India's ageing population needs robust elder care, not just new schemes

Celebrations over India’s demographic dividend a decade ago have metamorphosed into concerns at the ageing of India’s population. The current elderly population of India (those aged 60 and above) is about 153 million. By 2050, just 25 years from now, this cohort is expected to grow to a staggering 347 million. India’s population growth is slowing, with total fertility rates falling below replacement levels in several states, which means that the elderly will account for a larger share of the Indian population by then; estimates suggest a range of 15 to 20 per cent. There are many policy implications to this demographic transition, chief among them being the creation of an adequate elder care ecosystem. So far, however, this critical socio-economic dynamic appears to be acquiring a K-shaped structure.

 

A recent four-part series in Business Standard captured the rise of the “silver economy”, demonstrating how insurance companies, construction majors, medical conglomerates, and even software startups are devising schemes and products for India’s ageing middle and upper-middle class. This suggests a shrewd reading of the future consumer market. But the sobering reality is that these entrepreneurs address a relatively small proportion of the population that has the financial wherewithal to afford such products and services. But as much as 40 per cent of the country’s elderly are in the lowest wealth quintile and about 20 per cent have no income at all. For the bulk of India’s elderly and ageing population, the principal problem remains the loss of income and financial security and the concomitant lack of access to health care and elder care that follows. Poor and low-income families struggle to cope with elderly relatives suffering a range of age-related illnesses from heart and kidney problems, limited mobility, Alzheimer’s, and dementia, to name a few. An expanding lifespan and lifestyle changes such as growing nuclear families and urbanisation are imposing new pressures on elder care in India, resulting in a distressing rise in cases of outright abandonment of sick or disabled elderly relatives. There is, to be sure, no shortage of laws and schemes for the elderly.

 

Indeed, India was considered a frontrunner in terms of addressing the issue by coming up with its National Policy on Older Persons in 1999, three years ahead of an international plan. Among other signature programmes are the National Programme for Health Care of the Elderly (NPHCE), launched in 2010 to provide dedicated health care for the elderly, and the Maintenance and Welfare of Senior Citizens Act, 2007, which made it a legal obligation for children and heirs to provide maintenance to senior citizens and parents with a monthly allowance. The latter, a law ahead of its time, also provides for a fast-tracked and inexpensive mechanism for the protection of life and property of the elderly, and the setting up of old-age homes to provide maintenance to indigent senior citizens. Most of these forward-thinking policies on elder care have foundered on poor implementation. More recently, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana extended health-insurance coverage to all senior citizens aged 70 and above, irrespective of income. Being a relatively successful scheme, this extension could well be a game-changer. But it should be seen as the starting point of a robust system of humane, affordable elder care that offers India’s ageing population a degree of security.