Opinion

Policy Gaps between India and Other Developing Countries in Elderly Care: A Reflection

Introduction:

The 21st Century is considered to be the century of the aged while the next century is going to be all about the ageing of the aged. With this background, it is worth noting that Article 41 of the Indian Constitution recognises the duty of the state to protect the elderly people with employment and assistance for addressing sickness within the constraints of economic capacity and development. Given the fact that the elderly population in India is expected to reach 200 million by 2025 and a major proportion of this population will be female, it is imperative to start the discussion on policy gaps between India and other developing countries in the field of elderly care. 

The decadal growth rate of the elderly population between 2001 till 2021 in India shows that majority of the elderly is growing in rural India with a larger feminisation of the elderly population. The urban decadal growth rate of the elderly population in India between 2001 – 2011 has been 59.3% whereas the same for the rural population has been 27.6%.  Currently, about 77% of the elderly population in India are female and they are the ones who are fully dependent. The distribution of dependence of the elderly population on others follows the below distribution –

Percentage of populationNot DependentPartially DependentFully Dependent
Rural Person34.312.852.9
Rural Male5313.533.6
Rural Female16.312.171.6
Urban Person24.44.071.5
Urban Male41.05.153.9
Urban Female8.33.088.7
Source: Census Abstracts

The above table clearly highlights the urgency of the implementation of policies to immediately address the needs of the vulnerable female rural and urban population as a key measure of taking care of the elderly people in India. The situation is critical as they are vulnerable due to their dependence on other people.

Hence with the above background, the importance of robust, effective policy-making becomes more important.

Importance of Effective Policy Making in Elderly Care in India

Effective policy-making and its implementation are urgent and immediate in India as the family composition and functioning of homes have changed substantially in India post globalisation. Technology has made the traditional knowledge of the elderly a little redundant to the youth and for elderly people who have not been able to take care of their future in their youth.  The anxiety levels, therefore, have gone up both in youth and the elderly population. The youth does not rely and trust on the traditional knowledge, and wisdom of the elderly, neither the youth is able to sort out their own anxiety arising from varying and changing social constructs. Moreover, the elderly population is also not able to take care of their future as their dependence on the youth has gone up substantially between the time period 2001 – 2021 in India as per the Census Data. Hence, the feedback effect of this has raised social anxiety in India to a very large level.

This has to be addressed through immediate policy implementation.  The absence of social security, income, loss of social role, recognition, and non-availability of opportunities of using creative free time are some of the key concerns that the policy gap needs to address in India urgently from an elderly care perspective.  The gap in the policy in India in comparison to the best practices across the world within the paradigm of elderly care can be seen through the following pillars –

  • Economic Insecurity – Poverty is rampant in the elderly population of India. The major intervention areas for improving the lives of the elderly in India pertain to survival, security and quality of life. The elderly poor are not assessed in terms of their capability in India and therefore they are not seen as coping poor and improving poor. Therefore policies have to be addressed in India to address-
  • Housing Vulnerability – The policy framework has to touch upon the issue of lack of quality shelter with no ownership rights, lack of access to individual water connections, toilets, lack of safe drinking water, unhealthy and unsanitary living conditions
  • Economic Vulnerability – The policy framework has to address the issue of No/Irregular/casual employment, low paid work, lack of social safety net (at the backdrop of demonetisation, Covid Pandemic), lack of access to favourable credits, low ownership of productive assets
  • Social Vulnerability – The policy framework has to  deal with the low education, lack of social capital, and skills, inadequate access to food security programmes, issues of availability, affordability and accessibility with respect to welfare and health services
  • Personal Vulnerability –   The policy framework has to tackle the proneness to violence, gender disability, lack of information, access to justice

In addition to the above pillars, the upcoming policy has to also address the challenge of inadequate health care products, mental health challenges of the elderly population in India. With the growing disintegration of joint family system, elderly are left alone in-spite of chronic physical and mental health challenges and are left to isolation and loneliness with lack of dignity. This is enhancing their future mental health challenges. Elderly abuse has also been growing in India. At this backdrop, policies have to be immediately implemented to address –

  • Informal Support System and Services for elderly to address loneliness, mental and physical health issues.
  • Emotional loss, loss of close, dear and loved ones
  • Safe, secure, dignified space in the family and society
  • Enhancement of priority of the state, public and private institutions to address elderly care in India
  • Dignity and self-actualization of the elderly population in India

Currently, the state-level policies are not adequately taking care of the safety and protection of the elderly population as a senior, elder, women are often becoming soft targets of criminals in rural, and urban areas. Additionally, there is also no standard, coordinated data system on the degree of safety for the elderly population across the states of India. Therefore, evidence-based policy making is lacking in India in the space of creating and maintaining the safety of the elderly population of India in future.

