Typesetting
Caring for Old Age. Perspectives from South Asia
23 Apr 2020
Suburban Elderscapes and “Modern” Modes of Ageing: The Spatiality of Contemporary Urban Ageing in the Kathmandu Valley, Nepal
Abstract
This chapter focuses on the spatial experiences and place-making practices of older persons, mainly from the middle classes, in different suburban settings of Nepal’s rapidly transforming Kathmandu Valley. One key question here is how contemporary social trajectories with regard to ageing and care translate into the urban space of this metropolitan area in the Global South which is often represented as being “off the map” (Robinson 2006). The perspective of elderscapes, understood as multi-­layered, embodied spaces of age, proves to be a helpful conceptual tool to explore the intersectionality of shifting modes of ageing and altering urban space. In this chapter, I introduce two ethnographic case studies, conducted between 2013 and 2017, which give insight into the circumstances where novel elderscapes emerge in Kathmandu’s suburban middle-class spaces. They represent a response of older persons and actors from civil society to changing forms of cohabitation and intergenerational relations and reflect the relatively recent perception of older persons as a distinct, age-based peer group, the senior citizens. Novel spaces, such as senior citizens’ centres and care homes, epitomize changing “care-scripts” (Coe 2017) and altered cohabitation realities, mostly with regard to the mobility of younger generations, which provoke new approaches towards care and non-kin sociality. Through such urban and sensory ethnography, we can understand older persons’ creative urban citizenship and their concern for their social and spatial environment as practices of “ageing in place” and generativity, contributing to an “age-friendly city” for themselves and future generations.
Keywords urban ageing, elderscapes, “ageing in place”, environmental gerontology, Kathmandu / Nepal
Today Kathmandu holds out the prospect of a muddle where one loses one’s identity in a maze of dark alleys enticing one to a confused destiny. The narrow alleys of the city have no logic; the tall new buildings have no character; the old city is in steady ruins; the new city centres are breeding cosmopolitan philistines. No one can stop for a quarter of an hour in the New Road without being suffocated, both mentally and physically, by the muddle that is ­Kathmandu (Malla 1967, 9).
Sensing Kathmandu City
On a cold, sunny January afternoon in 2014, I was following Mr. ­Shrestha, a vivid and mobile Newar in his mid-sixties who had become a close friend of mine, through the narrow and shadowy lanes of Wotu, one of Kathmandu city’s central business areas, a bustling labyrinth of wholesale shops just behind Kathmandu’s famous New Road (Fig. 1).1 The slender ground floors of the new multi-storey concrete buildings were occupied by innumerable clothing shops using all front space to display their Chinese bulk commodities. Behind a small, almost imperceptible passage between two houses, we entered a larger courtyard (chowk)—now used as a parking lot for motorcycles—which unveiled the area’s old Newar architectural structure. Here, as well as in other alleys, a few older two- or three-storey Newar houses had still withstood the vertical growth of Kathmandu’s city centre, but due to highly increased real estate value it was just a question of time until they would be replaced by higher concrete buildings. Due to the height of the surrounding concrete buildings, the sunrays hardly entered any of the lanes, which meant that one could not escape the winter chill in the lower floors without a heater.
Absorbed by the surrounding impressions, I struggled to keep pace with Mr. Shrestha through the bustle of merchants pitching their goods, porters carrying away huge parcels, passers-by and motorcyclists. As in many places in Kathmandu, one had to watch one’s step on the uneven, partly unpaved ground, circumstances that I would have assumed to impact older people’s mobility. Mr. Shrestha navigated this meander of shops and lanes with ease, whereas I would have been lost on my own: he knew this place like the back of his hand since he had lived here for many years in a rented room with his wife and children, saving all their income to construct their own house in a suburban neighbourhood that was developed for housing in the early 1980s. Later, when we were standing on the airy rooftop of one of these multi-storey business buildings overlooking Kathmandu’s skyline (Fig. 2) which Mr. Shrestha’s eldest son now owned, Mr. Shrestha reflected about the spatial transformations he had witnessed and participated in over the past three decades in his previous neighbourhood:
Earlier, this was a residential area. […] There used to be old houses here, but they were demolished, and new buildings were constructed for business purpose. […] People used to live here with their families. Gradually they sold their [old] houses and shifted to other places […] where land was cheaper. They built a house there and saved the remaining money in the bank, and took up a job.
His thoughts illuminate not only the processes of gradual expansion of Kathmandu city through suburbanization and re-designation of residential space in the city’s centre into business areas, but also a profound change in this area’s ethnic community life which used to be predominantly inhabited by local Newars and characterized by the architectural structure and social interactions of this ethnic group (see B. K. Shrestha 2013, 134). His quote also offers a glimpse into the changing spatial and economic practices of the city’s new middle classes from the 1980s onward as a reaction to the city’s enormous population growth (Liechty 2003, 53).
Watching the winter sun as it set slowly on the horizon of rooftops and mountain ridge, I asked Mr. Shrestha what memories came up when he thought of his past in this area. He compared his family’s earlier life in their tiny rented room with living in the spacious self-owned house in a suburban neighbourhood and explained, from his view, how urban growth in the Kathmandu Valley was entangled with Nepal’s economic development: over the past decades, the meaning of cash had considerably increased and therefore influenced everyday life and local aspirations tremendously: 2
So much progress and development has taken place now, but [earlier] you could easily cover your basic needs. Now you need to spend a lot of money for that. Without money, nothing happens. Earlier all the neighbours grew spinach and would give some to you if you wanted to prepare spinach. Later they gave up farming, so they, too, had to buy things. And for buying things you need money. Money means income. And not everyone has income. […] [N]ow people wear good clothes, buy a car, so others feel they also need that. The ambitions have risen a lot (Mr. Shrestha, January 26, 2014).
Although Mr. Shrestha entirely supported the rise of living standards and “development” (bikās) in Kathmandu, his response mirrors a certain nostalgia about the past when lifestyles appeared simpler and more collaborative: a time when neighbours shared fresh, self-grown vegetables and life seemed to be less profit-driven, less competitive. While it was difficult to imagine that only a few decades ago there used to be open land in the now densely-built area of Wotu, I thought of a recent visit to the north-eastern edge of the Valley where such re-designation of farmland was happening at that very moment: single houses gradually formed new unplanned residential areas and swallowed up the remaining open fields, resulting in shrinking open spaces and various other urban vulnerabilities (Haack and Rafter 2006, 1057; Muzzini and Aparicio 2013, 64–65; also see Fig. 4, this chapter).
This vignette of “walking with” (Pink 2007) a senior resident of ­Kathmandu introduces from a sensorial perspective some aspects of the fundamental spatial transition that is taking place in the Kathmandu Valley (Muzzini and Aparicio 2013). Walking with Mr. Shrestha who himself was a passionate walker, a habit from his youth when there were only few vehicles available, through the dense centre of Kathmandu to his suburban middle-class neighbourhood allowed me to sensorially experience his “walking rhythm” and his “routes and mobilities” (Lee and Ingold 2006, 68–69) as place-making practices. Simultaneously, I could explore aspects of walkability and mobility for older people from his perspective in one of South Asia’s fastest growing cities, an important aspect in the global debate on age-friendly cities (Buffel et al. 2012). As expounded in more detail later, including a sensory approach in ethnographies of urban ageing creates a powerful tool to better understand the heterogeneous character and local particularities of ways of ageing in the complex and rapidly changing environments of cities (Pink 2009; Phillipson 2010).
In this chapter, I investigate place-making practices and spatial experiences of older people from the middle classes in the context of profound urban change in the Kathmandu Valley.3 Within this setting, I explore emerging middle-class “elderscapes” in the city, sites where older persons engage with the city or which form spaces specifically aimed at the elderly. These novel spaces reflect larger social processes of changing forms of cohabitation and intergenerational relations, but also processes of nation-building by civil society and around the relatively recent age-based peer group of senior citizens. The chapter is structured in three major parts: first, I introduce the focus of ageing in urban environments and suggest a stronger inclusion of urban and sensory ethnographic methods which allows for a better theorization of this field. Then I describe the Kathmandu Valley’s spatial and economic transition and contextualize emerging elderscapes as a response of older people to these shifts. Finally, I introduce two diverging case studies of such elderscapes: an ageing suburban neighbourhood of Kathmandu and its residents’ commitment in the local neighbourhood association; and the recent burgeoning of private care homes in the Kathmandu Valley which represents a fundamental shift in local practices of care and cohabitation.
