Saturday, July 28, 2018

#BookReview Story of heroic women who (thankfully) downplay their feminism

During my rather long commutes, I try to drown out the cacophony of traffic by listening to audio-books. I recently downloaded an audio copy of Kristin Hannah’s ‘The Nightingale’ and finished the book during my commute in a couple of weeks.

My review from Amazon follows:

Kristin Hannah’s ‘The Nightingale’ is a bestseller for obvious reasons: strong characters who draw you in while the author weaves an interesting plot. Set in France, during the span of over two years during World War II, this is a story of two women. However, it is not just a story of strong, heroic women but the resilience of the human spirit.

Hannah’s skillfully develops the characters while keeping the story engaging and readable.

The story revolves around the lives of two sisters Viann and Isabelle who come to grips with the horrors of war in their own way. The younger sister Isabelle has moved back to their father in Paris while Viann is content with life in the French countryside. The vagaries of war throw unique changes at both sisters who facing terrifying situations and respond in their unique ways.

Spoiler alert: The ending of this saga is a bit clichéd but satisfying.

This book kept me engaged during my long commute during the week, and is likely to keep you engaged as well.

Sunday, July 8, 2018

The digital divide: the wealth at the bottom of the pyramid ?

A interesting interview with Alana Semuels in marketplace podcast last week made me reflect on the digital divide, and on those at the bottom of the digital pyramid (apologies CK Prahalad). Ref: Your Amazon deliveries don't just magically appear at your door. The interview and Semuels’ detailed account of experiences as an Amazon Flex driver in The Atlantic (link) made for an interesting read. She recounts
My tech-economy experience was far less lucrative. In total, I drove about 40 miles (not counting the 26 miles I had to drive between the warehouse and my apartment). I was paid $70, but had $20 in expenses, based on the IRS mileage standards.

Semuels’ observations are significant since nearly $1 out of every $2 spent online in the US is going to Amazon (link).

Halfway across the globe in the Silicon-Valley of the East, life seems to be no different for those at the bottom of the digital pyramid. Motorists in Bengalurue are learning to avoid the ‘delivery boys’ in bikes with heavily laden bags crisscrossing gridlocked traffic

Photo from Author's smartphone

The e-commerce delivery-boys (yes, it is mostly guys who are into delivery) earn a minimum wage – about $200 to $300 per month, while accounting for other expenses.

 In the article, Alana Semuels highlights

All my frustration really hit when I went to the second office building on Market Street, home to a few big tech companies. One of them took up multiple floors, smelled strongly of pizza, and had dog leashes and kibble near the front door. Young workers milled around with laptops and lattes, talking about weekend plans. They were benefiting from the technology boom, sharing in the prosperity that comes with a company’s rapid growth. Technology was making their jobs better—they worked in offices that provided free food and drinks, and they received good salaries, benefits, and stock options. They could click a button and use Amazon to get whatever they wanted delivered to their offices—I brought 16 packages for 13 people to one office; one was so light I was sure it was a pack of gum, another felt like a bug-spray container

The e-commerce delivery-boys in India and China who are delivering packages to their tech-savvy brethren higher in the digital pyramid are bound to be echoing a similar sentiment.

There is perhaps a silver lining here as, Semuels writeup also acknowledges:

People are worried that automation is going to create a “job apocalypse,” but there will likely be thousands more driving and delivery jobs in upcoming years..... “We’re going to take the billion hours Americans spend driving to stores and taking things off shelves, and we’re going to turn it into jobs” 

Bottomline: The digital economy has defined invisible lines separating those at the top and bottom of the pyramid. However, such delivery jobs in developing economies like China and India are an opportunity for young, semi-educated youngsters to earn a living. Without such opportunities, scores of them might end up unemployed or remain under-employed.

Thanks for reading! Please click on Like, or Share, Tweet and Comment below to continue this conversation or share your favorite 'trend to watch' | Reposted from linkedIn Pulse blog | Also a link to an earlier blog on the topic: Digitization: Solutions to physical-world problems?!

Monday, February 19, 2018

Raise your hand if you have worked with an empathetic manager !

