ‘gods’ versus the rights of other animals [ 16 ], while others have argued that it is concerned with the worth of the individual in relation to other people [ 17 ]. The controversy concerning the concept of inherent dignity tends to detract from the political function of the UDHR which are intended “to protect individuals against the consequences of certain actions and omissions of their governments” [ 18 ]. Consequently, in this article, the concept of status dignity is used to describe the relationship of residents in an old age homes to the State and the agents of the State (staff in old age homes) [ 19 ].

Valentini [ 19 ] defines status dignity as “a status a human being possesses, comprising stringent normative demands” (p. 865). From this theoretical perspective, the duties to ensure the dignity of citizens (and that human-rights are fulfilled) primarily falls on the State and its agents. However, in order to explore whether the state is fulfilling their primary duty requires a definition of ‘normative demands’ essential for dignity [ 20 ]. In this respect, Nussbaum [ 21 ] has posited that governing bodies should secure for all citizens a threshold of ten central human functional capabilities (CHFC). CHFC are “opportunities that people have when, and only when, policy choices put them in a position to function effectively in a wide range of areas that are fundamental to a fully human life” [ 22 ].

The capability approach refers to the opportunities and freedom to undertake the activities necessary for survival, to avoid or escape poverty or serious deprivation and achieve a life that is  “not so impoverished that it is not worthy of the dignity of a human being” [ 23 ]. For example, bodily health (a CHFC) is partly underpinned by nourishment. Nourishment in turn requires resources to prepare meals (i.e. access to food products that are culturally or religiously acceptable and an energy source to cook upon) and the personal ability or external support to undertake the functions of cooking and eating. The capability approach resonates with other authors’ descriptions of the conditions necessary to support dignity in organizational and clinical settings [ 20 , 24 , 25 ]. All ten CHFC are relevant to supporting the dignity of residents in old age homes, however, this article focuses on four: life, bodily health, bodily integrity and play which correspond to Articles 3, 13, 25 and 24 of the UDHR (Table 1 ).

In India, there has been very little research within old age homes. The research that has been published has tended to focus on the private sector [ 7 ]. The available evidence suggests that a majority of homes require residents to be ambulatory, continent, and cognitively able at the time of admission [ 7 ]. Whether the CHFC are supported for residents that become unable to self-care because of physical or cognitive impairment is unknown. Presently, it is unclear as to the extent to which staff in old age homes, as agents of the State, uphold the dignity of residents. To explore human rights issues and experiences of old age home residents in India, this article addresses the following research question:

To what extent do old age homes in Tamil Nadu support the central human functional capabilities of life, bodily health, bodily integrity and play, and secure dignity for older residents?

Sample location

Tamil Nadu state is situated in the south India and covers 130,060km 2 . Tamil Nadu had a population of 72 million in 2011 of which 88% were Hindu. One-tenth ( n ≈ 7.2 million) of the population were age ≥ 60 years.

Sampling procedures

Old age homes were purposively selected from three southern districts in Tamil Nadu: Thoothukudi, Tirunelveli, and Kanyakumari (Fig.  1 ). Forty-three old age homes were located through a mapping exercise: 13 in Thoothukudi, 11 in Tirunelveli and 18 in Kanyakumari. The ratio of fee-paying to free old age homes in each district, and the size of the homes were used to inform our sampling strategy. Participants were randomly selected from lists of residents in 10 facilities, to obtain (as far as possible) a gender-balanced sample of 10 people in each district (Table 2 ).

Map of the states of India showing the location of Tamil Nadu, and map of Tamil Nadu showing location of selected states

Data collection

Face to face guided interviews (17–70 min; M  = 34 min) were conducted in Tamil with 30 residents (15 male, 15 female, age range 60–83 years) and 11 staff in old age homes, between January and May 2018 by three experienced female interviewers who were PhD scholars at Manonmanian Sundaranar University. To standardise approaches to interviewing, training was provided by the first and third author.

Interviewers explained the purpose of the study and established relationships with the residents and staff before the study commenced. All participants were interviewed in a private place where they could not be overheard or interrupted.

Semi-structured interview guides were used for residents and staff. Open-ended questions explored how residents came to be living in the old age home [described elsewhere, 4] and experiences of the old age facility. Examples of questions included: “Tell me about your typical day”, “What is the best thing about living here?” “What is the worst thing about living here?” “If you need help here, does anybody help you?” “What do you do with your time?” Staff were asked questions such as, “What services are provided to residents?” “How are residents’ needs assessed, if at all?” “What happens if a resident becomes sick?”.

The first three interviews were used to pilot the interview guide, and to check the quality of interviewing. Interviews were recorded, transcribed, and translated by a professional translator into English and anonymised. Pseudonyms are used throughout the article.

Framework analysis was used to analyse the data [ 26 ]. Five distinct but inter-connected phases (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) provided a rigorous methodological structure. Familiarisation, conceptual and cultural understanding of the interviews were clarified during team meetings (first and third author with interviewers) in Tamil Nadu. The second author created a list of a priori codes from the interview questions (e.g. support for each activity of daily living, discriminatory practices, food and nutrition, religious practices, leisure and recreation, worst and best things in the home). She applied these codes to transcripts (in NVivo 1.5.1), and while reading through the transcripts simultaneously created a new series of a posteriori codes, in an inductive thematic analysis. The first author read through the transcripts and coding to check validity. She then systematically applied a second coding index based on the capability approach: some thematic nodes became wholly subsumed in the ‘family’ nodes (e.g. ADLs were subsumed under ‘bodily health’) whereas others were relevant to more than one CHFC (e.g. worst thing in home). The first author charted the data into a framework which provided a decontextualized descriptive account of the data in relation to each CHFC.

The first author undertook the preliminary interpretation of data in three steps. First, taking an outcome-oriented approach, examples where each CHFC had/had not been secured were juxtaposed, providing an insight into the breadth of experiences of old age home residents. Second, residents’ and staff interviews were grouped by home and particular attention was paid to exceptions, contradictions and disconfirming excerpts. Third, experiences were contrasted between types of facilities (registered versus unregistered). All other authors (in India and the UK) were used as a sounding board, to check the persuasiveness of the analysis and to provide different ways of interpreting the research phenomenon [ 27 ].

‘Life’ refers to being able to live a normal life-span and not dying prematurely or before one's life is reduced as not worth living. This CHFC is closely related to bodily health. Participants referred to the ceiling of care available to them, if a resident was ill, or unable to carry out activities of daily living. In some cases, this was also referred to as the ‘worst thing’ about the old age home.

The first quote highlights the practical and ethical difficulties of deciding what ‘a life not worth living’ comprises. In this example, the resident perceived that the facility would judge that a sick older person’s life had no quality and would not be worth saving. Maalia explained what would happen if she became ill in the old age home in which she lived:

They will put me in the back room [sick room]. You may get a bath or you may not. You will have to lie there and die… If I become sick, the Sister will pour coffee and porridge. They will do that only when you become too sick. When you are going to die, they will pour water and bid farewell. That’s all. (Female, 65 years, widowed, H11 unregistered)

In other facilities, residents believed that if their health deteriorated to a point at which they were unable to take care of themselves they would be cared for by their children. For example, Rishi who had four daughters and lived with his wife said:

If we become too old and unable to do things, they [daughters] will only take us back. Now we are able to do things. So we are here. If we fall sick, these people will inform them and they will come and take us with them. (Male, 83 years, married, H14 registered)

Similarly, Hitendra said:

What if I become sick in the last stage of my life? Luckily I joined here when I was healthy. The facilities here are good. So, I want to be here for some time... I told my son that I would go to his house in [city > 200 miles away] if my health deteriorated. (Male, 83, separated, H10 unregistered)

The expectations for support at the end of life maybe unrealistic, as the residents were living in the facilities because their families were unwilling or unable to provide support. If support did not materialise, then this would not be problematic for Rishi, as the old age home he lived in provided life-long support. Diya, another resident in H14 noted:

If we are not well, the doctor will immediately attend. All medicines will be provided immediately. These three people [the doctor, the manager and the assistant manager] take such good care. One should have done punniyam [meritorious deeds in previous lives or in the past] to come here. (Female, 77, widowed, H14 registered)

However, there was no health care, personal support, or palliative care in the facility where Hitendra resided, and the manager noted:

The residents should take care of themselves. If they cannot take care of themselves, we cannot help. We do not have any attendant here. (Manager, H10 unregistered)

The Tamil Nadu Minimum Standards note that “each Old Age Home should ensure that the inmates [sic] should continue to receive care till the end of his/her life or up to natural death” [ 11 ]. Despite, mandatory care obligations, the Standards were only enforceable in registered facilities. Consequently, with one exception where a nun provided some personal support (see section on bodily health below), there were no care attendants to support residents in the unregistered facilities (Table 2 ).