Approaching ageing in urban environments in the Global South
On a global scale, the twenty-first century is characterized by significant shifts in the demographic composition and spatial distribution of societies, i.e. by processes of population ageing and urbanization. To capture these dynamics, sociologist Phillipson notes that this century has often been described as the “century of the city” or the “urban age,” catchy, but also somewhat indistinct labels which are used to highlight the scale, immense speed, and the complex character of urbanization processes, but also the spatial mobility of people (Phillipson 2010, 597–598). However, Gusmano (2009) and, more recently, Buffel and Phillipson (2015, 315), two of the few pioneers in research on ageing in cities, asserted that the interrelations of these two major social trends have so far been largely neglected in both research and policy: even though a number of publications from fields such as anthropology, environmental gerontology, and geography cover the research topic of ageing in cities, many of these studies do not explicitly theorize upon the urban dimension as a particular environment for ageing, or upon the entanglements of urbanity and old age.4 In view of the United Nations (UN) conference Habitat III 5 in October 2016, the non-­governmental organization (NGO) HelpAge International re-emphasized the relevance of the topic of ageing in cities:
The global population is both urbanising and ageing at historically unprecedented rates, particularly in low and middle-income countries. These century-defining mega-trends will change the way we live, work, play, socialise and experience our urban environments throughout our lives and into our older age. […] Over 518 million older people live in towns and cities today, representing 57 % of all older people.6
During Habitat III in 2016, the United Nations’ member states, including most South Asian countries, signed the “New Urban Agenda,” a non-binding declaration to set global standards for sustainable urban development that include age-responsive urban planning and development.7 These very general policy guidelines are based on previous global strategies to adapt to population ageing, such as the World Health Organization’s (WHO) framework of Active Ageing (2002), and its related initiative for global age-friendly cities (2007). “Active Ageing” is defined by the WHO as “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (2002, 12). In order to achieve this aim in urban environments, the WHO later conducted a large-scale, participatory research project on age-friendly cities in thirty-three cities of various scales in the Global North and South, reflecting “the diversity of contemporary urban settings” (2007, 7), and accordingly developed globally applicable guidelines to adapt a city’s “structures and services to be accessible to and inclusive of older people with varying needs and capacities” (2007, 1).
While such guidelines may represent a valid step towards a growing empowerment of older people in urban environments, some aspects of such a generalizing perspective are problematic. First, this approach—drawing from Western-centric gerontology and its medicalizing perspective on old age—focuses on older people’s challenges, vulnerabilities, and social exclusion, but tends to overlook their active contribution to and their “care for place,” i.e. their participation in shaping urban environments (Wiles and Jayasinha 2013, 93–94). Second, given the complexity of the ongoing processes of urbanization on a global level, which Brenner and Schmid suggest be designated as “planetary urbanization” (2015, 172–175), it is crucial for the research on urban ageing to overcome foregoing binaries of “traditional models of metropolis and hinterland, center and periphery, city and countryside” (2015, 174), and offer a stronger theorization of the field which takes findings from critical urban studies into account. Here, it might prove helpful to differentiate between the city “as a local entity” (Kip et al. 2015, 16) and the urban as a more abstract concept, understood as a particular form of “spatial organization of society […] [which] is comprised of structural aspects, i.e. the acceleration and densification of connections, which are materially embodied in the development of the built environment, but also cultural aspects, i.e. ways of dealing with difference and complexity, which are based in the micro-physics of the everyday encounter rather than sovereign planning” (2015, 17). As Brenner and Schmid emphasize, international organizations such as the UN, World Bank and also the WHO perpetuate the idea of the urban as a “bounded spatial unit”—rather equating the urban with the city—which does not grasp its processual characteristic that “even while continually reinscribing patterns of agglomeration across the earth’s terrestrial landscape, simultaneously transgresses, explodes and reworks inherited geographies (of social interaction, settlement, land use, circulation and socio-metabolic organization)” (2015, 165–166). Third, the theorization of urban ageing must take into account the specific local research setting, adequately representing cities and urban environments in both the Global South and North in all their heterogeneity and particularities, a recurrently addressed lacuna in urban studies (see e.g. Robinson 2006; Roy 2009; Edensor and Jayne 2012; Parnell and Robinson 2012), but not without contextualizing them within “a world of cities” (Robinson 2011).
What can we draw from these arguments for the approach of ageing experiences of older people living in urban environments subject to rapid transformations? As Phillipson has repeatedly argued, urban ethnography offers very helpful methods to achieve a nuanced perspective because it “captures the disparate experiences of living in cities now subject to intense global change and strongly influenced by complex patterns of migration. […] [It] bring[s] to the surface the attitudes, motivations, and experiences of older people who are ‘ageing in place’” (2010, 604). By including tools from sensory ethnography, such as the walk-along,8 or emplaced learning through participating in particular everyday activities, which understand ethnography as a multisensory and participatory research process, building upon the emplaced body and interconnected senses of the ethnographer, as also on new forms of representing research findings (Pink 2009), we can gain comprehensive insights into the manifold ways in which older people actually engage with, care about and for their urban environment, and what individual strategies they employ to “age in place” in an ever-changing surrounding. Simultaneously, these methods allow us to understand in more detail local notions of what features make the city age-friendly by moving around together with older interlocutors and learning how urban places feel to them and us. Only through combining the macro perspective of processes of urbanization, globalization, and gradual population ageing in a certain city or urban area with such micro perspectives from ethnographic research can we achieve a comprehensive understanding of ageing experiences in specific urban environments which then can be further analyzed from a comparative angle.
The methodological focus of this chapter is therefore to explore spatial practices and ageing experiences of older people in the rapidly transforming environment of Kathmandu Valley through methods from urban ethnography and a multisensory perspective. Novel elderscapes reflect the intense urban and social trajectories that have marked Nepal since the 1970s. Using this approach allows us sensitive insights into the life worlds of older people and the ways in which they participate as urban citizens in a capital of the Global South which is commonly perceived at the “global periphery” (Liechty 2003) or “off the map” (Robinson 2006).
Kathmandu’s urban transition through the lens of old age
The gradual shifts in Nepal’s demography towards a larger share of people above sixty years 9 are a social topic that is relatively new on its national agenda. Despite the fact that the Government of Nepal was the first in South Asia to have introduced its Old Age Allowance Programme in the financial year 1995–1996, providing universal social pension of initially Rs. 100 to all older persons of seventy-five years and above (Rajan and Palacios 2008, 340), and in 2002 agreed to the Madrid International Plan of Action on Ageing (MIPAA) (Geriatric Center Nepal 2010, 12), the topic of ageing was rather neglected in public and political discourses until the mid-2000s. One probable reason for this negligence was Nepal’s decennial civil war from 1996 to 2006 which significantly impacted the political stability of the country. Parker et al. (2014b, 354) see another significant reason in the prioritization of the Millennium Development Goals (MDGs) in Nepal’s policy and international development work which do not include objectives related to old age.10 Similarly, the other SAARC 11 member countries had also hardly addressed population ageing until then (Parker 2009, 89–91). Apart from a few early exceptions (Goldstein and Beall 1980, 1981, 1982, 1986; P. R. Sharma 1982; Jonas 1992), sociological or anthropological research in Nepal did not focus exclusively on older people before the mid-2000s either. In the last decade, the substantial rise in average life expectancy at birth for both sexes in Nepal from 49.5 years in 1981 to 66.6 years in 2011,12 together with a sharply mounting ageing index13 (Central Bureau of Statistics 2014c, 62–63, 190), has created an increasing awareness of the topic of ageing (Parker et al. 2014b, 354). Influential international NGOs have contextualized Nepal’s projected demographic shift as “global ageing,” resulting in the need for action to prepare the country for a larger proportion of elderly people (United Nations Population Fund and HelpAge International 2012). Local NGOs working in this field refer to these international discourses influenced by gerontology for a broader acceptance of their work (see e.g. Geriatric Center Nepal 2010), following established international paradigms of how to view and respond to population ageing (Cohen 1992, 128–129).
