Backdrop:
India is undergoing a demographic shift that is expected to reshape its social and economic landscape over the coming decades. While the country has historically been characterized by a young population enjoying what is known as “demographic dividend”, projections suggest a looming "elderly explosion" due to improved healthcare and increased life expectancy. The UN predicts that by 2050, India’s elderly population (aged 60 and above) will reach nearly 20 per cent of the total population. With such a large aging population and high “dependency ratio”, there are two imminent challenges: how to reverse the trend in terms of increasing fertility and how to serve the ever-growing elderly population. The demand for elderly facilities and services is thus becoming more pressing than ever.
Understanding Demographic Shift:
The surge in India’s elderly population is due to several factors:
1. Increased Life Expectancy: Advances in healthcare and better lifestyle management, particularly among the urban elders have raised life expectancy in India, leading to a larger elderly population.
2. Declining Birth Rates: Reduced birth rates mean fewer young people in the population, shifting the dependency ratio. Barring a few states in India, the average fertility rate is as low as 1.5 to 1.8 which is alarming and not sustainable.
3. Urbanization: As younger generations migrate to cities for job opportunities, more elderly people are left behind, often in rural areas with limited access to adequate elder care facilities. This phenomenon of “ruralisation of elders” is a serious issue.
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This demographic shift creates a need for specialized elder care facilities to provide support and services that older adults require, including healthcare, financial & social support, safety, and emotional care. Unfortunately, India is currently not adequately prepared to handle this impending burden, as elder care facilities remain limited and often not of quality. There is hardly any support system in rural places and the situation is alarming.
Need for Upscaling Elderly Facilities:
Elderly population in India faces unique challenges that require society and the government to work together in real earnest. It is the responsibility of all stakeholders to take part in this mission. Upscaling elderly facilities is not only a social imperative but also a preventive healthcare measure that can reduce the economic burden of age-related illnesses. Key areas of need include:
1. Quality Medical Facilities: As people age, they become more vulnerable to chronic diseases and other health issues, making it essential to have accessible quality healthcare facilities equipped to cater to these needs. The quality of healthcare particularly for the poor and in rural parts is below international standards by all means.
2. Mental Health and Social Support: The other important issues are mental in nature like loneliness and depression; these are significant concerns for the elderly, especially for those who live alone. Providing mental health services and social support is thus imperative to improve the quality of life.
3. Safety and Accessibility: Many homes and public spaces in India lack infrastructure necessary from the perspective of elder safety and accessibility, such as handrails, wheelchair ramps, and emergency response systems. The “accidents” and “falls” that senior citizens suffer as a result of the above result into untimely death of thousands of elders each year.
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4. Financial and Legal Support: Senior citizens often require financial assistance due to reduced earning potential, and some may need legal help to secure property rights or manage assets. Barring the elders who get pension from the government jobs where they retired from, the other types of central or state government pensions are minimum from sustenance point of view.
Strategies to Improve Elderly Facilities in India:
Upscaling elderly facilities in India requires multi-level strategies involving government policies, community-based programs, and the support of the private sector. Some key strategies include:
Policy Reform and Government Support
1. Increasing Budget Allocation for Elder Care: The government should allocate more funds specifically for the development and maintenance of elderly facilities. Subsidies and tax breaks for private elder care providers can also encourage investment. Amount of pension should be equal to minimum necessary for living say Rs 30,000/- per person in urban areas and Rs 20,000/- in rural areas.
2. National Elderly Care Policy: India needs a comprehensive policy on elder care that establishes standards for care facilities, mandates training for caregivers, and enforces regulatory standards. Today the entire caregiving system is in unorganized sector, an issue that needs to be tackled on priority basis.
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3. Health Insurance Expansion for the Elderly: Expanding affordable health insurance options for seniors can alleviate financial burdens and encourage preventive healthcare. The proposed government initiative to bring all seniors above 70 under the government insurance scheme is a welcome initiative; it is however too early to comment as we need to see what happens on the ground and whether private sector hospitals become party to the same.
Community-Based Support Systems
1. Encouraging Multi-Generational Housing: By promoting housing policies that encourage multi-generational living, communities can foster support for elderly members within family settings.
2. Building Community Centres for Elders: Community centres that offer social, recreational, and healthcare services can provide a supportive environment for seniors, particularly in rural areas. The existing NGOs should be supported and incentivized by the government.
3. Telemedicine Services and Application of Other Technology: Telemedicine can bridge the healthcare access gap, particularly in rural areas, allowing elderly individuals to consult doctors remotely. Other technological services like “alert system” or “smart watch”, etc. should be encouraged. The use of health monitoring devices can help families and caregivers track elderly individuals’ health status and alert them to emergencies.
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Private Sector Involvement and Investment
1. Encouraging Private Elder Care Facilities: Public-private partnerships can help to establish well-equipped elderly facilities that meet international standards. The private sector should be incentivized to develop elderly care homes, day-care centres, and assisted living spaces.
2. Geriatric Training Programs: Though offering of government grants or incentives for geriatric training programs, the private sector can help ensure a skilled workforce capable of providing quality care to the elderly.
Promoting Awareness and Social Responsibility
1. Raising Awareness About Elderly Rights: Educating families and communities about elderly rights can foster a more supportive social environment for seniors.
2. Involving NGOs and Community Volunteers: Local NGOs and community organizations can play a crucial role in elderly care by conducting home visits, offering companionship programs, and arranging local events to keep the elderly engaged.
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Conclusion:
The impending surge in India's elderly population calls for urgent and well-planned intervention. By prioritizing policies that enhance healthcare access, promote social inclusivity, and leverage community-based support, India can build a robust elder care infrastructure. This requires collaboration across governmental, private, and community spheres to ensure that the elderly population is supported, respected, and cared for. Elders in their prime time had given their best. It is now time for others to repay the debt.
(Dr A K Sen Gupta is the Chief Trustee of My Retired Life Foundation – MRLF. He may be contacted at [email protected] or 98211 28103.)