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India needs holistic regulatory framework

India is witnessing a generational change. Research indicates that 12% of India’s population will be over the age of 60 by 2030. The Longitudinal Ageing Study in India (LASI) India Report pointed out that people aged 60 and above accounted for 8.6% of the total Indian population and is projected to further rise to 19.5% (319 million) by 2050. Life above 60 years runs the risk of being fraught with frailty, illness, mobility restrictions, social stigma, neglect, and abuse. To fulfil the needs for services and social protection for senior citizens, protection of their rights, and enabling them to contribute to the development process, India needs an enabling senior care ecosystem.  

 While in the Western World, there is a more institutionalised support system for taking care of elders. From emergency systems to social security there exists an institutional mechanism to provide elders optimum and standardised services. But, in India, currently, there is a lack of adequate institutionalised systems and policy-supported mechanisms for taking care of the elders. Financial security, family or social support, healthcare, and community-based care among others are critical components, but much is still to happen in these areas.  

 Elders often suffer neglect, mistreatment and abuse. The Nuclearization of families along with an increase in life expectancy, higher economic dependency especially for women, and greater dependency of elders on others for day-to-day assistance are creating greater challenges for seniors. There are good models from the western world, UK, and the US where there is significant care for the elderly, and several institutions work in an integrated manner to take care of them. We can learn from them and adopt best practices or models. The concept of continuing care retirement communities is well established in the United States with seniors coming into communities through independent living and future care needs to be met through other settings within the community. The Indian Government, through several policy interventions in the last two decades, attempted to put in place a support system for elders but so far these initiatives did not provide the desired outcomes.  

In 1999, for the first time, the Government made a purpose-oriented attempt by introducing the National Policy on Older Persons (NPOP). The Policy aimed at extending support for financial security, health care, shelter, welfare, and other needs of older persons. Another attempt was made after years. In 2007, the Ministry of Social Justice and Empowerment (MoSJ&E) introduced into legislation the Maintenance and Welfare of Parents and Senior Citizens Act. This legislation provided a legal obligation for children and heirs to provide for their parents and senior citizens. While these policy interventions aimed at addressing economic needs of an aging society, it falls short in meeting both economic as well as the social needs of elders. 

 Building on the National Policy for Senior Citizens, the Union Ministry of Health & Family Welfare (MoHF&W) in 2011-12 launched the National Programme of Health Care for Elderly (NPHCE) to provide comprehensive healthcare facilities to the elderly through primary, secondary, and tertiary delivery systems. The government’s initiatives so far have made little progress in creating a new and robust elder care ecosystem. Policymakers realised the need to scale up the schemes. Hence, in April 2020, the MoSJ&E announced an Action Plan for an umbrella Scheme for senior citizens- the National Action Plan for Welfare of Senior Citizens (NAPSrC). Alongside promoting the silver economy, the scheme focuses upon convergence with different programmes existing in other Ministries/Departments of Government of India and States/UTs for the welfare of senior citizens.

 Moving a step further, last year the MoSJ&E came out with a draft National Policy for Senior Citizen 2020. To create a more vibrant senior care ecosystem, the Ministry sought suggestions from key stakeholders in June 2020. The Healthcare Federation of India (NATHEALTH), through its dedicated Senior and Rehabilitation vertical, collated views of private players. The feedback focused on the structural changes required in all critical components of elder care. The stakeholders emphasised Financial security, Health insurance, Shelter for senior citizens, Rehab care, Re-skilling and employment, Intergenerational bonding, Capacity building, Dedicated agency, Accountability, and Focus on securing senior women citizens among others. It was also recommended that there is a need for Silver economy promotion to increase liquidity, low-cost funding, preferred status with regards to land allocation, single-window approval, tax exemptions for senior care service. 

Senior living players and Senior Care providers find it difficult to raise funds for the development and operations of senior living communities and specialised care facilities, respectively.  Developers need to rely on advances from customers or operators to infuse equity to bear continued losses. Higher input costs lead to higher prices for seniors, therefore allowing only a small segment to buy or lease senior communities and avail specialised care services. Lower financing costs would allow for more affordable senior living projects. Insurance products to cover age related illnesses will ease the burden on operators and customers alike. Hence fiscal and monetary incentives including GST waiver to players who build assisted memory care homes, senior living communities, and other facilities would go a long way in transforming the elder care segment. The introduction of a quality rating system for senior living facilities would add another quality element to the senior living space. A quality rating system would allow consumers to make meaningful choices for desired care facilities and ensure facilities focus on quality of care and service.

  Thus, a paradigm shift is required. The Draft Policy for Senior Citizens displays the government’s priority areas and it also acknowledges the need and opportunity for private sector participation to achieve strategies. However, the Government needs to revisit the draft and incorporate the recommendations of key stakeholders to achieve a quality senior care space for our rapidly growing elder population.  

Old age is a natural progression in everyone’s life and not a curse and hence the policy should also aim to inculcate the use of positive and respectful messaging. This will go a long way in ensuring generations adopt a more positive and respectful outlook towards senior citizens- a critical need of the hour.  

A safe home environment and independent living are other critical areas that need adequate attention. While home and community care is an encouraged model for senior care, we should account for cases where senior citizens face abuse at home or prefer to live independently. Setting up a redressal mechanism through a dedicated agency and the provision of a safe environment needs to be included in the policy. It is expected that a dedicated agency either within the Department of Social Justice or separately would ensure coordination with relevant stakeholders, monitoring progress, risk mitigation, and other implementation aspects. Moreover, the availability of adequate facilities across different geographies and catering to different income segments of seniors preferring to live independently need to be made available through a combination of public and private models.  

The current system tends to work in silos with minimal outcome tracking and monitoring of seniors through different points of care to ensure optimal health and well-being. Greater focus on outcome measures specific to the geriatric population, outcome sharing among all care providers through the continuum of care, and promotion of value-based care with positive outcomes will contribute to greater effectiveness and efficiency in delivering quality care to support holistic and wellness. Hence, a holistic policy framework needs to be put in place at the earliest and that would pave the way for action and in creating a robust elder care ecosystem in the country

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Views expressed above are the author’s own.



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