Bodily health

This theme incorporated examples of supporting residents’ bodily health through medical and personal care (i.e. support for activities of daily living), adequate nourishment and shelter. Some difference between facilities in the availability of staff to provide health and personal care were mentioned above concerning CHFC life.

Residents in unregistered facilities were more likely to have to retain the ability to self-care or to provide support to each other than those in registered facilities. Dev and other residents in the same facility noted:

Here we don’t have anybody to get help. That is the rule here. One should eat oneself, one should wash oneself, one should sleep oneself. They are strict about it. Suppose you cannot walk by yourself, they, your co-residents may help you. That’s what happened to me for some 10 days. My roommates helped me. They would bring food for me. (Male, 72 years, never married, H15 unregistered)

However, this was not common to all unregistered facilities. Although there were no ‘paid’ attendants, in one facility a nun helped residents with personal care tasks, as Deepak said:

This Sister [name] takes me all by herself from the bed to the wheelchair. Takes me to the toilet for evacuation and cleans, gives me a bath, towels and brings me back here, dresses me and makes me lie down. She helps me eat food. She does everything in a good manner. (Male, 68 years, widowed, H16 unregistered)

In the only unregistered facility with a care attendant (the manager) the ratio of care attendants to residents was 1:20, whereas in the registered facilities, it was around one person for every four or five residents. The difference in levels of staff between registered and unregistered facilities was particularly stark for the largest facilities: whereas the registered facility had 19 staff for 65 residents, the largest unregistered facility had only three staff (one manager and two cooks) for 110 residents. In this facility the manager explained that “ we give work to those who are able among the residents” . Many of the manual jobs described by the manager, such as sweeping and cleaning rubbish are associated with lowest castes in India and are considered degrading [ 28 ].

We assign the older among them such work as making brooms with coconut leaflets. If they are young, we assign cleaning and gardening work. But we rotate the tasks. For the mentally retarded elders [sic], I ask them to take the firewood... I will give the vegetables to them and ask them to handover to the cook… They do such things as sweeping and removing cobwebs. They clear the dustbins. We ask them to help their fellow residents who are bedridden. (Manager, H11 unregistered)

In registered facilities, residents were more likely to receive support with personal care and medical or health care, even if this involved making clinical appointments outside the facility. In one facility some difficulties with personal support were noted: Pratik and Padma highlighted issues associated with assisting men and women to dress appropriately and with dignity.

There is a lady nurse. She takes me to the bathroom and gives me a bath and helps me dress. But she is a woman, and she does not know how to tie the veshti. Other men around will come to help at such times. (Male, 60 years, separated, H18 registered) That nurse gave me this petticoat without any saree. She is a nurse. Doesn’t she know that this petticoat is only suitable for a saree? (Female, age unknown widowed, H18 registered)

To support the nourishment of residents, most facilities had a set weekly menu. Residents in most facilities were satisfied with both the quantity and quality of the food that they received and Hitendra’s comment was typical of many “ The food is good. Even at home we will not get such food”. There were only two facilities in which residents indicated some dissatisfaction with the availability of food and drinks. In the first facility, this was mainly in relation to ‘snacks’ that had to be purchased. This was problematic for residents such as Varsha and Udit who had insufficient income.

Here they make coffee occasionally. It is black coffee. We don’t get it daily. They give biscuits rarely. If we give money, we can ge t. (Female, 75 years, widowed, H11 unregistered) I would like to eat some snacks like biscuits and omappodi. But I cannot get these. (Male, 80 years, separated, H11 unregistered)

In the second facility (H18, registered), the quality and range of food provided did not suit Padma’s food preferences or intolerances, she said:

Sour dosai. I don’t like it. If I eat this I will get leg pain. I don’t eat curd. I was advised not to eat sour things. They give just four idlies and they too will be sour. I will eat wheat dosai, but they will not give me any. (Female, age unknown, widowed, H18 registered)

In terms of providing shelter the cleanliness of the unregistered facilities varied, and this is contrasted in the following quotes from Maalia and Hitendra. Whereas Maalia had to clean faeces from the bathroom before she bathed, Hitendra was very satisfied with the cleanliness of the old age home in which he lived.

It [the bathroom] is befouled with urine and faeces. I clean it up with water and then, if I can tolerate it, I take a bath or wash clothes. I keep the clothes on my thigh and apply soap. What else can I do? Where can I go? (Female, 75 years, widowed, H11 unregistered) The rooms and the beds are neat. They change the bed sheet every month. They sweep daily. Bathroom and toilet are clean. (Male, 83 years, separated, H10 unregistered)

Bodily health is underpinned by opportunities to have good health (i.e. access to health and personal care), to be adequately nourished, and have adequate shelter. The Tamil Nadu Minimum Standards for old age homes specify the services that should be provided to residents. These include three meals (breakfast, lunch and dinner), two refreshment breaks (tea, coffee and snacks), and weekly visits by a medical officer. Furthermore, in-house staff should include a nurse, counsellor, cook and helpers (care attendants). While these services were more likely in registered homes there was still variability in terms of the quality of the services provided, an issue that is not addressed in the Minimum Standards. Overall, unregistered old age homes were less likely to provide opportunities for bodily health for residents: only one unregistered old age home in the study attempted to cater for the personal care needs of residents.

Bodily integrity

Bodily integrity refers to moving freely from place to place, secure against assault. The themes ‘abuse’ and ‘leaving the premises’ (i.e. freedom to move within and beyond the old age facility to the community) were incorporated in this family node.

Residents in H14 (registered) and H10 (unregistered) were permitted to leave the premises if they gave written notice and were accompanied by an attendant. Special occasions such as weddings and birthdays often warranted longer trips away from the facilities, and Joti noted that residents could be accompanied by their relatives. Avinesh also mentioned that residents were permitted to go to local places if they were accompanied by a member of staff:

If a resident wants to go out, like attending a wedding, the person who brought the resident here should come and take the resident. (Female, 84 years, widowed, H14 registered) The reason is that we are all old and if anything happens it will become difficult. If we request and if it is a nearby place, they will send us with an attendant. (Male, 78 years, married, H14 registered)

Only Dev mentioned being permitted to go out alone.

I can go and come alone. They allow for it. But one should go and come back properly. If we do anything unwanted, they will not allow. When they have confidence in us, they allow. (Male, 72 years, never married, H15 unregistered)

H11 (unregistered) particularly stood out in terms of denying residents freedom of movement. In this facility, most residents talked about their desire to leave and lamented the fact that they were not permitted to do so. Aanav’s reaction to a question about access to the local community was typical of residents in this facility, who expressed a desire to leave the old age home for good.

I am only thinking of when to leave this place. Even if I have to beg for food… I want to go somewhere. I don’t want to be here … If you raise the walls and put a tiger alongside, we cannot escape. Now I am with that tiger [the manager] here. (Male, 60 years, widowed, H11 unregistered) .

However, it was not only unregistered facilities that failed to support bodily integrity for residents. Padma noted that she was denied access to other areas of the old age home and said ‘ here we cannot move from one room to another’. She also cited an example of abuse by staff when she was initially left at the home, deserted by her family and distressed:

They first kept me on the staircase. As I kept on shouting, ‘Father Yesappa, save me!’ they took a plastic tea cup and gagged me. I fainted. Madam [the manager] went to her home. When I became conscious, I started chanting a prayer. The woman in the other room informed them. Madam came and ordered, ‘Don’t sing. Don’t pray. Shut up your mouth and lie down’. (Female, age unknown, widowed, H18 registered)

Deprivation of freedom of movement was not only a feature of old age homes in Indian society. A summary of Maalia’s life history demonstrates how actions assumed to improve her life (and that of her daughter) diminished her freedom and subjected her to unequal relations (Female, 75 years, widowed, H11 unregistered). Maalia spent the majority of her life in various facilities run by the same charitable organisation. At a young age, Maalia admitted herself to a children’s home to avoid abuse at home. She left briefly to marry but was abandoned by her husband when she was six months pregnant. Maalia left her daughter in a children’s home, moved into a women’s refuge and worked in the kitchen of the orphanage that she had been raised in. She borrowed ₹3,000 from the organization to arrange her daughter’s marriage (despite the organisational commitment to find suitable grooms for female residents, and meet all of the associated costs), and later required ₹27,000 for hospital fees to treat a burn sustained while working in the kitchen. After the first ‘loan’, the proprietors retained her salary (₹500 per month) for more than two decades. Eventually, Maalia’s sight deteriorated and she needed eye surgery. Unable to work to pay back another loan, Maalia requested to move to an old age home for older people that was located within the cluster of facilities. Thus, Maalia’s experience in the old age home was the result of a cumulative sequence of events. Deprivation of freedom was coupled with coercion through indebtedness to the cluster of charitable facilities. She suggested that death was preferable, “ I want to pass away as soon as possible. I should hurry to vacate this place .”

