Challenges Faced by India's Aging Population and Old Age Homes

The elderly population in India is continuously increasing and also the problems faced by these people are increasing simultaneously. The number of people in old age homes is constantly increasing and also most of the parents are now deciding to live in old age homes rather than living with their children. Nowadays these people are facing the problems like lack of care, emotional support and economic support from the family etc. Our culture recognizes the status of the parents as that of God.

A moral duty is put on the children to take care of their parents. But nowadays what we are observing in our society is that the children are not willing to take care of their parents, they do not want to spend money on them, they are treating their parents as aliens, they do not want to share an emotional bond with parents.

These children are forgetting that the foundation of their life is built up by the parents.

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They are forgetting their moral and ethical duties towards their parents. This is because of fast life, industrialization, money oriented minds, inflation etc. Children have no time to look after their parents because of their busy schedule and as a consequence of this situation the elders are getting neglected. At this age almost all the people need some kind of support. Definition

Elderly or old age consists of ages nearing or surpassing the average life span of human beings. The boundary of old age cannot be defined exactly because it does not have the same meaning in all societies.

Government of India adopted ‘National Policy on Older Persons’ in January, 1999. The policy defines ‘senior citizen’ or ‘elderly’ as a person who is of age 60 years or above.

Characteristic of old age
Poor eyesight
Hard of hearing
Grey/ White hair
Wrinkles
Cardigans
Suspicious of technology
Slower movements
More likely to suffer from diseases
Weaker immune system

Social cause of old age problem
Failing Health

It has been said that “we start dying the day we are born”. The aging process is synonymous with failing health. While death in young people in countries such as India is mainly due to infectious diseases, older people are mostly vulnerable to non-communicable diseases. Failing health due to advancing age is complicated by non-availability to good quality, age-sensitive, health care for a large proportion of older persons in the country. In addition, poor accessibility and reach, lack of information and knowledge and/or high costs of disease management make reasonable elder care beyond the reach of older persons, especially those who are poor and disadvantaged. To address the issue of failing health, it is of prime importance that good quality health care be made available and accessible to the elderly in an age-sensitive manner.

Health services should address preventive measures keeping in mind the diseases that affect – or are likely to affect – the communities in a particular geographical region. In addition, effective care and support is required for those elderly suffering from various diseases through primary, secondary and tertiary health care systems. The cost (to the affected elderly individual or family) of health has to be addressed so that no person is denied necessary health care for financial reasons. Rehabilitation, community or home based disability support and end-of-life care should also be provided where needed, in a holistic manner, to effectively address the issue to failing health among the elderly. Economic insecurity

Economic security is as relevant for the elderly as it is for those of any other age group. Those who are unable to generate an adequate income should be facilitated to do so. As far as possible, elderly who are capable, should be encouraged, and if necessary, supported to be engaged in some economically productive manner. Others who are incapable of supporting themselves should be provided with partial or full social welfare grants that at least provide for their basic needs. Families and communities may be encouraged to support the elderly living with them through counseling and local self-governance.

Neglect

The elderly, especially those who are weak and/or dependent, require physical, mental and emotional care and support. When this is not provided, they suffer from neglect, a problem that occurs when a person is left uncared for and that is often linked with isolation. Changing lifestyles and values, demanding jobs, distractions such as television, a shift to nuclear family structures and redefined priorities have led to increased neglect of the elderly by families and communities. This is worsened as the elderly are less likely to demand attention than those of other age groups. The best way to address neglect of the elderly is to counsel families, sensitise community leaders and address the issue at all levels in different forums, including the print and audio-visual media. Schools and work places offer opportunities where younger generations can be addressed in groups. Government and non-government agencies need to take this issue up seriously at all these levels. In extreme situations, legal action and rehabilitation may be required to reduce or prevent the serious consequences of the problem

Isolation
Isolation, or a deep sense of loneliness, is a common complaint of many elderly is the feeling of being isolated. While there are a few who impose it on themselves, isolation is most often imposed purposefully or inadvertently by the families and/or communities where the elderly live. Isolation is a terrible feeling that, if not addressed, leads to tragic deterioration of the quality of life. It is important that the elderly feel included in the goings-on around them, both in the family as well as in society. Those involved in elder care, especially NGOs in the field, can play a significant role in facilitating this through counseling of the individual, of families, sensitization of community leaders and group awareness or group counseling sessions. Activities centered on older persons that involve their time and skills help to inculcate a feeling of inclusion. Some of these could also be directly useful for the families and the communities

