18 May 2024 – The Hindu

Protecting Elderly Rights in India

• The stealthy increase in India’s senior population is often overlooked in the clamour about the demographic dividend. The number of people over 60 is expected to more than double from 100 million in 2011 to 230 million in 2036, accounting for about 15% of the world’s population, according to the United Nations Population Fund. By 2050, this is expected to increase even further to 319 million, or over one-fifth of the world’s population. According to certain theories, India is currently experiencing the third stage of the demographic transition model.

• This shift is being driven by longer life spans and declining fertility rates. In India, the typical household size shrank from 5.94 in 2011 to 3.54 in 2021. The health and social care systems need to be reset in light of the increased proportion of older individuals living in households with fewer children and potential chronic illness sufferers. Senior home care is becoming a more pressing issue as it frequently blurs the boundaries between social and medical care. External help in providing at-home care for elderly adults is becoming more accessible due to the evolving family structure.

• After independence, India’s life expectancy more than doubled, rising from about 32 years in the late 1940s to about 70 years in the present. It is still a historical achievement, even though many other nations have performed even better. The fertility rate decreased from roughly six children per woman to just two throughout that time, freeing women from the burden of repeated childrearing and child care. While all of this is positive, it also presents a new issue due to population ageing and the rising Elderly Dependency Ratio.

Dependency Ratio: What Is It?

• A demographic statistic known as the dependency ratio calculates the proportion of the working-age population (those who are normally employed) to the dependent population (elderly people and children, for example). It sheds light on the financial strain that supporting dependents places on the working population.

Different Dependency Ratio Types:

• Youth Dependency Ratio: This ratio contrasts the working-age population (those in the range of 15 to 64) with the dependent population (those in the range of 0 to 14). It represents the percentage of children that people of working age have to provide for.
• The Elderly Dependency Ratio contrasts people 65 years of age and older—who are deemed dependent—with people between the ages of 15 and 64, who are deemed working-age. It shows the percentage of senior citizens that the working-age population has to take care of.
• Formula: (Number of people 65 and more / Number of people 15 to 64) times 100
• Total dependent Ratio: This ratio provides an overall assessment of the working-age population’s dependent load by combining the youth and senior dependency ratios.

• Formula: (Age of Population 0–14 + Age of Population 65+) / Age of Population 15–64 x 100.

What are the Different Issues Concerning India’s Elderly Population?

 Adapting to Changing Needs in Healthcare:

• The largest problem in providing a range of high-quality, reasonably priced, and easily accessible health and care services to the elderly is that they are a cohort whose growth rate is significantly higher than that of the younger generation. They need a wide range of in-home specialised medical treatments, such as home or telemedicine consultations, physiotherapy and rehabilitation, mental health counselling and treatment, and prescription drugs and diagnostics.

India’s Low HAQ Score:

• India ranks 145 out of 195 nations in the 2016 Healthcare Access and Quality (HAQ) Index, with a score of 41.2, which is still much lower than the global average of 54 points. In smaller cities and rural areas, where basic quality health care services are severely lacking, the poor HAQ gets even worse.

 Social Concerns:

• The situation for the elderly is made worse by elements like poor education levels, stigmatised sociocultural attitudes, low trust in institutionalised health care systems, familial neglect, etc.
• For the elderly, who are already limited in their ability to understand and use these facilities due to physical, budgetary, and occasionally psychological constraints, unequal access to facilities exacerbates their issues. As a result, the majority of them spend their later years neglected.

 Vicious Cycle of Health, Economy and Unproductivity:

• An overwhelming proportion of the elders are from the lower socio-economic strata. The vicious cycle of poor health and unaffordable health costs is further accelerated by their inability to earn a livelihood. As a result, not only are they economically unproductive but it also adds to their mental and emotional problems.

 Inadequate Welfare Schemes:

• Despite Ayushman Bharat and public health insurance schemes, a NITI Aayog report indicates that 400 million Indians do not have any financial cover for health expenses. Despite the presence of pension schemes at centre and state level, a mere pittance as low as ₹350 to ₹400 a month is provided in some states which too is not universal.

 Issues against Reskilling:

• Ensuring proper technology, facilities etc for reskilling the elderly population at a large scale is a challenge. For instance, armies have an excellently systematised way to integrate the retired officers into the civilian setup. However, reskilling as a part of the system is quite a large task and is possible only in a few areas.

 Feminization of Ageing:

• One of the emerging issues of population ageing is the “Feminization of Ageing”, that is many more women than men reaching older ages. Census of India shows that the sex ratio of the elderly was considerably high (1028) in 1951 and subsequently dropped to about 938 in 1971, but finally increased up to 1033 in 2011.

 Lack of Access to Supportive Resources:

• In the recent past, more and more elderly people are living alone thus giving rise to the need for senior-citizen housing and development of security gadgets and health devices for them. All of these initiatives are coming from the startup sector. However, there is a large segment of the elderly population that lies in the poor category and is most likely left out of the ambit of these facilities.

What are the Legal Provisions Related to Elderly Population?

