GOV & SOCIAL ISSUES

Elderly

Introduction

The United Nations defines a person above 66 years of age as a senior citizen. The Indian census classifies people in the age range 60 years and above as old. Demographers categorize the elderly in the following three groups: the young-old aged (60-70 years), the old-old aged (70- 79 years), and oldest-old aged (85 years and above).
The real determining factor however, has to do with physical disability, loss motor functions, lack of productivity, and level of dependency – the higher these values, the older one is considered to be.
Old age as an issue of concern has gained importance due to the rapid demographic transition involving high to low fertility and mortality and coNnsequent ageing of population. Globally the 60-plus population constitutes about 11.5 percent of the total world population. By 2050 this proportion is projected to increase to about 22 percent.
Concerns around the elderly are more severe for highly populated, developing countries going through major demographic change like India.
Between 2000 and 2050, the population of India will grow by 55%. However, the population above 60 years and 80 years will grow by 326% and 700% respectively.
By the end of the century, the elderly will constitute nearly 34 percent of the total population in the country.

The Elderly in India: Statistics

According to Population Census 2011 there were nearly 104 million elderly persons (aged 60 years or above) in India.
The share is marginally higher for rural India at 8.8 percent, while it is 8.1 percent for the urban regions.
The sex ratio for general and elderly population are 943 and 1033 respectively which are quite close to the levels they were in 1951, that is, 946 and 1028 respectively. In 2011, there were 53 million females and 51 million males in elderly population.
Literacy rate amongst the elderly was largely skewered in favor of the urban dwellers (66 percent). Rural literacy stood at only 34 percent; for rural women, it was 18.4.
According to The State of Elderly in India Report (HelpAge India), every second elderly person suffers abuse within the family; more in case of women than men.
The 52nd round of the National Sample Survey Organisation found that nearly half the elderly are fully dependent on others for their economic needs and another 20% are partially dependent.
There are significant interstate variations in demographic profiles across the country, primarily due to differences in the onset and pace of fertility. The southern states along with Himachal Pradesh, Maharashtra, Odisha and Punjab are the front runners in population ageing. Whereas, the central and northern states such as Uttar Pradesh, Rajasthan, Madhya Pradesh, Bihar, Jharkhand, Chhattisgarh and Uttarakhand have much lower proportions of aged population.

Challenges faced by the Elderly

Social and Emotional Issues

Difficulty in assimilation and acceptance into new social groups due to generational gap.
The Report on the Status of Elderly in Selective States of India, (2011) shows that involvement of the elderly in social life, whether in public meetings, organisational meetings or religious programmes is also very limited.
A prevailing sense of being useless, worthless and powerless: and constant reminders of the same by immediate family.
Negligent care, humiliation and abuse by immediate family.
Challenges in adapting to new technologies.
Loneliness – which is a predominantly urban phenomenon- often accompanies old age, and is a serious problem amongst the aged. This is worse in cases of elderly widows/widowers.
Gender differences also act as a double edged sword. On one hand the younger generation might prefer keeping their elderly mothers at home as long as they help with the household chores, and tend to be less inclined to keep their fathers; but on the other hand, women can sometimes be worse off, as, in a quintessential rural-patriarchal paradigm they have to bear the brunt of nurturing and caring for the elderly, causing them to become both the victims as well as the perpetrators of abandonment.

Health (Physical and Mental) Issues

Old age in general is synonymous with increase in challenges to physical health and characterized by multiple disabilities.
The situation is worse in cases where inadequate attention is paid to a balanced diet and nutrition intake for the elderly.
An additional challenge in rural areas comes from absence of proper geriatric healthcare facilities, as well as a lack of will to make these accessible.
Limited regenerative abilities and general deterioration of the body and its functions – blindness, deafness, decrease in motor abilities among others.
Lack of company can make them reclusive which can lead to depression, and ultimately causes mental and physical deterioration.

Financial Issues

Financial dependency, coupled with a lack of social security has a huge impact on the erstwhile self-sufficient older adults.
The elderly work participation rate also varies across the states of India and varies between as high as 60 percent (Meghalaya) to as low as 8 percent (Goa).
Not only do the elderly become financially dependent, out-of-pocket expenditure on medical consultations and treatment is more likely to increase with age.
Out-migration of the younger generation in search of employment leads to degradation in the quality of life of rural elderly due to lack of financial independence.
The changing structure of families and increasing nuclearization leads to challenges related to living space for the elderly.