Business writers, academics and consultants periodically talk about the role of empathy in managing teams. Management gurus draw evidence from data and research on business leaders succeeding by demonstrating empathy, compassion, and humility. The argument is rather straightforward: organizations and teams are made up of people; and people - even high performing individuals - continually struggle for a work-life-balance.

Microsoft's CEO, Satya Nadella, begins the first chapter of his book “Hit Refresh” (my review) by exploring how his upbringing shaped some of his personal views on management. He briefly talks about empathy, and how the birth of his son Zain, who was diagnosed with cerebral palsy shaped his world-view.

Such candor from an accomplished tech-leader is refreshing, but is still rather rare. Most of us in the corporate world are motivated to downplay references to personal life and challenges or risk being seen as 'soft.' While the rare business leader like Nadella might be willing to talk about 'softer' aspects of management like empathy, the business world downplays it. Business operations, efficiencies and success criteria are measured in hard numbers and not by softer criteria.

Case-in-point: reflecting on a couple of instances

Years ago, I was managing a team of developers and engineers for a large project. One day, a young engineer, Raj*, came to me and said his father had passed away. He wanted to request vacation to leave immediately for his hometown. Raj had recently completed his programming-bootcamp training and had been assigned to my team. I called our HR business partner to check on the company's policies and benefits for 'bereavement leave,' and was surprised by the answer: “sorry, we don't have a bereavement leave policy.” On probing further she replied that it was not customary for Indian companies to offer such leave, and hence our management hadn't formulated such a policy (yet).

Raj hadn't accrued a lot of vacation time, and the 'official' response was to ask him to take an unpaid-leave. I knew the guy wasn't in a state of mind to bother about policies and was going to take such leave regardless. The performance of my team's goal was measured on the success of the project delivery and client feedback. And Raj's absence did not impact our timelines or deliverables; hence I did not feel the need to seek 'help' from senior management.

While the policy around leave was rigid, I knew managers had some leeway when it came to compensating time off against overtime , which I decided to extend to Raj. I continued to voice the issue of “bereavement leave policy” in internal forums in the company till it finally got institutionalized a few years later. No brownie points for sticking my neck out or an 'Atta boy' for showing some empathy.

Years later, I worked for a multinational that was undergoing transformation in light of an impending M&A. Teams were stretched, and busy working on a number of large 'strategic' programs – a number of ERPs were being consolidated while a sizable part of the portfolio was moving to the cloud. A senior member of our team in Europe, Jack*, had a severe bout of flu, that led to other complications including pneumonia. He was hospitalized for a few weeks and was advised bed-rest for a couple of months.

Jack reached out to the line-manager, offering to work-from-home or part-time for a couple of months while he recovered. The manager was under pressure to deliver on the ambitious goals that the CIO had committed to. He worked on a plan with the HR partner, and offered Jack a 'generous' severance to enable him to 'focus on his personal life.' He reasoned that he was showing empathy for a colleague dealing with personal issues in the way he was conditioned and motivated to do so. With that baggage shed, the manager was able to on-board an un-encumbered member and 'motivated' team to deliver on the promised goals; and some.

So, why is it hard to find empathetic managers?

There is a phrase from an interview with the business leader, Ratan Tata that jumped out when I was reflecting on this topic (link: The Economist). He is quoted saying

“I want to be able to go to bed at night and say that I haven't hurt anybody”

People and managers are inherently good intention-ed, and want to contribute and be valued. However, companies are not structured to recognize or reward such 'human' attributes. Business leaders across the corporate hierarchies are measured on their performance and targets that are generally aligned with 'corporate goals';

  • The targets for Public companies are measured quarter-by-quarter, and the (stock) market rewards or punishes them by pushing up or pulling down the stock price. Most companies reward their executives, and employees of a certain cadre, with long-term-incentives tied to stocks or stock options; and such incentives are easily tracked. 
  • Executives ensure that the line of sight to corporate goals – maximize shareholder value - is generally clear down the org-chart. They work with mid-level-managers and supervisors to define production, sales or other operational measures aligned with their targets  
This topic has been especially hard for me to write about though the concepts are rather straightforward, and one can easily find a lot of management literature, backed up by research. While thinking about the topic, I could easily see how some examples in the business world are really quid-pro-quo, masked as empathy:

