Ageing and Exchange of Care in Emigrant Households Ugargol, Allen
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10.33612/diss.127734371
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Ugargol, A. (2020). Ageing and Exchange of Care in Emigrant Households: Case Studies from Kerala and Goa, India. University of Groningen. https://doi.org/10.33612/diss.127734371
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Ageing and Exchange of Care
in Emigrant Households
Case Studies from Kerala and Goa, India
ISBN: 978-94-034-2817-8 NUR Code: 900
Copyright: © Allen Prabhaker Ugargol
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This doctoral study was supported by the Indian-European Research Networking Grant: Ageing and Well-Being in a Globalising World, funded by NWO-ESRC-ICSSR (Project Number: 465-11-009). The participating institutions included the Institute for Social and Economic Change, Bangalore, India; Center for Development Studies, Trivandrum, India; Population Research Centre, University of Groningen, The Netherlands and the University of Southampton, United Kingdom.
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Ageing and Exchange of Care
in Emigrant Households
Case Studies from Kerala and Goa, India
PhD thesis
Allen Prabhaker Ugargol
born on 11 October 1976 in Dharwad, India
to obtain the degree of PhD at the University of Groningen
on the authority of the
Rector Magnificus Prof. C. Wijmenga and in accordance with
the decision by the College of Deans. This thesis will be defended in public on
Thursday 25 June 2020 at 14.30 hours
Supervisors Prof. I. Hutter Prof. K.S. James Prof. A. Bailey Assessment Committee Prof. C. M. Fokkema Prof. T. Haartsen Prof. S. Irudaya Rajan
To God Almighty
&
ACKNOWLEDGEMENTS
I begin with the oft quoted phrase ‘The journey not the arrival matters’ (TS Eliot). Every accomplishment starts with a decision to try and my journey through the PhD has been no less. It began during an informal discussion with my mentor to be – Prof. K.S. James at the Institute of Social and Economic Change, Bangalore. I was soon a doctoral aspirant writing the PhD entrance test at Institute for Social and Economic Change (ISEC), Bangalore. After selection, I began my pre-doctoral courses there and was glad to be the offered and in fact became the first doctoral student pursuing the sandwich PhD position between the University of Groningen, The Netherlands and the Institute for Social and Economic Change (ISEC), Bangalore. It was at this juncture that I met Prof. Ajay Bailey, and his has been an inspiring guidance all through my doctoral pursuit. I am grateful to the Joint PhD opportunity between the Institute of Social and Economic Change (ISEC), Bangalore and the University of Groningen (RUG), The Netherlands.
My doctoral study was supported by the Indian-European Research Networking Grant: Ageing and Well-Being in a Globalising World, funded by NWO-ESRC-ICSSR (Project Number: 465-11-009). The participating institutions included the Institute for Social and Economic Change, Bangalore, India; Center for Development Studies, Trivandrum, India; Population Research Centre, University of Groningen, The Netherlands and the University of Southampton, United Kingdom. I am ever grateful to this collaborative grant. I am indebted to my wonderful supervisors – Prof. Inge Hutter, Prof. K.S. James and Prof. Ajay Bailey who constituted a perfect supervision team. I have been enormously blessed to have you all as my supervisors and I truly acknowledge and am grateful for the faith you have had in me, the support you provided, the patience, motivation and insightful guidance that helped me complete this doctoral journal. From the initial proposal development to the presentations at ISEC and RUG, in planning the field work and even accompanying me to the field, the support I received from my supervisors is unimaginable. Doctoral work can get lonely and difficult but in my case I was
so fortunate that I had the support at every step and the right direction given to go ahead and complete the work.
Prof Inge, I can fondly remember your friendly advice and your ability to help me overcome initial confusions and leading me to clarity whenever we interacted. Prof. James, I can never forget the influence you have had on my life and for supporting me to chart this PhD trajectory. Prof. Ajay, you have been a friend, philosopher and guide and your warmth and ability to make me think and improvise, guiding and at the same time enabling me to work independently has been a true blessing. I thank you and Kanika for helping me and my family adjust at Groningen and the fond memories we have had. I also fondly remember my doctoral committee members at ISEC, Bangalore – Prof. K.S. James, Dr. T.N. Bhat, Dr. Sobin George, Prof. T.S. Syamala who supported me through the progress of the proposal and guided the research study at every biennial seminar. I could never have gone ahead without their time, patience and attention to detail. I recall the support and encouragement from the then Director of ISEC, Prof. R.S. Deshpande who kept telling me I was the first student from the medical fraternity at ISEC and hence had to be a path breaker. I am grateful to the support and guidance received from my PhD Panel Members at ISEC – Dr. Lekha Subaiya and Prof. G. Giridhar whose advice, critical comments and suggestions helped shape the proposal and the ensuing research progressively.