However, this does not mean that there are no policies for elderly care in India. A thorough examination of the existing policies leads to the generation of certain gaps which are clearly evident in the existing policies in India. The following policies are therefore highlighted with an identification of the gap in the policy keeping in mind of the future context of the changing socio-economic, and cultural situation of the varying societies of India.

  1. Focused Constitutional Provision – Article 41 of the Constitution clearly lays out the scope of state intervention to facilitate and foster the State led intervention towards elderly care in India. In spite of this, policies  have not been drawn out or implemented by state agencies to legitimise the constitutional provisions in India regarding elderly care. Article 47 further highlights that it is the duty of the state to raise the nutritional quality and well-being of every individual which includes the elderly population. There is a clear gap in policy when it comes to the effective implementation of Article 41, 47 in India.
  2. Maintenance and Welfare of Parents and Senior Citizens Act of 2007 – As per this Act, the quality of life and wellbeing of senior citizens have to be ensured in future.  As per the Act, the dignity of senior citizens has to be protected. However, a time has come to assess the gaps, and effectiveness in the implementation of this Act of 2007.
  3. National Policy on Older Persons (NPOP), 1999-  As per this policy, every individual is supposed to make provisions for their spouses, and elderly people for their well-being in future. Each family as per this policy is supposed to do this. The policy also highlights the importance of the role of voluntary, involuntary and informal support from the government, private and non-governmental organisations to support the care provided by the family, protection and care lent to a vulnerable, elderly population. The policy also highlights the importance of geriatric care provided by informal caregivers, research, capacity building for geriatric caregivers and service providers for helping the elderly population to lead a quality life. A time has come to assess the implementation degree of this policy at the ground level and the gaps in the policy after assessing the challenges faced in the implementation process of this policy.
  4. State Policies – Some of the states like Madhya Pradesh have policy for the elderly and MP senior citizen rule 2009 addresses the various  state-specific  issues for the elderly population

In addition to the above ones, India has a range of policies for the elderly care which include the following –

  1. The national policy on older persons recognises interventions for the elderly population beyond the age of 60 in India through informal caregiving and service provisions for a good quality of life for the elderly population beyond 60.
  2. An integrated programme for older person scheme has been formulated by revising the earlier scheme of “Assistance to Voluntary Organisations for Programmes Related to The Welfare of the Aged”. Under this scheme, NGOs are being provided 90% of the cost of establishing old age homes, and maintaining them, along with day care centres, mobile medicare units, and non-institutional services to the elderly population. It is imperative to critically examine this scheme and the success, and gap in its implementation of this scheme.
  3. The Scheme of Assistance to Panchayati Raj Institutions/Voluntary Organisations/Self Help Groups for Construction of Old Age Homes/Multi-Service Centres for older persons (Non-Plan Scheme) provides one-time construction grant for Old Age Homes/ Multi-Service Centre to NGOs on the recommendation of the State Governments/UT administrations.
  4. Income tax rebate of more than INR 1.85 lakh per annum and annual interest rate of 9% is provided on the savings deposits made by senior citizens in post offices. An assessment has to be done on the actual number of beneficiaries created out of these schemes of the government.
  5. Indian Railways have been providing a 30% fare concession in all Mail/Express/Rajdhani/Shatabdi/Jan Shatabdi trains. Application of  wheelchairs, and ramps for senior citizens during the travel is being implemented by Indian Railways. Fare concessions are also given for the state-level transport.
  6. Senior Citizens are allowed to register for telephones under the N-OYT category.
  7. Earlier through Antyodaya Yojana and Scheme, the elderly population in the category of BPL were provided 35kgs per family per month. Food grains were issued at @INR3 per kg for rice and for wheat it had been issued @INR 2 per kg. Under the Annapurna Scheme, in states, 10 kg of food grains were provided to elderly people who were not covered under old-age pension scheme. At one point of time, in the States of India, almost INR 200 crores of allocation were being made for elderly care.

