Same Old, Same Old
Same Old, Same Old
Photo Credit: Mohamed Allouba
Available at: http://egypttoday.com/article.aspx?ArticleID=8706
In 2050, a fifth of Egyptians will be age 60 and older. How will the country accomodate its aging population?
By: Ethar El-Katatney
Drive down a series of rocky, unpaved streets in Imbaba, passing piles of garbage, packs of stray dogs and rickety tok-toks blasting Arabic pop music, and you’ll eventually come to a weathered, gray building. Out front is a group of shifty-looking young men standing under a faded sign that reads “Dar El-Hana’.”
This is one of Egypt’s 140 door moseneen, or homes for the elderly. Here you will meet Sabah Abd’alsalam, a frail 60-something-year-old widow with sunken eyes who has spent 16 years in the home’s worn confines. Blind and largely abandoned by her family, she a shares small, spartan room with three other women. The broad strokes of her story are, sadly, far from unique.
“My daughter committed suicide when she was 19,” says Abd’alsalam. “I never see any of my sons. One is a rich doctor, but when I had a problem with my eyes he didn’t pay, so I had to go to a cheap doctor and now I am blind.”
Abd’alsalam is one of forty seniors who call Dar El-Hana’ home, and one of thousands of older Egyptians who have been shunned by their families — a testament to the country’s fast-changing social fabric. As nuclear family households become more predominant, experts say a growing number of Egyptians are opting to send their parents to nursing homes. That is just one of several touchy issues, from pension funds to the cost of medicine, facing a country on the verge of a demographic time bomb.
In Egypt, the elderly are the fastest growing segment of the population. In the last two decades, the life expectancy of the average Egyptian has risen 13 years to 71. In December 2008, the Information Decision Support Center, the think tank of the Egyptian cabinet, published the first comprehensive study of the elderly in Egypt. According to the report, in 1986, 5 percent of Egyptians were age 60 and older. In 2015 they’ll make up 11 percent of the population and in 2050, over a fifth.
Getting older, as the United Nations Institute of Aging puts it, “is a privilege and a societal achievement.” However, it presents a massive challenge for both the public and private sectors, which will have to provide everything from wheelchair ramps to affordable healthcare plans. Dr. Ezzat Hegazy, senior researcher at the National Center for Social and Criminological Research, has been studying issues surrounding the elderly for the past 15 years, and written half a dozen books. The Minister of Social Solidarity, Dr. Ali El-Moselhi, has put him in charge of drafting a comprehensive plan that encompasses all the needs of the elderly. (But elderlyegypt.com, the initiative’s official website, has not been updated since 2007.) The biggest obstacle the 64-year-old Hegazy sees to caring for seniors is a lack of public understanding about the issues associated with a graying population.
“In 2050, we will have 24 million people over the age of 60,” he says. “This will affect absolutely everything and we haven’t paid any attention to this phenomenon until recently. It will need a lot or organizing in terms of accommodation, health insurance, pensions, hospitals, homes and much more.”
One of the most pressing issues facing the elderly is housing: As the number of seniors increases, the question becomes where will they live? Fifty years ago, when households included large extended families, grandparents, parents, grandchildren and other relatives lived together in one house. Today, fewer Egyptians are opting to live with their parents after marriage.
Dr. Mahmoud Shehata, vice president of The Egyptian Association of Aging, says many seniors want to stay with their families, but as the saying goes, “ma belyad heela” [my hands are tied].
“Two weeks ago a man called me crying because his children can’t stand him and he’s looking for a place to live. [This happened] after he gave his eldest son his apartment. A [seniors’] home will never give him what he wants, and he will never be comfortable away from his family.”
It’s a pain 73-year-old Ateyat Mansour knows well. She has spent 15 years at the Dar Al-Hana’ home. In a pink galabeyya and matching scarf, she says, “The truth is families are not what they used to be. Rather than the grandfather becoming kebeer el-‘ela, the family head, children can’t wait to get rid of their parents, [they] think we are a huge burden.”
Mansour is one of Abd’alsalam’s roommates. Each has a single bed, a small table and a quarter of the closet space. Garlands of artificial flowers and rosary beads hide the cracks in the walls, which used to be bright yellow but are now sallow.
In 1986, there were 29 homes like this in Egypt. Now there are 140 operating under licenses from the Ministry of Social Solidarity. Based mostly in Cairo and Alexandria, they serve 4,000 of Egypt’s 4.4 million elderly, or less than 1 percent. In developed countries, about 6 percent of seniors live in nursing homes. Abroad, these homes are usually compounds with individual units made specifically for the elderly, with facilities such as wheelchair ramps, customized bathrooms and handholds on the wall. But locally there were no such homes accessible to the middle class until 10 years ago. Those that existed were only for those who couldn’t afford to pay anything at all. They were simply “eewa’ [a roof over their heads]” says Hegazy.