Kathmandu’s phases of urbanization
In his book Kathmandu, Thomas Bell recapitulates the fundamental transformations that the older generations of Nepal’s capital have witnessed since the 1950s, such as several revolutions and changing political systems, linking the country to a road network, an increasingly cash-based economy, electricity and media, and a growing influx of rural migrants. Such changes have happened elsewhere, too, but it is the extremely condensed time span in which the city was connected to the political and economic logic and lifestyles of other places which is particular to the meteoric urban growth of Nepal’s capital in the late twentieth century:
The result of this shrinking time lag is a city that feels at once abandoned by the modern world and buffeted by it. The failed introduction of democracy, the failure of foreign aid, the crisis of social values, the environmental catastrophe: these things have their equivalent in many old cities’ experience of modernity, but probably no other city was woken so rudely from mediaeval sleep, to find itself exposed in the electric light of the later twentieth century. Suddenly Kathmandu is possessed by new spirits, of individuality, consumerism, class struggle, and identity politics (Bell 2014, xxviii).
What does it mean then at a personal level to be an older person in the Kathmandu Valley which is today one of Nepal’s fastest-growing urban areas (see Fig. 3) with an ever-increasing population density and spatial expansion that has reached the valley rims (Muzzini and Aparicio 2013, 27)? How do older individuals experience such fundamental spatial and economic transformations over their life course?
First, it is important to mention that in Nepal, a dualistic divide between urban (implicitly often equated with Kathmandu Valley) and rural areas has long been perpetuated through development aid and a very uneven distribution of capital. This dichotomy has been sustained by local tropes of “modernity” and “development,” contrasting between the centralized–­Kathmandu­ Valley as a hub of power and the epitomization of “modernity,” and Nepal’s rural, partly very remote, settlements, difficult to access because of the mountainous landscape, and by some urban elites derogatorily associated with an “uncivilized,” backward lifestyle (Pigg 1992; N. ­Shrestha 1993).14 Neglected in this oversimplifying divide are the ­numerous ­temporary and permanent migrants to Kathmandu Valley who likewise shape the city, be it through their soundscapes (Stirr 2009), or by renting middle-class property and influencing the architectural appearance of the urban periphery (Nelson 2017b). Concurrently, this attitude elides the fact that urban farmers continue to pursue agricultural activities in the remaining spaces for farming of the valley, such as small fields, and livestock farming in between houses or at the outer rims of urban settlements. With its urban population at a growth rate of six percent for the past four decades, Nepal currently represents South Asia’s fastest-urbanizing country (Muzzini and Aparicio 2013, 27). This trend can be explained through its comparatively low, but rising total urbanization level: while Muzzini and Aparicio still state ca. seventeen percent (2013, 27), the Population Monograph of Nepal 2014 already indicates it at 27.2 percent. The divergence of this data originates from the declaration of seventy-two new municipalities between the two publications, a strategy which probably illustrates Nepal’s ambition to catch up with its South Asian neighbour countries with respect to their urbanization levels (Central Bureau of Statistics 2014d, 100). This also means that the national definitions of urban concepts, terminology, and legal instruments need to keep pace with these developments (see Central Bureau of Statistics 2014d, 98). The classifications and terminology employed to describe the status of urbanization in Kathmandu Valley’s administrative subdivisions—an urban agglomeration with an urban core of five urban settlements and further peri-urban areas, officially termed as rural space, housing a population of ca. 2.5 million (Muzzini and Aparicio 2013, 34–35)—illustrate the diversity, fluidity and impermanence of settlements and land use that concomitantly coexist there. From this perspective, Brenner and Schmid’s above mentioned argument of approaching such rapidly changing dynamics of urbanization as “planetary urbanism” seems most helpful to grasp on-the-ground experiences.
Situated in Nepal’s central hill region in a bowl-shaped valley of ca. 665 km², with moderate climate and fertile grounds, Kathmandu Valley has been a main economic and political hub in the Himalayas for many centuries and has a long history of urbanism (Liechty 2003, 40–41; ­Chitrakar et al. 2016, 31). The three ancient Newar kingdoms of Kathmandu, ­Lalitpur, and Bhaktapur, dating to the late thirteenth century with a rare urban culture in the Himalayan region (Gutschow and Kreutzmann 2013, 17), formed the foundation for today’s three largest urban settlements in the Valley. The road network that was established to link the Rana palaces, built outside the medieval Newar cities during the Rana rule (1846–1951), with the city cores initiated the first phase of urban expansion along these roads, mainly north and west of Kathmandu in the form of scattered residences and markets (HMGN 1969, 74–82; Nelson 2017b, 60). Although several master plans and legal town planning measures were drawn up from the 1960s onward, their implementation mainly failed, and the majority of Kathmandu Valley’s urban settlements have grown in a largely unplanned way (KMC and World Bank 2001, 6; Gutschow and Kreutzmann 2013, 24–25; B. K. Shrestha 2013). With the construction of the Ring Road in the 1970s, which surrounded Kathmandu and Lalitpur, and of several highways during the Panchayat period (1951–1991), these two cities in particular grew rapidly so that the designated farmland situated between these major connecting roads was gradually converted into residential space.
This “Baneshworization” (Nelson 2013),15 as this haphazard development is informally known as, was the beginning of a “site-then-services” building practice lasting until today (see Fig. 4), where the provision of urban infrastructure follows—if at all—the construction of housing (Gutschow and Kreutzmann 2013, 30; Nelson 2013, 55–57, 2017b, 60). In the late 1970s and 1980s, three neighbourhoods were established under public management (the site and services programme, landpooling projects) as an urban development strategy which worked too slowly and insufficiently for the demand for housing—from 1977 to 2003, these programmes only provided 8,095 housing plots as compared to a housing deficit of 48,545 units in 2001, and a steep rise in slums and squatter housing since the mid-1980s (Gutschow 2011, 969; 2017b, 60; B. K. Shrestha 2010, 88–91). From the 1990s onward, Kathmandu Valley witnessed another considerable increase of population when, during the Maoist insurgency, many people left their rural homes for the safety of the Valley. During this time, the great demand for housing in Kathmandu Valley reached its peripheries, i.e. areas outside the once urban boundary of the Ring Road, where different types of housing have been emerging, from unplanned residential space to elite gated communities, as Nelson has analysed (2013, 2017a, 2017b).16
Suburban living and the new middle classes
As shown, the dynamics of suburbanization (in the 1970s and 1980s) and peri-urbanism (from the 1990s onward) constitute major changes in the spatial, but also ethnic composition of the Valley and illustrate the gradual shift to a more class-oriented and later neoliberal society. Liechty notes that between 1971 and 1985, more than a third of Kathmandu’s population moved from the city centre to suburban areas:
this process reflects important changes in patterns of domesticity and the sociological makeup of communities. On the domestic front, middle-class migration to the suburbs parallels the growing prevalence of nuclear families. In addition […] Kathmandu is home to a large number of first-generation residents and their children, who make up much of the new middle class (2003, 54).
The major part of my research took place in these suburban neighbourhoods—understood as the areas located between the Newar city centres of Kathmandu and Lalitpur, and the later peri-urban settlements surrounding them.
