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REFORMS IN INDIA
SENIOR CARE
Reimagining the Senior Care Paradigm
A POSITION PAPER
FEBRUARY 2024 Senior Care Reforms in India - Reimagining the Senior Care Paradigm: A Position Paper
Publisher
NITI Aayog Government of India, Sansad Marg, New Delhi–110001, India
Year of Publication: 2024
Language: English
Authors
NITI Aayog
Dr. K. Madan Gopal
Ms. Rishita Mukherjee
Dr. Shobhit Kumar
Ms. Shrestha Hazra
IPE Global
Ms. Aali Sinha
Ms. Dipika Joshi
Mr. Himanshu Sikka
Disclaimer
The report titled “Senior Care Reforms in India - Reimagining the Senior Care Paradigm:
A Position Paper” relies on secondary sources and information obtained from discussions
and deliberations with different stakeholders. NITI Aayog wishes to emphasize that while
every effort has been made to present accurate and up-to-date data, NITI Aayog does
not guarantee the accuracy of the information and does not accept responsibility for the
consequences of using this data.
NITI Aayog disclaims any legal liability for the accuracy or inferences drawn from the
material contained in the document or for any consequences arising from the use of this
material. Reproducing any part of this report, whether electronic or mechanical, is strictly
prohibited without prior permission or intimation to NITI Aayog. Users are encouraged to
seek permission for reproduction through official channels to avoid any legal implications. Senior Care Reforms in India i
Message, Vice Chairman, NITI Aayog��v
Message, Member Health, NITI Aayog��vii
Foreword, CEO, NITI Aayog��ix
Abbreviations��xi
EXECUTIVE SUMMARY��xiii
SECTION 1: SENIOR CARE – AN OVERVIEW��1
1.1 Background��1
1.2 Key Trends��6
1.3 Market Size and Growth Potential��15
1.4 Efforts in Senior Care��20
1.5 Key Issues and Challenges��26
SECTION 2: SENIOR CARE TRANSFORMATION – SERVICE DELIVERY PRIORITIES��37
2.1 Health - Comprehensive and Integrated Senior Care Package ��38
2.2 Social Empowerment and Inclusion��42
2.3 Economic Empowerment and Inclusion��43
2.4 Digital Empowerment and Inclusion��45
SECTION: 3 WAY FORWARD��47
3.1 Efforts to Ensure Health Empowerment and Inclusion��48
3.2 Efforts to Ensure Social Empowerment and Inclusion��54
3.3 Efforts to Ensure Economic Empowerment and Inclusion��56
3.4 Efforts to Ensure Digital Empowerment and Inclusion��57
3.5 Engaging the Private Sector and CSR Avenues in Increasing Coverage��59
3.6 Fueling Innovations��60
ANNEXURES��61
Annexure 1: Concept of ageing and senior care��61
Annexure 2: Private insurance products for seniors��63
Annexure 3: Key learnings from across the world��66
Annexure 4: Existing package of services at various levels for geriatric care in india
under the national program for the health care of the elderly��79
Contents Senior Care Reforms in India ii
Annexure 5: Schemes, programs, and activities of Ministries and Departments of the
Government of India for the welfare of the senior citizens��81
Annexure 6: Landscape of NGOs, private sector, and industry associations working in
senior care��99
Annexure 7: Technology for senior care��105
Annexure 8: Existing landscape of training and certification courses in geriatrics��107
Annexure 9: Nutritional requirements of the elderly��109
Annexure 10: Vaccination guidelines for the elderly��111
REFERENCES��112
LIST OF CONTRIBUTORS��118
LIST OF TABLES
Table 1.1. DALYs rate per 100,000 population
Table 1.2. Major Trends in the Health Domain
Table 1.3. Major Trends in the Social Domain
Table 1.4. Major Trends in the Economic Domain
Table 1.5. Major Trends in the Digital Domain
Table 1.6: Package of Services Provided at Various Levels Under National Programme
for the Health Care of Elderly (NPHCE)
Table 2.1. Service Delivery Priorities for Seniors
Table 3.1. An Indicative List for Healthcare Needs Assessment
Table 3.2: An Indicative List for Social Needs Assessment
Table 3.3: An Indicative List for Financial Needs Assessment
Table 3.4. An Indicative List for Digital Needs Assessment
LIST OF BOXES
Box 1: Key Findings from the Longitudinal Ageing Study of India (LASI)
Box 2: Senior Care Support Framework in India
LIST OF FIGURES
Figure 1A. Population by broad age groups in percentage, India, 1950–2050
Figure 1B. Life expectancy and total fertility rate, India, 1950–2050
Figure 2. Snapshot of the silver economy
Figure 3. Digital Care Ecosystem
Figure 4. Journey of senior care policy in India
Figure 5. Key challenges and issues around senior care in India Senior Care Reforms in India iii
Figure 6. Healthy and inclusive ageing through convergence among stakeholders
Figure 7. Inter-convergence among various stakeholders for senior care
Figure 8. Workforce required for senior care
Figure 9. Capacity building for medical personnel Senior Care Reforms in India iv Senior Care Reforms in India v Senior Care Reforms in India vi Senior Care Reforms in India vii Senior Care Reforms in India viii Senior Care Reforms in India ix Senior Care Reforms in India x Senior Care Reforms in India xi
Abbreviations
ADLActivities of Daily Living
AIArtificial Intelligence
AICAgency for Integrated Care
AISCCON All India Senior Citizens’ Confederation
ASLIAssociation of Senior Living India
BMRBasal Metabolic Rate
BPLBelow Poverty Line
BRICSBrazil, Russia, India, China, South Africa
CAGRCompounded Annual Growth Rate
CCRHContinued Care Retirement Home/ Housing
CHOCommunity Health Officer
CIIConfederation of Indian Industry
CSOCivil Society Organisation
CSRCorporate Social Responsibility
DALYDisability Adjusted Life Years
DOSJEDepartment of Social Justice and Empowerment
EAREstimated Average Requirement
IADLInstrumental Activities of Daily Living
FICCIFederation of Indian Chambers of Commerce and Industry
GDPGross Domestic Product
GHEGovernment Health Expenditure
GSTGoods and Services Tax
HRHHuman Resources for Health
HWCHealth and Wellness Centre
ICIntrinsic Capacity
IGNOAPS Indira Gandhi National Old Age Pension Scheme
IoTInternet of Things
IPOPIntegrated Program for Older Persons
IRDAInsurance Regulatory and Development Authority of India
LTCLong Term Care
LTCILong Term Care Insurance
MLMachine Learning
MOMedical Officer
MoHFWMinistry of Health and Family Welfare
MoSJEMinistry of Social Justice and Empowerment Senior Care Reforms in India xii
MSDHSMinistry of Social Development and Human Security
MWPSCAMaintenance and Welfare of Parents and Senior Citizens Act
NALSANational Legal Services Authority
NAPSrCNational Action Plan for the Welfare of Senior Citizens
NCDNon-Communicable Disease
NCOPNational Council of Older Persons
NEANew Enterprise Allowance
NGONon-Governmental Organization
NHANational Health Accounts
NHRCNational Human Rights Commission
NHSNational Health Service
NMTNightingales Medical Trust
NPHCENational Program for the Health Care of the Elderly
NPOPNational Policy on Older Persons
NSAPNational Social Assistance Programme
NSSONational Sample Survey Office
OECDOrganization for Economic Co-operation and Development
OOPEOut-of-Pocket Expenses
OPDOut Patient Department
PMJAYPradhan Mantri Jan Arogya Yojana
PMVVYPradhan Mantri Vaya Vandana Yojana
RDARecommended Daily Allowance
REITReal Estate Investment Trusts
RMNCHReproductive, Maternal, Newborn, Child, and Adolescent Health.
RVJSYRashtriya Varisth Jan Swasthya Yojana
RVYRashtriya Vayoshree Yojana
SACSenior Activity Centres
SAGESenior Ageing Growth Engine
SASSASouth African Social Services Agency
SCASenior Citizen Associations
SCCT Senior Citizens Council of Thailand
SDGSustainable Development Goals
SOPStandard Operating Procedures
SPICESingapore Program for Integrated Care for the Elderly
UNFPAUnited Nations Fund for Population Activities
UNIDOPUnited Nations International Day of Older Person
WHOWorld Health Organization Senior Care Reforms in India xiii
Executive Summary
Population ageing is a global phenomenon, and the number of people over 60 years
of age has been rising rapidly across the world. India, too, is witnessing an exponential
growth in the number and proportion of elderly people, coupled with a decreasing fertility
rate (less than 2.0) and increasing life expectancy (more than 70 years). The elderly in
India currently comprises a little over 10% of the population, translating to about 104
million, and is projected to reach 19.5% of the total population by 2050.
This phenomenon of population ageing impacts all aspects of society and has numerous
health, social, and economic implications, including changes in labour and financial
markets, shifting disease burden, rising dependency ratios, evolving family structures, and
altered consumption patterns. Moreover, medical expenses are more than double for this
population segment as older people are likely to consume more healthcare services. While
catering to the needs of the elderly population of this size is challenging, it also presents
an opportunity for the growth of the senior care industry, which is presently estimated at
USD 7 billion (` 57,881 crore).
The Longitudinal Ageing Study of India (LASI) 2021 report, a full-scale national survey
and a seminal study on the status and determinants of the ageing population in India
by the Ministry of Health & Family Welfare, highlights that 75% of the elderly have one
or more chronic diseases. 24% of the elderly have at least one Activities of Daily Living
(ADL) limitation, and 48% reported at least one Instrumental Activities of Daily Living
(IADL) limitation. One in three reported having depressive symptoms, and 32% reported
low life satisfaction. In terms of social protection, only 18% reported being covered by any
health insurance, 28% are aware of any concession for senior citizens, and 24% reported
problems in providing documents to avail services. The report highlights that 70% of the
elderly population is dependent for everyday maintenance, and 78% is living without any
pension cover.
The senior care system faces many challenges due to the lack of a comprehensive, integrated
policy for care and support. There are gaps in infrastructure and capacities necessary for
supporting the health and welfare of the elderly, evidence-based knowledge repositories
for geriatric illness management, enabling frameworks and monitoring mechanisms,
and emergency response systems. Other factors that need to be addressed include a
fragmented and narrow social support system, inaccessible physical infrastructure, and
inadequate R&D activities. A rising trend of nuclear families is also an important attribute
for diminishing traditional family support systems. In addition, inadequate financial security
nets and deficient financial planning for senior citizens are areas of concern, and they also
tend to fall prey to financial abuse and fraud. Digital inequities have emerged as a significant
challenge for seniors, as witnessed during the COVID-19 pandemic and lockdown period.
There is a knowledge gap in awareness about the available welfare support provided
by Government and other agencies, among the elderly and their caregivers. At present,
senior care services largely consist of facility-based medical care only. Non-medical care
and home-based senior care, in the field have received minimal attention. Senior Care Reforms in India xiv
Recognizing the challenges and opportunities associated with population ageing, the
Government of India has been implementing various initiatives, policies, and action plans
to address this demographic shift. The Constitution of India, under its Directive Principles
of State Policy, envisages protecting the rights of the citizens of India, which includes the
senior citizens as well. Further, the policy response has evolved over the last two decades,
guided by multiple national and international initiatives and frameworks. The Ministry of
Social Justice and Empowerment (MoSJE) is the nodal ministry responsible for the welfare
of senior people in India. It has led the overall policy and program development for senior
people in close collaboration with line ministries such as Finance, Health & Family Welfare,
Ayush, State Governments, NGOs, civil society, and the private sector.
In an attempt to develop a holistic understanding of the elderly population and their
requirements, several definitions and concepts have emerged in recent years. However,
there is a need to develop a conceptual framework – based on the literature review and
national and international experiences – in order to deliver a comprehensive response
to the elderly that addresses the various limitations, including functional mobility and
capacities. This report, therefore, categorizes the specific interventions needed in terms of
empowerment, service delivery, and their inclusions under four core areas: Health, Social,
Economic/ Financial, and Digital.
Priority Areas of Service Delivery for Senior Care
Health empowerment and inclusion can be achieved by promoting health literacy among
seniors as well as their caregivers, strengthening geriatric healthcare within the existing
healthcare system, and making special provisions for seniors. This will encompass
Comprehensive Primary Healthcare Services through the Ayushman Bharat – Ayushman
Arogya Mandir (Health and Wellness Centres), strengthening healthcare infrastructure
with a focus on needs of elderly, expanding tele-consultation services, enhancing the
skilled workforce for the elderly, and capacity building of existing workforce. It is also
important to strengthen mental health services, emergency response infrastructure and
services, and address nutrition-related issues through initiatives like Poshan Abhiyaan for
Senior Citizens. Integrating Ayush systems for senior care through preventive, wellness,
and therapeutic interventions has great potential to address their health issues in a holistic
manner.
For ensuring social inclusion and empowerment, specific actions such as creating
awareness to sensitize the larger community on the needs and challenges experienced
9

9
Senior Care Reforms in India xv
by the elderly, and establishing peer support groups are needed. Empowerment of the
elderly will also come through awareness of existing legal safeguards, welfare schemes
and ensuring legal reforms like strengthening the existing Welfare and Maintenance Act,
and disposal of pending cases in maintenance tribunals in a time-bound manner. Reforms
in the elderly-friendly living/housing sector and senior care homes are required, as also
developing a ‘one-stop’ centralized portal for senior care and promoting care economy.
Specific actions required to ensure financial empowerment and inclusion include
reskilling the elderly population, increasing coverage of public funds and infrastructure,
and mandatory savings plans for the affording segment. Reverse Mortgage mechanism
to increase liquidity for seniors, and tax and GST reforms on senior care products to
increase the ease of adoption and safeguard the elderly population from the financial
burden. Encouraging the private sector to design targeted and comprehensive geriatric
health insurance products, and increasing liquidity and capital allocation to the senior
care industry will help in addressing the needs of the affording segment. Protection for
the elderly from financial fraud by increasing awareness and literacy needs to be ensured.
Similarly, specific interventions for ensuring digital inclusion include improving access
to digital devices for seniors by making them affordable, focusing on increasing digital
literacy, and harnessing the potential of modern technology.
This document attempts to highlight the landscape of senior care services available, as
well as the gaps and challenges in the current senior care ecosystem. It strives to push
the frontiers of senior care by recognizing the evolving medical and non-medical needs
of seniors, thus envisioning a multi-pronged strategy for designing an effective and
synergized senior care policy. Senior Care Reforms in India xvi Senior Care Reforms in India 1
SECTION 1:
SENIOR CARE – AN OVERVIEW
1.1 Background
According to the World Health Organization’s (WHO) World Report on Ageing and Health
(2015), the percentage of people worldwide who are 60 or older is expected to nearly
double between 2015 and 2050, from 12% to 22%, with significant ramifications for socio-
economic structures and healthcare systems. As the population ages at an increasing rate,
countries worldwide recognize the need to change their perspective on ageing and shift
their focus to the needs of older adults.
In India, senior citizens, i.e. people aged 60 years and above, currently comprise a little
over 10% of the population, translating to about 104 million. The United Nations Population
Fund (UNFPA) projects that this population, which will make up 158 million people by
2025, is the one that is ageing at the fastest rate. By 2050, the elderly population is
projected to rise to 319 million (19.5% of the total population), as shown in Figure 1A.
Further, the total dependency ratio, which stood at 56.92 in 2020, is projected to decrease
steadily till the 2025 due to the rise in the percentage of the working-age population; but
it is expected to rise again to touch 61.22 by 2050.
Figure 1A. Population by broad age groups in percentage, India, 1950–2050
Source: United Nations (2019), World Population Prospects, the 2019 Revision, United Nations, New
York
These statistics and trends are largely a result of declining fertility rates and increasing life
expectancy rates, as shown in Figure 1.B . The total fertility rate stood at 5.9 in 1950 and Senior Care Reforms in India 2
declined to 3.4 in 2000. Currently, the fertility rate is 2 as per latest SRS data. Additionally,
the life expectancy at birth rose from 35.8 in 1950 to 62.5 in 2000 and is further projected
to rise to 75 by 2050.
