No country for old people

The number of senior citizens is on the rise, with India Aging Report 2017 indicating that 9.2 % of the state’s demographic is elderly. Over half this number lives either alone or with a spouse to care for them. As young people travel away from home to work, the services for the elderly, like affordable home healthcare are a growing problem. Agencies that source nurses are either unreliable or exorbitantly priced and only affluent hospitals have geriatric wards. Government policies exist, especially for BPL card holders but administrative shortcomings prevent these benefits from reaching the right people. Linking Aadhaar with pensions will only worsen the issue. With the average lifespan increasing, it’s time to look at solutions, including PPP models, to ensure that our senior citizens are not deprived of their right to dignity, reports Joyeeta Chakravorty.

Being old in IT City Bengaluru is not easy. While the young enjoy the vibrancy of the city and all its attractions, a good number of its old have a hard time getting medical care or even making a living.

Going by the India Aging Report 2017,  9.2 per cent of Karnataka’s population is elderly and of this number 5.3 per cent are either living alone or only with their spouse and have to take care of their material and physical needs  on their own.

If 10.4 per cent of the elderly in Delhi are dependant on children or other caregivers,  the number is as high as 19.6 per cent  in Kerala. The number has increased over time in all states , but is relatively higher in Kerala, Andhra Pradesh and Karnataka since 2001. Sadly, the country’s inefficient public health care system has led to the mushrooming of an  unregulated and very expensive private health care sector, which is particularly unaffordable for the elderly.

Take 65- year – old, D K Mukherjee , who is having a hard time finding a decent home nursing facility for his 90-year-old mother. Although he has paid a private agency to send him a nurse, it has not bothered to do so  after the last one , who came for a day and then took off for the Christmas holidays although his mother needs 24 x 7 care. “We cannot afford the big names in home healthcare as they charge a bomb,” Mr Mukherjee  adds sadly. While the bigger agencies are unaffordable to most, even an average agency charges  around Rs 19,000 to  Rs 23,000 a month depending on the experience of the nurse sent, he reveals, pointing out, “For the middle class people this is a huge expense,  in addition to the cost of medicines and doctor fee.”

His plight is not just a one- off case as there are many such stories in the city of  people finding it hard to look after their elderly in the absence of proper home nursing care. While the bigger agencies charge a huge fee, the smaller private agencies that provide more affordable home nursing care, are holding people to ransom with their poor services.

“Many nurses, who come home, want us to hire them privately despite  being sent by these agencies,” says another upset customer, who is  having a hard time with home nursing care.

If  financial problems and lack of proper health care services dog most of the elderly,  six  per cent of the old in rural areas and five per cent of the aged in urban areas are even worse off as they suffer from one or more disability with the most common  being locomotive disability.

Sadly, only wealthy hospitals in the city have a geriatric ward, while the government hospitals have no such facility. “Even  buses do not stop for the  elderly.  We cannot take this lightly,” stresses Mr Sebastian Devaraj, who has been  working with the elderly poor for the last 15 years.

Geriatric care leads to boom in home health services
The Nightingales Medical Trust in the city, which runs a dedicated care centre for senior citizens suffering from alzheimer’s or dementia, receives several calls asking if it provides long term stay for the elderly.

“We receive many calls from people asking for old age homes and whether we run one, but ours is a dedicated centre for alzheimer’s. A lot of the calls come from the elderly themselves, who are alone and find it difficult to manage on their own,” says Ms Swati of NMT.

The Department for the Empowerment of Differently Abled and Senior Citizens in Karnataka, which runs helpline centres across 28 districts ,  has noted a marked increased in the calls it receives. “The callers seek legal advice, complain about being shunned by their families or ask for old age homes,” says Ms Vasantha Prema D P, former Joint Director, Directorate of Welfare of Disabled and Senior Citizen, who admits that besides providing pension for those below poverty line ( BPL),  there are not many schemes for the elderly in the state.

Dr Arvind Kasthuri, professor, Department of Community Health, and co-ordinator of senior citizens’ healthcare at St John’s Medical College, says there is an increasing trend to look at the elderly  as a market.

“There is a boom in home healthcare services and nurses which all come at a huge cost. Of course it is a business opportunity, but we need to start with  a holistic healthcare programme. Perhaps we could have  ward level or village level healthcare centres for senior citizens, providing them daycare along with recreation and subsidised drugs,” he suggests, emphasising that the government needs to understand that the ageing population needs attention and make suitable long term efforts to take care of it both in urban and rural areas.

Role of ppp untapped: IIMB survey
A working paper on the ageing population of India and economic issues released by (IIM- B) says the elderly population is expected to rise from about 8% of the total population in 2011 to about 20% by 2050. By learning from experiences in the developed world, India could develop funded health and pension schemes before the consequences of an ageing population becomes apparent. It suggests that the role of PPPs in areas such as health, education and caring for the elderly, should be explored. In case of health, measures should be taken to minimise fiscal impact of relatively expensive modern medical techniques through telemedicine. In education, it calls for private sector involvement to provide significant benefits. “Timely action in a phased manner is required as evidence shows that in some developed and many developing countries, scope for increased public expenditure on health and education is limited.”