Old problems, new challenges

RIGA - It just happened to be the International Day of the Elderly (Oct. 1) when I paid a visit to the Mezciems Social Care Center in Riga. As the center's director ushered me into a half-filled hall, a male choir from the U.S.A. was attempting to sing a song that its members had especially learned in Latvian. But I was more interested in looking at the audience.

There were probably around 50 people altogether watching the performance, most of whom seemed decidedly unexcited about their special guests. A few people had dozed off in their chairs, while most just stared blankly in the direction of the choir. The elderly are not exactly the easiest people in the world to entertain.

It may have been the International Day of the Elderly, but that didn't really mean much to the aged residents in Mezciems. Being old is difficult in the best of circumstances, but being old in one of the underfunded state care centers in Latvia can be a grim sort of waiting game.

As Latvia continues with its breakneck socio-economic transformation, the elderly have no doubt been among the hardest hit in all the upheaval. The traditional social structures that once provided the necessary care for them are changing, and the outdated state system is struggling to cope with the new challenges of looking after Latvia's growing elderly population.

State-funded senescence

"I do not think that the elderly care system in Latvia could be called a system at all," says Aija Zobena, head of the sociology department at Latvia University. "Today what we have is the remains of the care system for the elderly which existed in the Soviet period."

Zobena believes that until recently Latvia had a traditional system of looking after its old, which basically entailed several generations of one family living together. The state care centers largely existed to take care of those elderly people who had no one else to take care of them.

"People still feel a moral obligation to take care of their elderly parents and often other close relatives. But in Soviet times this extended family model survived largely due to economic reasons - it was impossible to get a separate flat, or to start a separate household. Changes in this family model have started only recently - young people try to live separately from their parents as soon as they start to work or study at university, leaving their parents alone."

The Mezciems Social Care Center was built in 1975, although one could say that it looks an awful lot older for its years, much like the other 70 state institutions for the elderly in Latvia, which between them house a total of 4,700 people.

It's home to some 285 residents in all, but 70 of these are young, disabled people who have been lumped together with the elderly residents for lack of anywhere else to put them, something that clearly rankles the center's director, Inara Skipsna.

"It's totally wrong to mix the two groups together," she says. "But we don't have the facilities to take care of the two groups independently. The young people here feel very bored because there's nothing for them to do, and they understandably don't like being surrounded by all these old people."

Skipsana takes me on an extensive tour of the center and appears to go out of her way to give me a good impression of it. I see the tiny rooms where the residents sleep, the physiotherapy room, the typically Soviet-style cafeteria.

She also proudly shows me several new toilet facilities, which she says the center will be paying off for some time. But she is all too aware of the inadequacy of the center given its current crop of residents.

"This center can't meet the needs of a lot of our residents. It was designed for physically mobile people, but we have a whole floor set aside for disabled old people. The rooms are too small and in some there isn't proper sanitary conditions," she says.

Skipsana goes on to explain that, under EU law, each room must have its own restroom, something they're only gradually getting around to doing because of the cost. But then the already tiny rooms are even further decimated in size.

It has to be said, the patchwork attempts to adapt the Mezciems care center into an adequate, multifunctional care institution brings to mind the proverbial square peg and round hole.

New approaches

"Care for single elderly people is an unsolved problem," Aija Zobena says. "Private care homes are unprofitable, and local municipalities are unable to meet demands for care for the elderly, especially in rural areas, where there's a high proportion of old people."

The Latvian government insists that it is getting to grips with the problem though. The notoriously low pension is gradually rising. This year the average pension stood at 71 lats (106 euros), and that's set to increase to 79 lats in 2005. Also starting from next year the government is undertaking a new initiative to develop existing and new municipal housing for the elderly, while introducing reforms in assisting with the cost of medical treatment and increasing the number of social workers.

But these are all tentative first steps. At the moment it's really just a question of offering elderly people with nowhere else to turn the bare necessities. In the case of all elderly care centers, the Mezciems care center included, the elderly hand over most of their meager pension to pay their way, receiving 15 percent back as "pocket money." Such a system is about as perverse as logic gets. And yet the waiting line to get the elderly into a care center is enormous.

One residential home that the Ministry of Welfare rates highly, in terms of the quality of care it affords, is the Saulriets Sanatorium in Pardaugava, Riga. Half state funded, and half funded by the Baptist Church, the center has just 14 residents and 12 staff. It also has one of the longest waiting lists for people wishing to stay there.

Its director, Sarma Kleina, believes that the state-run care centers just can't give the personal attention that old people need to live out the remainder of their days in peace and with dignity. The biggest problem for her, she says, is finding the right staff.

"We have difficulty finding good staff because the salary is so low. Our director only makes 90 lats a month. So you see we have to work out of love," she explains.