With the exception H11 (unregistered), most residents were permitted to leave facilities if they were accompanied by a relative or care assistant. However, access to the community was not equal among residents. Padma (H10, registered) noted that she was not permitted to move around the facility, or to leave, whereas other residents in the same facility were able to go out if they were accompanied. Across all facilities, residents who were unable to walk (e.g. confined to bed) were rarely provided with sufficient support to move around the facility, and were not given sufficient support to leave the facility (see section on play). The Tamil Nadu Minimum Standards for old age homes have given scant attention to this particular facet of dignity for residents. The only reference to leaving the facility is in relation to ‘outings’ in which it is stated that “ The inmates should be taken out on local outings like temple, fairs, plays and places of tourist interests at least once in 3 months” . This suggests that old age homes should offer planned activities, rather than facilitating the freedom of movement for residents.

Securing dignity through play, concerns providing residents with the opportunity to laugh and enjoy recreational activities. Several old age homes provided residents with newspapers, books and opportunities to watch the television. One old age home (H14, registered) which provided accommodation and care for Brahmins, appeared to have the most ‘occupied’ residents. This facility provided residents with a range of religiously oriented activities such as chanting mantras, prayers, reading spiritual books, watching religious series on television, and singing devotional songs. On the other hand, residents of H10 (unregistered) were mainly reliant on the television and newspapers for recreational activities, as Hitendra noted:

We will get newspapers at 10 am. We get four newspapers... We also get magazines... Back at home, we had to walk some distance to go to a library… They put the TV on by 9.30 am, but I don’t have the habit of watching TV. I have to read all the four newspapers. (Male, 83, separated, H10 unregistered)

There was evidence that some old age homes (H11 unregistered and H18 registered) did not provide any leisure or recreational activities. Instead, in H11 the residents who were able to work were given jobs. For example, Varsha (Female, 75 years, widowed) said “ I sit at that gate [entrance of the home] and my work is to open and close it” . Saksham (Male, 84 years, widowed) said that residents who were unable to work were “ Sitting quietly… Nothing else” . Despite paying fees, there were no leisure activities for residents in H18, and Pratik noted:

Breakfast will be over by 9.30 am. Then I just sit. At 1 o’clock there is lunch. From 1.30 to 4 pm, we get time to recline. What else do we need at this old age? But we have to pay for all these. (Male, 60+ years, separated, H18 registered)

One old age home deliberately denied residents the opportunities for recreation, as described by Rajiv:

There is a TV in that hall. If we go there to watch it, they will switch off and say that there is no power supply, but if we come back to the room and put on the fan, it will work. So, they don’t like us to watch TV… Sometimes we get parcel food that is wrapped with old newspapers. I would carefully unwrap it and keep it for reading. I used to read the same paper again and again. You know, what they would do? They would select the food parcel with dampened wrapper and give it to me so that I cannot read it . (Male, 63 years, never married, H16 unregistered)

In other registered and unregistered old age homes, access to leisure activities was inequitable for certain residents. For example, there were few opportunities to participate in recreational activities for residents who were nonambulatory or tetraplegic, such as Deepak and Rina.

I can read newspapers. But there is no one to hold the newspaper for me. So, I don’t have anything else to do. It is just sitting or lying. If I am seated, I would keep on sitting until somebody comes and puts me to bed. (Male, 68 years, widowed, H16 unregistered) I cannot get up. I cannot sit… My only problem is that I don’t have anybody else here to talk to. I am always lying down. If they put on the TV, I will listen to the news. I don’t go to the hall and watch TV. Who will take me there? (Female, age unknown, never married, H18 registered)

The narratives indicated considerable variation in the extent to which residents in old age homes are supported to ‘play’. Whereas some homes met the Tamil Nadu Minimum Standards which stated that “games should be played in the evening singing songs (devotional) and other past time activities may be designed depending on the age category and health status of the inmates” and that recreational facilities (e.g. books, indoor games, radio, and television) should be made available, others failed to provide any facilities, or denied residents access to these.

Registration of old age homes is mandatory in Tamil Nadu. However, many remain unregistered. To date, Minimum Standards are only enforced in homes that are registered and receiving funding, as these are the only homes that the State is aware of. The results show that there is considerable variation in the extent to which the four CHFC life, bodily integrity, bodily health and play are met for older people living in these facilities. Furthermore, variation is not necessarily between old age homes that are registered versus those that unregistered. In essence, there is evidence that Articles 3, 13, 25 and 24 of the UDHR are contravened in both registered and unregistered old age homes in India. This suggests that the State (the Government of India) is not meeting its obligations under Article 1 to recognize that ‘all human beings are born free and equal in dignity and rights’ and has failed to mandate and implement safeguards for all older residents. In registered homes, it appears that Standards are not being regulated through inspection, nor is support offered to help maintain quality where old age homes fall short.

Considering the CHFC ‘life’ and Article 25 of the UDHR, in long-term care facilities and other healthcare settings around the world, routine clinical decisions are made about whether to treat older people at the end of life, or to prevent a life from being prolonged. The idea ‘that a life is not worth living’ is used to support these decisions [ 29 ]. However, in this study, in one unregistered home untrained, non-clinical staff (e.g. members of a religious order) were making judgements and withholding both curative and palliative care to residents. Furthermore, in four of the ten facilities, there were no health or support staff to secure appropriate and timely health care for residents, to ensure that they did not die prematurely.

A majority of older people requiring health care and support at the end of life in India – either living in the community or in old age homes—do not have access to services [ 30 ]. This is reflected in India’s poor global ranking on the 2015 Quality of Death Index, that places it 67 th out of 80 countries [ 31 ]. In 2014, the World Health Assembly passed a resolution to strengthen palliative care as a component of comprehensive care throughout the life course and urged national governments to carry out actions to develop palliative care (WHA67.19). In this respect, the education, clinical training, and competence of staff in old age homes are pre-requisites to facilitate dignity [ 24 ]. The State needs to ensure that old age homes are adequately staffed to secure health care for residents, and that staff are sufficiently skilled to uphold the rights of residents to a good life (and death).

Turning to bodily health and the associated Article 25 (emphasising access to health care and personal support, food and shelter as the foundations of health, wellbeing and a dignified life), results indicated considerable variation between old age homes. In some facilities human rights were violated, with residents living in filthy conditions, while others were expected to help each other without any other provision for personal care or support within the facility. Elsewhere in the world, studies identifying risk factors for neglect have found that staff shortages, time pressures, staff turnover, and a high ratio of residents to staff contribute to care quality [ 32 , 33 ]. Thus, the dignity of care and support afforded to residents in some old age homes in India, suggests that the State needs to develop policies and strategies that regulate staffing ratios but also attend to quality of care and the maintenance of dignity.

Considering bodily integrity and Article 13: the right to freedom of movement, the study showed that most of the old age homes considered the safety of the residents and permitted them to leave accompanied by relatives or staff. However, residents are described as ‘inmates’ in policies (e.g. the Tamil Nadu Minimum Standards is published in English), programmes, and in research publications on old age homes emanating from India [ 34 , 35 ]. This is the language of incarceration. The term ‘inmates’ has been rejected for prisoners as it is derogatory, stigmatising, and dehumanising [ 36 ]. We contend that it is inappropriate to use ‘inmates’ to describe old age home residents for these same reasons, but also because it reinforces the notion that imprisonment, deprivation of liberty and segregation from the community is legitimate. While the deprivation of liberty of old age home residents is governed by legal codes in most European Countries [ 37 ], the decision to detain residents in India is arbitrary. The results showed that some residents were detained against their will, violating their human rights and undermining their capacity to live a dignified life.