International Examples of Good Practices

Japan, Switzerland and the UK have what is termed a Time Bank Scheme wherein one puts in hours taking care of someone, in order to earn hours for themselves to redeem similar caretaking services in future.
Singapore has started the Silver Support Scheme provides additional support for elderly Singaporeans who had low incomes through life and who now have little or no family support.
Singapore also has a Caregivers Training Grant which allows using $200 subsidy every year for learning courses which help one take care of the elderly in the family.
In Scotland, a program called Reshaping Care for Older People was launched in 2011. This program puts a focus on preventing illness and injury in seniors, and prioritizes helping seniors remain independent for as long as possible through a more community-oriented approach.
The Netherlands has experimented with a different living situation for seniors, in efforts to decrease feelings of loneliness in nursing homes. University students are given the option to live in a rent-free flat in select nursing homes, where they live amongst their elderly neighbors and interact with them for 30 hours a week.
Most countries have comprehensive pension schemes to which one contributes during their working life, and can avail the benefits once they retire from active service. There are also varying levels of subsidies on travel and medical treatment for the elderly.

Government Approach to Elderly Care

Constitutional Safeguards

The rights of the elderly are protected under right to equality (Article 14). right against discrimination (Article 15), right against exploitation (Article 23)[v2] .
Direct constitutional protection is provided through Article 41 which mentions the old as a separate category whose well-being is the responsibility of the state. While the Directive Principles are not enforceable under the law, they create a positive obligation on the state to act on them.
Article 46 points out that the state shall promote the educational and economical interests of the weaker sections of society, especially those from disadvantaged castes and tribes.
Entry 24 in List III, Schedule IV deals with the “Welfare of Labour, including conditions of work, provident funds, liability for workmen’s compensations, invalidity and Old age pension and maternity benefits.
Item No. 9 of the State List and Item No. 20, 23 and 24 of the Concurrent List relates to old age pension, social security and social insurance, and economic and social planning.

Legislative Safeguards

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 makes it obligatory for children or relatives to provide maintenance to senior citizens and parents, and also provides for the setting up of old age homes by State governments. Chapter V of the Act provides for protection of life and property of senior citizens.
Criticisms of the law include: difficulty in implementation, no obligation on the state government to establish old age homes, no provisions for old age pensions, issues for formation and membership of the Tribunal, etc.
Section 88-B, 88-D, and 88-DDB of the Income Tax Act allow senior citizens to claim a discount in tax. The elderly are also entitled to get higher interest on tax saving plans apart from having a wide variety of LIC policies and post office saving schemes to choose from.
Section 20 of Hindu Adoption and Maintenance Act, 1956 makes it obligatory provisions to maintain aged parents.
Under Section 125 of Criminal Procedure Code, the elder parents can claim maintenance from their children.

Welfare Programs and Schemes

The Central Government has since 1992 been implementing its Integrated Programme for Older Persons, which aims to provide senior citizens with basic amenities such as shelter, food, medical care and entertainment opportunities.
The National Social Assistance Programme (NSAP) has been in function since 1995, under the Ministry of Rural Development and it introduces a National Policy for Social Assistance benefit to poor households (in both rural and urban areas) in the case of old age, death of primary bread-winner and maternity.
National Old Age Pension Scheme (NOAPS) (renamed Indira Gandhi Old Age Pension Scheme) is one of the five components of NSAP. It ensures that for households below the poverty line, a monthly pension of Rs.200 is given for each person in the age group of 60-79 years and Rs. 500 for those above 80 years and above. A proposal to increase the monthly pensions is underway.
The National Policy on Older Persons (1999), which followed from a UN General Assembly resolution, is also yet to be fully implemented. It envisages state support to ensure financial and food security, shelter, healthcare, an equitable share in development, and other services like daycare, supply aids and occasional visits by social workers services to improve the quality of the lives of the elderly and protect them from abuse and exploitation. This was followed by the National Policy on Senior Citizens, 2011.
The Annapurna Scheme (a part of NSAP) was launched in 2000 and it aims at providing food security to around 20 percent (13.762 Lakh) of senior citizens who, though eligible, have not received benefits under the NOAPS.
National Programme for the Health Care for the Elderly was started by the Ministry of Health in 2010-11. It provides preventive, curative and rehabilitative services to the elderly persons at various level of health care delivery system of the country.
Ministry of Finance started the Varishtha Pension Bima Yojana (VPBY) in 2003 (relaunched in 2014) as a social security scheme for senior citizens. The Pradhan Mantri Vaya Vandana Yojana (PNVVY) – a simplified version of VPBY – was launched in 2017.
The Rashtriya Vayoshri Yojana (RVY) is funded from the Senior Citizens’ Welfare Fund. Aids and assistive living devices are provided to senior citizens belonging to BPL category who suffer from age-related disabilities such as low vision, hearing impairment, loss of teeth and locomotor disabilities.
Various other Government of India ministries, including the Ministries of Health and Family Welfare, Finance, and Departments of Revenue, Railways, and Civil Aviation, offer concessions and similar schemes that promote access to resources by the elderly. These include, but are not limited to separate queues in hospitals and train stations, concession in rail and air fares, tax exemptions, special geriatric clinics and health insurance schemes.

