Ageing Population: It Isn't All 'Gently Go Into The Night' For India's Elders

The country's ageing population is set to increase from 10.5 per cent in 2022 to 20.8 per cent in 2050, according to a 2023 United Nations Population Fund (UNFPA) report. The population of the elderly is estimated at 15 crore or 150 million of the country's total population estimate of 142 crore, again according to the UNFPA's State of World Population Report.

India's population is growing and ageing fast at the same time. Barring Bihar, Uttar Pradesh, Jharkhand, Meghalaya and Manipur, the shift is visible in almost all states. Increasing life expectancy and decreasing levels of fertility have led to an increase in both the share and number of older persons in the country. In India, one is considered a senior citizen once she/he turns 60.

The NITI Aayog released a position paper in February 2024 on Senior Care Reforms and suggests specific interventions. The paper also underlines gaps in infrastructure and capacities necessary for supporting the health and welfare of the elderly. 

However, the position paper doesn't mention Article 21, a fundamental right guaranteeing the right to life which includes the right to live with dignity and the right to livelihoods, under ‘constitutional provisions’. This selective omission symptomises why elders, especially among the poor and vulnerable in India, do not live a life with dignity. Nor do they have a dignified source of livelihood. 

This section also doesn’t mention the binding international human rights covenants such as the Universal Declaration of Human Rights and the International Covenant on Economic, Cultural and Social Rights to which India is a signatory to as prescribed under Article 73. The two instruments state a signatory country has to honour the right to work and social security and the socio-economic well-being of every individual, including the elderly. 

What Do The Elderly Do For Their Livelihood?

The Central government acknowledges 93 per cent of the total workforce is employed in the unorganised sector. What this implies is that when people working in the informal sector grow older, a majority don’t get any social security, including old age pension, which ranges between Rs 200 to Rs 2000 depending on the state one lives in. In most cases, they barely get Rs 500 a month. Can that help in maintaining a life with dignity in India of these days? 

There are 15 crore elderly in the country at present. Let’s assume 40 per cent of them don't need any support, it still leaves us with 9 crore elderly who need some kind of monetary support. The  National Social Assistance Programme dashboard reveals only 2.21 crore people get old age pensions which leaves out 6.8 crore without any social security support! Atal Pension Yojana, based on contributions made when one is younger, was rolled out for workers in the unorganised sector who will get different amounts after turning 60 until death. Above 6 crore people enrolled in the Yojana by the end of 2023. However, data on how many above 60 are getting the pension is not yet available.   

The Mahatma Gandhi National Employment Guarantee Scheme (MGNREGS) is another livelihood source for the rural elderly. Let’s consider roughly 65 per cent of 15 crore elderly live in rural areas, which means 9.75 crore people. Of this, 7.8 crore in the 61-80 age group, and another 1 crore in the 80-plus age group register with MGNREGS for jobs. However, only about 41 lakh (5 per cent) got work in the former age group and 2.5 lakh (2.5 per cent) in the latter! This shows people in the older age groups are active but don't find work. 

Health Welfare Scheme Loopholes

The  WHO has documented that old age brings with it increasing challenges to one’s health. The Centre has three health schemes for the elderly. The first one is the National Programme for Health Care for the Elderly which got Rs 98.79 crore in the 2022-23 budget but the actual spending was just Rs 1.69 crore. The second is the Senior Citizens Health Insurance Scheme for which Rs 40 crore was provided in the same budget but nothing was spent! No information is available on what has been achieved under the third scheme -  The Pradhan Mantri Vayo Mitra Yojana (Ayush Geriatric Healthcare Services).

The Biju Swasthya Kalyan Yojana in Odisha is one of the most popular and widely appreciated health insurance programmes in the country. However, it suffers from many challenges when it comes to the medical treatment of the elderly. First, family members aren't willing to take the elderly to hospital because it would mean a loss of wages. Two, when the elderly arrive at a private hospital they have to pay for tests in cash to decide if they need to be admitted. Third, since test reports take time, some hospitals force them to get admitted which again serves the hospitals' cause. Hence, insurance programmes for the elderly may come with other challenges which can be mitigated through peer group or community-based arrangements.

The NITI Aayog position paper mentions a scheme for the elderly, the Action Groups Aimed at Social Reconstruction (AGRASR), which proposed formation of Elder Self-Help Groups (ESHGs) from deprived sections to be facilitated by State Rural Livelihoods Missions (SRLMs) and State Urban Livelihood Missions (SULMs). This has not been implemented because there is not much government enthusiasm to form ESHGs for the elderly. Apart from income deprivation, the elderly suffer loneliness, abuse, neglect, lower self-esteem, fear, loss of control and unpreparedness for old age. Hence, the formation of ESHGs would be a transformative idea to bring them together to help each other as traditional family support systems crumble. 

Women above 60 are eased out of the Women’s Self-Help Groups (WSHGs). Kerala's much-lauded WSHG Kudumbashree clearly mentions only women in the 18-55 age group are eligible to be members. Why should SHGs be constituted with government funding that excludes citizens above a particular age? How would it help equity and inclusivity?   

Many elderly also develop the capability to start small businesses that keeps them engaged with others in their peer group. This can also help them against isolation and loneliness. But again, there is no provision for them although the MUDRA Yojana speaks of accepting proposals from people up to 65 years of age. The MUDRA scheme doesn’t provide any age-disaggregated data, particularly how many elders have been provided loans for their ventures.

The Changes Needed Ahead, And Beyond The Market 

The NITI Aayog position paper makes many market-based prescriptions that aren't suitable for a vast majority of the elderly but are important for a particular segment of the elderly. Market-based solutions for pension, health, housing, shelter and other needs make it necessary for the elderly to have an adequate amount of money or income, which most in India do not possess. Even lakhs of elders, who were well off when they were younger, fall into financial discomfort, because they do not have a pension back-up and can’t easily find decent remunerative work after they become older. 

The paper discusses the silver economy which would at the most cater to only 20 per cent of the elderly in India. That silver can be turned to gold only if plans and practices get more inclusive nationally and locally. This needs a few steps to start with:

●     Increase old age pension to at least Rs 3000 per month. No eligible elder should be left out of the pension programmes at the national and state level.

●     Develop and promote ESHGs on a large scale through the existing livelihoods schemes and make them more broad-based in activities. Agility among the elderly must be capitalised on to maximise the opportunities of the silver economy.

●     Develop exclusive health insurance schemes with provisions to compensate anyone accompanying the elder to a hospital. Other provisions must be included after stakeholder inputs.

●     The elderly are not a homogenous group. A large number of them being active, need support to earn through work or small business. Solutions must be tailor-made to fit various age groups of elders.

●     Geriatric health care can't be just limited to Yoga or naturopathy. This discipline needs much more scientific attention and support. 

●     If any registered elder person in MGNREGS is not provided an age-appropriate job, they must be given minimum cash support as compensation to live with dignity. 

Population ageing has already arrived with potentially dramatic repercussions on our social, economic, and cultural landscapes. It is clear we haven’t done a good job to let our elders live with dignity. One hopes, the NITI Aayog’s position paper would help spur stakeholders to action.

The author is a Bhubaneswar-based policy researcher, social development practitioner and public narrative builder; he is the Founder Chairperson of India Age Care Trust. Views expressed are personal.