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While they leave for foreign lands for better economic prospects, immigrants leave behind their siblings and parents whose welfare overtime remains tied to the remittances. And while the immigrants accomplish success and wealth abroad, they remain increasingly concerned about the welfare of their aging parents left behind in the home country.
Despite having access to adequate financial resources, immigrants are finding it hard to look after the aging parents in the home country who become frail with time and require permanent care. Often parents are looked after by ill- or semi-trained caregivers when family members are not available to care for the elderly. In the absence of adequate living quarters for seniors or trained staff to provide home-based care, Pakistanis settled abroad have little options available to provide adequate care for their parents.
The story of the immigrant worker is not new. Often the male children leave home for better career opportunities abroad. Their remittances support those who are left behind while the immigrant workers continue to live modestly abroad. Until recently, parents and other family members back home lived with extended families where someone was always available to look after the aging parents. With several, if not all, children heading abroad in the globalised economy, the parents of today’s expatriates are often forced to live alone in the home country while still being connected to their children and grandchildren across continents, courtesy of telephone, the Internet, and Skype.
In the globalised economy, millions of workers are employed thousands of miles away from the places where they grew up. These trends are likely to continue in the future. The academic and professional literature has been increasingly focussed on the needs and welfare of expatriate workers in their adopted homelands. Only a handful of studies, such as the one by Loretta Baldassar of Italian immigrants in Australia, focus on how immigrants experience transnational lives as they strive to care for their aging parents in the home country.*
The present-day immigrant workers, especially those in the west, are often professionals with better education credentials than the average worker in the host country. The professional immigrant workers subscribe to the same lifestyle as their native neighbours. They live in suburban neighbourhoods where they children attend private or public schools. They own more than one vehicle to transport their children back and forth from soccer games. They hire nannies to care for infants and toddlers. The professional immigrant’s lifestyle is different from that of the immigrant workers in the Middle East who continue to live in shared accommodations as they save and remit most of their earnings back home.
Whereas many Middle Eastern countries do not allow the expatriate workers to bring along their parents, several western countries do permit immigrants to invite their parents for a visit or permanent stay. This, however, is not without latent financial risks. If the elderly parents arrive as visitors, their insurance becomes prohibitively expensive with their age. At the same time, most insurance companies provide coverage for only accidental care and do not cover hospitalisation or medication for any pre-existing condition, such as asthma or cardiovascular ailments. A few days stay in a hospital can easily cost several thousand dollars in North America.
The immigrants do have the option to sponsor their parents. This however, creates a moral hazard. If the immigrants’ parents require expensive healthcare in a country where such costs are borne by the State, the immigrants end up transferring the healthcare burden from themselves to the rest of the taxpayers. And in countries where state-subsidised healthcare is not available, immigrants’ may not have the financial means to pay for their parents’ healthcare costs. For these reasons the parents of migrant workers often end up staying back home.
At the same time, the political environment in countries with universal healthcare is not conducive for the immigrant’s parents’ to impose additional costs on the already stressed healthcare systems. Consider Mississauga, a suburban municipality adjacent to Toronto and known for its large South Asian immigrant population, whose mayor Hazel McCallion expressed her concerns about the healthcare costs imposed by immigrants’ parents. "If you go to the Credit Valley Hospital [in Mississauga] the emergency is loaded with people in their native costumes. A couple will come here as immigrants and each bring their parents. Now you have four people who never contributed a nickel toward our medical system using it at an age when they will cost everyone a great deal of money," the 91-year old Mayor said in 2006. While the mayor was criticised for her comments, most politicians do hold similar views, which they may not express in public fearing a backlash.
The mass economies of kinship globally account for billions of dollars. A large share of Pakistan’s nearly $11 billion in remittances is indeed spent on caring for the relations left behind by the immigrants. The remittances are often spent on food, shelter, marriages, savings and businesses. With such large sums remitted annually by expatriate workers one would have hoped to see organised care for the elderly parents where adequate service is provided at dedicated facilities, such as senior homes, or quality home-based care is made available.
In the next 25 years, even a larger number of Pakistanis will leave in search of jobs abroad. At the same time, theirs and the parents of those who have left Pakistan earlier will grow older and become increasingly frail requiring assisted living. This creates the opportunity for a systematic response to the growing demand for assisted-living created by the parents of expatriate workers who will have the financial means to provide for their parents’ care in Pakistan.
There is a greater need to build the necessary infrastructure, i.e. homes for seniors, and to train and certify caregivers who could be retained by the expatriates to care for their parents. Places like Murree, Swat, Abbottabad, Gilgit and Hunza offer hospitable climate where commercial establishments could develop senior homes that may be certified and regulated by the Overseas Pakistanis Foundation. A Professional body of healthcare providers, such as the one for doctors and/or nurses, may want to create an additional tier of caregivers who are trained to look after the elderly, but may not necessarily be required to hold professional designation of a doctor or a nurse. The services of such regulated and certified caregivers could then be retained by the expatriates to provide care for their parents through an exchange managed by a professional organisation.
Millions of Pakistanis are now employed abroad with their parents still living in Pakistan. It will be naïve to assume that the wellbeing of their parents can be guaranteed if the status quo were to prevail. The scale of the demand for elderly care in Pakistan requires an organised response by the private sector for both physical infrastructure and trained caregivers. Failing to do so will result in diminished quality of life for a large number of senior citizens in Pakistan.
*Baldassar, Loretta. Transnational Families and Aged Care: The Mobility of Care and the Migrancy of Ageing. Journal of Ethnic and Migration Studies. Vol. 33, No. 2, March 2007, pp. 275-297.
The views expressed by this blogger and in the following reader comments do not necessarily reflect the views and policies of the Dawn Media Group.
Murtaza Haider is a professor of Real Estate Management at Ryerson University and a Director of Regionomics Inc. He is also a syndicated columnist with Post Media and writes a weekly column on urban economics in Canada. He is the author of the book Getting Started with Data Science: Making Sense of Data with Analytics.