The results of the study indicated that both bodily integrity (freedom of movement) and play are more frequently overlooked when residents have higher level needs, for example, are nonambulatory. Under these circumstances, some residents were denied their human rights with fewer (if any) opportunities to leave the premises or to engage in recreation. Elsewhere, studies have indicated that many care home residents spend a large proportion of the day inactive [ 38 ]. This is particularly salient for residents with dementia where there is evidence of restrictive practices, confinement and systematic breaches of human rights in care homes [ 39 ]. Severe physical or cognitive impairment is likely to incur greater demands on staff time to support freedom of movement and opportunities for leisure, when compared to the level of support required by residents who are less impaired. However, based on the concept of status dignity, it is the duty of the State (and its agents in old age homes) to uphold the human rights of all older people even if this requires additional staffing to ensure equity in securing CHFC for residents.

Limitations

The study was conducted in only one state in India, Tamil Nadu, and there may be variation in the quality and types of support provided in old age homes across India. However, we have no reason to believe that we would find a higher ‘standards’ of provision elsewhere. In 2019, the Ministry of Housing and Urban Affairs, Government of India developed a set of ‘model guidelines’ that are applicable to real estate developments intended for older residents who are ‘ willing and able to pay for accommodation services and facilities’ [ 40 ]. These model guidelines focus on services and physical aspects of the environment rather than the quality of care. The authors are fairly confident that the types of human rights violations observed in this study, would be found elsewhere in India (see also, [ 41 ]). As Tamil Nadu was the first state to introduce a set of Minimum Standards for old age homes in 2016, one may expect provision in this state to be ‘better’ than elsewhere as the standards have become embedded into practice over time.

This study was undertaken before the COVID-19 pandemic was declared a Public Health Emergency of International Concern by the World Health Organization in 2019. Globally, the pandemic has resulted in human rights violations for older people, especially in relation to the right to health and life [ 42 ]. Policy directives that were developed to protect the life of residents in care homes, have also impacted on bodily integrity and play [ 43 ]. Therefore, the experiences of residents in old age homes in Tamil Nadu are unlikely to have improved over the last two years. As old age homes are largely unregulated it is unlikely that the full extent of the impact of the COVID-19 pandemic on the human rights of older residents in India will be established [ 44 ].

Conclusions

Residents in old age homes can function effectively in the range of areas that are fundamental to a fully dignified human when policy decisions and the legal apparatus of the State provide them with the opportunities to do so. The concepts of status dignity, CHFC, and human rights have been used to describe the relationship of residents in old age homes to the State and the agents of the State (staff in old age homes). The results suggest that a new legislative framework is required to ensure that all old age homes are accountable to the State, regardless of the source of funding. We recommend that Minimum Standards include clear definitions regarding the expectations for quality of care and dignity in care, that meet the basic needs of older people (shelter, clothing and food) but also provide health care, personal support, and opportunities for leisure, socializing and access to the community. The legislative framework should also stipulate staff ratios, staff training and raising awareness of human rights. Standards should be regulated and support offered to help maintain quality. The study has highlighted incidents where human rights have been violated, but these illustrative examples have been juxtaposed with good practice, where residents’ human rights and dignity were protected. The research has demonstrated that it is possible to protect the dignity of residents of old age homes, but highlights areas where the Government of India and/or State Governments have a role to play in strengthening and developing old age home policies and strategies to protect older residents.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available as restrictions apply to the availability of these data (intention of data analysis included in participant information forms) and sensitivity (i.e. human data) but are available from the corresponding author on reasonable request. Data are located in a controlled access repository at the University of Auckland.

Abbreviations

Central Human Functional Capabilities

Universal Declaration of Human Rights

Agarwal A, Lubet A, Mitgang E, Mohanty S, Bloom DE. Population aging in India: facts, issues, and options. In: Poot J, Roskruge M, editors. Population change and impacts in Asia and the Pacific. Singapore: Springer Singapore; 2020. p. 289–311.

Chapter   Google Scholar  

Ugargol AP, Bailey A. Family caregiving for older adults: gendered roles and caregiver burden in emigrant households of Kerala. India Asian Popul Stud. 2018;14(2):194–210. https://doi.org/10.1080/17441730.2017.1412593 .

Article   Google Scholar  

Lau RS, Johnson S, Kamalanabhan TJ. Healthy life expectancy in the context of population health and ageing in India. Asia Pac J Public Health. 2010;24(1):195–207. https://doi.org/10.1177/101053951037666 .

Article   PubMed   Google Scholar  

Burholt V, Maruthakutti R, Maddock CA. A cultural framework of care and social protection for older people in India. GeroPsych. 2020:1–3 https://doi.org/10.1024/1662-9647/a000251

Burholt V, Dobbs C, Victor C. Social support networks of older migrants in England and Wales: the role of collectivist culture. Ageing Soc. 2017, 38(7):1453–1477. https://doi.org/10.1017/S0144686X17000034

Issac TG, Ramesh A, Reddy SS, Sivakumar PT, Kumar CN, Math SB. Maintenance and Welfare of Parents and Senior Citizens Act 2007: a critical appraisal. Indian J Psychol Med. 2021, 43(5_suppl):S107-S112. https://doi.org/10.1177/02537176211043932

Kalavar JM, Jamuna D. Aging of Indian women in India: the experience of older women in formal care homes. J Women Aging. 2011;23(3):203–15.

Government of India. Atal Vayo Abhyuday Yojana. Delhi: Ministry of Social Justice and Empowerment Government of India; 2021.

Google Scholar  

Government of India. State/UT-wise list of NGOs/VOs & projects funded under the Scheme of Integrated Programme for Senior Citizens during last three years 2016-17 to 2018-19. Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.

Johnson S, Madan S, Vo J, Pottkett A. A qualitative analysis of the emergence of long term care (old age home) sector for seniors care in India: urgent call for quality and care standards. Ageing Int. 2018;43(3):356–65. https://doi.org/10.1007/s12126-017-9302-x .

The Government of Tamil Nadu. Fixing of Minimum Standards / Essential Standards to be Maintained in Old Age Homes run by Non-Governmental Organization (revised). Tamil Nadu: Social Welfare and Nutritious Meal Programme Department, The Government of Tamil Nadu; 2016.

United Nations. 1948. Universal Declaration of Human Rights. Paris: United Nations.

Giselsson K. Rethinking dignity. Human Rights Rev. 2018;19(3):331–48. https://doi.org/10.1007/s12142-018-0501-y .

Brännmark J. Respect for persons in bioethics: towards a human rights-based account. Hum Rights Rev. 2017;18(2):171–87. https://doi.org/10.1007/s12142-017-0450-x .

Kittay EF. At the margins of moral personhood. Ethics. 2005;116(1):100–31. https://doi.org/10.1086/454366 .

Haack S. Christian explorations in the concept of human dignity. Dignitas. 2012;29(3):4-13.

Habermas J. The concept of human dignity and the realistic utopia of human rights. In: Coradetti C, editor. Philosophical dimensions of himan rights some contemporary views. Dordecht, The Netherlands: Springer; 2012. p. 66–79.

Beitz CR. The idea of human rights. Oxford: Oxford University Press; 2011.

Valentini L. Dignity and human rights: a reconceptualisation. Oxford J Leg Stud. 2017;37(4):862–85. https://doi.org/10.1093/ojls/gqx011 .

Griffin-Heslin VL. An analysis of the concept dignity. Accid Emerg Nurs. 2005;13(4):251–7. https://doi.org/10.1016/j.aaen.2005.09.003 .

Nussbaum M. Capabilities and human rights. Fordham Law Rev. 1997;66:273.

Nussbaum M. Frontiers of justice: disability, nationality, species membership. Cambridge, MA: Harvard University Press; 2006.

Nussbaum M. Women and human development: the capabilities approach. Cambridge: Cambridge University Press; 2000.

Book   Google Scholar  

Franco H, Caldeira S, Nunes L. Dignity in nursing: a synthesis review of concept analysis studies. Nurs Ethics. 2020:0969733020961822 https://doi.org/10.1177/0969733020961822

Kadivar M, Mardani-Hamooleh M, Kouhnavard M. Concept analysis of human dignity in patient care: Rodgers’ evolutionary approach. J Med Ethics Hist Med. 2018;11(4):4.

PubMed   PubMed Central   Google Scholar  

Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Huberman AM, Miles MBT, editors. The qualitative researcher’s companion. Thousand Oaks, California: Sage Publications Inc; 2002. p. 305–29.