  • Team-members bending backwards to source an expensive gift for the boss' silver-jubilee-anniversary 
  • The vendor offering a plush guest-house for you to recover from jet-lag after a cross-continent trip 
  • The manager prompting his team members to use all their vacation time at the end of year to get back refreshed (perhaps gently nudged by leaders who don't want folks to carry forward vacation on the books) 
  • The VP of a global team stating "none of the American members will work or take calls on the 4th of July," (a week before the CEO's photo-op with Mr. Trump in Davos)
Corporate goals and targets are generally unforgiving, and don't have much room for 'softer' measures. Not surprisingly, managers who stick their neck out by trying to practice softer aspects like empathy risk being seen as soft. Those who do, might fear they will lose out in the corporate-race against their 'go-getter' peers. 

Thanks for reading! Please click on Like, Share, Tweet and Comment below to continue this conversation | Reposted from LinkedIn pulse blog

Tuesday, February 6, 2018

Enterprise Architecture 101: Keep your Architecture Repositories – KISS-S

Viewpoints on Architecture repositories are topics of perennial discussion in digital forums and communities (eg link). Such discussions are the tip of the iceberg, bubbling up some of the frustration over time and energies that Architecture and Design teams spend on evaluating and managing Architecture Repositories. The focus of discussions range from What information to capture and document, to How-to manage the repositories, and includes debates on tools, technologies and platforms to use.

Architecture frameworks like TOGAF have captured the first part of the question well, explaining the need for repositories to operate mature Architecture Capabilities at large enterprises. TOGAF references (link) describe
“An Architecture Repository that allows an enterprise to distinguish between different types of architectural assets that exist at different levels of abstraction in the organization. This Architecture Repository is one part of the wider Enterprise Repository, which provides the capability to link architectural assets to components of the Detailed Design, Deployment, and Service Management Repositories.”

Why don’t organizations just adapt Frameworks like TOGAF that are obviously well documented? Just a couple of reasons why:

  • While the documentation in TOGAF is rather extensive, it is also rather generic, and needs to be tailored to meet specific requirements of your organization. Like a Swiss-Army-knife, not all aspects of architectural information may be required or applicable for all organizations. 
  • Architecture documentation and processes don’t operate in isolation. They need to exist seamlessly with your enterprise's change management and governance processes. 

In an earlier write-up (link), I highlighted my experiences in establishing and running an Architecture Review Board (ARB). To succeed, the architecture governance had to be embedded with the existing processes, and ways of working.

The same holds true for Architecture Repositories too. Architecture and design teams in large organizations spend a lot of time and energy documenting the current and future state capabilities. The translation of such strategies and ideas into workable solutions - capability realization - is enabled by business funded projects and programs. Large programs also generate a tremendous amount of documentation to adhere to existing governance processes and project management and operational frameworks.  

It is fair to assume that large organizations will have extensive collaboration and team management tools and platforms including enterprise portals, wikis, blogs and even social media tools used by teams across the organization. Therefore, it is important to keep the design of any Architecture Repositories KISS-S. 

Architects should recognize the capabilities of existing organizational tools and platforms, and either extend them to include architectural repositories, or ensure that any additional tool integrates seamlessly with existing platforms. The additional S at the end of the common acronym KISS is to emphasize the 'S'eamless integration and ‘S’earchability of the artifacts in the repository. For example, if your organization uses a Sharepoint based intranet platform, you are better off designing a simple repository and workflow extending that platform. 

Those searching for "Design document for SFDC XYZ program" or "Solution Design template" should be easily discoverable using a simple search on your enterprise’s intranet without having to search for a member of your team who can help find that document. 

Bottomline: All your relevant non-confidential architecture references should be searchable across the enterprise and not 'guarded' behind a firewalled repository. Only then they will serve the purpose: to educate, inform and influence organizational design.

Thursday, February 1, 2018

Reflections on palliative care in India: a long goodbye

Those who read the papers regularly will notice two kinds of obituary messages. “Mrs. So-and-so passed away peacefully in his sleep. She was 82, and is survived by ….” or “Mr. ABC succumbed to Cancer after bravely battling it for over 6 months. He was 79 and is survived by....” If a detailed article is written after the passing of the latter, it may eulogize their life, and make a brief mention of “the brave battle with cancer” and that they were hospitalized for months. Such an article may or may not make a mention of the “brave battle” the family and caregivers undertake.

