Caring for the elderly

Longevity dividend can be both a burden and an opportunity

Sights of dying Italian villages populated only by the elderly and empty apartment blocks in China being demolished tell us a lot about the grim challenge of unfavourable demographics. In India too, an ageing population, coupled with a decreasing fertility rate and increased life expectancy, is set to offset the country’s demographic dividend in the years to come. Senior citizens, ie people aged 60 years and above, comprise a little over 10 per cent of the population, translating into about 104 million. By 2050, however, the elderly population is projected to rise to 319 million, approximately 19.5 per cent of the total. In this context, a recent position paper released by the NITI Aayog on senior care reforms in India does a remarkable job at contextualising the needs of the senior population, and also identifies the deficiencies in regulatory provisions, accessibility, and poor implementation of services in senior care. Population ageing in India is associated with a shifting disease burden, rising dependency ratios, evolving family structures, altered consumption patterns, and structural changes in labour markets. The rise of nuclear family systems and increased medical expenditure, for instance, add to the vulnerability of the elderly.

The paper emphasises some of the disturbing realities of India’s senior care industry. Close to 75 per cent of the elderly suffer from one or more chronic diseases, while one in three have depressive symptoms and complain of low life satisfaction. The high disease burden is aggravated by lack of proper geriatric illness management. Additionally, their lives are made difficult by inaccessible physical infrastructure, weak and fragmented social safety nets, deficient financial planning, food insecurity, and loneliness. For instance, 54 per cent of the elderly women are widows, and 9 per cent of them reside alone. At the same time, 78 per cent of the elderly live without a pension while only 18 per cent are covered by health insurance.

There are important lessons to be learnt here. An average Indian worker receives less than eight years of education. The process of educating a population takes time, and is generational. Tackling social attitudes that favour boys over girls is even more difficult. India has not done well in either, and this does not augur well for the country’s growing elderly population. On the health front, the paper calls for better wellness and therapeutic interventions to strengthen physical and mental health services and emergency response infrastructure. Integrating technology with health care through the use of wearable devices, artificial intelligence-based smart housing, and a well-developed telemedicine market have a huge potential to transform the lives of seniors. Increasing the coverage of pensions, geriatric health insurance plans, goods and services tax reforms on senior care products, and encouraging the “reverse mortgage” mechanism can bring the elderly within the ambit of formal financial institutions. Private-sector and non-profit voluntary organisations need to step in to fulfil these needs. In most countries, the care economy is run by private agents, and that includes both paid and unpaid work related to supporting people. Increased life expectancies also call for a transition to more flexible working models where rigid employment careers are no longer necessarily the rule. Instead, the government and the private sector must rethink the retirement age to unlock the longevity dividend. It not only keeps people young for longer, but is also fiscally sustainable. After all, the exchequer benefits from higher income-tax revenues and improved labour market incentives.