Fear

Many older persons live in fear. Whether rational or irrational, this is a relevant problem face by the elderly that needs to be carefully and effectively addressed. Elderly who suffer from fear need to be reassured. Those for whom the fear is considered to be irrational need to be counseled and, if necessary, may be treated as per their needs. In the case of those with real or rational fear, the cause and its preventive measures needs to be identified followed by appropriate action where and when possible.

Current statistics related to the old age problem
• The elderly population (aged 60 years or above) account for 7.4% of total population in 2001. For males it was marginally lower at 7.1%, while for females it was 7.8%. Among states the proportion vary from around 4% in small states like Dadra & Nagar Haveli, Nagaland Arunachal Pradesh, Meghalaya to more than 10.5% in Kerala.

• Both the share and size of elderly population is increasing over time. From 5.6% in 1961 it is projected to rise to 12.4% of population by the year 2026.

• The sex ratio among elderly people was as high as 1028 in 1951 but subsequently dropped to about 938 in 1971 and finally reached 972 in 2001.

• The life expectancy at birth during 2002-06 was 64.2 for females as against 62.6 years for males. At age 60 average remaining length of life was found to be about 18 years (16.7 for males, 18.9 for females) and that at age 70 was less than 12 years (10.9 for males and 12.4 for females).

• There is sharp rise in age-specific death rate with age from 20 (per thousand) for persons in age group 60-64 years to 80 among those aged 75- 79 years and 200 for persons aged more than 85 years.

• The old-age dependency ratio climbed from 10.9% in 1961 to 13.1% in 2001 for India as a whole. For females and males the value of the ratio was 13.8% and 12.5% in 2001.

• About 65 per cent of the aged had to depend on others for their day-to-day maintenance. Less than 20% of elderly women but majority of elderly men were economically independent.

• Among economically dependent elderly men 6-7% were financially supported by their spouses, almost 85% by their own children, 2% by grand children and 6% by others. Of elderly women, less than 20% depended on their spouses, more than 70% on their children, 3% on grand children and 6% or more on others including the non-relations. Situation Analysis of The Elderly in India, 2011

• Of the economically independent men more than 90% as against 65 % of women were reported to have one or more dependants.

• Mong the rural elderly persons almost 50% had a monthly per capita expenditure level between Rs. 420 to Rs. 775 and among the urban elderly persons, almost half of aged had monthly per capita expenditure between Rs. 665 and 1500 in 2002.

• Nearly 40% of persons aged 60 years and above (60% of men and 19% of women) were working. In rural areas 66% of elderly men and above 23% of aged women were still participating in economic activity, while in urban areas only 39% of elderly men and about 7% of elderly women were economically active.

• Even in 2007-08 only 50% men and 20% of women aged 60 years or more were literate through formal schooling.

• In rural areas 55 % of the aged with sickness and 77 % of those without sickness felt that they were in a good or fair condition of health. In urban areas the respective proportions were 63 % and 78 %.

• The proportion of elderly men and women physically mobile decline from about 94% in the age-group 60 – 64 years to about 72% for men and 63 to 65% for women of age 80 or more.

• Prevalence of heart diseases among elderly population was much higher in urban areas than in rural parts.

• About 64 per thousand elderly persons in rural areas and 55 per thousand in urban areas suffer from one or more disabilities. Most common disability among the aged persons was loco motor disability as 3% of them suffer from it.

• In age-groups beyond 60 years, the percentage of elderly women married was markedly lower than the percentage of men married.

• More than 75% of elderly males and less than 40% of elderly females live with their spouse. Less than 20% of aged men and about half of the women live with their children.

Solution and remedial measure to solve old age problem
1 Administrative set-up
The Ministry of Social Justice & Empowerment, which is the nodal Ministry for this purpose focuses on policies and programmes for the Senior Citizens in close collaboration with State governments, Non-Governmental Organisations and civil society. The programmes aim at their welfare and maintenance, especially for indigent senior citizens, by supporting old age homes, day care centres, mobile medicare units, etc.