My dad has been bedridden at home for the past six months, requiring constant care and attention for his daily needs. While caregiving has certainly been at the forefront of my daily routine, it sometimes takes an outsider to notice the pace of decline. A couple of weeks ago, an uncle of mine stopped by to visit my ailing dad. He later took me aside and quietly sobbed, and remarked about the “unfairness” of life. He simply said “we are praying for his peaceful passing.”

To be fair, my dad has led a rather eventful and fruitful life, rising from humble beginnings before retiring as a proud Officer in the Indian Air Force. After retiring from service, my parents continued to live on their own and traveled to scores of temples across South India well into their seventies. This rather active retirement gradually came to a halt after we found out that my dad had stage-4 Prostate cancer, which had metastasized, but by itself was not debilitating. Only subsequently after he was diagnosed with Parkinson's that his movements gradually slowed. What started as a gradual tremor in the hands progressed to the rest of his limbs. In a span of the following year, a combination of these and old age eventually knocked him over.

About five months ago, my dad got feverish and had to be hospitalized. Turns out he had a mild stroke, after which he lost the use of his right arms and both legs.  After a battery of tests and reviews, a panel of doctors said they had exhausted available medical options and that “palliative care” was the next course of action. I was a bit surprised by this in-your-face advice, more because it was delivered matter-of-factly, without sugarcoating. When I asked for further clarification, the senior resident was just as cryptic “We are just medical professionals, not gods. Just pray for some peace moving forward, and continue to provide him comfort.”

Every few weeks, dad's condition seems to take a dip, making us scramble while we come to grips with the new reality. His slow, slurred speech has reduced to a few gurgles, and he spends most of the time motionless in a slumber. Feeding solids have given way to semi-solid gruel supplemented by baby food. Perhaps the only redeeming factor here is that he seems to be cognitive and responds in a low gurgle or squeeze of hands when spoken to.

[ Counting one's blessings: video of little Vijay with his grandpa ]

The Philosophy

The Hindu philosophy that I loosely follow talks about Karma : actions, and the spiritual principle of cause and effect where intent and actions of an individual influence the future. Even without a deeper  philosophical reflection, many of us recognize that caring for an elderly parent is a part of one's Karma; after all they were there to nurture and guide us when we were young and impressionable. Paying that 'debt' back is the least we can do. If an extended palliative care before passing is in an elder's 'Karma,' who are we to argue?

The Hindu philosophy also makes fundamental assumptions of Saṃsāra, the theory of rebirth and "cyclicality of all life, matter, existence." When the body dies, the Atma (soul) leaves the body. In a tacit acknowledgment of the finality of death, Hindus cremate the body since the soul doesn't come back in the same form. It does not require a philosophical grounding to acknowledge the obvious: all who are born, must eventually die. The philosophy and scriptures, are however intentionally vague about the 'process' of death and dying which will be unique to an individual.


Even a generation or two ago, extended families in India lived under a roof, and caring for an elder, perhaps even palliative care was a non-issue. As urban Indians move towards 'modern' nuclear family structures, family-support for caregiving can be a trying experience, especially when it comes to extended palliative care. Those of us who can afford to, hire caregivers to assist with day-to-day needs, but even with such help, palliative care overwhelm the extended family.

Caring for a sick and infirm person takes a lot of emotional resilience, more so when the prognosis is a  terminal-end, and one is facing a downward slide that follows a textbook pattern (link). When a terminal patient suffers, caregivers and family suffer in equal measure. Caregivers may find it hard to sometimes suppress thoughts, of a peaceful and speedy end.

One sometimes reads of people in dire straits occasionally contemplating drastic actions by 'taking things into their hands,' although such thoughts and actions are unthinkable for most of us. A living will, and Euthanasia are things one reads about, though one generally does not encounter in real life.
A few weeks ago, social media was buzzing over an elderly couple's plea to the Indian President seeking permission for 'active euthanasia' (link). While that appeal made headlines. and will almost certainly be ignored by the President, it just highlights the reality that the couple are confronting as they grow older.

