India is experiencing a generation change. Research shows that 12% of the Indian population will be over 60 years old by 2030. The India Report by the Longitudinal Aging Study in India (LASI) indicated that people aged 60 and over make up 8.6% of the total Indian population and is expected to increase to 19.5% (319 million) by 2050. Living over 60 is at risk of frailty, illness, reduced mobility, social stigma, neglect and abuse. India needs an empowering ecosystem for seniors to meet the needs of seniors for services and social protection, to protect their rights and to enable them to contribute to the development process.
In the western world there is a more institutionalized support system for caring for elders. From emergency systems to social security, there is an institutional mechanism to provide optimal and standardized services to the elders. However, India currently lacks adequate institutionalized systems and politically supported mechanisms for caring for elders. Financial security, family or social support, health care and outpatient care are important components, among others, but much remains to be done in these areas.
Elders often suffer neglect, mistreatment, and abuse. The nuclearization of families along with an increase in life expectancy, a higher economic dependency, especially on women, and a greater dependence on the elderly on others for daily help, pose greater challenges for seniors. There are good models from the western world, UK and US where the elderly receive substantial care, and several institutions work in an integrated way to care for them. We can learn from it and adopt best practices or models. The concept of retirement planning is well established in the United States as seniors come into the community through independent living and future care must be met by other institutions within the community. The Indian government has attempted a support system for elders through several political interventions over the past two decades, but so far these initiatives have not had the desired results.
In 1999, the government first made a purposeful attempt by introducing the National Policy on Older People (NPOP). The directive aimed to expand support for financial security, health care, housing, welfare and other needs of the elderly. Another attempt was made after years. In 2007, the Department of Social Justice and Empowerment (MoSJ&E) incorporated the Parents and Seniors’ Maintenance and Welfare Act into legislation. This legislation provided a legal obligation for children and heirs to care for their parents and seniors. While these political interventions are aimed at meeting the economic needs of an aging society, they are unable to meet both the economic and social needs of the elders.
Building on the national policy for the elderly, the Union’s Ministry of Health and Family Welfare (MoHF & W) launched the National Health Care Program for the Elderly (NPHCE) in 2011-12 to provide the elderly with comprehensive health facilities beyond primary, secondary – and secondary education provide tertiary delivery systems. Government initiatives to date have made little progress in creating a new and resilient ecosystem for elderly care. Policy makers recognized the need to scale up the programs. Therefore, in April 2020, MoSJ & E announced an action plan for an umbrella program for seniors – the National Action Plan for the Welfare of Seniors (NAPSrC). In addition to promoting the silver economy, the program focuses on convergence with various programs that exist in other ministries / ministries of the Indian government and states / UTs for the benefit of the elderly.
To go one step further, MoSJ & E presented a draft National Policy for Seniors 2020 last year. To create a more vibrant ecosystem for seniors, the ministry sought proposals from key stakeholders in June 2020. The Indian Health Federation (NATHEALTH), through its dedicated senior vertical and rehabilitation views of private players. The feedback focused on the structural changes required in all critical components of elderly care. Stakeholders highlighted, among other things, financial security, health insurance, retirement homes, rehab care, retraining and employment, intergenerational bonding, capacity building, committed agency, accountability and a focus on securing older women citizens. Promoting the silver economy was also recommended to increase liquidity, low-cost funding, preferential status on land allotment, one-window approval, and tax exemptions for senior care services.
Senior living players and senior care providers find it difficult to raise funds for the development and operation of senior living communities or specialized care facilities. Developers must rely on advances from customers or operators to invest equity and bear ongoing losses. Higher input costs lead to higher prices for senior citizens, so that only a small segment of senior communities can buy or lease and use specialized care services. Lower funding costs would enable more affordable senior citizen projects. Insurance products to cover age-related illnesses relieve operators and customers alike. Therefore, tax and financial incentives, including waiving the GST for players who build assisted nursing homes, senior communities and other facilities, would go a long way in transforming the elderly care segment. The introduction of a quality rating system for senior housing facilities would add an additional quality element to senior housing. A quality assessment system would allow consumers to make meaningful decisions about the care facilities they want and ensure that the facilities focus on the quality of care and service.
A paradigm shift is therefore required. The draft policy for seniors identifies the priority areas of government, and also recognizes the need and opportunity for private sector involvement to achieve strategies. However, the government needs to reconsider the draft and incorporate recommendations from key stakeholders in order to create a quality senior care space for our rapidly growing elderly population.
Old age is a natural progression in everyone’s life and is not a curse. Hence, politics should also aim to encourage the use of positive and respectful news. This will go a long way towards ensuring that generations adopt a more positive and respectful attitude towards seniors – a critical need of the hour.
A safe home environment and independent living are other important areas that need to be addressed appropriately. While home and community care is an encouraged model for elderly care, we should consider cases where seniors are abused at home or prefer to live independently. The establishment of a legal protection mechanism by a dedicated agency and the provision of a safe environment must be included in the directive. A dedicated agency, either within the Department of Social Justice or separately, is expected to ensure coordination with relevant stakeholders, monitor progress, mitigate risk and other aspects of implementation. In addition, the availability of adequate facilities in different regions and the provision of different income brackets for seniors who prefer to live independently must be enabled through a combination of public and private models.
The current system typically operates in silos with minimal outcome tracking and monitoring of seniors through various care points to ensure optimal health and wellbeing. A stronger focus on geriatric specific outcome measures, sharing outcomes among all care providers through the continuum of care, and promoting value-based care with positive outcomes will contribute to greater effectiveness and efficiency in providing high quality care to support holism and wellbeing . Therefore, at the earliest, a holistic political framework must be created that paves the way for measures and the creation of a robust ecosystem for care for the elderly in the country.
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The views expressed above are the author’s own.
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