Figure 1B. Life expectancy and total fertility rate, India, 1950–2050
Source: United Nations (2019), World Population Prospects, 2019 Revision, United Nations, New York‘
The statistics stated above clearly indicate a demographic shift that will impact all aspects
of society. While we have identified the future vulnerabilities such as rising dependency
ratios, shifting disease burden, and increased number of senior parents to care for, little
is known about the magnitude and socio-economic implications of these vulnerabilities.
It is therefore necessary to comprehend the impact of ageing on our society to adapt,
alter, and strengthen our infrastructure capacities as well as response mechanisms for the
overall welfare of the elderly.
Box 1: Key Findings from the Longitudinal Ageing Study of India (LASI)
The Longitudinal Ageing Study of India (LASI) launched in 2016 by the Ministry of Health and
Family Welfare is a full-scale national survey and a seminal study on the status of the ageing
population in India. The report has provided several valuable insights into the process and impact
of ageing in India. The key highlights of the report are given below.
Dimensions Key Findings
Health
Physical Health
• Every fourth Indian over 60 years and every fifth Indian over 45 years
reported having poor health
• 75% of the elderly have one or more chronic diseases
• 40% of the elderly have one or other disabilities
• 1 in 4 has some kind of multi-morbidity
• Diabetes is more common among senior citizens in urban India
• Cancer prevalence is on the rise and is higher in urban India.
Mental Health
• Around 20% of the elderly in India have mental health issues
• The prevalence of probable depression among the elderly is ten times
higher than the self-reported prevalence of diagnosed depression,
implying a greater burden of undiagnosed depression Senior Care Reforms in India 3
Health
• Almost a third of the elderly population exhibits depressive symptoms
Functional Abilities
• 11% have some form of impairment
• 24% of seniors have limitations in activities of daily living
• 58% have difficulty stooping, climbing, or kneeling
• 43% use an aid or supportive device
Access to Healthcare Facilities
• 7% experience hospitalization
• 60% received OPD care (one year before the LASI survey)
Social
Demography-specific
• 12% of the total population consists of elderly people and is projected
to reach 319 million by 2050, growing at a rate of around 3% per year
• The overall sex ratio in the elderly population is 1065
• 58% of the total number elderly are women, out of which 54% are
widows
• The overall dependency ratio is 62 per 100 working-age population
Living Pattern–related
• Approximately 28% of the elderly are living with children without a
spouse
• Overall, 6% live alone, and 09% of women elderly live alone
• 7 out of 10 elderly persons reside in rural areas
Diet
• Food insecurity is increasing among India’s elderly
• Almost 6% of people in India over 45 years ate smaller portions or
skipped meals, and 5.3% did not eat, even when they were hungry
Knowledge and Awareness
• Low awareness levels among the elderly regarding welfare provisions
available for them. For instance:
- 12% are aware of the Maintenance and Welfare of Parents and Senior
Citizens Act 2007
- 28% aware of any kind of senior concession
- 50%, 44%, and 12% are aware of IGNOAPS, IGNWPS, and Annapurna
Scheme, respectively
- 24% experienced problems in providing documents
Living Conditions and Quality of Life
• 32% of the elderly have low life expectations
• At least 5% of India’s elderly population reported having experienced
abuse which can be physical, sexual, psychological, or financial
• Mistreatment is more common among elderly women and those living
in rural areas Senior Care Reforms in India 4
Financial &
Economic
Work
• Male senior citizens worked at a rate of approximately 50%, while
female senior citizens worked at a rate of 22%
• When compared to their urban counterparts, a greater proportion of
senior citizens in India’s villages work
Pension
• 78% of the elderly population without a pension
Access to Healthcare Finance
• Only 18% of seniors are covered by Health insurance
• Mean Out of Pocket Expenditure in private health facilities is `31,933
(last in-patient visit)
• Health-related expense is the most common cause of indebtedness
(26%) in urban India
Cost of Ageing
• MPCE (monthly per capita consumption expenditure) of a household
with at least one elderly is `2,948 compared to households without an
elderly member (`3,001)
• MPCI (monthly per capita income) of a household with at least one
elderly person is lower than households without an elderly member
(`3,568 vs. `4,098).
Digital Wellbeing
Access to mobile phones
• While mobile phone is the most prevalent consumer durable, with
nearly 87% of Indian households having access to it, their access, use,
and utility for the elderly people is still debatable.
In India, the challenges associated with population ageing are further exacerbated by the lack of
affordable healthcare services, shifting disease burden, evolving nuclear family structures, and
altered consumption patterns.
India will have 319 million older adults by 2050, accounting for 20% of the total population,
putting additional strain on India’s already overburdened healthcare system. Nearly one-half
(45%) of India’s disease burden is projected to be borne by older adults in 2030, when the
population age groups with high levels of chronic conditions will represent a much greater share
of the total population.
Further, neuro-degenerative diseases like dementia mostly affect older adults, though it is not
a part of normal ageing. According to the WHO, there are approximately 50 million people
worldwide, who are living with dementia, and this number is expected to triple by 2050. In India,
an estimated 4 million people are living with dementia, and this number is projected to increase
to 13.4 million by 2050. The burden of dementia on healthcare systems is substantial, with global
costs estimated at US$1 trillion annually. In addition, there is a need to address mental health
concerns such as depression and anxiety as well as issues related to mobility and independence,
such as fall prevention, assistive technology, and accessible transportation.
As per the Global Health Estimates data of the year 2019
1
, the leading causes of the DALYs lost
in the elderly (above 60 years of age) are due to non-communicable diseases like ischemic heart
diseases, stroke, and diabetes, which develop mostly due to the consequences of Ageing. Age-
1 Global Health Estimates 2019; https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-
estimates-leading-causes-of-dalys Senior Care Reforms in India 5
group and disease-wise list of DALYs rate per 100,000 is given in Table 1.1.
Table 1.1. DALYs rate per 100,000 population*
SNLeading cause
of DALYs
Age Group (in years)
60-64 65-69 70-74 75-79 80-84 85 &
above
1.Ischemic Heart
Disease
11076.98 13569.8616474.6319443.1824934.16 23773.64
2.Chronic
Obstructive
Pulmonary
Disease
6106.4 9671.94 14718.0418820.2127303.22 24022.85
3.Stroke 5811.64 7800.64 9114.14 10597.8210708.75 10586.64
4.Diarrhoeal
diseases
2637.42 4056.42 6694.12 8951.9 14723.64 17942.45
5.Diabetes
Mellitus
4121.17 4899.1 5496.59 6399.42 7263.73 6348.5
6.Lower
Respiratory
infections
1638.76 2550.77 3789.21 4665.7 6591.35 6388.77
7.Alzheimer’s
disease & other
dementias
339.18 657.34 1289.25 2424.26 5853.98 11288
* Source: Global Health Estimates 2019;
(https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-
leading-causes-of-dalys)
Moreover, many seniors, especially women and those residing in rural areas, face challenges
in accessing healthcare due to the limited availability of geriatric specialists and services, high
out-of-pocket costs, and a lack of awareness about age-related health issues. So, healthcare
systems will face numerous challenges in providing affordable and accessible healthcare
services to older adults because of their diverse physical and mental needs, along with their
social and financial challenges.
Apart from the health issues, hygiene related issues also affect the quality of life among
the elderly negatively. Maintaining good hygiene is essential for the health and wellbeing of
elderly individuals but certain age-related changes can make it difficult for them to maintain
proper hygiene. Though open defecation was a major concern earlier, the steps taken by the
government have curtailed the issue to a large extent, but disabled-friendly sanitation facilities
are still lacking in most public spaces.
The ageing population also has significant implications for India’s social and welfare system.
Many older adults in India rely on their children for financial support and care in their later years.
However, with the shift towards smaller nuclear families and increased migration due to work,
education, and marriage; the elderly are left behind with scarce or practically no support system.
Further, there are numerous negative stereotypes and stigma associated with ageing in Senior Care Reforms in India 6
India. Traditionally, ageing was seen as a natural part of life, and the elderly were respected
and valued for their wisdom and life experience. However, in recent years, there has been
a shift toward a more westernized view of ageing, where ageing is often associated with
decline and loss. The elderly are often viewed as a burden and are marginalized in society.
This shift may be due to the influence of media and globalization, which have created a
culture that values youth and beauty. These negative stereotypes about ageing can have a
detrimental effect on the health and well-being of older adults, leading to social isolation,
depression, and other health problems.
The economic impact of an ageing population is also a significant concern for India. As the
proportion of older adults in the population increases, their contribution to the labour force
decreases. Also, the social benefits extended by the elderly population through their unpaid
work, which includes care tasks, volunteer activities, etc., are neither recognized nor quantified.
Additionally, the shift in consumption patterns, as people age, can significantly impact the
demand for goods and services, including housing, healthcare, and social protection. The
country’s pension system leaves many older adults without a reliable source of income in their
retirement, so it needs to be strengthened and funded with additional resources.
Digital technology has become an essential part of our daily lives, and it has transformed
the way we live, work, and interact with others. However, there is still a significant digital
divide between different age groups, particularly when it comes to senior citizens. Seniors
may face challenges in using digital devices and accessing online services due to physical,
cognitive, or socio-economic reasons. According to a survey conducted by the National
Sample Survey Organization (NSSO), only 13 % of people aged 60 years or older have ever
used the internet. This is significantly lower than the overall internet penetration rate in India,
which is around 50%. The reasons for this low rate of internet use among seniors in India
include limited access to digital devices, lack of digital literacy, and limited awareness of
online services. Thus, there is a growing need to bridge the digital divide for seniors.
To address these challenges, India needs to realign, reorganize, and re-orient its existing
policy landscape to map out an effective and efficient senior care ecosystem. This includes
various programs and policies that address the specific needs of the ageing population,
such as increasing access to affordable healthcare services, strengthening the social welfare
system, and promoting economic opportunities to safeguard seniors against economic
hardships; in line with the concept of ageing and senior car (see Annexure 1 for details).
Additionally, there is a need for increased public awareness and education about the issues
facing older adults and the importance of including them in policy decisions.
1.2 Key Trends
The ageing of the population presents unique challenges for various nations and societies.
The response to the challenges of population ageing should take into account the realities
of each country or region, avoiding a “one size fits all” approach so that active ageing can
be encouraged. To do so, it is important to first understand the key trends in the process of
population ageing.
The current section highlights the key dimensions and trends observed in the sphere of
senior care in India. Senior Care Reforms in India 7
1.2.1 Health Domain
The health profile of a nation changes along with changes in the population. Major issues
around elderly healthcare have emerged due to population ageing like the rising burden
of NCDs, paucity of long-term senior care plans, deficient medical infrastructure, lack of
accessible and affordable healthcare, and regional and social inequalities in healthcare.
India’s healthcare programs and policies have prioritized issues like disease control,
maternal and child health, and population stabilization for many years. Long-term
palliative care and senior care have received little attention. Additionally, geriatric care is
still a relatively new area in healthcare and is mainly restricted to cities. So, a majority of
countries take a very long time to create adequate healthcare responses and solutions for
the ageing population.
To initiate reforms in the elderly healthcare landscape, it becomes important to understand
the key trends surrounding it. Table 1.2 presents a brief overview of key trends and figures
across various dimensions of Health.
Table 1.2. Major Trends in the Health Domain
Dimension Key Trend Key Figures Remarks
Physical
Health
Epidemiological
shift indicating a
shifting disease
burden from
infectious diseases
to degenerative
diseases and NCDs
The prevalence of
co-morbidity and
multi-morbidity
rises with age
Every 4
th

Indian over 60
years reported
having poor
health
75% of the
elderly have
one or more
chronic
diseases
23.3% of the
elderly suffer
from multi-
morbidity
• Because of increased longevity, many seniors
face a higher risk of degenerative diseases,
requiring long-term care and support. The de-
cline in immunity and age-related physiologic
changes further increases the burden of com-
municable diseases in the elderly. Increasing
incidence of CVD, Hypertension, Cancer, bone/
joint disease, Diabetes mellitus, chronic lung &
heart disease, anemia, blindness & low vision,
dental issues, and neurological/ psychiatric
problems like dementia, Alzheimer’s, and men-
tal health diseases such as depression, loneli-
ness, etc. is seen among the elderly.
• 1 in 4 has some kind of multi-morbidity i.e. the
presence of more than two illnesses in the
same person at the same time; complicating
their already deteriorating health.
Function-
al Capaci-
ties
Limitation in
Activities of Daily
Living (ADL)
and Instrumental
Activities of Daily
Living (IADL)
Mobility
Restrictions
24% of the
elderly have
at least one
ADL limitation
and 48%
reported at
least one IADL
limitation

• A quarter of the elderly reported having at least
one ADL limitation, and 14% reported having
two or more ADL limitations. Close to half of
the elderly reported having at least one IADL
limitation and more than a third reported hav-
ing two or more IADL limitations. The elderly
residing in rural areas, the elderly women, and
those who worked in the past but are currently
not working, are more likely to have ADL and
IADL limitations. Senior Care Reforms in India 8
Dimension Key Trend Key Figures Remarks
More
than 50%
experience
mobility
restrictions
• Only 43% of the elderly reported using any aid
or supportive devices and the use of such de-
vices is higher in the urban areas (59%) than in
rural areas (37%); suggesting better access to
such assisting devices in urban areas.
Mental
Health
A decline in
psychological
and cognitive
capacities among
the elderly
Around 20%
of the elderly
in India have
mental health
issues
1 in 3 elders
over 60 years
reported
having
depressive
symptoms
• The prevalence of probable major depres-
sion among the elderly is 10 times higher
than the self-reported prevalence of diag-
nosed depression, suggesting a markedly
higher burden of undiagnosed depres -
sion. It is higher among women than men
and those in rural (9%) than those in ur-
ban areas.
• A higher percentage of elderly than older
adults (45-59 years) are in the lowest 10th
percentile of the composite cognition
score; showing a rapid decline in cogni-
tion. Gender differences in cognition are
very pronounced among the elderly; with
over 20% of elderly women falling in the
lowest 10th percentile over 7% of men.
Access to
Health-
care
Facilities
Limited focus on
senior care and
limited healthcare
facilities focusing
on the elderly
Nearly 28%
of the elderly
utilized
out-patient
care and just
8% availed
inpatient
care
3
• Seniors have more hospitalization needs.
India’s health infrastructure is already
stretched; an increase in senior patients
is likely to accentuate the gap further.
Further, senior-focused care like geriatric
OPD, daycare centers, recreational plat-
forms, etc., is mainly available at the ter-
tiary level and in urban areas.
• Access to healthcare services can be a
challenge for older adults in India, partic-
ularly those living in rural areas. As per the
National Health Profile, in 2017, there were
only 43 physicians per 100,000 popula-
tion in rural areas, compared to 118 phy-
sicians per 100,000 population in urban
areas.
Health-
care
Finance
Limited healthcare
financing for the
elderly
Only 18% of
people over
60 years
are covered
by health
insurance.
• Medical expenses incurred by seniors
are financed primarily out of pocket, and
there is an urgent need for increased fi-
nancing in senior care. Only 1/5th of the
older population (over 45 years) is cov-
ered by health insurance, which falls to
18% of the people over 60 years.
• The Government provides subsidies for
healthcare through various schemes for
seniors, but the coverage is limited to
medical care upon hospitalization, limited
cover for OPD, physiotherapy, medicines,
memory care, home care, home-based
palliative care, etc. Although the Ayush-
man Bharat Scheme covers all eligible
low-income elderly, its utilization is limit-
ed. Moreover, coverage of private sector
insurance for seniors remains poor. Senior Care Reforms in India 9
Dimension Key Trend Key Figures Remarks
Geriatric
Nutrition
Prevalence of
lifestyle-based
issues due
to nutritional
mismatches
among the elderly
population
Increased
incidence of food
insecurity among
the elderly
Special and
specific needs
of the elderly
population
are largely not
recognized
More than
27% of the
elderly are
underweight,
and 22% are
overweight/
obese.
