Creating an inclusive eldercare ecosystem

A United Nations report identified population ageing as a global mega-trend along with other significant ones such as the climate crisis, new technologies, urbanisation and reducing inequalities. While it has not yet received the same attention, say as a new age topic like Artificial Intelligence, population ageing is an unfolding reality with profound implications. For India, the transition is going to be one of the most rapid--elderly (60-plus) population as a share of total to rise from 10% to 20% by 2050. It will not have the opportunity of becoming rich before getting old, but will have to navigate this demographic transition along with the journey to become a developed country. It may have the opportunity though to chart its own unique model suited to its socio-cultural strengths and resources, to tap into both the youth dividend as well as the longevity dividend.

The recent NITI Aayog position paper ‘Senior Care Reforms in India: Reimagining the Senior Care Paradigm” is timely and has called attention on major gaps and priorities on health, social, financial and digital, reflecting important aspects of lives of senior citizens. The emphasis is rightly on reimagining and collective effort of all stakeholders--government, private and social sector.

While most look at elderly as a 60-plus segment, this is not at all homogenous. With life expectancy at 60 touching 20 years, we are looking at three (or more) groupings such a 60-70, 70-80, and 80 plus. The 80-plus is one of the fastest growing segments. The health and care needs post-70 particularly rise (combination of chronic diseases and functional decline) and caregiving needs and costs increase. Older women who live longer face more challenges due to accumulated disadvantages and widowhood. Another significant vulnerability is of ‘living alone’ (10% plus in urban areas) due to changes in family structure, living arrangements and shifting preferences. While the reality of a large number of elders facing vulnerabilities (50% below poverty line, 75% with chronic diseases, 40% facing functional disabilities) is true, the longevity and health dividend is also bringing up a large group of active, healthy and aspiring seniors who want to continue to work, learn, volunteer and participate in the mainstream. Along with care and health systems orienting to elderly needs, response is needed for enabling work opportunities beyond 60, lifelong learning, volunteering and participation and other fulfilment options.

For a long time, family has been the mainstay of support for elders and, in Asian context, the ethos of duty and blessings has kept the frame in place. However, it is evident that due to multiple reasons--children moving out, changing values, financial pressure--this support is under stress and strain. The preferences of elders are also changing and some prefer to live independently. These changing socio-cultural realities are pointing towards need for special measures to support family in their caregiving role, as well as build support systems beyond family. The segment of senior living and assisted living (private sector for paying segment) and senior citizen homes (for disadvantaged by voluntary and government) is getting attention. It is however, at best a contingent option rather than a desired state from a policy view. The policy direction of ‘ageing in place’ (or in own homes and communities) should be the desired goal, and for which investment in community-based support and services needs to be done. For instance, these could be strengthening of senior citizen associations, elder self-help groups in rural areas, and setting up senior citizen active ageing centres. The community platforms could gain from drawing on the youth as volunteers, supporters, community care givers, building intergenerational bonding and solidarity.

In the current elder population of 140 million, a majority face financial and income insecurity. The non-contributory old age pension coverage for the poor elderly is limited in coverage and amount, and most elders belong to informal sector having limited social protection. Therefore, any approach to designing products and services will need to solve issues for the large and low-income elderly population. Just looking at the paying segment (at market determined prices) will exclude the majority. Health insurance is a case in point. Reports indicate about 20% elderly have health insurance coverage, and this is at a life stage where they need it the most. A recent announcement by the government of covering all 70-plus under PM-JAY is a welcome step. However, solving for those in 60-70 age group (about 60% of all elderly) remains a challenge. IRDAI recently took a landmark positive decision to remove the 65 age limit along with encouraging private insurers to develop tailored products and elder friendly processes for handling grievances and claims. The mechanism for financing health insurance for low-income elders, and similarly for long-term care and other services will require more thinking. Models of community-based care system with intergenerational involvement, could offer effective and efficient approach, and experience of other countries could be studied such as Japan’s long-term care insurance system.

In recent years, the central government has taken up several remarkable initiatives for senior citizens in line with their policy of welfare plus empowerment. Alongside, the private sector and age-tech is recognising the potential of the silver economy and developing products and services for seniors. In the social sector space, funding for eldercare by philanthropy and corporate social responsibility (CSR) are currently limited but rising. These developments have created an opportunity for building an eco-system for eldercare with collaboration of government-private and social sector (GPS) model, each bringing their strengths to solve problems at scale and make a system level impact.

A prominent example of this is the Government of India-led Elderline 14567 --a national helpline implemented by community connected NGOs, based on an architecture given by a private sector trust and funded by the government. The convergence and impact made during covid response phase exemplified the power of joint approach. CSR funding enabled HelpAge India to take the Elder Self-Help Group model from proof-of-concept to proof-of-scale. We see some private sector players building a geriatric care support services model for urban elders (subscription basis). This has potential for replication in semi-urban and rural areas, with innovative financing/subsidy mechanism, to reach out to the missing middle or the disadvantaged (bottom of the pyramid). For elderly, rapid scale up of digital literacy and safety programme could be immensely beneficial, and partnering can achieve impact at scale. The senior care ecosystem is at an early stage and co-developing with convergence approach through partnership could give immense traction.

(June 15, i.e. today, is designated as the World Elder Abuse Awareness Day.)

This article is authored by Rohit Prasad, CEO, HelpAge India.