I would like to thank the members of the Reading Committee, Prof. C. M. Fokkema, Prof. T. Haartsen and Prof. S. Irudaya Rajan. Thank you for the time and your effort in reviewing this thesis, and more so, for approving it. My sincere thanks also go to Prof. Clara Mulder, for all the encouraging discussions and interactions we had during my time at Groningen. I am obliged to the faculty members of the Faculty of Spatial Sciences, the Population Research Centre, Department of Demography and many colleagues outside the faculty. I would especially like to recollect and thank each one of you who have left a lasting impression on me and I am obliged for the warmth and affection I received during my stint at Groningen. I would like to thank Dr. Leo, Dr. Hinke, Dr. Shirish, Dr. Louise, Dr. Sepideh, Dr. Liesbeth. I wish I could mention all the faculty names! I would like to particularly thank
Prof. Fanny, Dr. Eva, Sylivia, Nikhil, Arun, Ziad, Lybrich, Linden, Vera, Dr. Marieke, Titissari, Dr. Sanne, Dr. Debbie, Dr. Anu, Elda, Jakko, Sergi, Mattias, Dr. Acul, Ruben, Antje, Roselinde, Dr. Emmy, Bo Zhang and all my other PhD colleagues. I would also like to thank Ms. Alida and Ms. Tineke from the Graduate school for helping me with all the procedures. I would also like to thank the secretaries at Demography department: Stiny, Mirjam, Eliza and others for always being very helpful and supportive. I thank Dr. Sanne Ponsioen, the PhD Coordinator for being ever supportive and understanding. The Language Centre at the RUG was very supportive in helping me with the translations to Dutch within a short period of time.
In my academic journey, I have being fortunate to have met many other scholars who have helped to shape my academic viewpoint and expand my horizon. I am also grateful to the support and facilitation I received from Caritas, Goa and the Kottayam Social Service Society (KSSS), Kottayam who enabled me to get access to the older adults’ households and also provided me with a translator and research assistant in the field. I would like to profusely thank Rev. Fr. Maverick Fernandes, the Director of Piedade Institute - Caritas Goa, Rev. Fr. Savio M. Fernandes and Ms. Ana D’ Mello who accepted me as their own and involved me in their daily activities and supported me so much in the field work and beyond. I am grateful to Rev. Fr. Michael Vettickat, Rev. Fr. Bins Jose Chethalil, Kottayam Social Service Society (KSSS), Kottayam, Kerala who provided me access to older adults in Kottayam district. I am highly obliged for the assistance and support received from Ms. Remya Mohan, Ms. Reshmi Mohan and the Mohan family who provided me support, hospitality and opened their home for me during the field work in Chingivanam, Kottayam, Kerala.
I am thankful to all the Bishops, Fathers and parishioners from South Goa and Chingivanam in Kottayam – the key gatekeepers who supported the study and provided me the much needed access to the homes of older adults. I am indebted to the students of St. Bridget Home Nursing Institute, Aldona, Bardez, Goa with whom my interactions and visits proved to be very engaging and fruitful. I thank the University of Groningen for supporting me on this exciting PhD journey through the Ubbo Emmius Fellowship and the financial support supported me throughout the PhD tenure. My special appreciation
goes to the International Office of the University of Groningen and the staff who played a central role in supporting and facilitating my visit and stay in the Netherlands. I truly enjoyed and gratefully acknowledge the warmth and hospitality that I experienced at the homes of older adults and thank them, their immediate family members and extended family for opening their hearts and homes to me. I am humbled by their frank accounts and enormous trust and magnitude to confide in an absolute stranger.
I thank my current organization, the Institute of Health Management Research (IIHMR), Bangalore, for supporting me as I was completing the PhD. I thank our Trustee Secretary – Dr. S.D. Gupta for his encouragement. I am indebted to our Director, Dr. Usha Manjunath for being a supportive mentor. I also thank all the faculty and staff at IIHMR, Bangalore.
In the end and most certainly not the least, I am grateful to my family in Bangalore, India for supporting me so much and enabling my journey through the difficulties and sacrifices. I am truly indebted to the support and encouragement I received from my mother, my brother Jason, my wife Veena - who has been patient and encouraging and my lovely kids Neil and Nicole who allowed me to proceed with the project even though it meant I was preoccupied and sometimes unavailable to them. Thank you for the relentless encouragement, patience, understanding and love. This achievement is yours as much as is mine!