4.7% of the
elderly are
anemic
• Studies have shown that between 50 and 80
years, muscle mass declines by around 30%,
and muscle strength reduces by 50%. The
BMR is 10-20% lower in older adults com-
pared to younger adults. The prevalence of
underweight is almost threefold (32%) high-
er in rural areas than in urban areas (12%)
while overweight (27%) and obesity (12%)
are more common among the elderly in ur-
ban areas.
• Food insecurity is increasing among India’s
elderly population. Almost 6% of people in
India aged 45 and above ate smaller por-
tions or skipped meals, and 5.3 % did not eat
even when they were hungry.
• As the body ages, its ability to absorb es-
sential vitamins and nutrients begins to de-
crease. At present, no elderly-specific nutri-
tion program/scheme is ongoing. Ministry of
Social Justice and Empowerment has envis-
aged Poshan Abhiyan for the elderly, but it’s
yet to be operationalized.
Preven-
tive Care
Adult
Immunization
remains a
neglected subject
Predisposition
to a variety of
preventable
diseases due to
the prevalence
of co-morbidities
and multi-
morbidities
Every 2
nd

person above
60 has one
co-morbid
condition
3
• The risk of severe outcomes from Vac -
cine-Preventable diseases like Invasive
Pneumococcal Disease or influenza-relat-
ed hospitalization in this segment is even
higher than the risk for the under-5 popu-
lation group. At present, adult immuniza-
tion is not yet operationalized in any on-
going program at a larger scale.
• The highest burdens of comorbid condi-
tions increase the overall risk profile of the
population. These comorbid conditions
predispose the elderly to many infectious
diseases like Pneumonia and Influenza.
Climate
Change
Increased
vulnerability
due to adverse
climate events like
pollution, global
warming, etc.
India recorded
an estimated
31,000 heat-
related deaths
among people
over 65 years
in 2018
2
• The elderly are disproportionately vul-
nerable to climate change with a signifi-
cant increase in ill health and premature
deaths, reduced mobility, social isolation
(in some cultures), and poor access to
health and social services.
• They are also at an increased risk of wa-
ter and food insecurity induced by climate
change and adverse climatic events
• Need for focused interventions to address
the impact of climate change on the el-
derly
1.2.2 Social Domain
The ageing of the population has far-reaching social consequences. India has seen the
erosion of social institutions and values due to changing economic structures, urbanization,
migration, mobility, and less reliance on traditional sources of income by families.
The search for new opportunities has led to redefined social roles, greater economic
2 The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises Senior Care Reforms in India 10
independence, and nuclear setups. The traditional structures, that once gave meaning to
different generations, have evolved and, in some cases, weakened.
Family is the primary and fundamental source of social support for the elderly in India. It
is expected to provide adequate support to the elderly when their functional and intrinsic
capacities are compromised due to ageing. However, seniors are now caught between
changing and eroding traditional joint families. Consequently, the inter-generational cross-
learning of experiences, division of labor, social security, and cohesion among different
generations have reduced considerably.
In such a scenario, it becomes important to understand the evolving social structures and
their impact on the ageing population so that adequate interventions can be made. Table
1.3 showcases some key trends related to the social domain.
Table 1.3. Major Trends in the Social Domain
Dimensions Key Trends Key Figures Remarks
Demography
Rising elderly
population
due to falling
fertility rates
and rising life
expectancy
rates
Increasing
dependency
ratios
12.8% of the
total population
comprises
people over 60
years
3
The total
dependency
ratio is 60 per
100
3
• India’s population is relatively young at pres-
ent, however, a substantial decline in fertility
rates and death rates indicates an increase
in the elderly population in the coming de-
cades. Rising life expectancy rates make it
important for the government to convert
these years into healthy years.
• A high dependency ratio means a higher
burden on the economically active popula-
tion to support and provide for the econom-
ically dependent older population.
Ageing and
Gender
A higher
percentage
of women
among
the elderly
population
Increased
incidence
of poverty
among
elderly
females
1065/1000 is
the Senior Sex
Ratio (Females
vs. males)
3
Only 10%
(rural) and
11% (urban) of
senior females
are financially
independent
3
• The sex ratio of the elderly population is on
the higher side for females as compared to
their male counterparts. Further, the average
life expectancy has increased, however, it
has not risen equally for males and females.
This gap means that India’s older female
population is growing faster.
• 2.8 million & 0.8 million senior women live
alone in rural and urban areas, respectively
4
.
54% of women are widows and are at higher
risk of social exclusion due to a lack of social
and financial security. Poor physical health
and the stigma around widowhood further
increase their vulnerability.
3 LASI India Report, 2020
4 National Sample Survey Organisation. Morbidity, HealthCare and the Condition of the Aged – NSS 60th Round (January-June) Senior Care Reforms in India 11
Dimensions Key Trends Key Figures Remarks
Rural-Urban
divide
Increased
proportion
of the elderly
residing in
rural areas
71% of elderly
persons reside
in rural areas
• Out of the total population of the elderly in
India, a very high proportion of them reside
in rural India. Rural India still lacks medical
infrastructure and other basic facilities such
as electricity, communication, etc. Further,
rural seniors reflect low healthcare utiliza-
tion, along with poor coverage of financial
cover
Living
Patterns
Migration and
socio-cultural
shift
Loss of family
& social
support for
seniors
Need for
senior living
communities
6% of the
elderly and 9%
of the elderly
women live
alone
19% of the
elderly are
divorced,
separated,
deserted, or live
alone.
• Globalization and migration of the young-
er working population are leading to an in-
crease in the number of elderly population
living alone, particularly in urban areas.
Moreover, there are more elderly women
than men who live alone.
• The disintegration of traditional family set-
up & shift to nuclear families has reduced the
amount of family support, home-based care,
and day-to-day psychosocial support to the
elderly.
• The COVID-19 pandemic exposed the vul -
nerability of seniors living alone & requiring
housing support. Moreover, the traditional
housing system is unable to cater to the spe-
cific needs of seniors, such as fall-resistant
flooring, no sharp edges, and required medi-
cal facilities closer to the living place.
Life
Satisfaction
A decline
in life
satisfaction
due to
decreased
engagement
with society
Increased
likelihood of
abuse and
ill-treatment
in the elderly
population
Nearly 32%
of the elderly
reported low life
satisfaction
5% of the
elderly reported
to have suffered
abuse & about
2/5th of them
were ill-treated
by their sons,
daughters, and
sons-in-law,
daughter-in-law
• The loss of involvement in important life ac-
tivities like work, household management,
and decision-making has negatively impact-
ed the life satisfaction levels among the el-
derly. Further, the debate around population
ageing has not focused on the social partic-
ipation aspect of ageing. Numbers indicate
lower social or community participation
amongst the elderly.
• The elderly population is more likely to suffer
abuse and ill-treatment because of a decline
in their financial status and functional capa-
bilities. Abuse and mistreatment are more
common among elderly women and those
living in rural areas. Caregivers are found to
be the primary abusers, making the elderly
even more helpless and reluctant to report
such incidents. Senior Care Reforms in India 12
Dimensions Key Trends Key Figures Remarks
Educational
Attainments
Low literacy
levels among
the elderly
More than 55%
of the elderly
population is
illiterate
• The proportion of the elderly population
that has never attended school increases
with age. A higher proportion of elderly men
(65%) attended school than elderly women
(35%).
• Literacy levels are higher among older adults
living in urban than those living in rural areas.
Nearly 60% of older adults from rural areas
do not have any formal schooling, compared
to 29% of those living in urban areas.
Access
to Social
Security
measures
Low
awareness
and
utilization
of social
security
schemes
among the
elderly
Only 28% of the
elderly aware of
any concessions
for senior
citizens
24%
experienced
problems in
providing
documents
• A little more than 50% of the elderly are aware
of IGNOAPS (Indira Gandhi National Old Age
Pension Scheme) and 44% of IGNWPS (Indi -
ra Gandhi Widow Pension Scheme). Aware -
ness of the Annapurna scheme is very lim-
ited (12%). Further, only 12% of the elderly
are aware of the Maintenance and Welfare of
Parents and Senior Citizens Act 2007.
• Further, the awareness of social security
schemes does not necessarily lead to their
utilization due to many reasons. More than a
third (35%) of elderly people could not uti-
lize these schemes because the process of
getting benefits is cumbersome.
1.2.3 Economic Domain
As per the WHO (2002), the overall well-being of older persons depends largely on their
economic conditions and work participation, along with their social and health factors.
The ageing of the population has given rise to various economic concerns like increased
expenditure on health and long-term care, shortages in the labour force, economic
dependence, old-age income insecurity, limited coverage of old-age pensions, and an
increased need for social protection. Additionally, loss of employment opportunities and
lack of adequate social security measures may push the elderly population into poverty,
further limiting their capacity to avail of healthcare services. Such trends may cause an
economic slowdown if interventions are not made at the right time. Table 1.4 mentions
key economic trends related to population ageing. Senior Care Reforms in India 13
Table 1.4. Major Trends in the Economic Domain
DimensionKey Trend Key Figures Remarks
Work
Status
The elderly
population
is financially
vulnerable due
to loss of work
or poor work
opportunities
Need of Silver
economy and
‘Grey interns’
Only a little
more than
one-third (34%)
of the elderly
are currently
working
• Formal work serves as a crucial physical, so-
cial, and financial safety net. Loss of work due
to ageing or retirement from employment is a
critical point in the life of a working individu-
al, which causes various socio-psychological
and economic changes, and makes them eco -
nomically vulnerable and prone to financial
shocks.
• Appropriate interventions are required on the
part of the government to provide a thrust to
the “silver economy,” i.e. economy driven by
goods & services demanded by the elderly.
Further, work opportunities that can provide
a platform for the elderly to use and utilize
their experience and expertise in various sec-
tors
Financial
Status
Increasing
financial
dependency of
the elderly
Increased
incidence of
poverty among
the elderly
70% of the
elderly are
dependent
on everyday
maintenance
(on family/
pension)
5
78% without
pension cover
• The dependency ratio to rise from 15.7% to
20.1% over the next decade (2021-31), indi-
cating a growing economic responsibility on
working Indians.
6

• With private cover at 8%, India’s aged popula-
tion is at risk of financial vulnerability post-re-
tirement
7
. Low financial security impacts ac-
cess, choice, decision-making, and reduced
use of healthcare, and it often pushes the el-
derly population into poverty.
Economic
Cost of
Ageing
Significant
economic costs
associated with
population
ageing
Health
expenditure
accounts for
13% of total
MPCE
The mean
OOPE of the
elderly on
inpatient care
was `8,028 in
public facilities
and `31, 933 in
private facilities
• The financial status of households with at
least one elderly member is lower than those
without any. The per capita health spending in
households with the elderly is higher (`405)
than in households with no elderly member
(`352). Furthermore, the per capita income
of households with an elderly member age is
lower (`42819) than households with no elder-
ly member (`49174).
• The contribution of medicines to the monthly
healthcare expenditure is the highest, i.e., 69%.
• Health-related expenditure is the most com-
mon cause of indebtedness in urban areas
(26%).
5 https://www.helpageindia.org/wp-content/uploads/2022/06/Bridge-the-Gap-Understanding-Elder-Needs-a-HelpAge-India-2022-
report-1.pdf
6 MOSPI, The elderly in India 2021 report.
7 https://www.pfrda.org.in/writereaddata/links/crisil%20pfrda%20report869bc61d-a231-42de-a77c-ff614b0af650.pdf Senior Care Reforms in India 14
1.2.4 Digital Domain
The digitalization process has left many elderly people excluded from the digital sphere.
Although many older adults frequently use ICTs, a majority of them live in rural areas or
tier II or III cities and have minimum or no access to such technologies.
The exclusion of elderly people from the digital field is driven by many factors like lack
of access to digital devices, lack of digital skills, and deteriorating vision. Moreover, the
perception that older people cannot be technologically savvy further excludes them from
these new and emerging digital technologies. So, policymakers need to prioritize digital
inclusion of the elderly population because digital tools can help senior citizens by helping
them reconnect with their friends and family; lowering dependency, raising autonomy, and
boosting self-worth and confidence.
The Table 1.5 highlights some key trends related to the digital well-being of the elderly
population.
Table 1.5. Major Trends in the Digital Domain
Dimension Key Trend Key Figures Remarks
Digital Divide
Age-based
digital divide
Nearly 87% of
Indian households
have access to
mobile phones,
but there are no
major studies
indicating their
access to elderly
people.
• Nearly 85.8% of the elderly were found
to be digitally and computer illiterate.
Out of this, 76.5% were elderly men and
95% were elderly women.
8

• There was a surge in digital solutions
during the COVID-19 pandemic which,
helped people navigate the lockdown,
but studies suggest that the use and
utility of such technologies for the el-
derly were minimal. The elderly were un-
able to make use of many of the digital
measures because of a lack of access to
digital devices and a lack of technolog-
ical skills.
Digitalization
& Consumption
Patterns
An expected
rise in digitally
driven care
and support
services

The digital
healthcare market
in India is valued
at ` 52,497 crores
(524.97 billion) in
2021; expected to
reach ` 2,52,869
crores (2528.69
billion) by 2027
9

• As service delivery is going increasingly
online, digitalization presents significant
opportunities for societies with ageing
populations. The market for digital tech-
nologies, especially those suited to the
needs of older people, like assistive &
health monitoring devices, smart home
technologies, and telemedicine ser -
vices; is expanding in response to rising
demand.
8 https://www.agewellfoundation.org/wp-content/uploads/2018/07/Annual_Report-2017-18.pdf
9 https://www.researchandmarkets.com/reports/5723420/digital-healthcare-market-in-india
10 https://www.columbiacommunities.in/news/how-lucrative-is-the elderly-market-in-india/ Senior Care Reforms in India 15
1.3 Market Size and Growth Potential
By 2050, one in every four Indians will be a senior citizen. In absolute numbers, it will be
equal to the population of the USA for the industry in the form of a “Silver Economy”. The
senior care industry in India is about USD 7 billion
10
(approximately ` 57,881 crore) and it
is expected to grow rapidly, showing ample opportunity for the health care companies to
create solutions for the silver generation. (See Figure 2)
Figure 2. Snapshot of the silver economy
Moreover, the recent COVID-19 pandemic has highlighted the significance of the
healthcare sector and has provided policymakers with the required context to explore the
growth potential of the Indian healthcare market. As a result, the market for tech-based
elderly solutions is expanding quickly both globally and in India. Indian elderly, especially
those aged 60-70, are embracing digital technology through various means like online
transactions, online shopping, social networking, etc. As more senior consumers become
aware of the advantages and convenience of digital technologies, this trend is anticipated
to continue.
11
This sector deals with the potential of the Indian geriatric healthcare market and its driving
factors.
DRIVERS OF GROWTH
1.3.1 Home Care Services
More than 75% of the elderly people in India suffer from chronic diseases and these figures
indicate the potential of the home-based care market in India. The size of the home
healthcare market in India was estimated at USD 6.2 billion (` 50, 840 crore) in 2020 and
it is projected to reach USD 21.3 billion (` 1.74 lakh crore) by 2027.
12
The home healthcare
market can lead to a 15–30% reduction in infrastructure and operational costs compared
to hospital costs for the same treatment.
13

Further, the COVID-19 pandemic has provided
an opportunity for policymakers to explore the home-based care market in India. The
hospital capacity was limited during the pandemic, which forced chronic patients to seek
home-based healthcare and it may continue to be the best alternative for such people due
to its flexibility and convenience.
11 Changing patterns of Income & expenditure of older people in India, Agewell Foundation
12 Investment Opportunities in India’s Healthcare Sector, Report by NITI Aayog, 2021
13 https://www.investindia.gov.in/sector/healthcare
The growth of silver
economy in India will enable
subsidized services required
for universal access to
senior care especially for
the bottom of the pyramid
segment. Senior Care Reforms in India 16
1.3.2 Health Technology
In 2020, the Indian health-tech market was worth USD 1.9 billion (` 15,580 crore) and it
is expected to reach USD 5 billion (` 41,000 core) by 2023. Further, the Indian digital
healthcare market is projected to grow at a CAGR of 27.41%, reaching ` 485.43 billion (`
48,543 crore) by 2024 from ` 116.61 billion (` 11,661 crore) in 2019.
