Caring for seniors

With India emerging as the most populous nation and increasing life expectancy, its ageing population is steadily rising. The proportion of the 60+ population in the country rose from 7.5 per cent in 2001 to 9.7 per cent in 2021 and is expected to touch 12.1 per cent in 2031 and 16.6 per cent by 2051. Those in the 70+ age group, currently around 5 per cent, are likely to double. In terms of numbers, we will have to deal with approximately 140 million to over 200 million senior citizens in the next 30 years.

It is estimated that 50 per cent of the elderly population is fully financially dependent, while a quarter of those aged 60 and above are still working. Some of the problems faced by the elderly include living alone or with only their spouse, with a higher proportion of women living alone. About 65 per cent of the elderly suffer from at least one chronic disease, such as arthritis, hypertension, or diabetes. Hospitalisation charges are significant, while health insurance covers only 2 per cent of this population. Additionally, a considerable number of them suffer from disabilities such as vision and hearing loss, requiring assistance for walking and speaking. Apart from physical ailments, about half of the elderly population faces some form of mental health issue.

What has been the policy response of the government to addressing the challenges of an ageing population? In 2007, the Union government passed the Maintenance and Welfare of Parents and Senior Citizens Act, which allows parents and grandparents to demand maintenance from their children. The National Programme for the Health Care of the Elderly (NPHCE), launched in 2010, aims to promote the concept of “active and healthy ageing” and provide accessible, affordable, and high-quality, long-term care services to the ageing population. The NPHCE includes services such as daycare and rehabilitative services, home-based care, establishing geriatric wards at district-level hospitals, training geriatric carers, expanding treatment facilities, and incorporating geriatric care into medical course curricula.

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The Rashtriya Varisht Jan Swasthya Yojana of 2016–17 envisions the establishment of two National Centres for Ageing, one at AIIMS, New Delhi, and another at Madras Medical College, Chennai. It also aims to provide services through Regional Geriatric Centres at 19 medical colleges in 18 states. The National Health Policy of 2017 addressed the issue of long-term care for the first time, recognising the growing need for palliative and rehabilitative care for geriatric illnesses and advocating for continuity of care at all levels.

The primary responsibility for dealing with the challenges faced by the elderly and providing for the implementation of their welfare measures within the broad legal and policy framework laid down by the Union government lies with the state governments. However, not all state governments give the necessary attention to this issue. It is disheartening to see that the recent Budget presented by Karnataka Chief Minister Siddaramaiah for 2023–24, which was expected to prioritise welfare, completely overlooked the problems of the aged and elderly population.

It must be noted that the private sector and various voluntary and charitable organisations play a crucial role in extending services to the elderly through residential care facilities, commonly known as old-age homes. However, these facilities cater to different income categories, with some falling into the luxury bracket that few can afford. While some voluntary bodies provide free or low-cost care, the preference for most elderly individuals in India has been home-based care due to the significance of family. Nevertheless, rapid urbanisation and changing lifestyles present new challenges in providing long-term home care, such as the diminishing ability of the family to care for older members due to the nuclearisation of families and women taking up employment. The increasing cost of medical treatment and out-of-pocket expenditures impose a heavy financial burden on families. Additionally, not all families can afford residential care facilities. Despite the law mandating children look after their parents when they are unable to support themselves, there are instances of cruel treatment, abuse, and abandonment of helpless elderly individuals by their families.

Although the government has established a legal and policy framework, more needs to be done to regulate and safeguard the elderly, particularly the poorer and more vulnerable sections, especially in rural areas. It is not an easy task, and the government alone cannot bear the entire burden. The efforts of non-governmental organisations are also insufficient. Each state must formulate its own strategies, comprising preventive, professional, and community involvement aspects. The following suggestions can be considered:

Create public awareness to emphasise the fact that everyone grows old and homes will require assistance in some way or another.

Provide professional training to staff engaged in providing care to the elderly.

Establish standards for residential care homes, including the quality of food, and ensuring proper sanitary facilities and hygiene.

Motivate the local community in rural areas, small towns, and resident welfare associations in cities to support organisations engaged in providing elderly care services.

Encourage philanthropists to provide financial assistance.

Explore the possibility of utilising CSR funds for voluntary organisations in the field.

Old-age problems extend beyond physical health or disabilities; they also encompass mental, social, and psychological aspects. Addressing these challenges requires a great deal of understanding and empathy to provide relief to those in need. It is important for those basking in the sunshine of youth to realise that one day they will also grow old, are likely to face similar problems, and will need the assistance of others.

As American writer Renee Oelschlagaer suggests in her poem, Ageing Well, youth is after all a passing phase:

The joy of being twenty-one gets lost / On folks that age. They don’t yet know the truth: That ageing comes to all, and wisdom’s cast / Is non-negotiable-And youth? / That shining bauble on a chair / Dissolves to life more precious and mundane.

Let D H Lawrence have the last word. A more optimistic note in his poem, Beautiful Old Age:

It ought to be lovely to be old /To be full of peace that comes of experience/ And wrinkled ripe fulfilment.

(The writer is former chief secretary, Government of Karnataka)