Today's Editorial

How to care for an ageing population

Relevance: GS Paper I

Why in News?

India's population of older people is increasing, with the number of people over 60 years old set to more than double from 100 million in 2011 to 230 million in 2036. This group will make up nearly 15% of the total population and will rise to 319 million by 2050, roughly one-fifth of the total population.

Changing family dynamics:

• Declining fertility rates and increasing life span are driving the transition. The average household size in India has reduced from 5.94 in 2011 to 3.54 in 2021.
• Households with smaller families and a growing number of older people who may suffer from chronic illnesses call for a reset of the health and social care system.
• Care for seniors at home is a growing concern as it oscillates between social care and health care, often blurring lines between the two.
• The changing family structure is paving the way for external assistance in caring for older people at home.

Home-based care: Market estimates project the home-based care industry to grow at a rate of 15-19% annually, from nearly USD 6-7 billion in 2021 to USD 21 billion by 2027.

• Significance:

• • According to a NITI Aayog report, healthcare offered at home can replace up to 65% of unnecessary hospital visits and reduce hospital costs by 20%.
  • The scope of services provided at home has expanded from assistance with activities of daily living to routine nursing care and specialised care.

• Challenges:

• Care practices at home are not well-defined and standardised.
• Caregivers who are well-trained and possess an empathetic outlook are in short supply and often complain of being mistreated by families.
• There are no specific grievance redressal mechanisms for either the users or the caregivers.
• Furthermore, the cost of hiring a caregiver at home is substantial. Currently, the private, for-profit sector offers the bulk of these services.

Way forward:

Home-based healthcare policy interventions -

• Recognise “home” as a place for providing care and a “place of work” for caregivers. It has implications for the rights and safety of both users and providers. The Insurance Regulatory and Development Authority of India (IRDAI) recognises hospitalisation at home in certain conditions.
• Care at home is a different proposition than in an institution like a hospital or an old-age home. The terms of engagement and treatment protocols must be tailored to the home environment.
• To meet the growing demand for trained caregivers, streamline their vocational training, nomenclature, roles, and career progression.
• All this should be brought together under a comprehensive policy on home-based care, incorporating aspects such as a registry of providers of such services, ensuring transparency and accountability, establishing grievance redressal mechanisms, and insurance coverage, among others.

Gender considerations -

• The policy should also consider the fact that women in India, on average, outlive men by three years. The sex ratio of older people is projected to increase to 1060 by 2026. Since women in India are usually younger than their husbands, they often spend their later years as widows.
• Therefore, the policy should mainly cater to the more vulnerable and dependent older single women so that they can live respectable and independent lives.

Collaboration between ministries:

• The Ministry of Health and Family Welfare (MoHFW), Ministry of Social Justice and Empowerment (MSJE) and Ministry of Skill Development and Entrepreneurship (MSDE) have a pivotal role to play in the matter.
• Greater collaboration between them could get the ball rolling on the required reforms.

Legislative efforts:

• The Maintenance and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019 seeks to regulate home-based care for older people.
• It proposes registering institutions providing home care services and prescribing minimum standards.
• However, since its introduction in Parliament in 2019, it has yet to be passed. Efforts should be made to pass the bill as early as possible.

Conclusion:

While the emphasis on making India’s youth population “future-ready” is welcome, it should not overshadow an equally critical group that needs attention. Countries like Japan's experience shows that systems to care for older people are essential for the younger population to contribute to the country’s economy. Besides, it is a society’s moral and ethical responsibility to care for its people beyond their prime, reciprocating their lifetime of physical, social, emotional, and economic investment in society.

Mains PYQ:

Q. The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC 2022)

Q. In order to enhance the prospects of social development, sound and adequate health care policies are needed particularly in the fields of geriatric and maternal health care. Discuss. (UPSC 2020)