India's Elderly at the Crossroads | 31 Jul 2024

India is experiencing a demographic shift that demands urgent attention. While much of the public discourse focuses on the country's youth bulge and demographic dividend, the rapidly aging population needs equal attention. By 2050, it's estimated that the proportion of older persons in India will rise to 20.8% from 8.6% in 2011. This rapid aging, occurring in just 20-30 years compared to a century in Western countries, is outpacing the development of adequate social protection systems for the elderly.

The needs of India's older population are not receiving sufficient visibility or policy priority. Unlike some East and Southeast Asian countries, India lacks a universal public pension scheme, comprehensive health insurance, or robust social-care provisions for the elderly. Available data highlights significant inequalities in the availability, accessibility, affordability, and acceptability of services needed by older persons. These disparities are influenced by factors such as geographical location, class, caste, gender, and access to formal employment. As India transitions into an aging society, addressing these gaps in financial security, health services, and social care for the elderly has become a critical imperative.

What are the Major Challenges Faced by Elderly in India?

• The Pension Predicament: India's pension system is woefully inadequate for its aging population.
  • Only about 12% of the workforce is covered by formal pension schemes (World Bank), leaving the vast majority without financial security in old age.
  • The National Social Assistance Programme (NSAP) provides a meager Rs. 200-500 per month to the elderly poor, barely enough for subsistence.
• Healthcare Hurdles: The burden of non-communicable diseases (NCDs) weighs heavily on India's elderly.
  • According to the Longitudinal Ageing Survey in India (LASI), the majority of those above 60 suffer from NCDs like diabetes, hypertension, and cardiovascular conditions.
  • High expenditure on health is impoverishing 55 million Indians annually, says WHO, with the elderly particularly vulnerable.
  • The lack of geriatric care facilities and specialists further compounds this issue, leaving many seniors struggling to manage their health needs.
    • India is home to 1/4th of the world's elderly but gets only 20 geriatricians/year.
• The Loneliness Epidemic: Rapid urbanization and changing family structures have left many elderly Indians socially isolated.
  • The traditional joint family system, once a source of support and companionship for the elderly, is giving way to nuclear families.
  • This isolation has severe mental health implications, with depression rates among the elderly estimated at 10-20%.
  • The Covid-19 pandemic exacerbated this issue, highlighting the need for community-based support systems and social engagement programs for seniors.
• Left Behind in a Tech-Driven World: As India rapidly digitizes, many elderly citizens find themselves on the wrong side of the digital divide.
  • From banking services to healthcare appointments, essential services are increasingly moving online.
    • About 86% of senior citizens do not know how to use digital technology or computers
    • This digital illiteracy not only limits their access to services but also hampers their ability to stay connected with family and friends, further deepening their isolation and dependency on others.
• Elder Abuse: Elder abuse is a growing concern in India, often hidden from public view. The data provided by Elders Helpline 1090 and Elderline 14567 has revealed that elder abuse increased by 251% post lockdown
  • Financial exploitation, neglect, and even physical abuse are also prevalent.
  • Despite the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, enforcement remains weak.
  • Many cases go unreported due to dependency on abusers, fear of retaliation, or societal stigma, underscoring the need for stronger protective measures and awareness campaigns.
• Housing Havoc: Adequate and affordable housing for the elderly is a significant challenge in India.
  • While retirement communities are emerging for the affluent, options for middle and lower-income seniors are limited.
  • Lack of age-appropriate design features, such as ramps, grab bars, and emergency response systems, in existing housing stock poses safety risks.
  • The shortage of affordable assisted living facilities further complicates housing options for those requiring regular care.

What are the Major Elderly Care Schemes in India?

• Department of Social Justice and Empowerment:
  • Atal Vayo Abhyudaya Yojana (umbrella scheme)
    • Integrated Programme for Senior Citizens (IPSrC): Establishing homes to improve quality of life for senior citizens by providing shelter, food, medical care, and entertainment.
    • State Action Plan for Senior Citizens (SAPSrC): Encouraging states/UTs to create their own action plans for senior citizen welfare.
    • Rashtriya Vayoshri Yojana (RVY): Providing physical aids and assisted-living devices to senior citizens.
    • Livelihood and Skilling Initiatives: Includes Senior Able Citizens for Re-Employment in Dignity (SACRED) and Action Groups Aimed at Social Reconstruction (AGRASR Groups).
    • Awareness Generation and Capacity Building: Training, sensitization, and National Helpline for Senior Citizens (Elderline: 14567).
• Ministry of Rural Development:
  • National Social Assistance Programme (NSAP): Financial assistance to elderly, widows, and disabled persons.
    • Indira Gandhi National Old Age Pension Scheme (IGNOAPS): Monthly pension for elderly BPL individuals.
• Ministry of Health and Family Welfare:
  • National Programme for the Health Care of Elderly (NPHCE): Comprehensive healthcare for elderly at primary, secondary, and tertiary levels.
    • Primary & Secondary Care: Geriatric OPD, IPD, physiotherapy, and lab services in 713 districts.
    • Tertiary Care: Regional Geriatric Centres (RGCs) and 2 National Centres for Ageing.
• Ministry of Finance:
  • Atal Pension Yojana (APY): Pension scheme for individuals aged 18-40, offering guaranteed pension at age 60.
• Ministry of Housing and Urban Affairs:
  • Model Building Bye Laws, 2016: Standards for elder-friendly environments in buildings and transport.
  • Urban Bus Specification-II (2013): Low floor buses for easy access for elderly and disabled.
  • Pradhan Mantri Awas Yojana: Priority housing allocation for families with senior citizens on ground or lower floors.
  • DAY-NULM: Shelters for urban homeless, including senior citizens.