In most cases, the caregivers and families bottle up their emotions, and focus on the present and try to make the little time left with the loved one comfortable.

Dad with caregiver

It takes a village to care for an elder... but not all think alike

I sometimes reflect on my dad's inner strength to continue to bravely fight the fight, and the utter lack of self-pity that he has demonstrated. Of course, his resilience is reinforced by the resolve around him. My aging mother has taken her marriage vows “ sickness and in health,....” quite literally; dedicating her time and energy to caring for him. Her initial prayers to 'get him back to normal' have been replaced by a more pragmatic prayers for continued peace and comfort.

Needless to say, not all families or even members of a family will react to these circumstances in the same way. For instance, my brother who lives thousands of miles away in England has been trying to stay updated on dad's condition. Although not in denial after a quick trip to visit dad, he harbors optimism. He perhaps believes that a miracle might just occur.

Our 8 year old, on the other hand, is a bit overwhelmed by the life-lesson unfolding in front of him. He has mostly been keeping his feelings to himself. The other day, he opened up a bit, and began telling Suja about his latent feelings for Thata (Grandpa). He said he was finding it really hard to go and greet Thata, "lying in his bedroom in this condition.” adding, “It is hard to see him like this. Even a few months ago, Thata used to ask about my school-day. Now he is only able to make some grunting sounds. I wish he were at least able to speak again.”

A redeeming factor in the gradual decline is that it has given us enough time to sit back, observe, reflect while we continue to provide the best care and comfort one can. The extended nuclear-family – mother, dad's caregiver, my wife and our little son - are involved in various aspects of the planning, logistics and care-giving. While dad goes through the gradual stages of withdrawing from the world, we continue to be around, although we continue with our daily life.

Paraphrasing an old adage; it still takes a village to care for an elder.


Related post : A review of cottage industry around ‘elder care’ in India

Tuesday, January 30, 2018

Adult diapers in India: Emerging business to meet a growing demand (Elder care)

I first heard about 'adult diapers' while reading an article about an astronaut's wife who drove from Texas to Florida non-stop. (link) She drove over 500 miles to confront a romantic rival. She was able to drive  considerable distance non-stop, without even a bathroom break aided by adult diapers. This tidbit was filed away in the back of my mind for years till the need for adult diapers hit home; literally.

A couple of years ago, my dad, who is suffering from Prostate cancer began to wet the bed at night frequently. We realized that the involuntary bedwetting while sleeping wasn’t healthy. It could lead to infections and other complications too. After exploring medical alternatives and therapy to control frequent urination, we decided to get him adult diapers.

Having that chat with a parent or adult who needs diapers 

It is not easy to have a conversation with an adult or senior-citizen who may obviously need an adult-diaper. While the symptoms of bed-wetting may be obvious, having the conversation can be awkward.

At some point, we realized that wearing an adult diapers was a medication-free alternative to his 'problem,' but convincing him was not easy.  After all, my dad, a proud Air Force veteran had refused to use a walking-stick even in his late seventies, till it became absolutely essential.  He would argue that an 'accident' was a one-off or that he would 'control' himself, but with persistence we were able to finally get him convinced.

I realized that we were not alone in this endeavor.  It is interesting how the term 'diapers' is itself a bit touchy, as a Wikipedia entry on the topic explains
“In the medical community, professionals are trained to use alternative terms such as "briefs" rather than "diapers" for the sake of dignity, as the term "diapers" is associated with children and therefore may have a negative connotation. In practice, though, most health care workers are accustomed to calling them diapers, especially those that resemble children's diapers.”

Market demand and supply 

I got the first few cartons of diapers for my dad while returning back from the US. The diapers I got in bulk from Sams-club were relatively inexpensive, but of rather good quality. At the time, my dad would go through one diaper a night. My brother, who lives in England also got a few cartons during his visit. After the initial stock of diapers got over, I realized that importing the diapers was neither practical nor sustainable, and I began to explore alternatives in the Indian market.