The increasingly multi-ethnic composition of these vicinities, as also the availability of new construction materials like cement and steel, and the influence of foreign architects brought considerable changes in architectural style (Gutschow 2011, 973–977, 2012, XI). Unlike the community-­oriented Newar houses in the ancient city cores which were clustered around semi-private spaces (B. K. Shrestha 2013, 127), many suburban middle-class houses were built with high boundary walls separating private domestic space from the public space of roads and paths (see Fig. 5), a feature that Nelson compares with the styles of Bahun-Chhetri or Tamang village houses (2013, 56). While there are probably a number of underlying reasons, such as ethnic background, a growing sense of security, or architectural fashion, these suburban building forms have significantly influenced social interactions among neighbours. Urban growth, the neoliberal real estate market, and a stronger emphasis on domestic space led to a negligence of public and open spaces, important for both community interaction and safety during natural disasters (see e.g. Shahi 2015; ­Himalayan News Service 2015): as Chitrakar et al. demonstrate (2016), in both planned and unplanned sub- and peri-urban settlements, most residents experience a considerable lack of public space or discontent with its design in their locality. Whereas the historic city centres are characterized by their emphasis on community and semi-private spaces such as the durbar squares, temples, resthouses (pāṭī) and courtyards (bahal) (B. K. ­Shrestha 2013, 127), there is hardly any equivalent space available in suburban neighbourhoods which stimulates social interactions to a similar extent.
Elderscapes: A spatial perspective on ageing
As briefly stated, population ageing is still regarded as a comparatively new issue in Nepal which had little priority in policy. Yet, from a gerontological and geriatric perspective, the Kathmandu Valley offers comparatively good facilities for some needs of older people: through public transport, various levels of medical care, and growing eldercare facilities, older people’s independent mobility, healthcare, and other care requirements are better than in most other regions of the country, especially the less densely populated and remote areas (see Parker 2009). All elderly interlocutors I spoke to during my research cited these provisions as the biggest assets for them being based in Kathmandu, often recalling how much more precarious the situation used to be in their youth. In opposition to these amenities stand serious health hazards, such as severe air and environmental pollution, and also infrastructural problems such as water scarcity, which are related to Kathmandu’s urban growth and lack of urban planning (ICIMOD et al. 2007). Moreover, various NGOs and voluntary organizations working in the field of ageing are based in Nepal’s capital. They mainly engage in health-related areas like dementia and Alzheimer’s disease, general awareness and advocacy work on the rights and specific needs of older people, or offer recreational programmes.
Over the past four decades, altering societal patterns of subsistence and education towards more individually-oriented labour for livelihood and institutionalized learning for children have brought fundamental changes in the lifestyles, co-presence and everyday practices of urban middle-class families (see Liechty 2003, 56–58). Furthermore, both international labour and educational migration from Nepal have steeply increased since the late 1990s. The vast majority of migrants seek work opportunities abroad. Urban migrants with higher education levels and middle-class students moving to destinations like the United States, Australia, or the ­European Union represent a minority among the large percentage of labour migrants who mostly aim for the Gulf region, Malaysia, and India (MoHP 2012, 22–24; Central Bureau of Statistics 2014c, 226; S. Sharma et al. 2014, 32–45).17 Consequently, many older people have at least one child living abroad, a fact which further impacts family structures and household sizes. Whereas many of the senior citizens of my study had themselves engaged in gainful employment and sent their children to school, especially those who were first-­generation migrants to the Kathmandu Valley, many are currently experiencing, first-hand, how far-reaching the consequences of this occupational shift are for older people. Combined with the migratory mobility of younger generations, it challenges and modifies intergenerational relations in general and, more specifically, cohabitation and previously valid care responsibilities, the “kin-scripts” of adult children towards their parents (Stack and Burton 1993), so that accustomed modes of ageing become increasingly fragile and need to be renegotiated. Furthermore, transcultural notions of “active ageing” and possible “potentials” of senior citizens, which are based on concepts from international gerontology, meander in the Kathmandu Valley through a wide scope of channels. Here, they are locally integrated into and adapted to “media-” and “ideoscapes” (Appadurai 1990) of old age. Among Kathmandu’s urban middle classes, notions of appropriate spaces for and spatial practices of older persons undergo profound transformation. Lamb (2013, 173) underlines that from a historical perspective, many countries have experienced similar shifts, particularly regarding the societal role of the family for eldercare and cohabitation. As shown above, in Nepal these transitions have evolved at an exceptionally fast pace, so that it is vital both to look at the “unique forms and meanings” (Lamb 2013, 173) of such changes in Kathmandu’s middle classes, as well as to locate them in the broader context of globalization and demographic shifts.
Elderscapes as embodied “spaces of age”
In her research in Kolkata, Lamb (2009) specifically referred to novel eldercare institutions, i.e. old-age homes, as a result of a partial shift away from mere family-based options towards market-based living and care options. To grasp the distinct atmosphere and dynamics I witnessed during my fieldwork in Kathmandu between 2013 and 2016, I take a slightly different perspective and focus on contemporary spatial practices of older people and related emerging elderscapes, social spaces aimed at or initiated by older people. The idea of new elderscapes emerging from the valley’s suburban fabric illustrates that very research momentum and helps to conceptualize these “unique forms and meanings” which fundamental social shifts bring to a “remote, predominantly rural society in transition, in all spheres […], [to] a nation on the move, […] increasingly becoming part of the globalized world” (Parker et al. 2014a, 234).
How do I exactly understand elderscapes? Initially, sociologist and critical gerontologist Katz (2009) used this term in his research on Florida’s unique coastal retirement communities to demonstrate how, in this setting, mobility became a key component of retirement that needed to be addressed in spatial gerontology:
[O]ne of the most interesting and unique spatial developments has been retirement communities. Unlike other elder spaces and networks, retirement communities call for a somewhat different kind of analysis because lifestyle and leisure values, rather than historical community and social relationships, frame their spatial characteristics and affiliated retiree identities (2009, 468).
Unfortunately, Katz does not offer any conceptualization of the term elderscape(s), but instead refers to Urry’s (2000) approach to frame and study global mobilities, so that his understanding may have been guided by Urry’s definition of “scapes” to view elderscapes as a spatial network for mobile retirees.18 Despite this, he remains vague on his actual purpose of using the term. I adopt Katz’ term to capture novel “spaces of age” (2009, 463) in Kathmandu for the following reasons: first, despite working in a very different cultural context and a different societal approach to ageing, Katz employs elderscapes as a spatial perspective on retirement communities and mobile retirees as unprecedented modes of ageing, a result of transformed economic and temporal practices in postwar North America. Against this background, Katz emphasizes the need for stronger inclusion of analysis of “the larger cultural forces at work redefining age” (2009, 468) in gerontological research which can be—at least partly—achieved through an interdisciplinary perspective drawing from urban anthropology and critical spatial gerontology. Second, I find the term elderscapes conceptually helpful in my research context if used in a more Appaduraian sense to denote an urban “ethnoscape” of and for older people who are part of and at the same time produce this social space. The emergence of these urban elderscapes can be theorized through Lefebvre’s (1991, 33–40) triad of spatial practice, representations of space, and representational spaces (or perceived, conceived and lived space): through spatial practices, i.e. their daily interactions and movements within the urban fabric, Kathmandu’s residents create representational, or lived, space, “the space of ‘inhabitants’” (1991, 39), which also comprises elderscapes, reflecting the fluid, ever-changing nature of urban space. In Kathmandu’s unplanned suburban areas, representations of space, or conceived spaces, follow a different social logic than in Lefebvre’s original context: it is not the “scientists, planners, urbanists” (1991, 38) who conceive and shape the structures of this particular urban space, but land brokers (dalāl), real estate companies, cement and brick companies, as well as home owners and builders (Nelson 2017b, 59–60). Combining Lefebvre’s approach with Low’s concept of embodied space, “the location where human experience and consciousness take on material and spatial form” (Low 2011, 467), allows me to phenomenologically capture the process of how new elderscapes evolve in Kathmandu’s suburban neighbourhoods:
The actor as a mobile spatial field, a spatio-temporal unit, with feelings, thoughts, preferences, and intentions as well as out-of-­awareness cultural beliefs and practices, creates space as a potentiality for social relations, giving it meaning and form, and ultimately through the patterning of everyday movements, produces place and landscape (Low 2011, 468).