13
Because of COVID-19,
certain product categories have seen a massive demand like telehealth applications,
remote patient monitoring, Internet-of-Things (IoT) products, AI-based smart housing,
and home equipment, assistive technology products, which have a huge potential to
transform the lives of seniors.
The following are the major growth areas within the health technology segment:
a. Wearables: The use of wearable devices for the elderly is expected to continue to
grow, driven by the increasing demand for remote monitoring and the need for more
personalized healthcare solutions. There are several wearable devices available in
the market that cater specifically to the needs of the elderly population, including
smart watches and fitness trackers with health monitoring features such as heart rate
monitoring, blood pressure monitoring, and sleep tracking. There are also specialized
devices such as fall detection sensors, GPS trackers, and emergency response systems
that can alert caregivers or emergency services in case of a fall or other medical
emergency. According to a report by Grand View Research, the global market for
wearable medical devices is expected to reach USD 87.77 billion by 2027, with a
compound annual growth rate (CAGR) of 27.9% from 2020 to 2027. This growth is
being driven by the increasing adoption of wearable devices by the elderly population,
as well as advancements in technology and the rise in chronic diseases.
b. Telemedicine: The Telemedicine market in India has the highest growth potential and
is anticipated to reach from USD 830 million (` 6806 crore) in 2020 to USD 5.4 billion
(` 44, 280 crore) by 2025, growing at a 31% CAGR. Further, the telemedicine market is
likely to develop into a full-fledged “virtual care ecosystem,” including teleconsulting,
e-pharmacy, telepathology, and teleradiology, which has the potential to bring
healthcare to fingertips.
1.3.3 Health Insurance
»With only 18% of people over 60 years covered with health insurance
3
, the elderly
health insurance industry continues to remain an untapped market which presents a
ton of opportunities for investors to enter the market.
»Although several insurance companies offer specialized health insurance plans for
senior citizens, a comprehensive and integrated insurance product for seniors, which
includes OPD care, diagnostic care, preventive care, etc., is still absent. Some of the
popular insurance products for seniors in India include Bajaj Allianz Silver Health, Star
Health Senior Citizen Red Carpet Plan, HDFC ERGO Health Optima Senior Plan, New
India Assurance Health Insurance, and National Insurance Varistha Mediclaim Policy
(see Annexure 2 for details.) Senior Care Reforms in India 17
»Therefore, with over 104 million seniors
3
, aged 60 years and above
3
, the geriatric health
insurance sector has the potential to develop as a separate insurance segment.
»The elderly health insurance segment is likely to be driven by various factors like
increasing health care costs and OOPE, rising awareness, increased incidence of chronic
& degenerative diseases, and the growing number of government health insurance
schemes like Ayushman Bharat.
»Moreover, India with its relaxed investment norms allows up to 74% FDI in the insurance
sector. Such liberalized norms can incentivize various multinational players to explore
the Indian geriatric insurance market.
1.3.4 Ayush-based Services
»The Ayush sector has grown significantly, from USD 3 billion (` 24,600 crore) in 2014 to
USD 18 billion (` 1,47,600 crore) in 2022, and it is further expected to continue growing,
reaching about 23 billion (` 1.88 lakh crore) by the end of 2023.
»The Ayush market has received a boost from the widespread acceptance of Ayurveda
and other traditional medical practices for their healing potential.
»The growth potential of the Ayush market was highlighted during the COVID-19
pandemic in India, where people increasingly turned towards Ayush-based practices
due to its holistic approach to health and overall well-being.
»Additionally, an increase in the demand from the elderly population for preventive
medications with almost no side effects or very few side effects is likely to fuel the
Ayush market.
1.3.5 Enabling Government Policy
»The Indian healthcare industry will be fueled by an enabling policy environment and
relaxed investment norms.
»Due to a liberalized FDI regime in numerous sub-sectors like hospitals, medical devices,
health insurance, etc., there is enormous potential for foreign investment in this area.
• 100% FDI is allowed under the automatic route for green-field projects and up to
100% FDI is permitted under the government route for investments in brownfield
projects.
• 100% FDI is allowed under the automatic route in the hospital sector and the
production of medical devices.
• 100% FDI is allowed for green-field projects and up to 74% for brown-field projects,
under the automatic route for the pharmaceutical industry.
• 100% FDI is allowed in the wellness and medical tourism sectors of the Ayush sector as
well.
»Further, healthcare is a notified area under Schedule VII of Corporate Social
Responsibility under section 135 of the Companies Act. Even though it is on the
government’s part to provide its citizens with last-mile health services, the corporate
sector holds enormous potential to drive healthcare delivery as a part of the required
2% spending under their CSR.
14https://www.brookings.edu/blog/future-development/2021/01/14/the-silver-economy-is-coming-of-age-a-look-at-the-growing-
spending-power-of-seniors/
15 https://social.un.org/ageing-working-group/documents/seventh/AgewellFoundationSubmission.pdf
16 https://socialjustice.gov.in/writereaddata/UploadFile/dnpsc.pdf Senior Care Reforms in India 18
1.3.6 Growing Silver Economy
»The economic activities, goods, and services that cater to the elderly people make up
the “silver economy”.
»India’s silver economy is estimated to be worth approximately `73,082 crore rupees at
present and is expected to grow multi-fold in the coming years.
»It is projected that around 13.2% of India’s population will be over 60 years of age by
2031 and around 19% by the year 2050. With the rise in the ageing of the population,
senior citizens are emerging as an influential consumer segment. Studies have put
senior citizens, along with professionals in the 45 to 64 age group, as the ‘wealthiest
age cohort’ in the world
14
.
»Further, research shows that healthcare constitutes about 31% of the total expenditure
of senior persons.
15
Hence there is a huge growth potential for health and wellness-
driven businesses within the senior care segment in India.
»Overall, the silver economy presents significant opportunities for businesses and
organizations that cater to the needs and wants of the elderly population. The market
size is expected to grow rapidly in both India and the world, and there is significant
potential for innovation and growth in this sector.
»The Government also recognizes this opportunity and is exploring various ways to
promote the idea of a silver economy, some of which are given below:
»In December 2020, the government released a draft National Policy for Senior
Citizens,
16
which included various enabling provisions like integrated insurance
products and savings schemes, comprehensive insurance and pension systems,
senior-friendly tax structures, subsidized financing products, etc., to provide policy
support for the silver economy.
»The government has recently launched the Senior Able Citizens for Re-Employment
in Dignity or the SACRED portal to connect senior citizens with job providers in
the private sector.
»Based on the recommendations of the Expert Group on Silver Economy, the Senior
Ageing Growth Engine (SAGE) initiative has been launched by the Ministry of
Social Justice and Empowerment government to promote and incentivize senior
care products and services. The SAGE portal provides a ‘one-stop access’ to senior
care products and services by identifying, aggregating, and delivering them directly
to the stakeholders.
17

»Further, an initial budget of 100 crore rupees has been set aside by the M/oSJ&E
for promoting the silver economy in India, of which approximately 25 crore rupees
had been assigned for use in FY 2021-22.
18
»The Ministry of Social Justice and Empowerment has been running various schemes and
programs like the Rashtriya Vayoshri Yojana, ADIP scheme (Assistance to Disabled
persons for purchase/fittings of Aids & Appliances), Sambhav portal, Artificial Limb
and Manufacturing Corporation, Sugamya Bharat Abhiyaan , etc.; to assist people
with disabilities (including seniors).
Further, healthcare being a major need among seniors, the potential of healthcare
technologies like AI/ML monitoring devices, IoT devices, assistive devices, and wearables
17 https://sage.dosje.gov.in/
18 https://pib.gov.in/PressReleasePage.aspx?PRID=1724425 Senior Care Reforms in India 19
such as watches, smart cameras, etc., needs to be utilized for delivering senior care
services, especially home-based care, and long-term care. These health technologies
can be supported by a team of care providers who can intervene whenever necessary .
Moreover, by 2030, there will be a need to shift from curative management to prevention
through cost-effective, integrated ‘smart’ services and solutions. Data and analytics
will allow healthcare providers to directly and continuously connect with users, placing
prevention ahead of treatment and cure (See Figure 3).
Embracing transformative digital disruptions in this field can play an important role in
improving the accessibility, affordability, efficiency, and quality of services, and creating
more sustainable models of care. To overcome the challenges of a shortage of skilled
workforce, strategic adoption of technology needs to be brought in by the government.
Figure 3. Digital Care Ecosystem
The impact that these digital disruptions could bring will boost the efficiency of the service
to the elderly by–
• Increasing the reach of services, even in the remotest areas
• Reducing care worker visits to elderly homes
• Digital enabled ‘Ageing in place
• Improving the health status of the elderly
• Digitally enabled elder living facilities & healthcare facilities
• Intelligent & easy to use assistive devices improve mobility
• Early responses leading to better health outcomes
Thus, the growth potential of the silver economy must be optimally utilized by employing
the right strategies and interventions in the right sectors, to realize its true potential of
serving over 300 million elders by 2050. The silver economy must place a greater emphasis
on including seniors as active contributors in the economy rather than reducing them to
just passive recipients. To achieve this, the country needs economic and social innovation
that is supported by legislative reform and executive action. Mainstreaming ageing both
from policymakers as well as by manufacturers, marketers, and industry will play a pivotal
role in the coming years.
19 United Nations, World Population Ageing 2019
20 https://www.un.org/development/desa/ageing/madrid-plan-of-action-and-its-implementation.html#:~:text=The%20Madrid%20
Plan%20of%20Action,ensuring%20enabling%20and%20supportive%20environments. Senior Care Reforms in India 20
1.4 Efforts in Senior Care
1.4.1 Global Efforts
Globally, the greatest demographic challenge is no longer rapid population growth, but an
increasingly ageing population. The number of people aged 65 and above worldwide in 2019
was 703 million, and by 2050, this number is expected to touch 1.5 billion; which effectively
means that by 2050, 1 in 6 people in the world will be over the age of 65.
19
Recognizing the
challenges associated with a rapidly ageing population across the world, various multilateral
frameworks and mechanisms for senior care have been initiated by various international
organizations.
The Vienna International Plan of Action is the first international initiative that sparked the
debate around ageing. The plan was adopted by the World Assembly on Ageing in 1982
and endorsed by the UN General Assembly later that year. It seeks to increase the ability of
governments and civil society to deal with population ageing and serves as a framework for
developing policies and programs on ageing.
The Vienna International Plan on Ageing was followed by the adoption of the United Nations
Principles for Older Persons by the UN General Assembly in 1991. Further, in 2002, the Second
World Assembly on Ageing adopted the Political Declaration and the Madrid International
Plan of Action on Ageing (MIPAA). The MIPAA aims at “building a society for all ages” and
indicates a paradigm shift in how the world approached ageing. Moreover, the plan offers a
comprehensive framework for understanding and managing the issue of ageing. Primarily it
focuses on three areas – older persons and development, advancing health and well-being
into old age, and ensuring enabling and supportive environments.
20
Adding to it, in 2020, the United Nations General Assembly declared 2021-2030 as the
‘Decade of Healthy Ageing,’ urging governments, civil societies, international organizations,
professionals, academia, media, and the private sector to work together towards improving
the lives of older people, their families, and the communities in which they live. It aims to not
only add years to life but also life to years. It focuses on the following four action areas:
a. change how we perceive age and ageing;
b. ensure that communities foster the abilities of older people;
c. deliver person-centered integrated care and primary health services responsive to
older people; and
d. provide access to long-term care for older people who need it.
Furthermore, efforts have also been made by various countries across the world to ensure a
healthy and inclusive ageing experience for their senior citizens (see Annexure 3 for details).
Most of the developed countries, such as European nations, the United States, Japan,
Australia, and New Zealand, face a greater burden of population ageing. These nations had
a long time to adjust to the growing number of elderly people in their population, so, these
countries have robust healthcare systems in place and have been spending a higher per-
capita income on healthcare, with models maturing over the years. They rely on institutional
delivery of healthcare via hospitals and non-medical care through multiple channels such as
nursing, home-based care, and elderly homes. Further, these countries recognize the role of Senior Care Reforms in India 21
technology in ensuring quality, efficient, and timely care to the older population and therefore
support new-age technology development and adoption.
In comparison, individuals and families in many developing countries, such as Eastern and
Southeast Asian countries, where reliance on public health-care systems is low, face greater
pressure to finance their medical and other needs during their old age. In terms of providing
services, Government funded facilities provide basic medical care and philanthropic / not-
for-profit / NGOs provide long-term care homes for severely ill patients. The private sector
functions along with the Government, as the provider of medical & non-medical care, senior
living facilities, long-term care facilities, and nursing at-home services for those who can
afford it. From a health financing perspective, developing countries mostly have a self-funded
elderly care model where most non-medical and long-term care is paid for by the people
themselves.
Analysis of the various country models highlights that no country has the perfect solution
to address ageing at an ecosystem level. Moreover, elderly people are now seeking higher
quality care because of the rise of new-age health entrepreneurs, who provide exceptional
services and a wide range of options; raising people’s expectations of the quality of care
available. Consequently, providing effective and affordable care for the elderly continues to
remain a major global challenge.
1.4.2 Efforts by the Indian Government
The Indian Government has been very active in addressing the demographic shift driven
by the ageing of the population by implementing various initiatives, policies, programs,
and action plans for the welfare of the elderly population. The Indian government’s
commitment to population ageing is evident from the fact that India has been a signatory
to almost all the global conferences or initiatives on ageing.
Moreover, the policy landscape around population ageing has evolved over the last two
decades, guided by multiple initiatives. The brief of the policy response in senior-care in
India with the rising number of elderly has been shown in Figure 4:
Figure 4. Journey of senior care policy in India Senior Care Reforms in India 22
The Ministry of Social Justice and Empowerment (MoSJE) is the nodal ministry responsible
for the welfare of senior people in India. It has been leading the overall policy and program
development for the senior people in close collaboration with other line ministries such
as Finance, Health and family Welfare, State Governments, NGOs, civil society, and the
private sector. MoSJE has led the way in framing India’s National Policy on Older Persons
and is also implementing the Atal Vayo Abhyudaya Yojana (AVYAY). Under the MOSJE,
the National Institute of Social Defense has been the nodal institute tasked with training
and research focusing on social defense issues, including the welfare of senior citizens, for
over a decade. Further, the Maintenance and Welfare of Parents and Senior Citizens Act,
2007 is a landmark legislation that was initiated by MOSJE.
The Ministry of Health & Family Welfare launched the National Programme for the Health
Care of Elderly (NPHCE) during 2010–11 to provide accessible, affordable, and high-quality
long-term, comprehensive, and dedicated care services to the elderly, thereby creating
new “architecture” for ageing and anenabling environment for “a Society for all Ages.” The
program aligns with various national and international commitments like the UN Convention
on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons
(NPOP) adopted by the Government of India in 1999 & Section 20 of “The Maintenance and
Welfare of Parents and Senior Citizens Act, 2007” dealing with provisions for medical care
of people aged 60 and above. It provides dedicated healthcare facilities to senior citizens
at various levels of primary, secondary, and tertiary health care as shown in Table 1.6 . (See
Annexure 4 for details.)
Table 1.6: Package of Services Provided at Various Levels Under
National Programme for the Health Care of Elderly (NPHCE)
Sr. No. Health FacilityFunctions
1.
National Centre
for Ageing
»Health Care delivery with 200 bedded facility
»Training of Health Professionals
»Research activity
»Development of Health Professionals.
»Development of IEC material and course curricula
»The NCAs will also implement a special programme for the 75+
population
2.
Regional
Geriatric Centre
»Provide tertiary-level services for complicated/serious Geriatric
Cases referred from Medical Colleges, District Hospitals, and below,
Conducting post-graduate courses in Geriatric Medicine
»Providing training to the trainers of identified District hospitals and
Medical Colleges
»Developing evidence-based treatment protocols for Geriatric
diseases prevalent in the country.