Allen Prabhaker Ugargol Bangalore, India
TABLE OF CONTENTS
Chapter 1: Introduction 1
1.1 Demography of Ageing in India and
the Emigration Context 1
1.2 Contextualization of Care for Older Adults in India 2
1.3 The Context and Study Setting 5
1.4 Research Objectives and Research Questions 9
1.5 Theoretical Framework 11
1.6 Data and Methods 12
1.7 Structure of the Thesis 18
Chapter 2: Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to
Older Adults in India 27
2.1 Introduction 27
2.2 Understanding Social Change and
Familial Support for Older Adults in India 29
2.3 Health, Functional and Disability
Needs of Older Adults in India 30
2.4 Objectives 31
2.5 Research Design 32
2.6 Variables 33
2.7 Results 36
2.8 Effects of Living Arrangements on
Caregiving to Older Adults for Their Care Needs 42
2.9 Effect of Control Variables on
Caregiving to Older Adults during Care Needs 43
Chapter 3: Perceived Care Needs of Older Adults:
Perspectives of Older Adults and their Caregivers
from Emigrant Households in Kerala and Goa, India 57
3.1 Introduction 57
3.2 Theoretical Construct 59
3.3 Data and Methods 61
3.4 Findings 62
3.5 Discussion 84
Chapter 4: Reciprocity between older adults and their
caregivers in emigrant households of Kerala, India 95
4.1 Introduction 95
4.2 Theoretical Construct 98
4.3 Methods 100
4.4 Findings 106
4.5 Discussion 120
Chapter 5: Family caregivers for older adults:
gendered roles and caregiver burden in emigrant
households of Kerala, India 133
5.1 Introduction 133
5.2 Methodology 137
5.3 Findings 140
5.4 Discussion 149
Chapter 6: Care Arrangements for Older Adults:
Exploring the Intergenerational Contract in Emigrant Households of Goa, India 159
6.1 Introduction 159
6.2 Background and Concepts 162
6.3 Methods 167
6.4 Intergenerational Care Arrangements: Findings 172
6.5 Discussion 182
Chapter 7: Summary, Conclusions & Recommendations 195
7.1 Introduction 195
7.3 Care Needs of Older Adults and Association between Living Arrangements and Care Available
to Older Adults in India 196
7.4 Care Needs of Older Adults living
in Emigrant Households 198
7.5 Identifying and Interpreting Reciprocity
in the Care Exchange Relationship 199
7.6 Gendered expectations of Care:
Perceived caregiver burden in emigrant households 201
7.7 The contract of intergenerational reciprocity: Adaptive intergenerational care arrangements in
emigrant households of India 202
7.8 Theoretical and Methodological Contributions
to Ageing Research 203
7.9 Recommendation for Future Research 206
7.10 Policy and Intervention Recommendations 207
Appendices 214
I In-depth Interview Guide – Older Adults 215
II In-depth Interview Guide – Primary Caregivers 221
III In-depth Interview Guide – Key Informants 226
IV Informed Consent Form (ICF) 230
V Elderly Survey - BKPAI questionnaires (2013) 235
VI Table - Description of Older Adults and their
Caregivers from Kerala 236
VII Table - Description of Older Adults and their
Caregivers from Goa 238
Summary / Samenvatting 243
Summary 243
Table 2.1 Description of the study sample (socio-demographic, socio-economic and financial status of older adults) by their living arrangements (N = 9850)
38
Table 2.2 Distribution and differences in health and
functional status by living arrangements 39
Table 2.3 Distribution and differences in caregiving by
living arrangement and type of health and functional needs
40
Table 2.4 Distribution and differences in caregivers who
paid for the treatment needs of older adults by living arrangements
41
Table 2.5 Unadjusted and adjusted effects (ORs, 95
% CIs) of living arrangements and other
independent variables on caregivers for different care needs of older adults
44
Table 4.1. Description of Older Adults and their Caregivers 102
Table 4.2. List of code families and codes for older adults
and their primary caregivers 105
Table 5.1 Description of Caregivers and their Care
Recipients (Older Adults) 138
Table 6.1 Description of Caregivers and their Care
Recipients (Older Adults) 170
Figure 1.1 Kerala Administrative Map 7
Figure 1.2 Goa Administrative Map 8
Figure 1.3 Conceptual Model 12
Figure 1.4 Kottayam Political Map 14
Figure 1.5 South Goa Political Map 16
Four chapters in this thesis are reprinted from the following publications and accepted manuscript:
Chapter 2
Ugargol, A. P., Hutter, I., James, K. S., & Bailey, A. (2016). Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to Older Adults in India. Ageing International, 41(2), 193-213.
Chapter 4
Ugargol, A.P., & Bailey, A. (2020). Reciprocity between older adults and their caregivers in emigrant households of Kerala, India. Ageing and Society, 1-27. doi:10.1017/S0144686X19001685
Chapter 5
Ugargol, A.P., & Bailey, A. (2018). Family caregiving for older adults: gendered roles and caregiver burden in emigrant households of Kerala, India. Asian Population Studies, 14(2), 194-210.
Chapter 6
Ugargol, A.P., Bailey, A., Hutter, I., James, K.S. (forthcoming). Care Arrangements for Older Adults: Exploring the Intergenerational Contract in Emigrant Households of Goa, India. In Bailey, A., Hyde, M. and James, K.S. (Eds). Care for Older Adults in India, Policy Press, UK. (accepted)