Hunter A, Lusardi P, Zucker D, Jacelon C, Chandler G. Making meaning: the creative component in qualitative research. Qual Health Res. 2002;12(3):388–98.

Sinha C, Kumar M. Conceal or Not? Management of dehumanized work identity among lower caste domestic workers and non-domestic scavenging workers. South Asian J Hum Resour Manage. 2018;5(2):173–93. https://doi.org/10.1177/2322093718787097 .

Farsides B, Dunlop RJ. Is there such a thing as a life not worth living? Br Med J (Clin Res Ed). 2001;322(7300):1481–3. https://doi.org/10.1136/bmj.322.7300.1481 .

Article   CAS   Google Scholar  

Chan N, Menon S. Goh Cr: Policies on palliative care for older people in Asia. In: Van den Block L, Albers G, Perieira SM, Onwuteaka-Philipsen B, Pasman R, Deliens L, editors. Palliative care for older poeple: a public health perspective. Oxford, UK: Oxford Univesrity Press; 2015. p. 60–8.

Economist Intelligence Unit. The 2015 Quality of Death Index: ranking palliative care across the world. London: Economist Intelligence Unit; 2015.

Goergen T. A multi-method study on elder abuse and neglect in nursing homes. JAdult Prot. 2004;6(3):15–25. https://doi.org/10.1108/14668203200400016 .

Yon Y, Ramiro-Gonzalez M, Mikton CR, Huber M, Sethi D. The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. Eur J Public Health. 2019;29(1):58–67. https://doi.org/10.1093/eurpub/cky093 .

Baranwal A, Mishra S. The condition of elderly inmates living in the old age homes of mumbai: an exploratory study. Indian J Gerontol. 2021;35(3):390–406.

Ulsah H, Indu PV, Anilkumar TV. prevalence of depression among the inmates of old age homes in Thiruvananthapuram, Kerala: a cross-sectional survey. Indian J Psychiat. 2022;64(Suppl 3):S565-S565. https://doi.org/10.4103/0019-5545.341631

Cox A. The language of incarceration. Incarceration. 2020;1(1) https://doi.org/10.1177/2632666320940859

Lloyd-Sherlock P, Penhale B, Redondo N. The admission of older people into residential care homes in Argentina: coercion and human rights abuse. Gerontologist. 2019;59(4):610–8. https://doi.org/10.1093/geront/gny014 .

Palese A, Del Favero C, Antonio Zuttion R, Ferrario B, Ponta S, Grassetti L, Ambrosi E. Inactive residents living in nursing homes and associated predictors: findings from a regional-based, Italian retrospective study. J Am Med Dir Assoc. 2016;17(12):1099–105. https://doi.org/10.1016/j.jamda.2016.07.010 .

Steele L, Swaffer K, Carr R, Phillipson L, Fleming R. Ending confinement and segregation: barriers to realising human rights in the everyday lives of people living with dementia in residential aged care. Aust J Hum Rights. 2020;26(2):308–28. https://doi.org/10.1080/1323238X.2020.1773671 .

Government of India. Model guidelines for development and regulation of retirement homes. Delhi: Ministry of Housing and Urban Affairs. Government of India; 2019.

Harbishettar V, Gowda M, Tenagi S, Chandra M. Regulation of long-term care homes for older adults in India. Indian J Psychol Med. 2021;43(5_suppl):S88–96. https://doi.org/10.1177/02537176211021785 .

Article   PubMed   PubMed Central   Google Scholar  

United Nations. 2020. Policy brief: the impact of Covid-19 on older persons. United Nations. Available from: https://unsdg.un.org/sites/default/files/2020-05/Policy-Brief-The-Impact-of-COVID-19-on-Older-Persons.pdf .

Green CEDA, Tinker A, Manthorpe J. Human rights and care homes for older people: a typology of approaches from academic literature as a starting point for activist scholarship in human rights and institutional care. Int J Hum Rights. 2021:1–23. https://doi.org/10.1080/13642987.2021.1961753

Rajagopalan J, Hurzuk S, Arshad F, Raja P, Alladi S. The COVID-19 long-term care situation in India. London: International Long Term Care Policy Network, Care Policy and Evaluation Centre, London School of Economics; 2020.

Download references

Acknowledgements

The authors wish to thank Dr R Anitha, Dr S Ponni, Dr R Hemalakshmi for contributions made to the research project. The source of maps for Fig. 1 is https://d-maps.com/carte.php?num_car=24853&lang=en

The cost of Open Access publication was supported by Health and Care Research Wales, Senior Research Leader fund.

Author information

Authors and affiliations.

School of Nursing/School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Room 235B, Level 2, Building 505, 85 Park Road, Grafton, The University of Auckland Private Bag, 92019, Auckland, New Zealand

Vanessa Burholt

Centre for Innovative Ageing, Faculty of Medicine, Health and Life Science, Swansea University, Swansea, Wales, UK

Vanessa Burholt, E. Zoe Shoemark & Carol Maddock

Department of Sociology, Manonmanian Sundaranar University, Tirunelveli, Tamil Nadu, India

R. Maruthakutti

Anugraha, Swabhiman Parisar, Kasturba Nagar, Shahdara, Delhi, India

Aabha Chaudhary

You can also search for this author in PubMed   Google Scholar

Contributions

VB: Conceptualization, Methodology, Project administration, Funding acquisition, Data curation, Formal analysis, Writing- Original draft preparation. EZS: Formal analysis, Writing- Reviewing and Editing. RM: Supervision, Writing- Reviewing and Editing. CAM: Writing- Reviewing and Editing. AC: Writing- Reviewing and Editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Vanessa Burholt .

Ethics declarations

Ethics approval and consent to participate.

Ethical approval was granted by the College of Human and Health Sciences, Human Science Ethics Sub-Panel, Swansea University on the 20 th December 2017. Research was performed in accordance with the Declaration of Helsinki. Informed consent was sought from each participant prior to interview. All participants who were able (managers and residents) signed a consent form. Consent forms were read aloud to residents who were illiterate: residents who agreed to take part provided a thumb print rather than a signature on the consent forms.

Consent for publication

Participant information forms indicated that de-identified data would be used in publications: participants consent forms indicated that they understood this information.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Burholt, V., Shoemark, E.Z., Maruthakutti, R. et al. Dignity and the provision of care and support in ‘old age homes’ in Tamil Nadu, India: a qualitative study. BMC Geriatr 22 , 577 (2022). https://doi.org/10.1186/s12877-022-03272-4

Download citation

Received : 09 January 2022

Accepted : 30 June 2022

Published : 14 July 2022

DOI : https://doi.org/10.1186/s12877-022-03272-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Residential care
• Cross-sectional studies
• Long-term care
• Leisure activities
• Reference standards
• Delivery of health care

BMC Geriatrics

ISSN: 1471-2318

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

SENIOR CITIZENS AND OLD AGE HOMES: A STUDY OF PUSHING FACTORS AND LEVEL OF SATISFACTION IN OLD AGE HOMES OF KASKI DISTRICT A Dissertation for the Fulfillment of Requirements for the Master's Degree of Arts in Sociology Submitted By

Related Papers

Amrita Limbu

Nepal is in the phase of age structure transition with a large proportion of young working-age population. This phase is also commonly known as the phase of ‘youth bulge’, ‘demographic dividends/bonuses’ or ‘window of opportunity’. This present phase and the consistent increment in the share of older-age population over the years signifies that the elderly population will continue to increase in the years to come. Amidst a limited formal support system for senior citizens and a weakening informal support system by family, relatives and society, the situation of senior citizens is destined to become a severe problem, if it is not addressed in time through effective policies. Existing policies in Nepal have incorporated the issues of the senior citizens and a general overview suggests that the policies are in tune with age structure transition. Yet, a deeper analysis of the policies reveal that they do not fully recognize the outcome of the transition. Thus, it is the objective of this policy study to highlight the importance of the transition and analyse the status of the aged population in light of it.The policy questions focuses on understanding the trend of age structure transition of the Nepali population and analysing its implications on the older age group. This policy study proposes enhancement of the informal support system as a policy alternative to address the challenges of the senior citizens in relation to the age structure transition.