»Developing / updating Training modules, guidelines, and IEC
materials.
»Research on specific elderly diseases Senior Care Reforms in India 23
Sr. No. Health FacilityFunctions
3.
District
Hospitals
»Geriatric Clinic for regular dedicated OPD services to the Elderly.
»Facilities for laboratory investigations for diagnosis and provision
of medicines for geriatric medical and health problems
»Ten-bedded Geriatric Ward for in-patient care of the Elderly
in addition to services provided by the existing specialties like
General Medicine, Orthopedics, Ophthalmology, ENT services,
etc.
»Provide services for the elderly patients referred by the CHCs/
PHCs and conduct camps for geriatric services on other sites
»Referral services for severe cases to tertiary-level hospitals
4.
Community
Health Centres
»First Referral Unit (FRU) for the Elderly from PHCs and below.
»Geriatric Clinic for elderly persons twice a week.
»Rehabilitation Unit for physiotherapy and counseling
»Domiciliary visits by the rehabilitation worker for bedridden elderly
and counseling of the family members
»Health Promotion and Prevention
»Referral of difficult cases to District Hospital/higher health care
facility
5.
Primary Health
Centres
»Weekly geriatric clinic run by a trained Medical Officer
»Conducting a routine health assessment of the elderly persons
based on simple clinical examination relating to the eye, BP, blood
sugar, etc., and provision of medicines and proper advice on chronic
ailments
»Public awareness on promotional, preventive, and rehabilitative
aspects of geriatrics during health and village sanitation day/
camps and referral for diseases needing further investigation
and treatment, to the Community Health Centre or the District
Hospital as per need.
6. Sub - Centres
»Health Education related to healthy ageing
»Domiciliary visits for attention and care to home-bound /
bedridden elderly persons and provide training to the family care
providers in looking after the disabled elderly persons.
»Screening of the elderly for NCDs (Hypertension and Diabetes)
»Arranging the suitable calipers and supportive devices from the
PHC to the elderly disabled persons to make them ambulatory
»Linkage established with other support groups and daycare
centers etc. operational in the area
»Availability of Telemedicine facilities for geriatric healthcare
services. Senior Care Reforms in India 24
Additionally, the Ministry of Rural Development has been administering the National Social
Assistance Programme (NSAP), which provides social assistance benefits to vulnerable
groups, including seniors, widows, disabled persons, and transgender people. Presently,
NSAP, through the Indira Gandhi National Old Age Pension Scheme (IGNOAPS) provides
social protection to the elderly through pensions. The central contribution of pension under
IGNOAPS is `200/- per month per beneficiary up to 79 years and `500/- per month per
beneficiary from 80 years onwards and the State Governments may contribute over and
above this amount. According to the Ministry of Rural Development, more than 2.85 crore
senior citizens were receiving social pensions under the NSAP as of December 2020.
Besides this, India’s policy response to population ageing encompasses multiple programs,
schemes, and laws which include social protection, financial security, and healthcare
service provisions for senior people, especially those belonging to socio-economically
vulnerable groups. The provisions, schemes, programs, and other initiatives for the welfare
of the elderly are mentioned very briefly in Box 2. (See Annexure 5 for detailed initiatives
for senior citizens by the various ministries and departments of the Government of India.)
Box 2: Senior Care Support Framework in India
Constitutional
Provisions
o Article 41: Right to work, to education, and to public assistance in certain cases
- 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 disable-
ment, and in other cases of undeserved want
o Article 46: Promotion of educational and economic interests of Scheduled Castes,
Scheduled Tribes, and other weaker sections
- Other weaker sections include the elderly, disabled, etc.
o 7
th
Schedule of the Indian Constitution
- Item No. 9 of the State List and item 20, 23 & 24 of the Concurrent List relates
to the old age pension, social security and social insurance, and economic
and social planning
- Entry 24 in the concurrent list deals with “Welfare of Labour, including con-
ditions of work, provident funds, liability for workmen’s compensation, inva-
lidity and old age pension and maternity benefits.
Legal
Measures
o Section 20 of the Hindu Adoption and Maintenance Act, 1956 makes it an obliga-
tion to maintain an aged parent
o Under Section 125 of the Criminal Procedure Code, elder parents can claim mainte-
nance from their children
o Section 88-B, 88-D & 88-DDB of the Income Tax Act allow senior citizens to claim
a discount in tax
o The Maintenance and Welfare of Parents and Senior Citizens Act, 2007
o NALSA (Legal Services to Senior Citizens) Scheme, 2016
Policy Supporto National Policy for Older Persons (NPOP) Senior Care Reforms in India 25
Welfare
Schemes &
Programmes
o National Social Assistance Program (NSAP)
- Indira Gandhi Old Age Pension Scheme (IGNOAPS)
- Indira Gandhi National Disability Pension Scheme (IGNDPS)
o Atal Vayo Abhyudaya Yojana (AVYAY)
- Integrated Program for Senior Citizens (IPSrC)
- State Action Plan for Senior Citizens (SAPSrC).
- Rashtriya Vayoshree Yojana’ (RVY)
- Livelihood and Skilling Initiatives for Senior Citizens
- Promoting silver economy
- Channelizing CSR funds for elderly care
o National Program for Health Care of the Elderly (NPHCE)
o Pradhan Mantri Vaya Vandana Yojana
o VayoMitra – Ayush Geriatric Healthcare Services under Ayush Public Health Pro-
grams (National Ayush Mission)
o National Council of Senior Citizens (NCSrC)
o Rashtriya Vayoshri Yojana (RVY)
o Varishtha Pension Bima Yojana
o Atal Pension Yojana
o Ayushman Bharat – PMJAY
o Ayurswasthya Yojana
o Senior Able Citizens for Re-Employment in Dignity (SACRED)
o Action Groups Aimed at Social Reconstruction (AGRASR Self-Help Groups)
o Senior care Ageing Growth Engine (SAGE)
o Annapurna Scheme & Antyodaya Anna Yojana
Other Welfare
Measures
o National Helpline for Senior Citizens i.e., Elder Line with toll-free number 14567
o Senior Citizens’ Welfare Fund
o Vayoshreshtha Samman
o Accessible India Campaign (Sugamya Bharat Abhiyaan)
o E-Anudaan Portal
o Seats reserved in buses, railways, and metro trains
Overall, the government has taken foundational affirmative steps for the welfare of senior
citizens, but its presence across the various domains of senior care remains limited.
Further, the senior care segment is currently fragmented across a range of other providers
such as voluntary and philanthropic organizations, NGOs, private providers, and industry
associations (see Annexure 6). The government, therefore, has a crucial role in providing
guidance and regulatory space to ensure accountability and quality of services provided
by NGOs and private providers.
Moreover, the COVID pandemic, with its disproportionately higher impact on the elderly
population, exposed the gaps and issues in the existing policy framework for the elderly.
The pandemic has highlighted the need to review our basket of schemes and programs
towards the changing context and needs of the elderly. Further, policymaking needs
to embrace various strategies to promote the engagement and participation of senior
citizens in the development process, for an “inclusive ageing experience”. Senior Care Reforms in India 26
1.5 Key Issues and Challenges
This section briefly summarizes the challenges faced in providing comprehensive senior
care in India across the domains of Health, Social, Economic, and Digial Inclusion. The key
challenges in empowerment, service delivery response, and inclusion in senior care are
elaborated in this section. Figure 5 presents a summarized overview of these challenges.
• Lack of a comprehensive and integrated
package of services
• Elderly care infrastructure gap
• Paucity of trained manpower
• Need for an evidence-backed geriatric
diseases knowledge repository
• Limited financing of care for the elderly
• Inadequate emergency response
infrastructure
• Need for enabling frameworks and
monitoring mechanisms
• Insufficient focus on hygiene-related
issues
• Fragmented and narrow social
support system
• Limited awareness regarding their
rights and provisions available
• Changing family structure and loss
of social support
• Social inequality
• Inadequate elderly-friendly
infrastructure
• Inadequate R&D activities
• Contribution and challenges of
care workers neglected
• Need to ensure digital literacy
among seniors
• Insufficient access to digital
goods
• Paucity of digital training
modules for the elderly
• Unaffordable digital equipment
and limited broadband
connections
• Need for universal and
comprehensive financial systems for
old age security
• Insufficient levels of financial literacy
• Deficient support in lifetime financial
planning
• Financial abuse and fraud
Health
Inclusion
Social
Inclusion
Economic
Inclusion
Digital
Inclusion

Figure 5. Key challenges and issues around senior care in India
1.5.1 Health Domain
Lack of a
comprehensive
and integrated
package of ser-
vices
o Fragmented approach to Service Delivery
- Quality healthcare for the elderly remains a challenge as multiple
service providers, who continue to work in silos are involved in
providing that care
21
like nursing agencies, physiotherapists, and
medical suppliers. Further, most providers are small in scale or
unorganized, extending only a sub-optimal quality of care.
o Gap in the availability of specific healthcare goods and services for
the elderly in an integrated manner
- Non-availability of targeted immunization programs for the elder-
ly under national immunization programs
- Need to extend mental health services like counselling, psychiat-
ric support, etc., to elderly
- Need for focused attention on the elderly nutrition
- Crucial to scale up innovations and availability of assistive devices
- Need to prioritize home-based care models to ensure service de-
livery within the comforts of one’s own home and community Senior Care Reforms in India 27
21 https://www.indiatimes.com/health/healthyliving/did-you-know-about-these-challenges-old-people-face-every-day-242817.html
Eldercare Infra-
structure Gap
o Mismatch between demand and supply of care & support institutions:
- The Maintenance and Welfare of Parents and Senior Act, 2007 has
a provision that State Governments may set up at least one old age
home in every district to house 150 senior citizens. However, less
than 500 districts have old-age homes as per the report submitted
by the Standing Committee on Social Justice and Empowerment
in 2021.
- As portrayed earlier, the maximum number of the elderly
population is staying in rural India (71%), and there is a serious
deficiency in the models of senior care in rural areas.
- Moreover, the existing housing structures are not ready to cater to
the needs of elders.
o Tertiary care services dependent on the private sector :
- Senior care continues to be dependent on private tertiary care
centres. Holistic senior care infrastructure, customized to the
special needs of elderly people, is inadequate. Services to seniors
are usually delivered through internal medicine or other relevant
departments. Further, dedicated senior care centres (medical and
non-medical) are predominantly located in urban areas, though
the majority of senior people reside in rural areas.
Paucity of trained
manpower and
adequate exper-
tise to support the
healthcare needs
of seniors
o Insufficient focus on geriatric healthcare :
- The Health system, at present, is focused on RMNCH, communica-
ble diseases, and NCDs, with low priority for geriatric care.
o Limited manpower :
- India has 7.35 physicians and 17.48 nurses and midwife personnel
per 10,000 people, vis-à-vis a global physician and nurse density
of 16.37 and 39.53, respectively (2020).
22
It indicates that India is
facing a shortage of skilled personnel, which is leading to poor
quality of care and overcrowding of facilities.
- Besides the limited senior care workforce, there is an acute short-
age of home-health care workforce and home-based services be -
cause there are very few clinicians to meet the medical needs of
the homebound elderly.
- Moreover, at present, the healthcare workforce is trained to re-
spond to acute illness and communicable diseases, with a low pri-
ority on workforce training on palliative and end-of-life care.
22 https://www.who.int/data/gho/data/themes/topics/health-workforce Senior Care Reforms in India 28
Need for an
evidence-
backed
geriatric
disease
management
knowledge
repository
o The rising incidences of NCDs, chronic diseases, falls, etc. among the
elderly require rigorous research, while R&D activities in geriatric care
remain limited. Some potential research gaps in the field of senior
care services in India:
- Limited research on the health and well-being of elderly popula-
tions, including research on age-related illnesses, mental health,
neuro-degenerative diseases, and chronic conditions.
- Limited research on nutritional aspects of ageing, including prev-
alent nutritional deficiencies and disorders caused by them, opti-
mum nutritional supplementation, etc.
- Insufficient research on the impact of technology on senior care
and how technology can be used to improve senior care services,
including the use of wearable devices, telehealth, and other digital
tools.
Limited financ-
ing of care for
the elderly
o Senior people have long-term healthcare needs with high health ex-
penditures, particularly OOPE. Maximum non-medical care and out -
patient care of the elderly are financed out of pocket. Thus, funding
remains one of the most important aspects of senior care to address.
Thus, there is a need to focus on developing adequate methods for
financing the healthcare needs of the elderly.
o Moreover, Senior Care Health Insurance has a very shallow penetra-
tion (only 18%) with a poor pay-out history. Insurance companies, with
their cumbersome process of documentation, complex eligibility cri-
teria, and profit-driven approach, further limit the access to insurance
for the elderly, and that too at a time when their health costs are rising.
Inadequate
Emergency
response infra-
structure
o While the government has put in place a general emergency response
infrastructure like ambulances, trauma units, etc., a tailored emergen-
cy response infrastructure especially customized for senior citizens,
is not given due attention. With increasing numbers of senior people
living alone, 24-hour access to emergency facilities, lesser response
time, and support like public geriatric ambulances are imperative.
Need for en-
abling frame-
works and
monitoring
mechanisms
o Paucity of regulatory frameworks:
- The senior care infrastructure is emerging in various models, but
there are no national standards or quality checks for senior care
services in India, leading to poor service delivery. Further, the ab-
sence of regulatory and monitoring frameworks to ensure uniform,
holistic, and quality geriatric care in the private sector makes pri-
vate healthcare goods and services unaffordable and inaccessible
to the elderly. Senior Care Reforms in India 29
23 Status of Social Security and Social Protection Floors in India, Report by Age Well Foundation
Insufficient fo-
cus on Hygiene
related issues
in seniors
o Some of the specific hygiene problems that elderly individuals include:
- Bathing and showering: Many elderly individuals may have diffi-
culty bathing or showering due to mobility issues or fear of falling.
This can lead to body odor, skin infections, and other hygiene-re-
lated problems.
- Dental hygiene: As people age, their teeth and gums become
more prone to decay and infection. Elderly individuals may also
have difficulty brushing or flossing properly, which can lead to bad
breath and dental problems.
- Incontinence: Incontinence is a common problem among elderly
individuals, and it can lead to issues with hygiene and skin health.
Those who suffer from incontinence may have difficulty keeping
their skin clean and dry, which can lead to rashes and other skin
infections.
- Foot care: Elderly individuals may have difficulty reaching and
caring for their feet, which can lead to foot odor, fungal infections,
and other foot-related problems.
1.5.2 Social Domain
Narrow and
inadequate
social security
system
o Limited scope of social security nets:
- Only a small part of India’s elderly population is covered by the public
social security systems. The majority of the elderly population is retired
from the unorganized sector and is not covered by social security.
23
Fur-
ther, LASI notes that a mere 8% of people above 60 are covered under
any work-related pension.
o Gaps in the implementation of social security schemes & programs :
- Although the Government has implemented several well-crafted policies
and laws still; most of them are ineffective due to poor execution, defi-
cient knowledge, and various other administrative, social, and geograph-
ic barriers. For instance, as low as 12% the elderly people are aware of the
Maintenance and Welfare of Parents and Senior Citizens Act 2007 and
the Annapurna scheme.
Limited
awareness
among the
elderly re-
garding their
rights and the
provisions
available to
them
o The limited awareness among elderly people about various provisions and initia-
tives available for their welfare excludes them from various social security nets. An
awareness study conducted in 2019 revealed that 57% of the elderly population
had a moderate level of awareness, whereas 39% of the elderly population had a
poor level of awareness regarding benefits & provisions available to them.
24
There-
fore, elderly people should be empowered and informed, and their contribution
needs to be endorsed at all levels – family, society, and nation.
o Various polls and surveys have been conducted on ageing in India, such as Hel-
pAge India’s “State of the Elderly in India” report, India Today-Karvy Insights Mood
of the Nation poll, Global Age Watch Index, National Sample Survey’s 60
th
round
on “Health and Morbidity” and 71st round survey on “Social Consumption: Health,”
and their results highlight the lack of awareness among people regarding various
government initiatives and programmes for senior care.