Proposed Schemes/Legislations

The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019, has been approved by the Union Cabinet and will soon be tabled in Parliament.
The Bill seeks to remove the Rs 10,000 ceiling prescribed by the Maintenance of Parents and Senior Citizens Act, 2007, and further looks at expanding the definition of ‘parents’ and ‘children’ to include son-in-laws, daughter-in-laws as well as stepchildren.
The Amendment Bill mandates government registration of the old age homes, NGOs, and other governmental and autonomous bodies that engage with the elderly, so as to ensure the maintenance of minimum standards.

NGO Sector and Elderly Care

Due to the paucity of public sector funds and resources, the existence of NGOs is essential for developing a holistic welfare mechanism for the seniors.
The people working with NGOs tend to be volunteers, who are not only well trained to take care of the elderly but also have a greater understanding of the challenges faced by this segment of the society.
NGOs play a pivotal role in providing the elderly with adequate support and essential facilities. They offer a plethora of services including but not limited to, health care, shelter, legal assistance for property disputes, and income generation and subsistence training.
Some examples of the leading organizations in this field include HelpAge India which is one of the most prominent NGOs in the country. Registered under the Societies Registration Act, 1960, HelpAge India was formed in 1978 and has been committed to providing care and support for the elderly for more than four decades. In recognition of its considerable contributions towards elderly welfare in India, the organization has received numerous accolades from United Nations.
Other important NGOs involved in elderly care include International Longevity Centre-India, Age-Care India, Anugraha India, Dignity Foundation, Agewell Foundation, Silver Innings Foundation, Harmony, and others.

Way Forward and Recommendations

The National Council for Senior Citizens, constituted in 2012, must be functionalized at the earliest. State level councils must also be established.
Pensions given under NOAPS should be increased, and should also be given to the elderly above the poverty line.
A health insurance scheme must be formulated for senior citizens. Alternatively, the Rashtriya Swasthya Bima Yojana, which provides health insurance to BPL families, must be universalized.
The tax exemptions of up to Rs 2.5 lakh and Rs 5 lakh per year for people above 60 years and 80 years respectively should be raised periodically.
Exemplary international practices should be adopted.
Efforts should be made to strengthen the family care, because the preferred source of support for the aged is still the family.
It is imperative to encourage proactive research in geriatric diseases, and push for capacity building in the geriatric departments across the primary and tertiary health-care systems.
There needs to be a spread of awareness about common diseases like Dementia and Alzheimer’s so that family members, care-givers, and society at large are sensitised to incontinence, the momentary lack of comprehension, the hallucinations — all the painful behavioural, physical, emotional and mental struggles of those who suffer from these degenerative diseases.
The Institutional care must be able to enhance relationships within families that incorporate both young and old persons. There is a need for effective legislation for parents’ right to be cared for by the children.
A network of old age homes –both in the private and public sector – needs to be created and maintained. State governments must take it upon themselves to set up quality, affordable homes.
Businesses could look at harnessing the talent of elders by retaining or hiring older workers and offering flexible working hours for those who want to continue working after retirement.
At the community level we also need to increase the avenues for older people to participate in local issues, in resident associations, to leverage their experience, give them an opportunity to share their concerns, and help them feel that they contribute socially.
The general population needs to acknowledge the importance of the elderly and the fundamentality of elderly care in the society in order to ensure that the aged can age gracefully and continue to live with dignity.