Additionally, the country also has seen several state level schemes like –

  • Mother Father Bharan Poshan Yajna – Bharan Poshan and Kalyan Adhiniyam Act of 2007 which has focused mostly on the welfare of parents and the elderly population.
  • Integrated Programme for Senior Citizens – These state-specific schemes dealt with old age homes for the welfare of senior citizens.
  • Establishment of Home for Beggars – Various states have been working on establishing home for beggars who are vulnerable and elderly

Additionally, within the country, states have introduced a range of policy measures for elderly care through –

  1. State specific schemes to conduct proper funerals for the elderly population
  2. Regional resource, training centres for caregivers for elderly population
  3. Awareness generation for the elderly population and caregivers
  4. Formation of senior citizen associations
  5. State-specific measures to support the elderly population for pilgrimage visits to various pilgrim sites of India
  6. State-specific schemes and measures to address the health issues of the elderly population pertaining mostly to cancer and diabetes without any coverage on mental  health

Therefore, the time has come to conduct a baseline monitoring and analysis of all the above measures. It is imperative to understand the benefits and costs of all the measures and then modify the existing policies to suit the changing future context of the Indian society across cities, towns and villages. Hence, based on the above analysis, this article highlights some of the recommendations for implementing an effective elderly care framework and policy in India. Some of the recommendations for a futuristic elderly care framework for India are as follows –

  1. Economic Security Net –   There is a need to increase state-level old-age pension coverage beyond INR 2000 per month considering the post demonetisation and Covid pandemic situation of the country
  2. There is a need to implement measures to promote the participation of elderly population with their functional capability in all spheres of life with a special focus on their health, disabilities and special abilities with differential needs across states
  3. An urgent need  exists to implement community-based rehabilitation measures with State Support complemented by Private Players in future
  4. An immediate need exists to implement evidence-based policy implementation measures by addressing the gaps in the domain of elderly care in India
  5. Identification, and implementation of resource-neutral policies have to be implemented immediately to take care of the elderly population. Such resource-neutral policies  can include – income tax exemption, legal and constitutional support, travel concession etc.
  6. Inclusion of the lense of age care in NRHM (National Rural Health Mission) with a larger focus on Alzheimer’s Disease and Mental Health issues for the elderly population
  7. Provision of one hospital with geriatric care in each district of India with more primary health care services for the elderly population of India
  8. Better health insurance provisions with a focus on mental health issues of the Elderly Population in India with comprehensive mental health care service provisions in India
  9. Creation of R&D, capacity building and training in schools (within class VI to class VIII with a value-based education) , academia, universities, departments, and research institutions for larger educational material on elderly care with new value-based education system being sensitive to elderly care in India
  10. Under the Integrated Child Development Services Programme a provision for nutritious food for the elderly BPL population can be made
  11. Proactive measures for ensuring the safety, health and wellbeing of elderly women and destitute women have to be initiated
  12. Imaginative scheme of contributory pension needs to be introduced for those who can afford to save in their prime years can be introduced and the benefits can be allocated across the sections of the society
  13. Microfinance schemes for self-help groups of the elderly population need to be introduced
  14. State-specificfic elderly care accounting or budgeting should start immediately
  15. The eligibility age under the National Old Age Pension needs to be introduced from 65years to 60 years immediately
  16. Effective judicial measures to ensure property rights for the elderly population with a quick disposal of litigations involving senior citizens
  17. Sensitisation of the police force to reduce all elderly abuse and violence from the society across different state-specific contexts
  18. Revival of a social fabric where the elderly population play a key role in all functionalities of the society
  19. More friendly modes of transportation for the elderly population
  20. Manual preparation for elderly care and their effective dissemination, communication and awareness building through the Self Help Groups and Panchayati Raj System
  21. Enabling, and enforcing disability friendly building bye laws which can be integrated to elderly care laws and policies in the urban context of India

Disclaimer:  Views are Personal.

 

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About the author

Anandajit Goswami, Amit Seth & Isha Goswami

Anandajit Goswami is Professor, Director, Manav Rachna International Institute of Research and Studies. Amit Seth is Professor, Director, Manav Rachna International Institute of Research and Studies. Isha Goswami is Research Scholar, Manav Rachna International Institute of Research and Studies.

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