By marrying Appadurai’s framework of global cultural flows, Lefebvre’s concept of the production of urban space and Low’s approach of embodied space, I suggest to employ elderscapes as a spatial lens to conceptualize the intersectionality of ageing and urbanism. The perspective of elderscapes acknowledges older people as creative urban residents, actively engaged in shaping their urban environment through their actions and bodies and, at the same time, considers the various transcultural entanglements at work without falling into dichotomic traps.19
Kathmandu’s suburban elderscapes
In the initial phase of my research, my attention was soon drawn to the socio-spatial epitomization of the challenges that Nepal’s manifold transitions caused for Kathmandu’s senior citizens. I discovered long-established and more recent elderscapes in the Kathmandu Valley: the established elderscapes were embedded in the historical and religious architecture and partly marked by a temporal and ethnic-based use of the space, such as some of the Newar pāṭī (Newari: phalcā),20 public arcaded platforms, in Lalitpur and Bhaktapur’s historical areas (see Fig. 6), the early morning and afternoon Buddhist kora 21 around the stupas of Boudha and Swayambu, or the country’s oldest bṛddhāśram (old-age home) located at the temple complex of Pashupatinath.
As a response to the need for more public and semi-public spaces for sociality in suburban areas, paired with the growing awareness of senior citizens of themselves as a distinct peer group, novel elderscapes have contemporarily been emerging out of community or private initiatives (see Fig. 7). These spaces comprise a variety of self-organized interest groups of older people, various forms of day-care programmes for diverse social strata, senior citizens’ clubs aimed at suburban middle-class seniors, and also residential care facilities ranging from community-based charitable “old-age homes” (bṛddhāśram) to private-paying care homes. The recentness, but also connectivity of these spaces to “modern” institutions of other countries was reflected in the ways the initiators described them in their narratives. As if they were referring to Cohen’s seminal article “No Aging in India” (1992), I was told by a prominent NGO founder that until the end of the first decade of the 2000s, there was no awareness about dementia and Alzheimer’s disease in Nepal at all—a field that was rapidly gaining importance as a result of the increase in life expectancy. On a different occasion, a young founder of a senior citizens’ centre peremptorily declared that her institution, which offered computer, reading, and music classes—“Nepal’s first life-long learning centre”—was the first of its kind in the country.
These burgeoning elderscapes are a response of Kathmandu’s older generations and stakeholders from civil society to the above-described complex interplay of migration and changed working and co-presence practices of urban families, haphazard urban growth, and a consequent scarcity of community space (Chitrakar et al. 2016). They must be understood in the wider context of the immense trajectories in Nepalese society and represent the quest for a unique Nepalese way of responding to contemporary needs of older people, without entirely disconnecting from previous norms and practices in old age.22 It is important to note that novel elderscapes are not a pure middle-class phenomenon: as the diversity of institutions functioning under the umbrella term “day-care centre” illustrates, their activities range from offers for elderly farmers from Newar communities to middle-class retirees in suburban neighbourhoods.23 Residential care facilities show a similar range from small charity-run shelters for destitute elderly to private care homes of middle-class standard offering nursing care and care for dementia patients. Elderscapes are also a reaction to the changing needs for sociality of older people and epitomize a certain turn towards peer-based support and friendship. This is strongly linked with an increased withdrawal into private space, fostered by architectural designs of suburban housing (Nelson 2013) and the spatial arrangements of new neighbourhoods (Chitrakar et al. 2016; B. K. Shrestha 2013), as the following case study among senior residents of a suburban neighbourhood will show. Therefore, new “spaces of age” also constitute strategies to counter feelings of loneliness and social isolation: many of my interviewees stated they experienced loneliness (eklopan) through the day and saw it as a major cause for the increase in depressive episodes among older people (see Chalise et al. 2007a; Chalise et al. 2007b).24 Elderscapes do not mean a turn away from the family, but through the contemporary structure of everyday activities, the time span of jointly spent, shaped, and experienced time of all family members has shrunk considerably from the perspective of older persons, so that earlier generations’ norms and role models of shaping and spending later life clash with the situation of “modern times” (adhunik kāl).25
Ageing of a neighbourhood
The first case study is a suburban middle-class neighbourhood of ­Kathmandu Metropolitan City which was established in the late 1970s as one of the first housing projects of the city, i.e. it represents one of the few government-planned areas. The available plots in this area were allotted through a lottery system where service holders without their own property in the Kathmandu Valley could register (B. K. Shrestha 2013, 129). Many of these service holders had come from other regions of Nepal to the Valley for higher education so that the new settlement naturally became a multi-­ethnic neighbourhood of the new middle classes (Liechty 2003, 51–52). Until today, the neighbourhood’s original character of a better-off government workers’ vicinity has largely remained, but naturally some owners sold their houses, new houses were added, and local shops changed their product range. Whereas the neighbourhood was located at the outskirts of Kathmandu City in the late 1970s as one of the first suburban settlements, it is today fully encircled by other vicinities which grew in an unplanned manner. Nowadays, many of the initial house builders are retired, which has created a unique suburban setting: the first generation of service holders growing older together as neighbours, what could be designated as the “ageing of a suburban neighbourhood.” 26
Education, a central part of middle-class culture in Nepal, has been playing a major role in the life of many of these senior citizens (see Liechty 2003; Donner and Neve 2011). Many of the residents—both female and male—in the 1970s and 1980s received stipends for higher education and consequently found employment in the government sector, military, the educational sector, or private business. A large number of these older generations’ children followed their parents in pursuing higher education, either in Nepal and India, or further abroad in countries like Australia, the United States, or Great Britain. Because of the country’s manifold crises, many students decided to settle abroad, seeking a better future for them­selves and their children outside of Nepal. Kripendra, one son of seventy-­year old Pramila’s four children who was visiting his parents in the neighbourhood over the festival of Dashain,27 explained to me how in the late 1990s he and many other youth from the vicinity went to Australia for their master’s degrees and finally became permanent residents overseas:
[E]ven my childhood friends were also going to Australia. With me there were ten to twelve of my close friends who went at the same time. All of them are citizens of Australia now, and all of them went for further studies. […] We tried to finish the studies and then come back [to Nepal] to bring something. In the middle of our studies [around 2000] we found out that they [the Australian government] just started caring about what they call “migration for special studies,” and we thought that time why not finish the studies and try to settle over there and apply for a permanent residency (PR) from the studies. […] That’s how we settled over there (Kripendra, October 6, 2014).
This quote demonstrates how initially Kripendra and the others had planned to return to Kathmandu, but ultimately decided in favour of the opportunities that opened up in Australia in contrast to the unstable political environment and uncertain future in Nepal, marked by the Maoist insurgency during those years (see MoHP 2012, 1). Other interviewees from the neighbourhood also felt that international migration had become an omnipresent topic, stating that almost every family there had at least one family member abroad.28
If these changes are looked at from an older person’s perspective, on the one hand they may be rationally understood as the natural consequence of educational advancement in Nepal. On the other hand, many households have constantly shrunk in size,29 and daily periods of jointly spent time, i.e. co-presence in multi-generational families, are much shorter than in previous generations, as Liechty expounds in his analysis of Kathmandu’s middle-class culture of the late 1990s:
The city’s new cash and market-oriented economy demands that people pioneer new forms of cultural practice, identification, and privilege. […] Unlike their great grandparents, today’s residents are likely to work individually to make money, not as a family or caste group to farm, trade, or make products. They are engaged in a monetized economy where their subsistence depends on wage labor and commodity purchases. They spend most of their time away from home and are tied to rigid daily work schedules that do not vary with the seasons (Liechty 2003, 56–57).
Although this shift is not a particularly recent phenomenon, their interviews showed that many interlocutors intensely reflected on these trajectories and their effects on their generation, and searched for a new position and appropriate behaviour as an older person in such “modern times” (adhunik kāl). For practical reasons, older people from the middle classes in their everyday life spend considerable time on their own because younger family members work in offices and grandchildren go to school and join tuition classes in the afternoons. The following quote illustrates how loneliness (eklopan) had become a troubling issue for the senior neighbours who met that afternoon in one of their gardens to chat over tea and enjoy the warm winter sun: 30
Mr. Shrestha: Earlier we used to live in joint families, with many family members. Now we live much lonelier. Loneliness has increased a lot. […] If only our relatives were with us, we would talk to them. We don’t even meet our neighbours so frequently. We only meet the neighbours on the way, greet them, that is it.