Senior Care Reforms in India 30
Changing fam-
ily structure
and loss of
social support
o It is often witnessed that elderly people prefer to stay with their families and
communities based on various research across cultures.
25
The 2011 Census
data revealed that there had been a significant increase in the number of
households with 1 to 4 members and a decline in households with 5 and
above,
26
indicating a shift towards nuclear families. This shift is likely to cause
mental, physical, social, and financial insecurity among elderly people in the
years ahead.
Social
Inequality
o Regional Divide :
- A study conducted in 2021 reported considerable rural-urban inequality
disfavoring rural residents. Healthcare utilization was percentage points
higher among the older population residing in urban India than their rural
counterpart
27
, indicating the presence of a rural-urban divide among the
elderly population.
o Gender-based disparity and inequality :
- Various studies indicate that older male adults are more likely to experi-
ence healthy ageing than female older adults. A large share of this gen-
der gap in health status can be attributed to gender discrimination driven
by the patriarchal structure of our society. In a study, at the 10th percen-
tile, 55.68% of the gender health status gap was due to discrimination,
and the contribution of discrimination to the total gap increased among
older adults in the higher percentiles.
28

o Other socio-economic inequalities :
- The elderly people are also subject to similar discrimination that the
broader society faces and their age further compounds the negative ef-
fects of such discrimination on their health and overall well-being. For
instance, stats in LASI highlight that more than 80% of the elderly be-
longing to the Scheduled Tribes are working in agriculture and allied ac-
tivities, indicating their exclusion from work-related pension schemes.
Inadequate el-
derly-friendly
infrastructure
o The lack of accessible physical infrastructure is a major barrier to the social
inclusion of elderly people. Basic facilities like accessible transportation, dis-
abled-friendly toilets, accessible buildings, wheelchairs, ramps, wide doors,
and elevators to enable unrestricted mobility are either missing or not main-
tained properly, thereby limiting the access of seniors to public places.
24 https://www.ijhsr.org/IJHSR_Vol.9_Issue.6_June2019/38.pdf
25 https://www.walshmedicalmedia.com/open-access/levels-of-lonelines-and-family-structure-amng-geriatrics-2475-319X-1000135.pdf
26 https://journals.sagepub.com/doi/10.1177/21582440211008178
27 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10773-1
28 https://events.development.asia/system/files/materials/2021/09/202109-healthy-ageing-and-gender-gap-india-evidence-longitudinal-
ageing-study-india-wave-1-final_0.pdf Senior Care Reforms in India 31
Insufficient
R&D activities
o Various socio-economic issues around ageing like isolation and loneliness,
restricted mobility, and socio-economic disengagement, require developing
a thorough understanding; so that adequate response mechanisms can be
mapped out. Some gaps in the research landscape in senior care are:
- Lack of research on the experiences of caregivers, including family mem-
bers and professional caregivers, to identify the challenges they face.
- Lack of research on the efficacy of different senior care models, includ-
ing institutional care, home-based care, and community-based care, to
understand which model is most effective in addressing the needs of the
elderly population.
- Limited research on the impact of social and economic factors on senior
care, such as poverty, education, and social isolation, on the delivery and
effectiveness of senior care services in India.
- Insufficient research on the needs of specific subgroups within the elder-
ly population, such as those living in rural areas, those with disabilities,
and those from marginalized communities, to ensure that senior care ser-
vices are tailored to meet their unique needs.
Contribution
and challeng-
es of care
work and
care-workers
remain ne-
glected
o Contributions of care-workers remain unrecognized: Care work and care
workers remain undervalued and underpaid in India. Care work is often
viewed as a low-skilled job and is mostly performed by women. Although the
COVID-19 pandemic has highlighted the crucial role that care workers play in
providing essential services to the elderly and other vulnerable populations,
there is scope for further empowerment and capacity building, particularly
in countries like India, where the need for care workers is high but resources
are limited.
o Various challenges faced by caregivers remain unacknowledged: Caregiv-
ing for elders can be a challenging and demanding task, both physically and
emotionally. Elderly care requires a significant amount of time, effort, and re-
sources, and can impact the well-being of caregivers. Some of the difficulties
caused by the care of elders include:
- Physical Demands: Caring for elders can involve physically demanding
tasks such as lifting, bathing, and assisting with mobility, which can be
challenging for caregivers, particularly if they are elderly themselves.
- Emotional Stress: Caregiving can cause emotional stress, particularly if
the elder has a chronic illness or requires extensive care. Caregivers may
also experience feelings of guilt, frustration, and depression.
- Financial Burden: Elderly care can be expensive, particularly if the elder
requires long-term care or specialized services. Caregivers may have to
bear the cost of medical bills, transportation, and other expenses.
- Social Isolation: Caregiving can be a full-time job, which can cause care-
givers to become socially isolated. They may have little time to socialize
with friends or participate in leisure activities.
- Time Management: Caregiving can be a time-consuming task, and care-
givers may find it challenging to balance the needs of the elderly with
their own personal and professional obligations. Senior Care Reforms in India 32
1.5.3 Economic Domain
Need for a
universal and
comprehensive
financial
support
system for old
age security
o On the one hand, the elderly are assumed to be ‘less productive’ and expect-
ed to retire from work, and on the other, provisions like pensions and health
insurance are inadequate, pushing them into financial insecurity. Less than
20% of the elderly population is covered with any health insurance and near-
ly 78% of them remain without any pension cover. Also, a major part of the
healthcare expenses of the elderly are financed out of pocket and a majority
of seniors are devoid of any regular source of income due to their disengage-
ment from economic activities. Thus, a universal and comprehensive financial
security system needs to be envisaged for seniors due to their increased vul-
nerability to a financial crisis.
Insufficient
levels of
financial
literacy and
awareness
about
available
financial
avenues and
schemes
o Financial Illiteracy:
- Over 76% of the adult population still lacks a fundamental comprehension
of financial concepts.
29
A 2019 report revealed that only around 25% of
adults aged 50-69 years and around 23% of adults aged 70-80 are consid-
ered financially literate.
30
This indicates that the awareness about financial
security schemes is very low among the elderly and it has emerged as a
significant challenge over the years.
o Digitalization of financial services
- As the shift towards digital financial services continues, low financial and
digital literacy levels can increase the likelihood of exclusion among the
elderly; and may further threaten their financial security in old age.
Deficient
support
in lifetime
financial
planning
o Many adults reach old age without sufficient savings, insurance, or public or
private pensions to live on or to fund long-term care. Nearly 70% of the el-
derly are dependent for everyday maintenance on family & relatives
5
. As a
result, many older adults may find it difficult to manage everyday living costs.
Some mitigate this uncertainty by continuing to work in old age, attempting
to borrow money to cover any shortfall, or relying on family members or so-
cial assistance where available.
Financial
Abuse and
Fraud
o Elder financial abuse has received recognition as a growing socio-economic,
and public health problem. The WHO estimates that 6.8% of people aged 60
years or over are subject to financial abuse,
31
including fake investment oppor-
tunities, phishing, fake prizes, lottery scams, and Advance-fee frauds. Older
persons have more financial resources than their younger counterparts, and
other factors, such as a higher prevalence of social isolation, cognitive impair-
ment, etc.; make them more vulnerable to financial exploitation.
29 https://www.ibef.org/blogs/india-s-growing-financial-literacy
30 https://ncfe.org.in/images/pdfs/reports/NCFE%202019_Final_Report.pdf
31 https://www.oecd.org/finance/Financial-consumer-protection-and-ageing-populations.pdf Senior Care Reforms in India 33
32 https://journals.sagepub.com/doi/full/10.1177/0973258619872085
33 Kumar, S., Kumar, K.A. Living Arrangement and Economic Dependency among the elderly in India: a Comparative Analysis of EAG and
Non EAG States. Ageing Int 44, 352–370 (2019). https://doi.org/10.1007/s12126-019-9344-3
1.5.4 Digital Domain
Need to en-
sure digital lit-
eracy among
seniors
o According to an Age Well Foundation Survey, approximately 85.8% of respon-
dents were digitally and computer illiterate. Out of this, 76.5% were elderly
men, and 95% were elderly women. While the government’s National Digital
Literacy Mission (NDLM) aims to empower at least one person per household
with crucial digital literacy skills, the elderly population seems to be missing
from the plan. Digital illiteracy has emerged as the most crucial issue leading
to the digital gap among older people.
Insufficient
digital access
o Senior citizens comprise almost 8.6% of the country’s population, and less
than 3% are Internet users.
32
Further, the wide disparity between older and
younger people in terms of internet usage can be explained partially because
older people may not have the financial means to pay for digital equipment.
Overall, 72% of the elderly are economically dependent on others (spouses,
children, or relatives).
33
Moreover, broadband services can be cost-prohibi-
tive, particularly for low-income and fixed-income elders.
Paucity of
digital training
modules for
the elderly
o A Help Age India analysis of the elderly released in August 2020 indicates
a tremendous increase in the age-related digital divide after the pandemic.
Though many urban seniors have access to smartphones and other digital
devices, they do not know how to use them beyond the basics. Thus, elderly
people need to be equipped with the required skills needed to access the dig-
ital environment through well-resourced digital empowerment and inclusion
packages with tailor-made training and support.
1.5.5 Fostering Inter-sectoral Convergence
While India has recognized the concerns around population ageing at the policy level,
certain emergent areas of senior care still require inter-linkages to create an integrated
and comprehensive response to senior care, by bringing in seamless convergence among
all stakeholders. The NPOP (1999), later renamed as NCSrC, also recommends that people,
families, communities, organizations from civil society, and the private sector must work
together as partners and the state should not be left alone to achieve the goals of the
policy; thereby underlining the need for an inter-sectoral convergence.
There are many stakeholders and providers in the senior care ecosystem who continue to
function for the welfare of the elderly but in silos, thereby limiting the scope for holistic
and integrated care for the elderly. These stakeholders include the following:
• The central government, along with the Ministry of Social Justice & Empowerment as
the nodal ministry and other line ministries, including:
1. Ministry of Health and Family Welfare
2. Ministry of Ayush
3. Ministry of Finance
4. Ministry of Rural Development
5. Ministry of Consumer Affairs, Food & Public Distribution
6. Ministry of Textiles
7. Ministry of Personnel, Public Grievances, and Pensions
8. Ministry of Home Affairs Senior Care Reforms in India 34
9. Ministry of Railways
10. Ministry of Road Transport and Highways Surface
11. Ministry of Civil Aviation
12. Ministry of Housing & Urban Affairs
13. Ministry of Labour and Employment
14. Ministry of Law & Justice
15. Ministry of Agriculture and Farmers Welfare
• State Government and its departments,
• International agencies,
• Not-for-profit organizations, and
• Private providers.
Further, due to the federalized nature of senior care policies, service delivery is broadly
fragmented and the states are expected to fund these initiatives and are also made
responsible for their successful execution. Also, because the effective implementation
of senior care policies and programs is mostly left to the states, their implementation
remains uneven and inadequate.
Although the government has designed various enabling policies and programs for the
welfare of the elderly, much remains to be done to address the emerging needs of the
elderly in a comprehensive and integrated manner.
Further, it is crucial to bring a continuum across primary, secondary, and tertiary healthcare
centres to cater to the special needs of the elderly and to improve geriatric care at all
levels by creating inter-linkages among them.
Synergies between the voluntary sector and the government need to be explored for
better health and socio-economic outcomes in the elderly population. The NGOs can be
used to train village-based caregivers and generate awareness among the elderly and
caregivers on self-care, healthy and productive ageing, intergenerational bonding, etc. It
will not only lessen the burden on the government but will also lead to better outcomes.
The health care service delivery remains scattered across the private providers. So, it
becomes important to bring a seamless convergence among all the stakeholders, including
TPAs and insurers, labs, pharmaceuticals, private hospitals and clinics, wellness centres,
and Ayush practitioners.
Thus, there is a vast scope and need for inter-sectoral, inter-ministerial, and inter-stakeholder
convergence and linkages at all levels to provide comprehensive and integrated elderly
care and service delivery (See Figure 6). Senior Care Reforms in India 35
Figure 6. Healthy and inclusive ageing through convergence among stakeholders Senior Care Reforms in India 36 Senior Care Reforms in India 37
SECTION 2:
SENIOR CARE TRANSFORMATION
– SERVICE DELIVERY PRIORITIES
To ensure comprehensive senior care, there is a need to identify and ensure all aspects
of care for seniors, which may include but are not limited to health, social, financial, and
digital dimensions. The service delivery priorities for seniors under these dimensions are
given in Table 2.1 .
Table 2.1. Service Delivery Priorities for Seniors
HEALTHSOCIALECONOMICDIGITAL
- Managing chronic/ acute ill-
ness through a comprehen-
sive package of services,
including the following:
o Early Detection and
Treatment
o Focus on preventive in-
terventions like Adult im-
munization to deal with
immunosenescence
o Promoting physician-pre-
scribed physical activity
o Ensuring recommended
nutritional intake
o Enhancing functional in-
dependence through re-
habilitative services and
assistive devices
o Ensuring palliative and
long-term healthcare
services, along with pain
management
o Promoting mental health
services
- Increasing health aware-
ness
- Capacity building of medi-
cal professionals and care-
givers
- Realigning existing health-
care infrastructure towards
geriatric healthcare
- Promoting R&D in geriatric
care
- Developing a com -
prehensive social se-
curity system to en-
sure seniors’ access
to basic facilities
- Strengthening legal
awareness
- Encourage communi-
ty-based support
- Developing engage-
ment opportunities
for seniors
- Developing Acces -
sible Physical Infra-
structure
- Build and strengthen
provisions for Assist-
ed Living Facilities
(ALFs)
- Creating occupa -
tional opportunities
to utilize their expe-
rience and expertise
- Promoting financial
literacy
- Widening scope and
coverage of pension
products
- Designing special
health insurance
products to reduce
OOPE
- Expand and diversi-
fy financial security
nets
o Tax benefits and
senior discounts
o Strengthening the
reverse mortgage
mechanism
- Promoting digi -
tal literacy among
seniors as well as
their caregivers
- Adoption of digital
tools and ensuring
access to digital
devices
- Enhancing ease
& safety of digital
operation
- Developing en -
abling digital infra-
structure Senior Care Reforms in India 38
HEALTHSOCIALECONOMICDIGITAL
- Exploring synergies be-
tween the public and pri-
vate sectors through PPP in
geriatric healthcare
- Scaling up digital health in-
terventions
Based on the above table, the service delivery priorities for seniors are detailed below.
2.1 Health - Comprehensive and Integrated Senior Care
Package
Integration of healthcare delivery to include nutritive, preventive, promotive, curative,
rehabilitative, mental, dental, ophthalmological, and palliative services. A continuum of
support should be evolved that includes all aspects of senior care, such as medical care,
non-medical care, long-term support, and end-of-life care for a more holistic ageing
experience. This usually requires a comprehensive assessment to comprehend the unique
needs of seniors. Based on individual assessment, a customized and targeted plan can be
prepared, which is shared across all providers to optimize service delivery.
Key aspects of health inclusion are provided below:
8Increase Awareness to ensure adequate uptake of healthcare services for early
identification, prevention, and management of chronic conditions. Targeted and
continued support towards adopting positive health behaviors such as regular physical
activity, proper nutrition, and micro-nutrient supplementation. The potential of modern
technology must be explored for imparting health education to the elderly as well as to
their care-givers.
8Emphasize early detection for better management of both acute and chronic diseases
through population based screening of seniors and regular monitoring systems.
• Expand the network and reach of diagnostic services related to common chronic
conditions like high blood pressure and cholesterol, oral cancer, cervical cancer,
dementia, Parkinson’s, diabetes, dental and ophthalmologic issues, etc., among
the elderly through the provision of mobile screening centres.