Patan Pragya

Gokarna Aryal

Elderly citizens are the sources of knowledge, experiences and collections of different ideas in every society or nation. If we use their ability, long experiences and their conscience, our society or nation will be benefitted to reform national development and prosperity. Ageing population is a global phenomenon and the number is rapidly increasing in developing countries as compared to developed countries. The government of Nepal has declared that people with 60 years or more are elderly citizens. The growth rate of the elderly population is faster than that of the total population in Nepal. The observation shows that the proportion of elderly population is high in mountain and hilly regions as compared to Terai. However, it is noted that female elderly population is the highest among three ecological regions. The growing numbers of ageing population is a major concern in most of the developing countries like Nepal. The social, economic and demographic impacts of ageing population...

Today Publication

Sathyamurthi Karibeeran

The 21st century is generally being considered as the „century of the elderly‟ and population ageing is one of the most important global trends of the period. The problems arising out of it have varied implications for developing and developed countries. In India, as a result of the change in the age composition of the population over time, there has been a progressive increase in both the number and proportion of aged people. The proportion of the population aged 60 years or more has been increasing consistently over the last century, particularly after 1951. According to official population projections, the number of elderly persons will rise to approximately 140 million by 2021. As a development concern, the projected increase of the elderly population in India may pose mounting pressures on various socio-economic fronts. Also, elderly population faces a myriad of challenges - social, physical, psychological and economic which are unique to them. It warrants greater attention to ageing-related issues and for economic and social policies to become elderly friendly. To create opportunities for positive aging, there is a need for understanding elderly persons on various aspects and to initiate policy and programme debates about ageing in India. In this context, a national conference on „Emerging Challenges of Elderly: Implementation of Programme and Policy Making‟ was organized by the Department of Social Work (Aided), Madras School of Social Work, Chennai in collaboration with ASTRA- Social Work Forum of the Department. The conference was sponsored by the National Institute of Social Defence (NISD), Ministry of Social Justice and Empowerment, Government of India. This edited volume of the book, published as the outcome of the conference, contains empirical papers, case studies and conceptual papers. These are included in five different domains namely Ageing: Issues and Challenges, Ill Health and Well Being of Elderly, Aging in Institutions, Social Policies and Programmes for Elderly, and Positive Ageing: Outlook and Approaches. The book will help to identify the emerging areas of key concern in elderly care and protection. It has high relevance to government departments, policy planners, educationists, researchers, social workers, parents, children and especially for those elderly who fight for their rights and privileges.

Ageing Research Foundation of India

Ilango Ponnuswami

Dhaulagiri Journal of Sociology and Anthropology

Pradeep Acharya

During the study information about the existing state of the seven elderly homes around Kathmandu, Bhaktapur and Kavrepalanchowk district was collected during October-November, 2007 on behalf of Geront World Nepal, Kathmandu. An attempt has been made to come across physical, economic status of different homes, their problems and challenges as well as the personal feelings of senior citizens living in there. The survey has tried to clarify the problems and challenges of elderly homes and the elders. Effort has been provided to see whether the elderly homes are helpful in providing proper care and support for the senior citizens. An analysis of four data sets (interview of 61 senior citizens out of total 122 in 7 homes, interview of all seven home&#39;s authorized persons, published/unpublished profile of the homes, and interview of key informants) as well as field observation shows significant positive effects of homes on the life of senior citizen. The survey results indicate that i...

yogesh mahor

Human development has remained one of the major concerns for social planners and policy makers over time. While improvements in human development aspects like health, decline in fertility, and an increase in longevity are desirable, the projected increase of the elderly population over the next few decades is emerging as serious development concern that warrants priority. The Paper is a first-of-its-kind attempt by Poverty Monitoring and Policy Support Unit (PMPSU) of Madhya Pradesh State Planning Commission to outline the situation analysis and major Issues that affect the elderly and review of existing gapsin policy and practice. This Paper is a compilation of various reviews, factsheets and research articles to highlight the contrast of the happy picture of increased longevity, and the prospect of long years of hopelessness, bereft of family andsociety. Finally, it provides suggestive measures so that the 'golden age' does not become synonymous with 'destitution' for about two-thirds of the elderly population in the country.

Publisher ijmra.us UGC Approved

This article helps students to evaluate their own attitudes oward people over 65. It begins with the students taking an pinion survey on the characteristics of older people and oncludes with the opportunity for students to learn the ctual statistics and summarize the "Fundamental Hurdels f ld Senior Citizens Of India"

Hom Nath Chalise

Sanevata Devi

Aging is an inevitable part of life and brings its own set of problems and challenges which may not be unique to the senior citizens but affect their life the most. In the Indian society, the family members used to be responsible for taking care of the senior citizens of the family and to help them get over the wide range of problems that they may face, ranging from psychological to physical ailments. But today’s changing family structure and the prevalence of nuclear families have exposed the elderly members of the family to physical, psychological and financial insecurity. Subsequently many laws have also been enacted and rights have been provided in order to protect the senior citizens from any possible harm that may be inflicted on them by their family members or otherwise. This study paper provides insights into the problems faced by senior citizens and their rights

Journal of Geriatric Care and Research (JGCR)

RELATED PAPERS

Zeszyty Naukowe Uniwersytetu Przyrodniczo-Humanistycznego w Siedlcach. Seria: Administracja i Zarządzanie

Jevgenijs Kurovs

El pasado histórico de Castilla y León

Mª Concepción Marcos Del Olmo

AJP: Regulatory, Integrative and Comparative Physiology

Yvette Tache

Un curriculum pour un accueil de qualité de la petite enfance

Pierre Moisset

Scientific Journal of Kurdistan University of Medical Sciences

Elham Maraghi

Lynne Nemeth

Primary : Jurnal Keilmuan dan Kependidikan Dasar

Citra Utami

Cahiers du Centre de Linguistique et des Sciences du Langage

Patrick Seriot

Maikel Peppelenbosch

International Journal of Computer Applications in Technology

heiko thimm

Manna Satama

Archaeologia Lituana

Ludvig Papmehl-Dufay

Le Centre pour la Communication Scientifique Directe - HAL - Université Paris Descartes

Ayla Carvalho

Analytica Chimica Acta

Saad Hassan

Jurnal IMPACT: Implementation and Action

nurul inayah

International Journal of Computer Applications

Sunita Soni

Revista Ibero-Americana de Estudos em Educação

ELADIO HEREDERO

The Journal of Infectious Diseases

GDTH D2021C NGUYEN QUY HUONG

Clinical Drug Investigation

Engy Mogahed

GEORGE PSILLAS

International Journal of Veterinary Science and Research

Information Fusion

Tamás Bécsi

qq空间加密相册如何查看破解相册访问密码权限/如何去破解qq空间访问权限?破解QQ空间访问权限

破解QQ空间访问权限 查看相册密码

Seminar Keinsinyuran Program Studi Program Profesi Insinyur

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

Advertisement

Supported by

O.J. Simpson, Football Star Whose Trial Riveted the Nation, Dies at 76

He ran to football fame and made fortunes in movies. His trial for the murder of his former wife and her friend became an inflection point on race in America.

• Share full article

By Robert D. McFadden

O.J. Simpson, who ran to fame on the football field, made fortunes as an all-American in movies, television and advertising, and was acquitted of killing his former wife and her friend in a 1995 trial in Los Angeles that mesmerized the nation, died on Wednesday at his home in Las Vegas. He was 76.

The cause was cancer, his family announced on social media.

The jury in the murder trial cleared him, but the case, which had held up a cracked mirror to Black and white America, changed the trajectory of his life. In 1997, a civil suit by the victims’ families found him liable for the deaths of Nicole Brown Simpson and Ronald L. Goldman, and ordered him to pay $33.5 million in damages. He paid little of the debt, moved to Florida and struggled to remake his life, raise his children and stay out of trouble.

In 2006, he sold a book manuscript, titled “If I Did It,” and a prospective TV interview, giving a “hypothetical” account of murders he had always denied committing. A public outcry ended both projects, but Mr. Goldman’s family secured the book rights, added material imputing guilt to Mr. Simpson and had it published.

In 2007, he was arrested after he and other men invaded a Las Vegas hotel room of some sports memorabilia dealers and took a trove of collectibles. He claimed that the items had been stolen from him, but a jury in 2008 found him guilty of 12 charges, including armed robbery and kidnapping, after a trial that drew only a smattering of reporters and spectators. He was sentenced to nine to 33 years in a Nevada state prison. He served the minimum term and was released in 2017.

Over the years, the story of O.J. Simpson generated a tide of tell-all books, movies, studies and debate over questions of justice, race relations and celebrity in a nation that adores its heroes, especially those cast in rags-to-riches stereotypes, but that has never been comfortable with its deeper contradictions.