Mr. Khakurel: Here in the city, the [houses’] doors are closed. Had it been in the village, people would have come out in the grounds [in front of their houses], in the fields and would have met each other. […] But here, the doors are closed, and houses have dogs, so one cannot [just] walk in (Neighbour chat, January 20, 2014).
In this conversation, the senior citizens of this neighbourhood articulated the impediments they experienced in social interactions and ascribed them to a suburban lifestyle.
With respect to the community sense of neighbourhoods, B. K. ­Shrestha (2013, 134) also considers the combination of intense urban and social trajectories “to weaken the traditional social network and reduce the scope of instrumental […] and emotional support” which, to a large extent, is based on ethnicity. Certainly, the older neighbours’ views expressed a nostalgia towards past village lifestyles and idealized earlier family life in larger households.31 However, the metaphor of closed main doors and watchdogs in suburban gardens, often behind high compound walls, powerfully illustrates the withdrawal into the private sphere in many suburban areas of Kathmandu Valley (see Fig. 8). The underlying reasons probably range from middle-class consumption practices (owning property, keeping a dog), architectural design (compound walls), to security concerns (entrance gate, closed doors) because of urban growth. However, if we compare the architectural principles of this conceived space (Lefebvre 1991) to the central ancient settlements of the Malla period with their shared courtyards (bahal) or arcaded platforms (pāṭī ) (B. K. Shrestha 2011, 110–111), the tremendous impact of architectural design on spatial practices becomes apparent. In this context, it is also important to mention that the spatial mobility of older people within the neighbourhood as well as outside is a highly gendered practice: whereas older men can sometimes be seen immersed in long conversations at the small local shops in the lower market area of the neighbourhood, older women, especially widows, would not feel comfortable doing so because of existing social norms and middle-class morality. If someone had the impression that they were roaming around, it would negatively affect their own and the family’s prestige (ijjat), so that a woman would not leave the house without an appropriate reason (Liechty 2010, 323–324): it was morally accepted to go on a morning walk with others, to buy groceries or visit a temple, but not to go anywhere without a distinct purpose or have long chats with others in the street (Field notes, February 4, 2015). The discussion with neighbours also revealed that the large amount of spare time that came with retirement within the transformed urban economy and the need to shape, structure, and fill this time with activities that were meaningful to oneself—and morally accepted by others—was still an unusual, ambivalent experience for both older men and women.32 This process conflicted at times with notions of intergenerational reciprocity and the “appropriate dependence” of older parents involved (Lamb 2013, 173–174).
Relating to the spatial arrangement of middle-class houses and the few public spaces in the neighbourhood, many middle-class senior citizens expressed their frustration about lacking community space (see also B. K. Shrestha 2013, 135–141) and a need for more opportunities for social interaction outside the domestic sphere. The residents of this locality have been organised in the local neighbourhood association since 1989 (2046 B. S.) that was jointly founded by many of these now senior neighbours. Mr. Pokhrel explained why the members of the neighbourhood association, mostly above sixty years themselves, established an elderscape for the local seniors in 2012:
Mr. Pokhrel: All of us senior citizens have one problem or the other: that becomes obvious in our conversation. Like someone has lost his wife, someone has lost her husband. […] But we can do something for senior citizens, for their peace of mind, be it to a small extent only. That’s the main reason why we have started the day-care programme in our neighbourhood.
The idea was strongly inspired by a wealthy widower in his eighties who had been very supportive of his children becoming successful in life, but now felt this hindered them, especially his sons, from fulfilling their filial responsibilities to the extent he had hoped for:
Mr. Pokhrel: We have taken people like him into consideration, we have considered their thoughts, and have pondered what can be done for their good […]. Even if it is only once a week, by organizing programmes for recreation, like pilgrimage, or other plans, like spiritual talks, religious singing, etc. we can help them to be at peace, even if it is to a little extent only (Neighbour chat, January 20, 2014).
As a new base for the neighbourhood association, a long-needed community building was constructed step by step through donations from the neighbourhoods. There, the volunteers of the newly founded committee for the senior citizens’ programme started to run a weekly afternoon programme for the local seniors (see Fig. 9), the jyestha nāgarik milan kendra, literally translated as “meeting centre for senior citizens.” 33 Most people colloquially referred to this elderscape as the “day-care centre” when speaking in English, contextualizing it with other day-care centres that had been emerging across Kathmandu Valley over the past decade.
Regular participants from the vicinity need to register with the committee and pay an annual membership fee. In 2014, more than one hundred registered participants were from mid-fifty to just over a hundred years old, so that actually several generations of elders were addressed through the programme. The jyestha nāgarik milan kendra was scheduled every Wednesday after morning dāl bhāt, and took between two and three hours, depending on the agenda. The programme followed a regular routine: it usually started with a short session of kirtan bhajan, the singing of devotional songs, then the main programme took place, and concluded with a light meal or tea and snacks. The senior citizens’ committee raised awareness about their rights and helped with administration, such as applying for the senior citizens’ card which is needed to receive discounts on public transport or in hospitals. The main programme, arranged by the senior citizens’ committee, varied: external speakers were sometimes invited for particular topics related to old age, popular were also spiritual talks by the local priest or one of the neighbours who took up topics of the Bhagavad Gita (see Fig. 10).34 Other programmes included yoga and interactive sessions, and some religious festivals, birthdays or death anniversaries were jointly commemorated. The entire programme was realized through donations (dāna) among the neighbours: for instance, it was a popular practice to sponsor a joint meal on the occasion of one’s birthday, or to donate an amount to better equip the community building, such as kitchenware or curtains.35
As the members of the senior citizens’ committee explained, the programme’s general principle was to offer a community space for elderly women and men in the neighbourhood to socialise and exchange, irrespective of their ethnic or economic background. One important aspect that was repeatedly mentioned was that older people should be supported to achieve peace of mind (manko shānti), which underlines the challenges of negotiating new modes of ageing. Many participants joined the programme because they appreciated socializing with like-minded peers: here they could share their experiences and challenges of old age with others in the same situation, as one resident explained during a session when he commented on his donation to sponsor curtains for the large meeting hall:
This is our common place. It’s a great pleasure to do something for it [donating]. […] We are getting introduced to so many new people. We can share our joys and sorrows, we can open up to the others here, and we learn new things through the contacts here. This centre facilitates such interactions (Mr. Duwadi, January 22, 2014).
The senior citizens’ programme strengthened social bonds within the neighbourhood community, and the large number of participants reflected their interest in such community space as a form of an “extended neighbourhood” (de Jong 2005)36 where they could expand their emotional and social support beyond the family. Furthermore, this elderscape represents a crucial local contribution to age in place: decreasing physical mobility influences the spatial practices of older persons, so that the proximity of the community centre and its location in a calm area was a central reason for many elders to join. Especially the very old participants could manage the short walk to the centre independently since no wide roads or traffic had to be negotiated.
To conclude, this elderscape is a unique example of how older people use their agency to respond to the economic, social, and urban trajectories: as active urban citizens who participate in shaping their urban environment, they added, in a joint effort, community space to the settlement to adjust it to the needs of the ageing generation of neighbours. However, it must be stressed once more that this specific planned neighbourhood and the middle-class economic background of its residents represent a privileged and unique situation. The process of establishing a community building and designing a specific programme to facilitate social interaction is a powerful example how such embodied “spaces of age” are created. It reveals how older persons engage in place-making and care for their environment, for themselves and for others in future—socio-spatial practices which gerontologist Kruse describes in his work with the German terms Selbstgestaltung, Weltgestaltung, and Generativität (generativity) (see Kruse 2013, 33; 2017, 90–91).
“Mushrooming” care homes
The second case study of a novel elderscape focuses on one of the first private care homes in Kathmandu Valley which has been operating since 2005. To explain the background of and ambivalences towards such institutions, I first give a brief general overview of eldercare facilities in the Valley.