• Establish robust monitoring systems, especially for neuro-degenerative dementia
and other age-related disorders. Although, the World Health Organization (WHO)
has developed the Global Dementia Observatory, and similarly, the National Institute
of Mental Health and Neurosciences (NIMHANS) in Bangalore has also established
the Indian Dementia Observatory; there is a need to strengthen the network of these
monitoring systems to help in identifying and tracking the progression of these
conditions, as well as providing timely and appropriate care for those affected.
8Preventive Measures
• Focus on Adult Immunization , especially in seniors with co-morbidities and
multi-morbidities, to decrease their predisposition towards contracting various
communicable diseases and NCDs. Senior Care Reforms in India 39
• Focus on immunity-boosting interventions for seniors to deal with
immunosenescence i.e., decline in immunity with age. Promotion of preventive
interventions based on the Ayush system of medicines to enhance general wellbeing
among the elderly is also critical.
• Address the hygiene-related issues among the elderly by encouraging assistance
from caregivers or family members, along with the use of adaptive equipment,
such as shower chairs or grab bars, to make bathing and showering easier and
safer. Positive hygiene practices like regular hand washing, brushing and flossing
teeth, and wearing clean clothes should be inculcated among elderly individuals to
prevent illness and maintain their overall health and wellbeing.
8Promote physical activity and Yoga, especially for active seniors, to enhance their
physical health, functional abilities and mobility, mental well-being, and quality of
life, thereby ensuring an active and independent ageing experience. This requires a
multi-faceted approach that includes education about the benefits, community-based
activities like group exercise programs, home-based exercise programs, expanding the
network of open-air gyms in public parks, and advocacy.
8Encourage nutritional guidance services for seniors as well as their caregivers to address
various issues around geriatric nutrition like obesity, nutritional deficiencies, electrolyte
imbalances, lifestyle-based diseases, etc. Ensuring a balanced diet among seniors for
delaying/decreasing the onset of various chronic diseases and for the maintenance of
overall health. Provisions for nutritional supplements, such as vitamin D, vitamin B12,
calcium, zinc, proteins, magnesium, probiotics, etc., to supplement the nutritious diet
and under the guidance of a healthcare professional must be made to fulfill the nutrient
requirements and prevent deficiencies among the elderly.
8Enhance functional independence through rehabilitative care like physiotherapy,
therapies from the Ayush system, assistive devices, etc. Restoring mobility among
seniors through the provision of assistive devices to compensate for age-related
functional losses among them. These devices can play a crucial role in improving the
care of seniors by helping them with various activities of daily living, enhancing their
mobility, and ensuring their safety (see Annexure 7 for details). Assistive devices for
elderly care may include the following:
• Mobility aids: Devices such as walkers, walking sticks, canes, orthosis and
prosthesis, and wheelchairs can help seniors move around more easily and safely.
These devices can also prevent falls and injuries.
• Personal emergency response systems (PERS): PERS can help seniors in case of
an emergency. These devices usually come in the form of a wearable pendant or
bracelet and allow seniors to call for help at the push of a button.
• Medication reminders: There are various devices available that can help seniors
remember to take their medications on time. These medical alert devices can be
as simple as a pillbox with reminders or as advanced as a smart pill dispenser that Senior Care Reforms in India 40
dispenses medication at the right time.
• Smart home technology: Smart home technology such as smart thermostats,
smart lights, and smart door locks can help seniors manage their homes more
easily. For example, smart lights can turn on automatically when a senior enters a
room, and smart door locks can be controlled remotely, allowing family members
to check on their loved ones.
• Hearing and visual aids: Hearing aids and visual aids can help seniors who have
difficulty hearing or seeing. These devices can improve the communication abilities
of seniors, thereby enhancing their quality of life.
8Support palliative and end-of-life services to help seniors and their caregivers with
pain management and symptom control, ensuring quality and dignified end-of-life care.
Supporting these services is crucial for ensuring that individuals receive compassionate
care during their final stages of life. This can be done by involving local NGOs and
volunteers, along with collaborating efforts that involve healthcare providers, home-
based care providers, caregivers, community organizations, and policymakers.
8Extend mental health services like counseling and psychiatric support to senior people
as well as to their caregivers to help them deal with various emotions like feelings of
helplessness, isolation, stress, and anxiety; and to improve their overall well-being and
quality of life. Improving the access and affordability of mental health services through
various provisions like transportation facilities, tele-health options, at-home counselling,
and financial assistance for those who cannot afford these services, etc., is also crucial.
Further, efforts should be made to address the stigma around mental health through
constructive collaborations with community organizations and by encouraging family
involvement.
8Capacity building healthcare professionals and caregivers: Workforce development
and sensitization of medical professionals to augment their skills and competencies
throughout the value chain of geriatric care is essential to improve health and wellness
outcomes among the elderly population. A trained and skilled cadre of home-based
care providers to cater to the care demands of the elderly needs to be developed.
Further, capacity building should be prioritized among primary caregivers in families
to equip them with the required skills, knowledge, and information. Additionally,
healthcare providers should also be trained to recognize and address various mental
health concerns among elderly patients to ensure that they receive appropriate mental
health services in a timely manner.
8Strengthening and realigning the existing healthcare infrastructure towards geriatric
healthcare, so that healthcare services can be delivered in an efficient and time-sensitive
manner to seniors.
• Expand the package of services available for senior people within the primary
healthcare system to include every aspect of senior care, right from prevention to
palliation. Senior Care Reforms in India 41
• Integrating primary healthcare centres and facilities with other service providers
like Ayush service providers/dispensaries, physiotherapists, psychologists,
dieticians, rehabilitation experts, etc. to provide more holistic and comprehensive
care for the elderly.
• Pooling of existing infrastructure by combining resources from different healthcare
organizations, such as hospitals, nursing homes, home health agencies, Ayush
centres, etc., to create a more coordinated and efficient system of care.
8Develop and encourage home-based care models as an alternative and supplement
to institutional care, in order to ensure the access and availability of personalized care
services for seniors within the comfort of their own homes. Home healthcare providers
can provide direct assistance with ADL and IADL. Further, they can provide training
to seniors and their caregivers in senior care like teaching them the use of various
monitoring and assistive devices, helping them in managing medication schedules, etc.
Apart from being a cost-effective care model, home-based care also reduces the risk of
infections among the elderly that can occur in nursing homes or assisted living facilities.
8Promote R&D in geriatric care: Expand and strengthen the knowledge and evidence base
in geriatric care. Undertake rigorous research in specific thematic areas like degenerative
diseases (dementia, Alzheimer’s, Parkinson’s), NCDs (hypertension, cancer, diabetes,
cardio-vascular diseases, stroke, osteoporosis, etc.); dental and ophthalmologic diseases,
nutritional deficiencies & lifestyle-based diseases, communicable diseases, Ayush, etc.
which are relevant to senior care. Disseminating the learnings among key stakeholders
for the development of evidence-based integrative treatment modalities is also vital.
8Explore synergies between the public and private sectors through PPP in geriatric
healthcare to develop low-cost healthcare delivery models/practices for filling the
infrastructure gap.
• Developing partnerships with the private sector through various PPP models to
encourage private medical care at discounted prices to senior persons across the
medical care cycle, from consultation to diagnostics to treatment. Private sector
engagement should also be explored in providing home-based care to the elderly.
• Move beyond PPP to PPC, i.e. Public-Private-Community, to include the community
members in key decisions regarding senior care. Community involvement can be
used for the development, implementation, and evaluation of health services for
seniors. Community support can ensure and enhance the sustainability of healthcare
delivery strategies/models.
8Invest in technology, and scaling up of e-health to improve the access and affordability
of care and support services to senior people. Incentivizing digital health technologies
like internet-based care, remote patient monitoring, wearables, digital assistive devices,
medication management, etc., for chronic health monitoring and management.
• Utilizing the potential of telemedicine for providing healthcare services to the Senior Care Reforms in India 42
elderly who may have difficulty in accessing in-person care due to various mobility
issues or other health conditions. Telemedicine can also be useful for seniors
residing in rural or remote areas, who may not be able to travel to far-off healthcare
facilities for accessing care services.
2.2 Social Empowerment and Inclusion
Senior people require special care and attention due to their increased vulnerability to
various physiological, psychological, and socio-economic problems. Recognizing the same,
the government has evolved its legal and policy framework for seniors. Various enabling
provisions like the ‘Integrated Action Plan for Senior Citizens’ and the ‘Maintenance and
Welfare of Parents and Senior Citizens Act (MWPSC), 2007’; have been laid to ensure the
social and legal rights of elders. However, due to various socio-economic barriers, these
remain insufficient and underutilized.
Increased social engagement and participation of seniors to ensure a more cohesive
community; and an enduring network of family, friends, and caregivers. Further, increased
awareness regarding the legal provisions is required to reduce the likelihood of violence and
abuse among seniors. Additionally, it is important to challenge the negative stereotypes
about ageing and to promote a more positive view of ageing that values the contributions
of older adults in society.
Some key aspects of social and legal empowerment of the elderly for their complete
inclusion are given below:
8Develop a Comprehensive and Integrated Social Security System for seniors through
a multi-pronged approach, involving the government, private sector, and civil society
organizations; to ensure their access to basic facilities like food, housing, sanitation
facilities, etc. Expanding the scope and coverage of existing social security nets is also
crucial.
• Targeted and customized social support programs for seniors to address their
unique and varied needs
• Shifting from a welfare-based approach to a rights-based approach, where social
security provisions are made available to seniors as a matter of right.
8Strengthen legal awareness to inform elderly persons of their rights. Encouraging
community-led efforts and campaigns to raise awareness of various social security
benefits among seniors as well as their care-givers is essential to increase their utilization
of various social services available to them. Sensitization of community members,
police, and neighborhood welfare committees through online resources, workshops,
seminars, community programmes, etc., is also vital. Further, the government could
establish specialized courts or legal aid clinics for the speedy disposal of complaints of
senior citizens relating to abuse, violence, and fraudulent dealings.
8Encourage community-based support and care services for seniors. Community care can
help seniors in accessing care and support services while staying in their communities,
surrounded by family, friends, and others. Promoting community involvement through
the provision of ‘community fellows’ or ‘care fellows’; who can assist seniors with Senior Care Reforms in India 43
transportation facilities, legal formalities, and documentation, which are required to
access various social security provisions.
8Increase engagement opportunities for seniors – especially for those living alone,
widowed, homeless, etc. – to ensure their continued engagement and socialization for
a fruitful ageing experience. Increasing the participation of seniors to make sure that
they aren’t marginalized through the following measures:
• Encouraging community participation/social responsibility undertaken by
seniors
• Sensitizing community members about the contribution of the elderly to society
• Networking among the elderly through Octogenarian clubs, Centenarian clubs,
Hobby clubs, Senior Citizens Associations, Social Support Groups, etc.
• Healthy and active engagement through recreational and sports activities like
laughing clubs, activity clubs, and Yoga Centres
• Promoting community-led initiatives to address issues of social isolation and
loneliness; and enhancing inter-generational transmission of expertise to help
the younger generation through various engagement initiatives
8Developing accessible physical infrastructure as per the specialized needs of seniors
to enhance their engagement with the wider community.
• Age-friendly infrastructural changes to improve accessibility in residential
buildings, public spaces, market places, public toilets, and means of transportation
• Reserve lower floors in residential societies for senior citizens
• Provision of reservation of lower berths in trains for seniors
• Ensuring easier access to assistive devices such as wheelchairs along with
wheelchair-accessible ramps in public places
• Smart Housing, driven by digital technologies like Artificial Intelligence and the
Internet of Things (automatic stove controllers, fire detectors, fall sensors, etc.)
8Build and strengthen provisions of Assisted Living Facilities (ALFs) like adult day-
care facilities and residential care facilities. ALFs can assist seniors with their daily
living activities while their primary caregivers are at work. These facilities might also
be employed to provide caregivers with a temporary break from their caregiving
responsibilities. ALF may include health-related services like medication management,
nursing, etc., along with social services like housekeeping, laundry, recreation, meals,
and assistance with other ADL.
2.3 Economic Empowerment and Inclusion
The current ageing scenario is likely to increase the financial vulnerability among the senior
people in India. Although the government has laid down a range of social and financial
security provisions for seniors, their actual utilization remains low. Further, the current
senior care financing is largely focused on funding medical care, with limited attention to Senior Care Reforms in India 44
non-medical care and healthy ageing.
34
In order to move towards financial empowerment and inclusion , ensuring financial
security among seniors through various enabling and support provisions is essential,
along with measures to extend subsidies and tax benefits to seniors to promote adoption
and adherence to positive financial behaviours.
Key dimensions of economic and financial inclusion are given below:
8Create alternative employment opportunities like training, teaching, advisory and
consulting roles, work-from-home roles, etc., for seniors, so that their vast experience
and expertise can be adequately utilized. Extending their economic participation will
ensure their meaningful engagement with society along with financial security. The
SACRED portal developed by the Ministry of Social Justice and Empowerment is one
such initiative for the re-employment of able elders.
35
Further, work opportunities like
remote work, freelancing, involvement in NGOs, job training, etc. can be explored for
seniors who want to continue working but prefer to work from the comfort of their own
homes with flexible work options.
8Expand financial literacy to promote healthy financial behaviours among seniors and to
help them make informed decisions about their finances. This can be achieved through
education and awareness campaigns, simplification of financial terms, utilizing digital
technology, financial counseling, community partnerships, etc. Designing targeted
financial literacy campaigns for seniors to increase their uptake and utilization of
financial products is also essential. Further, it is important to build capacities around
the use and utilization of financial products to help them manage their finances more
responsibly and to caution them against financial fraud and scams.
8Design a comprehensive public pension system to guarantee access to basic minimum
facilities for seniors, which may include but not be limited to:
• Developing age-friendly micro-pension products with flexible payment and
withdrawal options to help seniors in their post-retirement years
• Increasing the uptake and penetration of pension products through various
government incentives like an equal contribution by the government, tax
exemptions, higher returns, etc.
• Extending pension programs to cover disadvantaged and more vulnerable seniors
like women and seniors working in the unorganized and informal sector, etc.
• Leveraging JAM Trinity (Jan-Dhan, Aadhar, Mobile) for streamlining the delivery of
pension products
8Provision of a comprehensive and universal geriatric insurance which includes both
medical as well as non-medical care. Expanding the scope and coverage of existing
insurance products to cover provisions of home care, institutional care, assisted living,
long-term care, care related to degenerative diseases like dementia and Alzheimer’s,
outpatient costs, etc.
34 https://iussp.org/sites/default/files/event_call_for_papers/T.V%20Sekher-IUSSP%20pdf.pdf
35 https://sacred.dosje.gov.in/ Senior Care Reforms in India 45
Key aspects:
• Incentivize geriatric health insurance and address insurance companies’ hesitancy
in providing insurance products to seniors because of their deteriorating health
• Leverage PPP in the insurance sector to build comprehensive, targeted, and tailored
insurance products for seniors as per their unique needs
8Expand and diversify financial security nets to ensure financial support to seniors in
their sunset years. This may include:
• High-yielding investment opportunities and long-term saving plans to incentivize
the habit of savings among seniors;
• A strengthened and simplified reverse mortgage mechanism to help seniors with
their financial requirements, saving them from financial distress;
• Tax incentives and relaxations in income tax to seniors;
• Senior discounts on senior care products like geriatric ambulance services, home
care services, assistive devices, etc., to enable faster penetration of such products
and services.
2.4 Digital Empowerment and Inclusion
One of the most important lessons from the COVID-19 pandemic was the need to address
the digital divide among the elderly population. Digital empowerment has the potential
to connect people and has gained global recognition as a driver of social and economic
inclusion, especially among seniors. Recognizing the same, “Digital Equity for All Ages”
was decided to be the theme for the United Nations International Day of Older Persons
in 2021.
36
It reaffirmed the elderly’s need for access and participation in the digital world.
Ensuring the reach and coverage of digital tools and services to senior people is key
towards their digital empowerment and inclusion. It is also important to understand the
penetration of technology among seniors, their current use of digital tools, and barriers in
accessing these digital technologies in order to develop focused strategies.