My brief research indicated that the market for adult diapers in India has really taken off as the aging and relatively affluent middle class continues to live longer.  A couple of other factors also drive this trend. A middle class that can afford to spend 40-50 rupees on 1 or 2 diapers a night, and is increasingly aware of its benefits and use. The topic of 'good quality and cheap' diapers is surprisingly common among the younger generation who are comfortable 'shopping' for it at pharmacies and online stores. Hiring full-time domestic help and caregivers in urban India can be relatively expensive. Use of diapers at night for senior citizen can be a viable alternative for some.

During the past year, I have shopped for a variety of adult diapers brands in the market. We tried unbranded diapers from local chemists, though we generally stuck with popular brands like Tena, Friends, Kare, Keane etc. My dad also tried several kinds of diapers including pant-style pullup diapers and the other velcro-enabled ones. We finally zeroed in on a couple of pull-up diapers that he used like an extended underwear at night and for hospital trips and outings.

Other Practical Applications of Adult-diapers

Adult diapers seem to have other practical applications to. For example, Astronauts wear trunklike diapers called "Maximum Absorbency Garments", or MAGs, during liftoff and landing. On space shuttle missions, each crew member receives three diapers—for launch, reentry and a spare in case reentry has to be waved off and tried later. (NASA)

The Wikipedia entry explains “The super-absorbent fabric used in disposable diapers, which can hold up to 400 times its weight, was developed so Apollo astronauts could stay on spacewalks and extra-vehicular activity for at least six hours.  Originally, only female astronauts would wear Maximum Absorbency Garments, as the collection devices used by men were unsuitable for women; however, reports of their comfort and effectiveness eventually convinced men to start wearing the diapers as well.”

Bottomline: With an aging population of an affluent middle-class, demand for this practical aid for adults  will continue to grow India. While senior-citizen are the primary consumers of adult-diaper, most of the shopping and research is done by the middle-generation (like self) or even tech savvy youngsters stepping in to help grandparents.

Articles on the topic:

A review of cottage industry around ‘elder care’ in India

During the past year, I have taken on the responsibility for caregiving for my elderly father and mother. My 80-year-old dad was diagnosed with Prostate Cancer and Parkinsons, and needs help with his basic needs including care and feed. My mother, senior in age herself, was unable to manage the affairs at home. Therefore, my wife and I decided to move back to India to live with them.

I decided to hire a caregiver to assist with my father’s day-to-day needs. For about six months, we hired an elderly lady to help at night with dad’s diaper change and bath and breakfast next morning. For about a year, he was a bit mobile and was able to walk around with assistance. Towards the end of last year, his condition took a nosedive and he was bedridden. We decided to engage a full-time caregiver at home.

My experience in hiring and managing caregivers has given me some insight into the highly fragmented cottage industry around senior-care. The vast majority of elderly-caregiving in India, is still managed by family members. However, nuclear families like mine are realizing that they are ill-equipped to take on the complex chores involved in supporting aging parents while also managing their own lives and families.

These are my observations on my year-long journey of vetting, hiring and managing caregivers for an elderly gentleman in India.

Hiring a caregiver for an elderly? Define your requirements

Elders at home who need a caregiver are obviously going to be infirm and helpless. They may find it hard to acknowledge that they need help with caregiving. The senior citizen will generally not be in a position to define all their requirements.

In a reversal of roles, the younger members of the family take on the responsibility of vetting and hiring caregivers and supervising them.

Caregiving for the elderly requires a person with empathy who can manage - and sometimes challenge - the whimsical needs of frail elders. They also need the physical and emotional resilience to manage highly stressful situations; and sometimes pushback doting family members who might have their own demands.

If you happen to be responsible for caregiving, you should begin with a simple checklist based on your specific needs and commitments that may include
  • Help with basic care and feeding of the senior citizen
  • Help with bathing or sponge bath and a change of clothing and general hygiene (e.g to prevent bedsores if the person is bedridden)
  • Change of diapers and cleanup, and fixing a catheter and urine bag as required
  • Administering medication and assistance with basic medical needs like a nebulizer or inhaler 
  • Generally keeping the environment clean and sterile to prevent infections
A checklist like this can be handy while vetting and hiring a caregiver since you will have to guide her/him with your specific needs during the initial days after they join your family.