Residential eldercare institutions have a comparatively short history in Nepal compared to other South Asian countries, most probably because Nepal was never incorporated into the British Empire, and the regimes prior to 1951 strictly controlled external influence, which also included transcultural flows of institutional concepts.37 In India and Sri Lanka, charitable institutions for destitute elderly were founded from the eighteenth century onwards and gradually increased in the nineteenth century. They were initiated mostly by religious or philanthropic organizations, and to date government institutions are much fewer in number in South Asian countries. A major reason to found these care institutions was to provide shelter for the destitute elderly, a charity-based idea adapted by both ­Christian missionary organizations and Hindu and Buddhist reform movements in South Asia (Liebig 2003, 160; Rajan 2000, 11–12; Risseeuw 2012a, 696). In Nepal, “old-age homes,” shelters for poor elderly, usually denoted as ­briddhashram (bṛddhāśram), have only been existing since the late 1970s when the prominent and only government-run facility, Pashupati Social Welfare Centre Briddhashram (Samaj Kalyan Kendra ­Briddhashram), was officially founded at the premises of the temple complex of Pashupatinath (Tandan 1996, 588).38 Today, it has a maximum capacity of 230 residents who are only admitted if they can prove their destitute situation, and then are provided with accommodation, food, clothes, and basic healthcare, and can attend religious activities like singing bhajans in the mornings and evenings. The old-age home’s auspicious location at Nepal’s most important pilgrimage destination (tīrtha) is an important feature for the elderly residents, promising mokṣa (liberation) at the time of death through the location’s qualities (see Michaels 2008, 193–200). At the same time, this location means a high visibility of the country’s largest old-age home: many pilgrims and tourists pass by the institution, and media frequently use visual material of Pashupati Briddhashram in TV and newspaper reports on old-age homes, or more generally on older people, presenting its residents as “forgotten elderly” who were abandoned and later life as a deplorable state (see e.g. Adhikari 2014; Kwok 2015; The Himalayan Times 2015). Such undifferentiated reports create a stereotype imaginary of residential care facilities as shelters for the destitute, connoting institutional care with poverty and abandonment (Brijnath 2012, 699–700), which is then implicitly projected onto private institutions.
Non-contributory, community-based old-age homes have been rising since the 1990s, and private care homes have been emerging in ­Kathmandu Valley since approximately the early 2000s, so that we can speak of a differentiation process of these elderscapes.
Because Nepal’s government does not further engage in this field, the absence of options for better-off senior citizens from Nepal’s middle classes is tackled through private social initiatives and entrepreneurs. Regmi (1993, 41–42) earlier pointed to an urgent demand for diverse types of institutions catering to different income groups (destitute, low-income and more affluent), which seems to have gradually been responded to within the past two decades (see Fig. 11 and Fig. 12). Since Nepal’s government does not keep a central index of residential—and other—eldercare institutions, it is impossible to give an accurate account of the number of existing institutions, neither for the Valley nor on a nationwide level (Geriatric Center Nepal 2010, 11–12; Parker et al. 2014b, 359). It is important to note, however, that only a very minor percentage of Nepal’s senior citizens reside in eldercare facilities 39 against the large majority who live with their married sons (eighty percent), and a much smaller proportion with their married daughters (three percent), due to patrilineal cohabitation practices (Ministry of Urban Development 2016, 25).
Private care homes represent small and modestly expanding elderscapes which mainly aim at middle-class families because of their high costs as compared to the average income. The monthly fee at the five different private care homes I visited averaged between NPR 10,000 and 20,000 (ca. € 85–175) in the years 2013 to 2014, excluding the costs for individual medicine.40 The recent burgeoning of these institutions can be explained by a variety of interrelated reasons: increasing longevity, which is the result of improved healthcare and nutrition, creates novel needs, especially in the context of the increasing mobility of younger generations at the both national and transnational levels. The present extent of transnational migration constitutes an unprecedented situation among many families, which challenges hitherto existing practices of intergenerational reciprocity and multigenerational living on a very physical level. Therefore, institutionalized eldercare outside of the family represents a very recent idea which is quite stigmatized and clashes with old-established “kinscripts” (Stack and Burton 1993) of intergenerational reciprocity (sevā), the service and respect to one’s elders.41
Eldercare in Nepal, as well as elsewhere in South Asia, is primarily regarded as a family affair (Brijnath 2012; Lamb 2013, 2016). This attitude is based on reciprocal practices between parents and children, and the patrilineal understanding that mature sons and their wives, as Lamb proposes,
live with and care for their aging parents—out of love, a deep respect for elders, and a profound sense of moral, even spiritual, duty to attempt to repay the inerasable debts (ṛṇ) they owe their parents for all the effort, expense and affection the parents expended to produce and raise them (Lamb 2009, 32).
Therefore, the emergence of institutional eldercare, as minor as it may be in actual numbers, is conceived as a powerful threat to the multigenerational family concept itself and, to link again to Lamb’s research, to “a quintessentially” Nepali “way of life, morality, and tradition” (2013, 174). After long periods of political instability and ethnic disparities, the institution of the family as the “glue” of Nepali society seems at stake, so that the very existence of private care homes provokes emotional moral discussions about a perceived decline of social norms and values. The following quote from an article published in 2014 in The Kathmandu Post represents a widespread conservative opinion and exemplifies well the normative character of such narratives:
[W]e, as their next of kin are the only people responsible for taking care of the old people around us. It is necessary to understand that sending the elderly to old age homes does not qualify as fulfilling the responsibility towards one’s aging parents. Old-age homes only provide food and medicine and not the true love that these aged people long for and expect their children to give (N. Khatiwada 2014).
The normative emphasis on the family as the ideal place for ageing and care pushes those who depend on institutional eldercare service into a moral dilemma. Opting for a care home is a stigmatized step among ­Kathmandu’s residents since it implies that familial circumstances deviate from normative ideals. In addition, middle-class families do not want to be associated with this negative imaginary of old-age shelters which might harm the family’s prestige (ijjat). Yet, for locally dispersed families who can neither provide “personal support,” including “’hands-on’ caring” (Baldassar 2007), nor come up with an alternative care scenario, external eldercare institutions are increasingly becoming a necessary and at the same time immensely ambivalent option. While some families circumnavigate these shifts by determining one child—or daughter-in-law—as the main on-site caretaker, others seek ways to come to terms with such novel, non-kin based care settings.
To illustrate how residents and staff navigate these ambivalences and how they shape this particular novel elderscape of a private care home, I finally return to the case study I conducted between late 2013 and early 2015. The care home is located near one of the Valley’s historic city centres and had an initial capacity of thirty-five residents before two more storeys were added in 2015 to house up to sixty residents. According to manager Ashish, the care home had received increasing requests and even had a waiting list, which prompted the expansion. The initial idea for opening a private institution providing residential space and geriatric care in this central location was pursued by a local foundation in the early 2000s which is organized as a non-governmental organization (NGO). The diverging financial concept of this care home in a way mirrors its pioneering aim: while the physical infrastructure of the care home was funded by a foreign organization and individual donors, the operating costs were covered by monthly fees paid by the residents and by irregular donations. The major financial focus was to cover the institution’s running expenses (e.g. staff salaries, food, basic medicine), not to make a profit. On various occasions, groups and individuals contributed financially or in kind (dāna) to pay respect to the elderly residents.
The residents were aged between fifty-eight and ninety-six years, had different ethnic backgrounds, and mostly belonged to the middle classes. The gender ratio was quite uneven with about thirty percent male versus seventy percent female residents, which coincides with other findings that female residents represent the large majority at eldercare facilities and illustrates the vulnerable position of elderly women in a predominantly patriarchal society (Acharya 2008; Khanal and Gautam 2011). The residents’ reasons for joining the care home were manifold: some residents had dementia and Alzheimer’s disease, there were diabetic patients, and many needed regular medical assistance; some of them lived in the institution because their children were abroad or their daughters could not take them to their in-laws’ household. Through conversations with some residents and background information provided by the staff, it became apparent that the residents attached great importance to maintaining their own and their family’s moral prestige in the environment of the care home, for instance by presenting a morally accepted reason for their stay (e.g. need for medical care, children living abroad), or by highlighting that they had taken this decision on their own and funded their stay themselves (e.g. by renting property). Still, I experienced a strong ambivalence behind these narratives told to me as an outsider: in general, the majority of the residents were content with the living and care standards of the care home, and in particular with the staff’s dedicated and affectionate performance of service (sevā),42 but at the same time they would have preferred to stay with a family member if possible, and somehow felt deprived of the filial reciprocity and respect through kin that old age entitled them to.
