Old and far from gold

The 60-plus portion of India’s population is growing fast, but the country is nowhere near ready to cope with the needs of this under-the-radar age group

Old age is a no-profit, no-gain state of life,” says Ishwara Chandra Sahoo, a Bhubaneswar resident who wears his years heavily. “Basically, getting old means a reduction in every good thing: health, strength, courage, appetite, energy... Respect is very important to me and that I don’t get at the hospitals that I have to go to.”

The 78-year-old Mr Sahoo’s laments reflect one slice of the bitter truth faced by a majority of India’s seniors. He’s lucky, though, in that he is not strapped for money, unlike 67-year-old Bhagiratabai Dandekar, who lives in Rajoli village in Chandrapur district of Maharashtra. “I need medicines, but [the people at the hospital] won’t give me that,” she complains. “What should people like me do? Die?”

Health is the big concern

Healthcare is the overriding concern for Mr Sahoo and Ms Dandekar, two respondents in a research survey conducted by the Tata Trusts to gauge the state of elderly care in India and the inevitable gaps therein. The findings were reinforced by a more recent study done by the nonprofit Helpage India, which highlighted the neglect, even abuse, that the country’s ageing have to live with.

The multiple shortfalls in India’s approach to caring for seniors is what prompted the Trusts to kick-start their ‘elderly care, wellness and engagement programme’. Initiated in early 2017 following a research and preparedness period of two years, the programme’s objective is simple: to improve the quality of life of India’s elderly. That means enabling them to preserve their dignity, providing them with care as well as social and economic opportunities, and helping create an empathetic ecosystem for them.

Sunset years, golden agers, senior citizens, silvers — the terms are pretty but they are euphemistic, shrouding rather than revealing the reality of existence for those in the autumn and winter of their lives. It’s a reality more dire in India perhaps than any other country globally, and it’s fuelling a crisis that is hidden amid all the talk of demographic dividends and the development potential of a youthful citizenry.

India remains a relatively ‘young’ nation, with about half its population below 25 and over 65% under the age of 35. That’s cause for cheer at a time when economists chant ‘younger the better’. The flip side is the concern: some 116 million Indians are in the 60-plus age category and — driven by decreasing birth rates and increasing life expectancy — the figure is expected to reach nearly 300 million by 2050 (18% of the populace). Forget preparedness, few in the country are even aware of what the jump portends.

The anomalies in the system indicate where the Trusts are headed with the project. It begins with awareness and acceptance of, and preparation for, happy and healthy ageing. From that flows the rest: access to healthcare facilities; generating re-employment opportunities; advocating for elderly-friendly policies, public spaces and greater investment; encouraging and regulating services and homes for seniors; building a helpline and other resources for geriatric care; and crafting innovative products for the ageing.

Pilot projects and a helpline

The first phase of the Trusts’ programme includes pilot projects in Bhubaneswar for the urban elderly and in three districts in Telangana, Maharashtra and Karnataka for their rural compatriots, all in partnership with the respective state governments. Also underway is the seeding of a helpline, or response system for the elderly. Now being tried out in Telangana, the idea here is to connect with and provide solace to seniors.

Under the pilot project in Bhubaneswar, a ‘model activity centre’ is being built, primarily to increase awareness of health and health facilities, and to develop platforms that keep the elderly engaged. The rural-centric projects in Telangana, Maharashtra and Karnataka involve working with the health departments of the three states to make meaningful the central government’s National Programme for the Health Care of the Elderly.

The response system pilot will cover about 1 million elderly across Telangana. Experimental to a large extent, the system is being equipped to be extended in its second phase to 10 million seniors in other states and languages. The goal is to reach and thereby enhance the everyday lives of 100 million Indian seniors by 2025.

Supporting the government in reacting and responding to the elderly care challenge is critical from the Tata Trusts perspective. To that end, it has made advocacy a crucial component in the rollout of the programme. This takes in the framing of policies, the design of public spaces and facilities, schemes for financial and medical assistance, and understanding the specific — and different — requirements of rural and urban seniors, and of the men and women among them.

The Trusts have contributed to the framing of elderly care legislation and the proposed amendment to the Maintenance and Welfare of Parents and Senior Citizens Act is an example. Passed in 2007, the Act is now being revised. The Trusts team has made suggestions to amend this law, notably on regulations and standards for facilities that house seniors.

There is no understating the importance of government interventions in easing the path to a better life for India’s elderly. The country needs to set aside a greater share of resources for senior citizens and budgetary allocations for elderly care have to be better utilised and made more effective.

Challenges aplenty

“The challenges fall in separate categories and healthcare is a primary one, particularly in rural regions,” says Sugandhi Baliga, who heads the elderly care programme at the Tata Trusts. “A second challenge is that we in India see the elderly as the responsibility of their families. Our public spaces are unfriendly to seniors and our old-age homes are deficient and unregulated. Also, Indians tend to associate ageing with inactivity, when the opposite is true.”

Ms Baliga, who has been with the Trusts since 2003 and has worked on various development sector projects, is an ardent votary for keeping the elderly occupied with the world around them. “Simple socialisation is not enough; constant engagement is vital because it defines a lot of the requirements of seniors.”

Besides Ms Baliga, the elderly care team at the Trusts has two other members, Saraswati Padmanabhan and Ankur Nair, and a team of 16 in the field. Compassion and zeal are must-haves for what is more than a job. As for Ms Baliga, caring for the elderly in her family has provided her with intimate experience of what old age can do to body and spirit, and how to counter the inescapable decline. “We have to create a culture where the elderly can remain productive members of society,” she says. “Active ageing is what we are promoting.”

It’s essential, insists Ms Baliga, for the government to look beyond the delivery of pensions and other financial benefits as the principal means of lending a hand to the elderly. “Our point is that a person at 60 may well have a further 25 long years to live. Why can’t we make it possible for our elders to contribute economically and socially during those 25 years?”

The timeline plotted for the Trusts’ elderly care initiative has it operating till 2025. By then, the expectation is, the programme and its many parts would be functioning smoothly enough, and sustainably too. The Trusts have earmarked substantial funds for the first project phase (2017-20) and, after hitting the ground running, are aiming for high targets.

Partners and collaborations

Partners are being roped in and the Trusts are involved directly with the state and central governments in phase one, by the end of which the urban and rural pilot projects and the response system model would have matured. The plan for the 2020-23 period has the Trusts operating alongside and directly with the official machinery. Collaboration with the government will get greater still from there on.

What the Trusts have learned from executing the elderly care programme until now will come in handy when the going gets trickier in the post-pilot stage of scaling up. Resources are not as much a problem as employing them fruitfully. “We have to use the state’s budgetary allocations, which are already in place,” says Ms Baliga. “We are making use of these same funds in our rural pilot in Chandrapur in Maharashtra and we are adding it up with training, awareness building and also by giving visibility to elderly care in villages.”

A debilitating drawback is the absence of demand on matters that affect seniors. “Unlike with, say, women and child health, there is no demand from society for better care for our ageing,” explains Ms Baliga. “The push from families is not there; they neglect the elderly.”

Health is an issue where committed governmental support is an obvious boon to seniors. There are two facets to this, physical and psychological, and one of them is out of sight. “We are, on the physical side, very aware of health conditions and the interventions required,” says Ms Baliga. “But what is really needed is emotional and psychological support.”

That and more can be within grasp if the burden of caring for India’s elderly is shared. The government has the biggest role to play, for sure, yet there is plenty that families, nonprofits, charities and civil society can do to ease the loss that ageing — a period that is longer for humans than other animals — leaves in its wake.