Although Dar Al Hana’ isn’t a world-class home by any means, it is cozy, and run by a woman who cares deeply about its residents. Dalia Nageeb, 32, joined Dar Al-Hana’ in 2000 and became the home’s administrator in January 2008. Sitting in her office with threadbare carpets, she calls residents family. During her time with Dar Al-Hana’, she says attitudes towards nursing homes have started to change.
While many seniors are sent away because of family conflicts, others move into homes because they have no immediate relatives “and come because of loneliness,” she says. Some need physical and mental care. And a small minority go because they want to be around others like them.
For those who come unwillingly, Nageeb says, “they feel they are in a prison and so hate the place in the beginning, but then [come to accept it] and even [appreciate] being around people their own age.” Men, she says, are much harder to deal with than women. “The men are used to being in charge of their house, wife and children. So they find it very hard to relinquish control.”
Aly Abdel Hamid, 86, is one of those men. Sitting in a chair in a spotless galabeyya and red scarf, he knits a skullcap in silence. When he talks, he recites poetry: “Oh the soul that wishes to look upon the beloved, but sits here grounded by the body.”
Sitting on the carpeted roof of the six-floor building, the eight men and women gathered around clap for Abdel-Hamid, who goes back to knitting.
“Don’t mind him,” says rosy-cheeked 78-year-old Kamal Hegab with a grin, “He’s just not used to speaking to pretty girls.”
Resting his coffee cup on a table covered with a plastic pharaonic tablecloth, Hamid says, “I’ve been here for seven years. I married off my four daughters and now I don’t have to worry about anyone. We don’t live in a five-star hotel, but we’re all happy together. We pray, we eat, we have a place to sleep. What more could you want from life?”
The Duhr prayer is heard, and everyone gets up to prepare for prayer. While they do so, Nageeb gives me a tour of the building. On the ground floor is a physical therapy clinic with dusty contraptions. The first and second floors are for the female residents, the third is the kitchen, the fourth is for the 15 male residents, and the fifth is for the female attendants who live in the building. Going up to the roof, you can the Nile on a clear day.
Although the home could do with some major renovations — it has only two rusty washing machines and is laced with broken tiles — Nageeb has tried to make it as homey as she can. Qur’anic verses are on the walls, vases of artificial flowers grace every table, and on every floor there’s a small living room where the residents can sit together and talk. Nageeb is most proud of the elevator that was installed five years ago.
As small as the home is, for many of the residents it’s a life better than the one they lived. For LE 110 a month (if they can afford it), they get three square meals a day, a bed and laundry service. Residents spend the time between meals talking on the roof, playing chess or dominoes, watching TV or taking naps. Some days they have lectures or day trips.
“We subsist mainly on donations,” says Nageeb, who receives between LE 36,000 and 48,000 annually from residents.
“[That] doesn’t even cover half the costs [especially medicine, which is expensive]. In 2008, our expenses were LE 92,000 but they’re happy and content, which is all that matters.”
The biggest problem with homes for the elderly, Nageeb says, is finding qualified personnel “If the people who help them somehow make them feel like they are a burden, or belittle them somehow, it’s a disaster. You have to realize that the people here are not working, they’re old, they’re tired, they’re sick, they’re not with their families, they get depressed and they deserve our respect. Imagine if you are in their position  it can be humiliating when you have to ask a stranger to help you bathe.”
As their numbers grow, the nature of nursing homes is changing. “The understanding of a home was that it sheltered poor old people,” says Hegazy. “But now you have homes where the residents used to be respected doctors and university professors,  people who pay good money to stay in a home.”
Although their numbers are very small — Hegazy estimates there are not more than a couple of hundred wealthy nursing home residents — they have more than doubled in the past five years. These nursing homes are private investments and profit-making businesses. “Even the Ministry of Health has one of them in Helwan,” says Hegazy.
One of these homes is Dar Sayedat Masr, located in the middle class neighborhood of Heliopolis, overlooking a garden directly opposite Heliopolis Hospital. A room here costs between LE 2,000–4,000 a month, depending on its size, whether it’s shared and if it has a view or an en-suite bathroom. About 100 residents live there, with 18 rooms on each floor.
Colonel Mohamad Amin has been running this home, which he prefers to call the “Honoring the Elderly Hotel,” since 1996. According to him, people now prefer to live in homes because families aren’t what they used to be— mah’adesh taye’ had [no one tolerates anyone].” He says most seniors are there because their children live abroad, or because their spouse died and they were living alone.