• Article 41 and Article 46 are the constitutional provisions for elderly persons. Although directive principles are not enforceable under the law, but it creates a positive obligation towards the state while making any law.
• Section 20 of Hindu Marriage and Adoption Act, 1956 makes it obligatory provisions to maintain an aged parents.
• Under Section 125 of Criminal Procedure Code, the elder parents can claim maintenance from their children.
• The Maintenance and Welfare of Parents and Senior Citizens Act, 2007, seeks to make it legal for the children or heirs to maintain their parents or senior citizens of the family.
• Convention on the Rights of Older Persons is proposed in the United Nations.
• In 1982, the Report of the World Assembly on Ageing (also known as “the International Plan on Ageing”) was published, which represented the first international debate on the rights of older persons and presented a plan for their implementation.
• The United Nations Population Fund were tasked with implementing the Plan of the Second World Assembly which adopted “Madrid International Plan” on ageing in 2002.

What are the Various Aspects of Home-Based Care for Elderly Population? 

Scope:

• The scope of services provided at home has expanded from assistance with activities of daily living to routine nursing care as well as specialised care. According to a NITI Aayog report, healthcare offered at home can replace up to 65% of unnecessary hospital visits and reduce hospital costs by 20%.

 Concerns:

• Care practices at home are not well-defined and standardised. Caregivers who are well-trained and possess an empathetic outlook are in short supply, and often complain of being mistreated by families. There are no specific grievance redressal mechanisms for either the users or the caregivers.
• Furthermore, the cost of hiring a caregiver at home is substantial. Currently, it is the private, for-profit sector that offers the bulk of these services. Market estimates project the home-based care industry to grow at a rate of 15-19% annually, from nearly USD 6-7 billion in 2021 to USD 21 billion by 2027.

 Suggestions:

• First and foremost, recognise “home” as a place for providing care and as a “place of work” for caregivers. This has implications for the rights and safety of both users and providers. The Insurance Regulatory and Development Authority of India (IRDAI) recognises hospitalisation at home in certain conditions.
• Secondly, care at home is a different proposition than in an institution like a hospital or an old-age home. The terms of engagement and treatment protocols must be tailored to the home environment.
• Thirdly, to meet the growing demand for trained caregivers, streamline their vocational training, nomenclature, roles, and career progression.
• Finally, all this ought to be brought together under a comprehensive policy on home-based care, incorporating aspects such as a registry of providers of such services; ensuring transparency and accountability; establishing grievance redressal mechanisms; and insurance coverage, among others.

 What are the Various Steps to be Taken to Alleviate the Concerns of Elderly Population?

Protection from Destitution:

• The first step towards a dignified life for the elderly is to protect them from destitution and all the deprivations that may come with it. Cash in the form of a pension can help to cope with many health issues and avoid loneliness as well. That is why old-age pensions are a vital part of social security systems around the world.
• Another critical area would be bringing reforms in the social security pensions. They also need other support and facilities such as health care, disability aids, assistance with daily tasks, recreation opportunities and a good social life.

Emulating the Frontrunners:

• The southern States and India’s poorer States such as Odisha and Rajasthan have achieved near-universal social security pensions. Their actions are worth emulating. It would be much easier for all States to do the same if the central government were to revamp the National Social Assistance Programme (NSAP).

Transparent “Exclusion Criteria:

• A better approach is to consider all widows and elderly or disabled persons as eligible, subject to simple and transparent “exclusion criteria”. Eligibility can even be self-declared, with the burden of time-bound verification being placed on the local administration or gram panchayat.
• Although there are chances of privileged households taking the advantage, it is much preferable to accommodate some inclusion errors than to perpetuate the massive exclusion errors as is the case today.

Recognising Concerns of Elderly Women:

• The policy should also take cognisance of the fact that women, in India, on average outlive men by three years. The sex ratio of older people is projected to increase to 1060 by 2026. Since women in India are usually younger than their husbands, they often spend their later years as widows.
• Therefore, the policy should particularly cater to the more vulnerable and dependent older single women so that they can live respectable and independent lives.
• Passing Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019:
• The Ministry of Health and Family Welfare (MoHFW), Ministry of Social Justice and Empowerment (MSJE) and Ministry of Skill Development and Entrepreneurship (MSDE) have a pivotal role to play in the matter. Greater collaboration between them could get the ball rolling on the required reforms.
• The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019, seeks to regulate home-based care for older people. It proposes the registration of institutions providing home care services and prescribing minimum standards for them. However, it has not been passed since being introduced in Parliament in 2019.

Policy Interventions:

• It is crucial to have a robust public policy to support homes for the elderly. These old age homes must be guided by policy interventions to make their facilities, buildings and social environment elderly-friendly. Design, architecture and civic facilities must be thought from the ground up — and these innovations must be available for all residents, not just those living in expensive ones.

Building Elderly Inclusive Society:

• One of the effective ways of ensuring proper health facilities to all the elderly in the Old-Age-Homes (OAHs) is to ensure a lesser number of the elderly people in these homes. Elderly are an asset to the society and not a liability, the best way of taking advantage of this asset is by assimilating them into the mainstream population rather than isolating them in old age homes.

Conclusion:

• While the emphasis on making India’s youth population “future ready” is welcome, it should not overshadow an equally critical group that needs attention. The experience of countries like Japan shows that systems to care for older people are essential for the younger population to contribute to the country’s economy. Besides, it is a society’s moral and ethical responsibility to care for its people beyond their prime, reciprocating their lifetime of physical, social, emotional, and economic investment in the society.

• For the welfare and care for the older persons, we must focus on the protection of already existing social support systems/traditional social institutions such as family and kinship, neighborhood bonding, community bonding and community participation must be revived and kins should show sensitivity towards elderly citizens.