There were many in the Simpson saga. Yellowing old newspaper clippings yield the earliest portraits of a postwar child of poverty afflicted with rickets and forced to wear steel braces on his spindly legs, of a hardscrabble life in a bleak housing project and of hanging with teenage gangs in the tough back streets of San Francisco, where he learned to run.

“Running, man, that’s what I do,” he said in 1975, when he was one of America’s best-known and highest-paid football players, the Buffalo Bills’ electrifying, swivel-hipped ball carrier, known universally as the Juice. “All my life I’ve been a runner.”

And so he had — running to daylight on the gridiron of the University of Southern California and in the roaring stadiums of the National Football League for 11 years; running for Hollywood movie moguls, for Madison Avenue image-makers and for television networks; running to pinnacles of success in sports and entertainment.

Along the way, he broke college and professional records, won the Heisman Trophy and was enshrined in pro football’s Hall of Fame. He appeared in dozens of movies and memorable commercials for Hertz and other clients; was a sports analyst for ABC and NBC; acquired homes, cars and a radiant family; and became an American idol — a handsome warrior with the gentle eyes and soft voice of a nice guy. And he played golf.

It was the good life, on the surface. But there was a deeper, more troubled reality — about an infant daughter drowning in the family pool and a divorce from his high school sweetheart; about his stormy marriage to a stunning young waitress and her frequent calls to the police when he beat her; about the jealous rages of a frustrated man.

Calls to the Police

The abuse left Nicole Simpson bruised and terrified on scores of occasions, but the police rarely took substantive action. After one call to the police on New Year’s Day, 1989, officers found her badly beaten and half-naked, hiding in the bushes outside their home. “He’s going to kill me!” she sobbed. Mr. Simpson was arrested and convicted of spousal abuse, but was let off with a fine and probation.

The couple divorced in 1992, but confrontations continued. On Oct. 25, 1993, Ms. Simpson called the police again. “He’s back,” she told a 911 operator, and officers once more intervened.

Then it happened. On June 12, 1994, Ms. Simpson, 35, and Mr. Goldman, 25, were attacked outside her condominium in the Brentwood section of Los Angeles, not far from Mr. Simpson’s estate. She was nearly decapitated, and Mr. Goldman was slashed to death.

The knife was never found, but the police discovered a bloody glove at the scene and abundant hair, blood and fiber clues. Aware of Mr. Simpson’s earlier abuse and her calls for help, investigators believed from the start that Mr. Simpson, 46, was the killer. They found blood on his car and, in his home, a bloody glove that matched the one picked up near the bodies. There was never any other suspect.

Five days later, after Mr. Simpson had attended Nicole’s funeral with their two children, he was charged with the murders, but fled in his white Ford Bronco. With his old friend and teammate Al Cowlings at the wheel and the fugitive in the back holding a gun to his head and threatening suicide, the Bronco led a fleet of patrol cars and news helicopters on a slow 60-mile televised chase over the Southern California freeways.

Networks pre-empted prime-time programming for the spectacle, some of it captured by news cameras in helicopters, and a nationwide audience of 95 million people watched for hours. Overpasses and roadsides were crowded with spectators. The police closed highways and motorists pulled over to watch, some waving and cheering at the passing Bronco, which was not stopped. Mr. Simpson finally returned home and was taken into custody.

The ensuing trial lasted nine months, from January to early October 1995, and captivated the nation with its lurid accounts of the murders and the tactics and strategy of prosecutors and of a defense that included the “dream team” of Johnnie L. Cochran Jr. , F. Lee Bailey , Alan M. Dershowitz, Barry Scheck and Robert L. Shapiro.

The prosecution, led by Marcia Clark and Christopher A. Darden, had what seemed to be overwhelming evidence: tests showing that blood, shoe prints, hair strands, shirt fibers, carpet threads and other items found at the murder scene had come from Mr. Simpson or his home, and DNA tests showing that the bloody glove found at Mr. Simpson’s home matched the one left at the crime scene. Prosecutors also had a list of 62 incidents of abusive behavior by Mr. Simpson against his wife.

But as the trial unfolded before Judge Lance Ito and a 12-member jury that included 10 Black people, it became apparent that the police inquiry had been flawed. Photo evidence had been lost or mislabeled; DNA had been collected and stored improperly, raising a possibility that it was tainted. And Detective Mark Fuhrman, a key witness, admitted that he had entered the Simpson home and found the matching glove and other crucial evidence — all without a search warrant.

‘If the Glove Don’t Fit’

The defense argued, but never proved, that Mr. Fuhrman planted the second glove. More damaging, however, was its attack on his history of racist remarks. Mr. Fuhrman swore that he had not used racist language for a decade. But four witnesses and a taped radio interview played for the jury contradicted him and undermined his credibility. (After the trial, Mr. Fuhrman pleaded no contest to a perjury charge. He was the only person convicted in the case.)

In what was seen as the crucial blunder of the trial, the prosecution asked Mr. Simpson, who was not called to testify, to try on the gloves. He struggled to do so. They were apparently too small.

“If the glove don’t fit, you must acquit,” Mr. Cochran told the jury later.

In the end, it was the defense that had the overwhelming case, with many grounds for reasonable doubt, the standard for acquittal. But it wanted more. It portrayed the Los Angeles police as racist, charged that a Black man was being railroaded, and urged the jury to think beyond guilt or innocence and send a message to a racist society.

On the day of the verdict, autograph hounds, T-shirt vendors, street preachers and paparazzi engulfed the courthouse steps. After what some news media outlets had called “The Trial of the Century,” producing 126 witnesses, 1,105 items of evidence and 45,000 pages of transcripts, the jury — sequestered for 266 days, longer than any in California history — deliberated for only three hours.

Much of America came to a standstill. In homes, offices, airports and malls, people paused to watch. Even President Bill Clinton left the Oval Office to join his secretaries. In court, cries of “Yes!” and “Oh, no!” were echoed across the nation as the verdict left many Black people jubilant and many white people aghast.

In the aftermath, Mr. Simpson and the case became the grist for television specials, films and more than 30 books, many by participants who made millions. Mr. Simpson, with Lawrence Schiller, produced “I Want to Tell You,” a thin mosaic volume of letters, photographs and self-justifying commentary that sold hundreds of thousands of copies and earned Mr. Simpson more than $1 million.

He was released after 474 days in custody, but his ordeal was hardly over. Much of the case was resurrected for the civil suit by the Goldman and Brown families. A predominantly white jury with a looser standard of proof held Mr. Simpson culpable and awarded the families $33.5 million in damages. The civil case, which excluded racial issues as inflammatory and speculative, was a vindication of sorts for the families and a blow to Mr. Simpson, who insisted that he had no chance of ever paying the damages.

Mr. Simpson had spent large sums for his criminal defense. Records submitted in the murder trial showed his net worth at about $11 million, and people with knowledge of the case said he had only $3.5 million afterward. A 1999 auction of his Heisman Trophy and other memorabilia netted about $500,000, which went to the plaintiffs. But court records show he paid little of the balance that was owed.

He regained custody of the children he had with Ms. Simpson, and in 2000 he moved to Florida, bought a home south of Miami and settled into a quiet life, playing golf and living on pensions from the N.F.L., the Screen Actors Guild and other sources, about $400,000 a year. Florida laws protect a home and pension income from seizure to satisfy court judgments.

The glamour and lucrative contracts were gone, but Mr. Simpson sent his two children to prep school and college. He was seen in restaurants and malls, where he readily obliged requests for autographs. He was fined once for powerboat speeding in a manatee zone, and once for pirating cable television signals.

In 2006, as the debt to the murder victims’ families grew with interest to $38 million, he was sued by Fred Goldman, the father of Ronald Goldman, who contended that his book and television deal for “If I Did It” had advanced him $1 million and that it had been structured to cheat the family of the damages owed.

The projects were scrapped by News Corporation, parent of the publisher HarperCollins and the Fox Television Network, and a corporation spokesman said Mr. Simpson was not expected to repay an $800,000 advance. The Goldman family secured the book rights from a trustee after a bankruptcy court proceeding and had it published in 2007 under the title “If I Did It: Confessions of the Killer.” On the book’s cover, the “If” appeared in tiny type, and the “I Did It” in large red letters.