“Even if they’re rich, they can be lonely. Loneliness equals depression. And living alone involves responsibilities like doing the laundry, cooking and cleaning. Here they don’t have to worry about that.”
Running a seniors’ home, says Amin, is expensive. “Think of laundry, maintenance, the air conditioners, the employees, the food, the elevators. We employ at least 50 people.  The elevator we installed in 2001 cost LE 65,000. Now to install a new one costs LE 150,000.” The cost of food has gone up so much, he says, the home has cut back on serving meat.
The conventional wisdom is that most elderly who live with their families are provided with everything they need. But many face mounting health care costs and the burden of supporting their children well into their golden years.
As of June 2008, 84 percent of all seniors had dependents (generally supporting between two and four people, including themselves) with men being more likely to have dependants than women.
“The divorce rate is increasing and a lot of women return to their fathers’ homes with children,” says Hegazy, the researcher. “The catastrophe is that she doesn’t work  and an even bigger catastrophe is that she usually gets no alimony. So her father has to find the money to support her and her children. Likewise, a lot of men don’t work and remain financially dependent on their fathers well into their mid-thirties, and then also need their help in order to get married.”
As of December 2006, only 16 percent of the elderly worked, and most were men (only 3 percent of elderly women work). This means that for many, the notoriously ineffective pension system (see box), which gives stipends ranging from LE 60–600, is their only source of funds.
Covering the cost of healthcare is another major challenge for seniors. Currently, 62 percent of elderly men have health insurance compared to 35 percent of elderly women. However, medical care for the elderly, in the absence of a comprehensive health insurance plan, is extremely expensive. Few hospitals have wings just for the elderly, two percent of whom have a permanent disability (that’s 81,000 people). There are only 52 physical therapy centers in Egypt serving 1,258 of those over 60.
Clubs and Community
In Egypt, there are very few community clubs or charity organizations that focus solely on helping the elderly. Instead, most cater to orphans or the disabled.
“The problem is that their resources are limited and there is a misperception that the number of elderly is small and that their needs are few,” says Hegazy. And even then, he explains, these services usually only focus on Cairo and Alexandria.
“Lets say there’s a lonely widow in Sa’eed [Upper Egypt]. If she’s lucky, someone will feel sorry for her and provide her with food. Every now and then they’ll go to see her and give her a shower. And that’s if she’s lucky. Is that enough?”
Hand in Hand is a community club at the American University in Cairo that began with the aim of visiting elders in homes twice a month, and hosting two large events for them every year — an iftar and a Mother’s Day party.
“We get them medicine and food,” says Hand in Hand President Mohammad Saeed. “We also have a donations campaign for elders to send them on umra, the lesser pilgrimage. But most importantly, we visit homes that are very bad, where the people aren’t happy and not much attention is paid to them. I don’t think anyone can be happy living in a home, but it’s made worse because they have no form of social entertainment. The quality of the food, the beds and the bathrooms is so bad.”
Unfortunately, says Saeed, membership in the club is low. “The problem is that dealing with the elderly is not like dealing with orphans, who are satisfied with toys and hugs. The elderly need more than that, and it’s hard. Some are happy when we visit them, but some are annoyed, thinking that we are pitying them, so you have to be very good to deal with them.”
Dar Al-Hana’ wal roh, which is not related to the nursing home, is one of the few official charity organizations in Egypt that serves the elderly, though it also helps orphans and the disabled. It opened its doors in 1996, and today helps 1,500 people every year.
Sitting in her office with faded stickers of Mickey Mouse on the wall and a large crack in the ceiling, Aisha Ezzeldin talks about the organization which is based in a tiny four-room apartment in Haday’e El-Oba, an impoverished area in Cairo.
“For the elderly we take them on trips, and we have lectures for them — about religion, families, health, everything. Around 300 men and women attend, but most don’t pay, not even for the trips, because they don’t have money.”
For Zakeya Shehata, 72, dressed in a brown abaya with jaundiced eyes, the center was a lifeline.
“My 50-year-old son lives abroad so I live alone,” she says. “I used to feel that if I died, no one would find out until they came to see what the smell was.  When we get old, we need to sit with people like us. It makes me happy to come here.  We need to talk, it’s just as important as food and drink.”
Talking, says Hegazy, is an often-ignored need that is not considered when thinking of the elderly. “They also have psychological needs, one of the biggest being what to do with their days. They need entertainment and ways to feel useful.”
The Egyptian Association of Aging (egypt-aging.org), which is the largest association for the elderly and was founded by the Ministry of Social Solidarity in 2003, organizes activities for the elderly, from sports to pilgrimages. But out of 4.4 million people over the age of 60, only 8,000 are members.