2 Relevant Constitutional Provisions
Article 41 of the Constitution provides that the State shall, within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want. Further, Article 47 provides that the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties

3 Legislations

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 was enacted in December 2007, to ensure need based maintenance for parents and senior citizens and their welfare. General improvement in the health care facilities over the years is one of the main reasons for continuing increase in proportion of population of senior citizens. Ensuring that they not merely live longer, but lead a secure, dignified and productive life is a major challenge.

4 National Policy on Older Persons (NPOP), 1999
The National Policy on Older Persons (NPOP) was announced in January 1999 to reaffirm the commitment to ensure the well-being of the older persons. The Policy envisages State support to ensure financial and food security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives. The primary objectives are:

• to encourage individuals to make provision for their own as well as their spouse’s old age;
• to encourage families to take care of their older family members; Situation Analysis of The Elderly in India, 2011
• to enable and support voluntary and non-governmental organizations to supplement the care provided by the family;
• to provide care and protection to the vulnerable elderly people;
• to provide adequate healthcare facility to the elderly;
• to promote research and training facilities to train geriatric care givers and organizers of services for the elderly;
• to create awareness regarding elderly persons to help them lead productive and independent live.

The Implementation Strategy adopted for operationalisation of National Policy envisages the following:
• Preparation of Plan of Action for operationalisation of the National policy.
• Setting up of separate Bureau for Older Persons in Ministry of Social Justice & Empowerment.
• Setting up of Directorates of Older Persons in the States. • Three Yearly Public Review of implementation of policy.
• Setting up of a National Council for Older Persons headed by Ministry of Social Justice & Empowerment from Central Ministry, states, Non-Official members representing NGOs, Academic bodies, Media and experts as members
• Establishment of Autonomous National Association of Older Persons
• Encouraging the participation of local self-government

5 National Council for Older Persons
In pursuance of the NPOP, a National Council for Older Persons (NCOP) was constituted in 1999 under the Chairpersonship of the Minister for Social Justice and Empowerment to oversee implementation of the Policy. The NCOP is the highest body to advise the Government in the formulation and implementation of policy and programmes for the aged. The Council was re-constituted in 2005 with members comprising Central and State governments representatives, representatives of NGOs, citizen’s groups, retired person’s associations, and experts in the field of law, social welfare, and medicine. 6 Inter-Ministerial Committee on Older Persons

An Inter-Ministerial Committee on Older Persons comprising twenty-two Ministries/ Departments, and headed by the Secretary, Ministry of Social Justice & Empowerment is another coordination mechanism in implementation of the NPOP. Action Plan on ageing issues for implementation by various Ministries/ Departments concerned is considered from time to time by the Committee. 8 Maintenance and Welfare of Parents and Senior Citizens Act, 2007 24 Situation Analysis of The Elderly in India, 2011

The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 was enacted in December 2007 to ensure need based maintenance for parents and senior citizens and their welfare. The Act provides for:- • Maintenance of Parents/ senior citizens by children/ relatives made obligatory and justiciable through Tribunals • Revocation of transfer of property by senior citizens in case of negligence by relatives • Penal provision for abandonment of senior citizens

• Establishment of Old Age Homes for Indigent Senior Citizens • Adequate medical facilities and security for Senior Citizens The Act has to be brought into force by individual State Government. As on 3.2.2010, the Act had been notified by 22 States and all UTs. The Act is not applicable to the State of Jammu & Kashmir, while Himachal Pradesh has its own Act for Senior Citizens. The remaining States yet to notify the Act are - Bihar, Meghalaya, Sikkim and Uttar Pradesh. 9 Central Sector Scheme of Integrated Programme for Older Persons (IPOP) An Integrated Programme for Older Persons (IPOP) is being implemented since 1992 with the objective of improving the quality of life of senior citizens by providing basic amenities like shelter, food, medical care and entertainment opportunities and by encouraging productive and active ageing through providing support for capacity building of Government/ Non- Governmental Organizations/Panchayati Raj Institutions/ local bodies and the Community at large. Under the Scheme, financial assistance up to 90% of the project cost is provided to nongovernmental organizations for establishing and maintaining old age homes, day care centres and mobile medicare units.