A good caregiver can certainly help with basic needs, including feeding, bathing, toilet and other requirements of the elder. However, I realized that even engaging a full-time caregiver does not let a family abdicate its responsibilities that can include managing the logistics. For instance, I still have to manage the procurement and administration of medicines, medical supplies and other sundry needs.

My wife and mother manage the domestic chores at home, that now include care and feed for my father and also the needs of the caregiver. After all, a full-time caregiver becomes an extended member of the family, and will have their needs.

The cottage industry around caregiving for elders

The caregiving needs of home-care in India is unique since the middle-class families are increasingly fragmented and nuclear, and elders try to live and manage on their own till they are unable to. The concept of old-age-homes and senior living is still at a very nascent stage and is generally not tailored for the infirm and bedridden elders. Elders generally fallback on family at their hour of need.

Given the unique needs of the Indian middle class, an entire cottage industry has sprung up in this sector. Most caregivers are either individuals or small ‘agencies’ employing a few people who get clients via word-of-mouth referrals.  Unlike other menial services – like hiring servants or cleaners - caregiving for the elderly and infirm is a highly personalized affair. The needs can range from simple care-and-feed to more unique care depending on medical and other health-related conditions.

Caricature of Dad's caregiver - by our son Vijay

Caregivers in India are generally independent contractors who work for small-time agents. A few elder-care ‘chains’ like Portea are also trying to grow in this market by hiring and training caregivers and might include other ‘packages’ like service of nurses and doctor home visits.

There are some vocations like nursing and caregiving that require people with a certain even temperament who can step up and care for the needy and helpless. Caregiving is a service job that requires minimal training. As there are no requirements for training or education, the barriers to entry are low.

For a manual-job, with minimal medical skills, caregiving pays reasonably well. The current rate for a live-in caregiver in large cities like Bangalore ranges from 20-25,000 rupees a month; and about 14-16,000 for a day or night-shift. The ‘agency’ keeps a percentage of this amount as a fee and pays the caregivers about 10-12,000 rupees a month. Of course, the price I am quoting (circa 2018) is a ballpark and is generally open to negotiation based on one’s specific requirements and location where you live.

Hiring Caregivers: Lessons and tips: You can’t abdicate your responsibilities  

If you are hiring a live-in caregiver, you will also have to plan for other basic logistics like a living area for the caregiver and the elderly so that it doesn’t intrude into the day-to-day activities for the rest of the family. We are fortunate to be living in a house with a spare room with an attached bathroom that we have dedicated for my bedridden father and the caregiver, Andy. I arranged for a TV and some bedding for Andy and he was all-set.

By hiring a caregiver, you are essentially ‘outsourcing’ your day-to-day responsibilities. And like any outsourcing contract, you may delegate, but will have to retain administrative control. A caregiver can be expected to help with the basic needs of the senior-citizen, but will also require some active monitoring. You should also be willing to step in when required. For example, a senior’s health may not follow a steady trajectory and one must be around to understand the day-to-day changes and step-in and seek medical help when required.

Andy, the caregiver, we had hired for a small-agency, was from Manipur and had decided to travel back to his hometown for Christmas. His reasoning was simple: he had spent the past four years in Bangalore working for the agency and needed a break. He and I knew that he was probably not going to come back, but my mother had become very dependent on Andy. The agency promised a replacement a month in advance, but the transition to the new caregiver, Wyisng, wasn’t seamless.

The agent said he had identified Wyisng, who was coming out of another contract, but couldn’t ‘hold’ and house him till Andy was relieved; would we be okay to have two people living with us till Andy left on his vacation? My mother was distraught and confused that she would have to depend on yet another person to help with caregiving for my father.  I weighed my options and said we couldn’t accommodate two more people at home. I asked the agent to house the new guy till Andy was ready to leave. This is just a small example of a ‘firefighting’ I couldn’t have done if I had delegated the caregiving remotely.

The lesson here is simple: Vetting and hiring a good caregiver can certainly help with the basic needs of the elderly, but others in the family need to continually chip-in. A caregiver also needs to be continually monitored.

Dad's caregiver Wysing