Lost in the shuffle

Old age could be a blessing for some who can pass time blissfully in luxurious homes in retired gated communities situated in quiet and picturesque locations with all amenities. But only a handful of Indians are fortunate to afford such packages sold by private developers, where a home costs between Rs 50 lakhs to Rs 3 crores. The vast majority of elderly citizens, especially above 70 years, just struggle to survive with frugal incomes, physical ailments and, without a hope for a happy ending to their lives. Though India is a success story in many fields among the developing economies one area remains grossly neglected — the old age care. The size of elderly population — the senior citizens or elderly people after 60 years of age (as defined by 'National Policy on Older Persons', 1999) — is around 13 per cent of the population today and, it is expected to rise to 19 per cent by 2050 — a fifth of all Indians will be above 60 years or more. The question is whether we can ensure decent social security for millions of our aged people, guaranteeing a comfortable life with dignity in the twilight of their lives. The challenge is huge, though not insurmountable.

Majority of old people live in rural areas and solely depend on 'social security' pension which is not even Rs 1,000 a month. Secondly, being from an unorganised sector, they don't even receive robust pensions unlike the employees or workers in the organised sector. Inadequate health insurance increases out-of-pocket expenses as treatment for old age ailments (geriatric medicine) is expensive. The figures from the Ministry of Social Justice are telling. The old-age dependency ratio in India, which was 13 per cent in 2001, is expected to rise to 17 per cent by 2021. A grim fact is, less than 20 per cent of aged men and about 50 per cent of women live with their children and 65 per cent of the aged depend on others for their day-to-day maintenance. Some of the aged people, when abandoned by families, even end up as homeless or beggars. Unfortunately, the data around them is very little since no proper research or survey has ever been undertaken in India. The reason is old age care has never been a serious agenda because in the sociocultural value system of India, welfare of the old has always been a family responsibility. But over time, the emergence of the nuclear family system, change in attitudes, struggle for existence led to emotional, physical and financial insecurity for old age people.

The woes of old age are exacerbated by socioeconomic inequalities, gender-discrimination and the rural-urban divide. According to official data, around 66 per cent of elderly men and above 23 per cent of aged women still participate in hard labour to make their both ends meet while the respective percentages are much lower in urban areas — 39 per cent of elderly men and about 7 per cent of elderly women. The percentage of old people suffering from disabilities was 64 per cent in rural areas while it was 55 per cent in urban areas. Most of the amenities for old age care are urban centric and inaccessible for people in rural areas. Gender discrimination doesn't spare even old age. When the majority of elderly men were economically independent, more than 80 per cent of elderly women had no earnings or savings of their own and were the worst victims of aging due to low literacy, poor mobility, lack of property or regular income.

The National Policy on Older Persons (1999) was meant to ensure the well-being of aged people by providing financial security, healthcare, shelter, protection of life and property. Integrated Programme for Older Persons (IPOP 1992) revised w.e.f. April 1, 2008 provided more financial assistance to projects and expansion of care homes and day care centres for Alzheimer's disease / dementia patients, physiotherapy clinics, helplines and training centres for caregivers. But, except a spartan old age home in each district headquarters nothing much is provided in terms of physical and mental health, economic security or care giving facility for the old. Health care workers in districts have no training in geriatric care and the existing hospitals are otherwise overburdened with dozens of programmes of general healthcare. Only 18 Regional geriatric Centres (RGCs) are functional in the country which provide only post-graduate courses but no certificate or diploma courses to produce geriatric care professionals. Committee on Estimates on Medical Education and Healthcare, in its 23rd report in 2017, underscored the need for more RGCs and NCAs (National Centres for Ageing), especially in rural areas and emphasised on introduction of geriatric medicine at undergraduate level and in paramedical courses. A few private colleges introduced 'certificate' courses. IGNOU has also recently introduced a PG diploma course.

Neglect of elderly people by families is a direct consequence of either poverty or lack of ability of family members. The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 makes maintenance of parents a legal obligation on children and has penal provisions against violations. Such laws are penal in nature and negative in approach; law cannot restore lost emotional bonds. No wonder the Act is seldom taken as a recourse.

Old-age care in developed countries is run by a hybrid model with private businesses for profit, state responsibility and philanthropy. In Australia, every senior citizen is expected to contribute towards the cost of care. However, by 'Living Longer' and 'Living Better' amendments in 2013, assistance is provided to the homeless and patients of dementia. Canada has both private for-profit services as well as non-profit facilities for the old. In the UK, old-age care, though traditionally funded by the State, is highly rationed today due to the cost factor. There is a shift from 'care as service' to 'care as businesses' with increasing privatisation. Multi-facility providers in the US are mostly for-profit private businesses while philanthropic services are provided by religious organisations. China, on the other hand, is expanding both institutional and community-based services to meet the challenge of the growing population of aged people.

A business model can be successful in urban areas, but it has to be inclusive in nature, addressing the concerns of affordability and equity. For rural India, sociocultural specific models need to be developed by combining government initiatives, private entrepreneurship and philanthropic work to provide affordable medical and caregiving services. Lack of infrastructure for geriatric care is a serious problem in India. Besides, care-nursing agencies, medical suppliers, physiotherapists etc. are mostly unorganised and have quality issues. There is a dire need to encourage and develop the 'elder care industry' in the country.

Absence of a comprehensive vision, limited funding and lack of community participation seems to eclipse old-age care. Poor coordination between the Centre and the state governments adds to the misery. For instance, states and UTs could not utilise more than 7 per cent of funds released under National Programme for Healthcare of the Elderly (NPHCE) between 2015-17. Old-age care is an obligation under the directive principles of the Constitution. The government must protect the old age people as a special class of citizens with affirmative action; concessions in travel or tax reliefs are not good enough. Extensive research and studies also need to be conducted on old age people to help formulate policy planning. In addition to 'medical care' we also need to ensure 'social care' to erase the stigma around old age. We must ensure an ecosystem with social awareness for care and respect for the old, failing which our age-old family value system — rich with love and care — will soon become a thing of the past.

The writer is a former Addl. Chief Secretary of Chhattisgarh. Views expressed are personal