The Scheme has been made flexible so as to meet the diverse needs of older persons including reinforcement and strengthening of the family, awareness generation on issues pertaining to older persons, popularization of the concept of lifelong preparation for old age, facilitating productive ageing, etc. The Scheme has been revised w.e.f. 1.4.2008. Besides increase in amount of financial assistance forexisting projects, several innovative projects have been added as being eligible for assistance under the Scheme. Some of these are: • Maintenance of Respite Care Homes and Continuous Care Homes; • Running of Day Care Centres for Alzheimer’s Disease/Dementia Patients, • Physiotherapy Clinics for older persons;

• Help-lines and Counseling Centres for older persons;
• Sensitizing programmes for children particularly in Schools and Colleges; • Regional Resource and Training Centres of Caregivers to the older persons; • Awareness Generation Programmes for Older Persons and Care Givers; • Formation of Senior Citizens Associations etc. Situation Analysis of The Elderly in India, 2011 The eligibility criteria for beneficiaries of some important activities/ projects supported under the Scheme are: • Old Age Homes - for destitute older persons

• Mobile Medicare Units - for older persons living in slums, rural and inaccessible areas where proper health facilities are not available.
• Respite Care Homes and Continuous Care Homes - for older persons seriously ill requiring continuous nursing care and respite. During 2007-08, Government has spent more than 16 crores of rupees for assisting 660 such Programmes around the country which covered around fifty thousand
beneficiaries.

10 Assistance for Construction of Old Age Homes
A Non-Plan Scheme of Assistance to Panchayati Raj Institutions/ Voluntary Organisations/ Self Help Groups for Construction of Old Age Homes/ Multi Service Centres for Older Persons was started in 1996-97. Grant-in-aid to the extent of 50% of the construction cost subject to a maximum of Rs. 15 lakhs was given under the Scheme. However, the Scheme was not found attractive by implementing agencies and was discontinued at the end of the X Plan (2006-07). Section 19 of the Maintenance & Welfare of Parents & Senior Citizens Act 2007 envisages a provision of at least old age home for indigent senior citizens with 150 capacities in every district of the country. A new Scheme for giving assistance for Establishment of Old Age Homes for Indigent Senior Citizens in pursuance of the said provision is under formulation. 11 International Day of Older Persons

The International Day of Older Persons is celebrated every year on 1st October. On1.10.2009, the Hon’ble Minister of Social Justice & Empowerment flagged off “Walkathon” at Rajpath, India Gate, to promote inter-generational bonding. More than 3000 senior citizens from across Delhi, NGOs working in the field of elderly issues, and school children from different schools participated. Help age India, New Delhi collaborated with the Ministry in organizing the event of the day. .

Action taken by trainee for solving the problem

Give awareness program should be conducted for the parents and children Parents should aware about their children proper growth .Then only they can be understood about the value of their parents Physiotherapy Clinics for older persons;

Help-lines and Counseling Centers for older persons;
Sensitizing programs for children particularly in Schools and Colleges; Regional Resource and Training Centers of Caregivers to the older persons; Awareness Generation Programs for Older Persons and Care Givers Be a role
model by caring aged persons in their all needs

Comments and suggestion
Elderly or old age consists of ages nearing or surpassing the average life span of human beings. The boundary of old age cannot be defined exactly because it does not have the same meaning in all societies. People can be considered old because of certain changes in their activities or social roles. Also old people have limited regenerative abilities and are more prone to disease, syndromes, and sickness as compared to other adults. The medical study of the aging process is called gerontology and the study of diseases that afflict the elderly is geriatrics. Nowadays the number of old age homes are increasing. Reasons for this rapid increasing are improper caring their children, unrespectable to their own parents, aim only to be earn money, parents become burden and time of loss in their lives, aged people may have many diseases etc…..

Conclusion
Aged people are really like children in their old age. When they have enough strength they gave care for their children and when they grew they avoid their parents because of their neat less performance towards others. We should understand their needs and have obligation to care aged persons. It is not only our duty but also our need. They may have many problems in their life that because of their age. They cannot avoid these problems themselves but it is the problems of this stage of growth. So we should care our parents as our gifts and become a role model for others. It is the collection of good deeds in our lives. So be proud about our parents.