Another Trial, and Prison

After years in which it seemed he had been convicted in the court of public opinion, Mr. Simpson in 2008 again faced a jury. This time he was accused of raiding a Las Vegas hotel room in 2007 with five other men, most of them convicted criminals and two armed with guns, to steal a trove of sports memorabilia from a pair of collectible dealers.

Mr. Simpson claimed that he was only trying to retrieve items stolen from him, including eight footballs, two plaques and a photo of him with the F.B.I. director J. Edgar Hoover, and that he had not known about any guns. But four men, who had been arrested with him and pleaded guilty, testified against him, two saying they had carried guns at his request. Prosecutors also played hours of tapes secretly recorded by a co-conspirator detailing the planning and execution of the crime.

On Oct. 3 — 13 years to the day after his acquittal in Los Angeles — a jury of nine women and three men found him guilty of armed robbery, kidnapping, assault, conspiracy, coercion and other charges. After Mr. Simpson was sentenced to a minimum of nine years in prison, his lawyer vowed to appeal, noting that none of the jurors were Black and questioning whether they could be fair to Mr. Simpson after what had happened years earlier. But jurors said the double-murder case was never mentioned in deliberations.

In 2013, the Nevada Parole Board, citing his positive conduct in prison and participation in inmate programs, granted Mr. Simpson parole on several charges related to his robbery conviction. But the board left other verdicts in place. His bid for a new trial was rejected by a Nevada judge, and legal experts said that appeals were unlikely to succeed. He remained in custody until Oct. 1, 2017, when the parole board unanimously granted him parole when he became eligible.

Certain conditions of Mr. Simpson’s parole — travel restrictions, no contacts with co-defendants in the robbery case and no drinking to excess — remained until 2021, when they were lifted, making him a completely free man.

Questions about his guilt or innocence in the murders of his former wife and Mr. Goldman never went away. In May 2008, Mike Gilbert, a memorabilia dealer and former crony, said in a book that Mr. Simpson, high on marijuana, had admitted the killings to him after the trial. Mr. Gilbert quoted Mr. Simpson as saying that he had carried no knife but that he had used one that Ms. Simpson had in her hand when she opened the door. He also said that Mr. Simpson had stopped taking arthritis medicine to let his hands swell so that they would not fit the gloves in court. Mr. Simpson’s lawyer Yale L. Galanter denied Mr. Gilbert’s claims, calling him delusional.

In 2016, more than 20 years after his murder trial, the story of O.J. Simpson was told twice more for endlessly fascinated mass audiences on television. “The People v. O.J. Simpson,” Ryan Murphy’s installment in the “American Crime Story” anthology on FX, focused on the trial itself and on the constellation of characters brought together by the defendant (played by Cuba Gooding Jr.). “O.J.: Made in America,” a five-part, nearly eight-hour installment in ESPN’s “30 for 30” documentary series (it was also released in theaters), detailed the trial but extended the narrative to include a biography of Mr. Simpson and an examination of race, fame, sports and Los Angeles over the previous half-century.

A.O. Scott, in a commentary in The New York Times, called “The People v. O.J. Simpson” a “tightly packed, almost indecently entertaining piece of pop realism, a Dreiser novel infused with the spirit of Tom Wolfe” and said “O.J.: Made in America” had “the grandeur and authority of the best long-form fiction.”

In Leg Braces as a Child

Orenthal James Simpson was born in San Francisco on July 9, 1947, one of four children of James and Eunice (Durden) Simpson. As an infant afflicted with the calcium deficiency rickets, he wore leg braces for several years but outgrew his disability. His father, a janitor and cook, left the family when the child was 4, and his mother, a hospital nurse’s aide, raised the children in a housing project in the tough Potrero Hill district.

As a teenager, Mr. Simpson, who hated the name Orenthal and called himself O.J., ran with street gangs. But at 15 he was introduced by a friend to Willie Mays, the renowned San Francisco Giants outfielder. The encounter was inspirational and turned his life around, Mr. Simpson recalled. He joined the Galileo High School football team and won All-City honors in his senior year.

In 1967, Mr. Simpson married his high school sweetheart, Marguerite Whitley. The couple had three children, Arnelle, Jason and Aaren. Shortly after their divorce in 1979, Aaren, 23 months old, fell into a swimming pool at home and died a week later.

Mr. Simpson married Nicole Brown in 1985; the couple had a daughter, Sydney, and a son, Justin. He is survived by Arnelle, Jason, Sydney and Justin Simpson and three grandchildren, his lawyer Malcolm P. LaVergne said.

After being released from prison in Nevada in 2017, Mr. Simpson moved into the Las Vegas country club home of a wealthy friend, James Barnett, for what he assumed would be a temporary stay. But he found himself enjoying the local golf scene and making friends, sometimes with people who introduced themselves to him at restaurants, Mr. LaVergne said. Mr. Simpson decided to remain in Las Vegas full time. At his death, he lived right on the course of the Rhodes Ranch Golf Club.

From his youth, Mr. Simpson was a natural on the gridiron. He had dazzling speed, power and finesse in a broken field that made him hard to catch, let alone tackle. He began his collegiate career at San Francisco City College, scoring 54 touchdowns in two years. In his third year he transferred to Southern Cal, where he shattered records — rushing for 3,423 yards and 36 touchdowns in 22 games — and led the Trojans into the Rose Bowl in successive years. He won the Heisman Trophy as the nation’s best college football player of 1968. Some magazines called him the greatest running back in the history of the college game.

His professional career was even more illustrious, though it took time to get going. The No. 1 draft pick in 1969, Mr. Simpson went to the Buffalo Bills — the league’s worst team had the first pick — and was used sparingly in his rookie season; in his second, he was sidelined with a knee injury. But by 1971, behind a line known as the Electric Company because they “turned on the Juice,” he began breaking games open.

In 1973, Mr. Simpson became the first to rush for over 2,000 yards, breaking a record held by Jim Brown, and was named the N.F.L.’s most valuable player. In 1975, he led the American Football Conference in rushing and scoring. After nine seasons, he was traded to the San Francisco 49ers, his hometown team, and played his last two years with them. He retired in 1979 as the highest-paid player in the league, with a salary over $800,000, having scored 61 touchdowns and rushed for more than 11,000 yards in his career. He was inducted into the Pro Football Hall of Fame in 1985.

Mr. Simpson’s work as a network sports analyst overlapped with his football years. He was a color commentator for ABC from 1969 to 1977, and for NBC from 1978 to 1982. He rejoined ABC on “Monday Night Football” from 1983 to 1986.

Actor and Pitchman

And he had a parallel acting career. He appeared in some 30 films as well as television productions, including the mini-series “Roots” (1977) and the movies “The Towering Inferno” (1974), “Killer Force” (1976), “Cassandra Crossing” (1976), “Capricorn One” (1977), “Firepower” (1979) and others, including the comedy “The Naked Gun: From the Files of Police Squad” (1988) and its two sequels.

He did not pretend to be a serious actor. “I’m a realist,” he said. “No matter how many acting lessons I took, the public just wouldn’t buy me as Othello.”

Mr. Simpson was a congenial celebrity. He talked freely to reporters and fans, signed autographs, posed for pictures with children and was self-effacing in interviews, crediting his teammates and coaches, who clearly liked him. In an era of Black power displays, his only militancy was to crack heads on the gridiron.

His smiling, racially neutral image, easygoing manner and almost universal acceptance made him a perfect candidate for endorsements. Even before joining the N.F.L., he signed deals, including a three-year, $250,000 contract with Chevrolet. He later endorsed sporting goods, soft drinks, razor blades and other products.

In 1975, Hertz made him the first Black star of a national television advertising campaign. Memorable long-running commercials depicted him sprinting through airports and leaping over counters to get to a Hertz rental car. He earned millions, Hertz rentals shot up and the ads made O.J.’s face one of the most recognizable in America.

Mr. Simpson, in a way, wrote his own farewell on the day of his arrest. As he rode in the Bronco with a gun to his head, a friend, Robert Kardashian, released a handwritten letter to the public that he had left at home, expressing love for Ms. Simpson and denying that he killed her. “Don’t feel sorry for me,” he wrote. “I’ve had a great life, great friends. Please think of the real O.J. and not this lost person.”

Alex Traub contributed reporting.

An earlier version of this obituary referred incorrectly to the glove that was an important piece of evidence in Mr. Simpson’s murder trial. It was not a golf glove. The error was repeated in a picture caption.

How we handle corrections

Robert D. McFadden is a Times reporter who writes advance obituaries of notable people. More about Robert D. McFadden