The residents lived in either larger rooms for up to six residents or in single or double rooms, the latter for married couples to stay together. Manager Ashish highlighted that he and the staff kept close and regular contact with the residents’ families and offered counselling because many experienced this care arrangement as a challenging novelty. They mediated between family members and residents in case of problems, encouraged regular visits by both sides, and tried to relocate elders to join their family whenever possible (Field notes, November 6, 2013). An initiative to integrate the residents into a larger social network was the spiritual day-care programme for older people from the care home and the local community that took place in a large hall next to the care home’s building (see Fig. 13). The programme was established to respond to the elderly’s spiritual needs, but also to promote interaction between the predominantly Newar farmer community and the home’s residents.
The care home’s staff played a central role in shaping this elderscape, therefore I focused on their understanding of care and negotiations of social norms in an ambivalent social space.43 Initially, both staff and residents had lacked role models and guidance in this unprecedented situation: past experiences of life in old age were not necessarily any longer valid, and the concept of an eldercare institution based on care provided by non-kin caretakers still had to be given new meaning (see Coe 2016). So, they gradually developed their own method of performing non-kin care, a process that Coe (2017) describes as “care-scripts” in reference to Stack and Burton’s above-mentioned concept of “kinscripts.” One strategy the staff team included in their care approach was counselling, a form of emotional care to help residents, their family members, and sometimes also staff members themselves, to cope with the new care situation and the challenges involved, as nurse Sushila explained:
The old mothers need to feel that they’re in their own house because they are alone. Sometimes they weep, you know. […] We make them feel that they are our mothers and fathers. […] In counselling, I learn about their family history and tell them not to worry. They come here for different reasons. Some do not have families here [in Nepal], but some do. Like [Sumati Ma]. Her family comes to meet her, but she is not satisfied. But she can’t go along with them to home because she is sick. She can’t go. We need to counsel such old people in any way and give them immense care (Sushila, January 27, 2014).
Another strategy employed by the care home’s staff was to revert to intergenerational, family-based norms to create a fictive kin relation, e.g. by using kinship terms like “mā’ / ’āmā” (mother) and “bā” (father, sir) when addressing a resident. This was not only meant as a respectful form of address which is also common in non-institutional everyday situations, but also to make residents feel at home as members of a new intergenerational, kin-like group (Lamb 2009, 150–153). These fictive kin relations provided a source of guidance for their daily interactions.
The concluding strategy briefly illuminates nurse Sangita’s personal commitment in the care home which are based on her own experiences abroad. Sangita had worked in a care home in the Middle East for several years where she became familiar with different care technologies. She shared her knowledge with the other staff as much as possible, especially in areas such as dementia care that hadn’t been taught at nursing schools in Nepal until then. Having experienced the challenge to maintain relationships over distance herself (see Brown 2016), one of the novelties she attempted to introduce at the care home was to connect the residents with their family members outside Kathmandu Valley through social media like Facebook and video calls via Skype and Viber. Sangita’s approach was based on intra-kin caregiving strategies and the use of information and communication technologies (ICTs) to increase contact and emotional care in a situation of physical distance (Baldassar 2007, 389). During her nightshifts when she had more spare time than during the day, she encouraged the residents to look with her at their children’s photos on social media and assisted them with communication technology:
[Rajendra Ba’s] daughter [is] now in the UK, and I asked him, “What’s your daughter’s name?” and he told me, and I just typed it in the ­Facebook search frame. And there was a picture, and he said, “This is my daughter!” After I think five years, he saw his daughter [for the first time]. He had been talking to her, but never saw her. And when he saw her [photos on Facebook], oh my god, he was crying! She had a baby, and he saw his daughter and son-in-law with the baby on the photos, their friends, he just opened his mouth and didn’t close it anymore. […] So the technology made him so happy, he was so happy! All the time his blood pressure was rising. From that day on, everything was normal. You know, how much this is influenced [by the psyche]!” (Sangita, November 24, 2014).
Although Sangita and Rajendra Ba initially used Facebook not to directly communicate with his daughter, but to look at his daughter’s virtual photo gallery, seeing photos of his daughter and her current activities seemed to lessen his sense of disconnectedness from her life. This strategy strongly illuminates the potential of ICTs in Nepal’s care homes to offer possibilities to families and residents to maintain stronger ties by adding “real time” (video calls, e.g. Skype) and “intermediate” (social media, text messages) visual features to the existing forms of care, i.e. the standard phone calls and personal visits (Baldassar 2016, 153).
To conclude, this novel elderscape was initiated and shaped in an entirely different context than the first case study. In this case, social entrepreneurs from the community in this part of the Valley identified a growing need for care options for middle-class families and elders who struggled to organize sufficient care within the conventional family setting, but did not consider it suitable to join one of the charitable old-age homes. The institutional concept of this care home responded to this institutional void and gradually developed a unique care approach that contextualizes this novel elderscape within long-established forms of intergenerational reciprocity and social work.
Conclusion
In this chapter I have shown how the notion of elderscapes can be used as a lens to conceptualize how (a) older people as creative urban residents actively engage in shaping their urban environment through their actions and bodies, and (b) new spaces of ageing emerge as a response to the enormous speed and intensity of social and urban trajectories. It represents a helpful perspective to acknowledge the contribution of older people to urban place-making instead of focusing on older people’s challenges, vulnerabilities, and social exclusion, as some perspectives from international agencies tend to, reducing their role to passive recipients of urban change. The concept of elderscapes adds a conceptual tool to the anthropology of ageing and spatial gerontology to frame spatial trajectories initiated by or created for older people. Therefore, it contributes to a much-needed, stronger theorization of interdisciplinary research on urban ageing, which should assemble the state of research of urban and ageing studies.
In Kathmandu Valley, contemporary modes of ageing and eldercare are characterized by manifold tensions deriving from intense socio-economic and urban shifts. I have used the concept of elderscapes to look at two contrasting emerging spaces for middle-class senior citizens in Kathmandu Valley, and have given insight into the strategies through which senior citizens navigate between social roles, expectations from their families, their changing environment, and their own wishes and needs. There are of course limitations to the findings from these two case studies: they mainly represent the opinions and lifestyles of a privileged group of older persons in a privileged part of Nepal. More ethnographic research will be necessary to illustrate the diversity of experiences of ageing in context with older people’s economic and ethnic background, as well as in Nepal’s many rural areas or smaller urban centres. These arguments notwithstanding, my research intends to illustrate the older generations’ interest and agency to contribute to their social and spatial environment. This allows us not only to see the diverse societal dynamics in the Valley from their perspective, but also to get an insight into their strategies to make use of their knowledge and experience to impact urban society and get involved with their country’s future.
Figures
Fig. 1–2:
© Roberta Mandoki, Jakob Gross and Annika Mayer.
Fig. 3–13:
© Roberta Mandoki.
Abbreviations
BS
Bikram Sambat, the official Hindu calendar of Nepal
ICT
information and communication technologies
MDGs
Millennium Development Goals
MIPAA
Madrid International Plan of Action on Ageing
NGO
non-governmental organization
OPA
Old People’s Association
SAARC
South Asian Association for Regional Cooperation
UN-Habitat
United Nations Conference on Housing and ­Sustainable Urban Development
UN
United Nations
WHO
World Health Organization
Suburban Elderscapes and “Modern” Modes of Ageing: The Spatiality of Contemporary Urban Ageing in the Kathmandu Valley, Nepal
Roberta Mandoki
Sensing Kathmandu City
Approaching ageing in urban environments in the Global South
Kathmandu’s urban transition through the lens of old age
Elderscapes: A spatial perspective on ageing
Ageing of a neighbourhood
“Mushrooming” care homes
Conclusion
Figures
Abbreviations