In addition, there are currently 190 clubs for the elderly in Egypt with approximately 40,000 members. For a nominal membership fee, around LE 10 per year, they have access to an activity center, a library, a physical therapy center, and can take courses to learn skills such as sewing.
For those over 60, the government also offers special discounts on local transportation and flights and on entry tickets for theaters, cinemas, clubs and fairs, although it is unknown how many people actually make use of these services.
Building homes that take care of elderly people’s physical and psychological well-being is only the first step in helping Egyptian society deal with the forthcoming demographic evolution.
Hegazy and his team have been working on a national framework that brings together the Ministry of Social Solidarity, the Ministry of Health and Population, and the Ministry of Insurance and Social affairs to create a bill of rights for the elderly.
The program has two main aims: To streamline existing laws related to the elderly (such as the arduous process of licensing a nursing home) and to develop new initiatives, like a helpline.
“So many old people are living alone and a helpline will be there for them if they encounter any problem,” says Hegazy, “whether it’s finding someone to help them fix a burst pipe or advice on how to deal with their blood pressure.”
Renovating and building geriatric health care centers as well as physical therapy clinics just for the elderly are in the works. In 2008, the UN Institute of Aging launched training programs at the Geriatric Unit of Ain Shams University for Egyptians working in the field of aging.
The UN Institute of Aging says that any plan to deal with the elderly must encompass health, housing, entertainment, income, work and education. Advocates hope this is what Hegazy’s plan will do.
“Old age is not a disease; it’s a stage of life,” says Hegazy. “The elderly are not parasites. They have given some 40 years of their lives to the country. They have fulfilled their role as producers and employees and spouses and parents and grandparents. It’s time for us to give back to them. Their care is not aid—it’s a right.  You must all remember that you will be old one day.” et
Aperson used to die before he retired or soon after, so the government didn’t worry about pensions,” says Dr. Ezzat Hegazy, senior researcher at the National Center for Social and Criminological Research. “And even if I’m being very considerate, the truth is that the elderly are mostly consumers and not producers. So, where are they going to get the money to accommodate their needs?”
Theoretically, they should get their money from the government pension fund, collected from them while they were younger under Law 70 of 1975. Hegazy puts the amount the government collected at LE 300 billion, while Dr. Shokry Azer, president of the People’s Committee to Protect the Insurance and Pensions Fund, puts it at LE 362 billion.
Regardless of the figure, there is legitimate worry that the government has included the amount in the treasury of the Ministry of Finance, which Azer says is “ridiculous and unconstitutional.” The Committee has raised a case to the State Council and Supreme Constitutional Court, demanding that an independent body monitor the LE 362 billion.
And along with the Protection for Pensioners group, Azer is also working against the new Social Insurance Act, which will be discussed in the next People’s Assembly session. The new act, which Azer says will be a “travesty” if allowed to pass, aims to privatize the social security and health insurance systems, which he says will not be in the best interests of “pensioners, orphans and widows.”
Currently, Ministerial decree 1140 of 2006 says a retired man or woman is eligible to take LE 60–80 minimum per month based on number of dependents. Minister of Finance Youssef Botros Ghali announced in late 2009 that more than 50 percent of pensioners take LE 500 per month, claims which were shot down by many.
According to Azer, “out of 4 million Egyptians over the age of 60 eligible for pensions, almost none get more than LE 300, and 1.35 million get less than LE 150, which means they take less than $1 per day, below the poverty line.”
That LE 150 per month though, has Egyptians aged 60 and above standing in line for hours (often in the sun) and visiting a dizzying number of offices to collect their paltry sum.
Hegazy also points out that the new increases for pensions discriminate between those who worked for the government and those who didn’t. Still, for many it is a lifesaver.
“If it wasn’t for my pension, I would have starved in the street,” says 68-year-old Nafeesa Samy. “I was married for nine years when I was 20 and then my husband, who worked in a government office, died and left me with two young sons. I received a LE 300 pension and saw that it was very good so also decided to work at a government office. And when I retired I got a pension of LE 300 too, which gives me LE 600 a month. My 32-year-old son is unemployed and unmarried and still lives with me, so LE 600 is great.”
But not everyone is as lucky as Samy. 70-year-old Khadija Ahmed, who suffered second-degree burns on her arms and face when she was 12, has eight children, all girls. In 1979, her husband died, and she stepped into the kiosk in his place.
“I stopped working when I couldn’t do it anymore,” she says. “I receive no pension at all. I am renting out the kiosk, because otherwise my girls who still live with me wouldn’t be able to live.”