Home, old-age homes

In the first overview of wellbeing of older people around the world, HelpAge International and the United Nations Fund for Population Development have prepared an index. On the Global AgeWatch Index (GAWI), released in October 2013, India ranks a lowly 73rd among the 91 countries. This when countries like Bolivia, Chile and Sri Lanka, which have high poverty level, rank much above India. ‘India’s dismal performance shows that despite catering to a large elderly population, we do not have mechanisms in place to ensure them healthy ageing with other social security measures,’ says Cherian.

International experience shows a combination of welfare policies lead to healthy and quality life for the elderly. Even in the absence of a well-endowed economy, strong political will can do the job.

Take Bolivia for instance. Despite being one of the poorest countries, it ranks 46th on GAWI. Analysts link its achievement to the government’s progressive policy for the elderly. In 2009, the Bolivian government rewrote the Constitution to include the rights of elderly, who account for 10.4 per cent of the country’s population. Its National Plan on Ageing ensures free healthcare to the elderly. Unlike India, which has a pension scheme for elderly below the poverty level, Bolivia’s pension scheme serves all those above 60. Called Renta Dignidad, literally dignity of the elderly, the pension scheme offers $340 a year to those who do not receive a retirement pension, and $255 to those who do. At the core of Rental Dignidad is the policy of income redistribution. It is financed by levying direct taxes on oil and gas and by using the dividends of public companies. Salaried citizens, including military personnel and apprentices, also contribute 10 per cent of their income towards it. In addition, 20 per cent of the contribution by the salaried goes towards pension for the disabled elderly. They receive an increased amount of pension from the age of 50 depending on their degree of disability. For example, if an elderly person’s degree of disability is 50, the pension amount would be 50 times his average earnings in the last five years. Disability pension ceases at the age of 65 and the person becomes entitled for regular pension.

‘Renta Dignidad is part of a strategic set of programmes that direct resources towards measures that secure and ensure a life of dignity for Bolivians,’ wrote Marcelo Ticona Gonzales, in Social Protection Floor Experiences, a 2011 publication by the International Labour Organisation. Chile, Bolivia’s immediate neighbour, also ensures quality of life to its elderly. GAWI ranked it at 19th, saying ‘older people have fared as well as the overall population’. Unlike India, Chileans prefer government hospitals over private health centres. In the 1990s, the Patricio Aylwin-led government, which brought in a democratic system after 17 years of military rule, set up an impressive infrastructure that provides high quality healthcare by spending a whopping $86.5 million a year. Under the military rule US $15 million a year was spent on healthcare. The investment is now paying off. Government data shows that 74 per cent of the beneficiaries belong to the poorest section. 

India’s neighbour Sri Lanka also ranks 45th on GAWI. This has been made possible by long-term investments in education and healthcare facilities for the entire population. Can India learn from others’ models? ‘We can, but it is not advisable to copy,’ says Dey, head of the geriatrics department at AIIMS. ‘There is no ready-made solution for care of the elderly. I started working in the field to find solutions. By the time I was in the committee and we were finalising NPHCE, I realised there is no model that fits our country. Ageing population is a new phenomenon for India. 

The society will evolve itself to find solutions,’ he says, adding that the focus should be on long-term care. ‘It’s not just about house and shelter, but management of chronic diseases and deteriorating motor skills.’ Several other healthcare experts also emphasise on long-term care for the elderly. ‘The maximum burden on the healthcare system is caused when a patient comes with acute trauma,’ says Santosh Rath of George Institute of global Health, University of Oxford. Early this year, HelpAge India prepared a set of healthcare measures and submitted them to political parties to be included in their manifestoes. As expected, very few of these measures find a mention in the manifestos.

One demand is extending geriatric care to all districts and implementation of Rajiv Arogyasri Scheme, a community health insurance scheme that provides financial protection of up to Rs 2 lakh a year to BPL families. It covers serious ailments requiring hospitalisation and surgery. Some states have adopted the scheme, but only Andhra Pradesh is implementing it. The state has gone an extra mile by introducing Elder Helpline under the scheme so that care is just a phone call away.