What Additional Measures Should be Adopted to Enhance Elderly Care in India?

• Silver Economy Boost: Implement a national "Silver Skills" program to retrain and employ seniors in sectors like childcare, traditional crafts, and mentorship roles.
  • Create tax incentives for companies hiring workers over 60, and establish a government-backed microfinance scheme specifically for elderly entrepreneurs.
  • For example, Singapore's successful "WorkPro" scheme, which provides grants to companies that implement age-friendly practices, could be adapted for India. This approach not only provides income for the elderly but also utilizes their vast experience.
• Tech-Empowered Eldercare: Launch a nationwide "Digital Dada-Dadi" initiative to improve digital literacy among the elderly (considering all measures for digital penetration is taken to the last mile).
  • Partner with tech companies to develop user-friendly apps and devices tailored for seniors, focusing on health monitoring, social connectivity, and essential services.
  • Implement a subsidized smartphone program for low-income elderly.
  • Additionally, create a network of "Digital Sahayaks" - young volunteers who can provide tech support to the elderly in their communities.
• Community Care Hubs: Establish formalized "Varishtha Seva Kendras" (Senior Service Centers) in every urban ward and rural panchayat.
  • These centers would serve as one-stop shops for elderly needs, offering links for health check-ups, legal aid, pension services, and social activities.
  • Modeled after Japan's successful community-based integrated care system, these hubs would also coordinate home care services and provide respite care for family caregivers.
  • Involve local NGOs in managing these centers to ensure community participation.
• Geriatric Health Corps: Create a cadre of "Geriatric Health Workers" within the existing ASHA (Accredited Social Health Activist) framework.
  • Provide specialized training in elderly care to these workers and equip them with digital health toolkits for remote monitoring and basic geriatric assessments.
  • Establish mobile geriatric clinics to reach remote areas, and integrate geriatric care modules into medical and nursing curricula to address the specialist shortage.
  • Additionally, the Indian Institute of Science (IISc) Bengaluru has launched 'Longevity India' to study aging-related health issues and develop interventions for improved elderly care, a significant step.
• Improving Financial Security Net: Introduce a "Senior Citizen Savings Bond" with higher interest rates to encourage financial planning for old age.
  • Create specialized health insurance products for the elderly with lower premiums and wider coverage, including mental health and home care services.
  • For example, Japan's Long-Term Care Insurance system, which covers a range of elderly care services, could be adapted to the Indian context.
• Elder Rights Protection: Establish dedicated "Elder Protection Units" in police stations to handle cases of elder abuse and exploitation.
  • Implement a mandatory reporting system for healthcare providers and bank officials to flag potential cases of elder abuse.
  • Strengthen the implementation of the Maintenance and Welfare of Parents and Senior Citizens Act by setting up fast-track courts for elder-related cases and increasing penalties for non-compliance.
• Age-Friendly Cities: Develop a national "Age-Friendly City" certification program with guidelines for accessible public spaces, transportation, and services.
  • Incentivize cities to implement these guidelines through additional funding and recognition.
  • Key features could include accessible public toilets, priority seating in public transport, and elderly-friendly parks with exercise equipment.
• Elderly Nutrition Mission: Launch a "Poshan for Elders" scheme, extending the principles of the successful child nutrition program to the elderly.
  • This would include providing fortified meals through community kitchens, nutrition education for caregivers, and regular health check-ups focusing on nutritional status.
• Silver Volunteers: Create a national "Senior Volunteer Corps" to engage healthy elderly individuals in community service roles.
  • Provide incentives like health insurance coverage or travel allowances for active volunteers.
  • This approach not only benefits the community but also promotes active aging and a sense of purpose among the elderly, as demonstrated by successful programs like the Senior Corps in the US.