Some key aspects of digital empowerment of the elderly for their complete inclusion in
the digital world are given below:
8Digital Literacy Campaign: Ensuring timely and accurate information to senior people
as well as their caregivers regarding the use of digital platforms, along with cautioning
them against online risks and fraud is crucial to increase their uptake of digital tools.
It is vital to identify the specific needs and challenges of seniors concerning digital
technology.
• Addressing the lack of trust among seniors related to the use of digital devices
• Addressing seniors’ negative attitudes and anxiety around smart gadgets
• Designing user-friendly and easy-to-understand instructional materials, including
video tutorials, step-by-step guides or hands-on training sessions, online learning
modules, etc., to enhance digital skills among seniors.
36 https://www.un.org/development/desa/ageing/2021-unidop-digital-equity-for-all-ages.html Senior Care Reforms in India 46
• Collaborating with local organizations to enhance the reach of digital literacy
campaigns to a wider audience.
8Increasing the uptake and adoption of digital tools by making their access cheaper
and easier through various measures like senior discounts
• Ensuring a smooth digital experience for seniors through larger screens, bold
letters, simpler interfaces with larger app icons, etc.
• Ensuring installation and maintenance support of digital devices
• Ensuring continuous support to seniors who might require additional assistance or
have questions regarding the use of digital tools.
8Designing user-friendly digital infrastructure for catering to the various needs of the
elderly like telemedicine, e-banking, etc.
• Developing digital platforms to encourage the engagement of younger people
with seniors, bridging the inter-generational gaps
• Encouraging digitally enabled living through developing age-friendly digital
service delivery platforms like telemedicine, e-pharmacies, online grocery delivery,
e-banking, e-payments, online cabs, etc.
• Developing a One Stop-Senior Citizens App to link multiple services, products, and
information for elderly users
• Ensuring the safety and security of seniors through digital tools like location
tracking services, emergency buttons on phones, smart-watch alerts, etc.
• Developing digital assistive devices like speech-to-text systems, audiobooks, smart
home devices, etc.
8Develop a digital safety mechanism to ensure the ease & safety of digital operations,
especially among seniors, who may not be as familiar with technology and the
potential risks associated with it. Further, it is crucial to encourage seniors to adhere
to basic internet safety guidelines, such as creating strong passwords, enabling two-
factor authentication, installing anti-virus software on digital devices, not clicking on
suspicious links, avoiding downloading unknown attachments, and not sharing personal
information with strangers online; to save them from online frauds and attacks.
• Toll-free numbers to assist seniors with digital tools
• Speedy disposal of senior citizens’ complaints relating to online fraudulent dealings
The aforementioned service delivery priorities are designed to give seniors the support and
assistance they need for their healthcare, social, financial, and digital inclusion in society.
To maximize the intrinsic and functional abilities of seniors and to ensure them a dignified
and inclusive ageing experience, an inter-sectoral, inter-ministerial, and inter-stakeholder
convergence, cross-cutting across various aspects of senior care, must be sought. Senior Care Reforms in India 47
SECTION 3:
WAY FORWARD
In order to achieve comprehensive senior care, a paradigm shift is required that is focused on
the needs of the senior people, bringing various stakeholders, both public and private sector,
through the continuum of care, in delivering quality care to support holistic wellness and
address the priority areas listed in the previous section. This will ensure comprehensive senior
care, where seniors receive all required services and care.
Recognizing senior care as a sector with appropriate regulations and standards, policy support,
tax structures, availability of subsidized financing, and appropriate governance mechanisms
need to be undertaken. Policy and regulatory reforms with a clear evaluation framework need
to be implemented to strengthen the elderly care program to be more outcome-oriented.
The government has initiated several strategies under numerous welfare schemes and programs
across various dimensions for senior citizens. These initiatives can be better implemented
through coordinated efforts by several Ministries and Departments of the Government of India.
The Ministry of Social Justice and Empowerment, being the nodal ministry for senior care,
needs to take an anchoring role in close coordination with other line ministries, including the
Ministry of Health & Family Welfare, Ministry of Finance, Ministry of Ayush, Ministry of Rural
Development, and others. Further, many other organizations like Panchayati Raj Institutions,
Urban Local Bodies, Non Governmental Organizations and private providers are also working for
elderly care (see Annexure 6 for details) but in their limited capacities. Hence, coordinated and
complementary efforts, by bringing in inter-convergence across all stakeholders, are required
to implement these programs in an effective, efficient, and time-bound manner (Figure 7).
Health
Ministry of Social
Justice and Empow-
erment.
Ministry of Finance.
Ministry of Health &
Family Welfare.
Ministry of Ayush.
Financial
Ministry of Social
Justice and Empow-
erment.
Ministry of Finance.
Ministry of Rural Devel-
opment.
Ministry of Textiles.
Department of Pension
and Pensioners
Welfare.
Social
Ministry of Social Justice
and Empowerment.
Ministry of Finance.
Ministry of Consumer Af-
fairs, Food, and Public
Distribution.
Ministry of Home Affairs.
Indian Railways.
Ministry of Civil Aviation.
Ministry of Housing and
Urban Affairs.
Ministry of Road Trans-
port & Highways.
Digital
Ministry of Social
Justice and Empow-
erment
Ministry of Health &
Family Welfare.
Ministry of Finance
Empowerment, Service Delivery, and Inclusion for Seniors
State and UT Governments, Panchayati Raj Institutions, Urban Local Bodies, NGOs, and Private Players
NITI Aayog: Inter-Sectoral Convergence, Monitoring, and Nudging the States
Figure 7. Inter-convergence among various stakeholders for senior care Senior Care Reforms in India 48
It is necessary to facilitate convergence between various Ministries/ Departments, and other
stakeholders. It is vital to nudge the States/UTs for implementing various mandates assigned
to them as per various central Acts and welfare schemes for senior citizens in a time-bound
manner.
Given the demographic transition, by 2050, collectively, 19% of India’s population will
comprise senior citizens that would need a senior care support system. India, therefore,
requires a well-thought-out action plan that allows the emergence and development of
such a senior care ecosystem. The following focus areas need to be intensified with a
strategic & outcome-oriented approach:
3.1 Efforts to Ensure Health Empowerment and Inclusion
A proposed model for healthy & active ageing in India should focus on enabling the elderly
to remain independent and healthy as they age. To achieve the same, a tailored service
delivery plan should be mapped out based on their specific needs and preferences. A
trained health worker/provider should be able to conduct a standardized healthcare needs
assessment for the elderly to customize their package of services. An indicative list for
needs assessment, is given below in Table 3.1 .
Table 3.1. An Indicative List for Healthcare Needs Assessment
Information category Objective
Basic health status To capture basic information like patient’s age, weight, height, and com-
mon vitals at home/institution
Medical history To list the patient’s past & current medical diagnoses, surgeries, hospital-
izations or other medical conditions, ongoing medications & procedures,
immunization status & allergies, if any (should cover all aspects of physical
& mental health), and ABHA registration
Risk assessment Risk evaluation for fall risk screening, pain assessment & scoring
Nutritional status and
needs
Information on preferred /prescribed diet type & restrictions, medical con-
ditions limiting/enhancing diet, any difficulty faced during eating, chew-
ing, swallowing, etc.
Hearing, speech, vision,
and sleep
Basic information on vision, hearing & speech challenges & abilities, sleep-
ing patterns & quality of sleep
Functionality
assessment
To evaluate the level of functional independence and to measure the mag-
nitude and type of mobility restrictions
Continuity and
transition
Physical activity (type, intensity & duration), emotional well-being, conti-
nuity at work, overall health rating by patient
Personal goals and
expectations
Patient health & wellness goals, health motivation, any additional remarks/
concerns that patients wish to share
Based on the above assessment, an integrated and comprehensive healthcare ecosystem
should be developed and designed by the government with the following focus points:
1. Promote health literacy among seniors as well as their caregivers to enhance their
understanding of geriatric health issues and related risks. Additionally, there is a need
to inform them of the various healthcare programs and provisions available for the Senior Care Reforms in India 49
elderly to promote the penetration and utilization of health services among them. To
augment health literacy among the elderly, there should be a special focus on using
plain and simple language, along with providing accessible formats. Digital technology
like mobile applications and specifically tailored health education programmes may be
used to promote health literacy among the elderly.
2. Strengthen Comprehensive Primary Healthcare Services through the Ayushman
Bharat – Health and Wellness Centres initiative: Provisions for screening and
management of common NCDs, including cancer, have been made at the primary
healthcare level. Screening of the senior population for age-specific disorders like
dementia, Parkinson’s, fall tendency, etc., needs to be included in the comprehensive
assessment plan for the elderly. The existing packages of services like rehabilitative
services, including physiotherapy, palliative services, etc., need to be strengthened.
Moreover, the package of services under CPHC should be further expanded to include
the following packages for fall tendency, psycho-social services, and post-menopausal
gynaecological health services for elderly women:
a) Provide Fall Prevention Package: A fall prevention package, including regular
physical activity, home safety modifications, and medication review, to prevent falls
should be included in the CPHC program to address the high incidence of falls
among the elderly.
b) Provide Women’s Health Package: A women’s health package should be included
in the CPHC program to address the unique health needs of women, especially those
residing in rural areas. This package can include post-menopausal gynaecological
health services for issues like fibroids, cysts, hot flashes, genital prolapse, etc.;
breast and cervical-uteri cancer screening services; orthopedics services to deal
with issues like osteoporosis, etc.
c) Provide Psycho-Social Support Package: A psycho-social support package,
including counselling services, online therapy services, access to support groups,
and mental health professionals, should be included in the CPHC program to address
the mental health needs of the elderly population.
3. Expand tele-consultation services: Currently, the provision of tele-consultation services
has been made at the primary healthcare level. However, there is a need to expand
the coverage and scope of these services for the senior population through outreach
efforts, health camps, home-based care, mobile medical units, and other accessible
platforms in order to bring care closer to their homes. This requires a comprehensive
telemedicine strategy that addresses the issues surrounding the accessibility and
affordability of technology, along with the provision of additional support services like
remote technical support or telehealth navigators.
4. Focus on strengthening healthcare infrastructure with a focus on senior needs.
a) Develop a framework for setting up senior care facilities and operations to
ensure sustained high-quality services. While developed nations have a regulatory
framework, enabling the establishment of senior care facilities, there are no model Senior Care Reforms in India 50
acts or guidelines in terms of minimum standards for setting up senior care facilities
or home operations in India. There is a need to develop legal provisions, SOPs,
and guidelines at the Central and State levels to facilitate the development of
independent senior care facilities at block, district, and state-level hospitals. There
is a requirement to set up independent geriatric hospitals, research centers, and
health facilities in all the States/UTs with an added focus on rural and remote areas.
b) Making specific provisions for geriatric healthcare within existing healthcare
infrastructure for catering to their unique healthcare needs. Special provisions like
separate beds, queues, and facilities for senior citizens need to be developed in
both public and private sector hospitals. Ayush services and infrastructure also
need to be better utilized for senior care. NHP-2017 also recognizes the growing
need for palliative and rehabilitative care for all geriatric illnesses and advocates
the continuity of care across all levels. The same needs to be ensured in a mission
mode. Further, NHP-2017 also advocates that most drugs and diagnostics should be
free or subsidized at the tertiary care level, at least for in-patients and outpatients
in geriatric and chronic care segments. The same needs to be ensured at all levels.
5. Enhance skilled workforce for elderly care: Human resources for health (HRH) is
identified as one of the core building blocks of a health system (WHO 2006). The WHO
Global Strategy on Human Resources for Health highlighted that investment in HRH
can deliver a triple return of improved health outcomes, global health security, and
economic growth. Although the geriatric workforce shortage affects all care settings,
it is especially critical in home-health care, partly because we are starting with far too
few clinicians to meet the medical needs of the homebound elderly. Currently, the
health workforce is trained to respond to pressing health needs associated with acute
illness and communicable diseases rather than proactively anticipate and counter
changes in people’s intrinsic capacity (physical and mental). Moreover, the geriatric
component within the current medical education and training landscape has not been
given a prominent place. See Annexure 8 for the existing landscape of training and
certification courses in geriatrics.
Figure 8. Workforce required for senior care
Figure 8 illustrates the workforce requirements in order to address the gaps in senior care
provision. Key interventions that need to be employed to achieve an appropriately trained
workforce in senior care:
»Train all healthcare professionals in gerontology and geriatrics
»Include core geriatrics competencies in all health and medical curricula
»Match the supply of geriatricians to the population’s needs, and develop geriatric units Senior Care Reforms in India 51
to manage complex cases.
»Introduce new workforce cadres and extend the roles of existing staff to act as care
coordinators and self-management counselors.
»Ayush human resources can be skilled and utilized in senior care, especially for
preventive care, NCDs, and nutrition-related issues. Department of Jara Chikitsa
(Geriatrics) can be started in Ayurveda academic institutions for making specific
provisions for geriatric healthcare within existing healthcare infrastructure.
»Creating a cadre of personnel trained in home-based care
»Periodic capacity building and training of CHOs/MOs/Mid-level health providers at
primary level needs to be strengthened
»Capacity building of family members and primary caregivers on identifying early signs
of dementia, deafness, declining visual capabilities, mobility, cognitive abilities, etc.
A large presence of an under-skilled but practicing health workforce in India, if leveraged
strategically, could boost the country’s overall health system. The bridge between the
under-skilled to the skilled workforce could be achieved through effective education and
training programs, as shown in Figure 9.
Figure 9. Capacity building for medical personnel
Hence, there is a need to develop training institutions that are dedicated to training
personnel in senior care industry requirements. The efforts of the Department of Social
Justice and Empowerment (DoSJE) and the National Institute of Social Defense must
be appreciated in this regard in setting up training centers for geriatric care programs.
It is essential to increase partnership possibilities between academic bodies, senior care
institutions, and senior care service providers to enhance the supply of trained resources
in the sector. NHP-2017 also recognizes the need to develop specialized nursing training
courses and curricula for palliative care and the care of terminal illnesses. Senior Care Reforms in India 52
6. Increase accessibility of services –
a) Home Health Care is an emerging area that includes health care services provided
by both skilled (physical therapy, nursing care, doctor visits) and non-skilled medical
(companion and personal care activities, assistance with ADL, transportation, etc.)
professionals in the comfort and convenience of the home. The demand for home-
based care is expected to increase manifold in the coming years. Although home-
based care models offer great potential for improving healthcare, it’s also critical to
carefully evaluate and mitigate their risks. Therefore, regulatory provisions must be
developed to define the scope and standards of services to safeguard consumers.
Moreover, their effective implementation needs to be prioritized.
b) Poshan Abhiyan for Senior Citizens to address their specific nutrient requirements,
as envisaged by the Ministry of Social Justice and Empowerment, needs to be
operationalized in a mission mode. Further, it is crucial to work closely with the
Ministries of Health and Family Welfare, Women and Child Development, and
Ayush for framing guidelines and nutritional packages for the elderly; so that the
recommended estimated energy requirements (EER) for various essential macro
and micro-nutrients for the elderly can be ensured.
37
Provisions for nutritional
supplements under the guidance of a suitable healthcare professional should be
made to fill any nutritional gaps in the diet (see Annexure 9 for details).
c) Mental Health Services: Although we have the National Program for Health Care
of the elderly in place, there is immense scope for integration and strengthening
of mental health services, particularly neurological and substance use conditions
among seniors. Further, focusing on the mental health of the elderly within the
existing mental health services ecosystem is required to address the increasing
burden of mental illness on the elderly population. It is also crucial to increase the
awareness of various mental health conditions among the elderly as well as their
caregivers through community outreach programs, and informational sessions,
along with the promotion of regular mental health check-ups to identify potential
mental health issues at early stages. Finally, specialized geriatric mental health
training is also crucial for skilling the human resources involved in the same.
d) Ensure emergency response infrastructure and services for senior citizens. While
we have a general emergency infrastructure in place, targeted efforts should be
made to make the existing infrastructure more sensitive to the healthcare needs
of seniors. Timely availability of ambulance services with Basic Life Support and
Advance Life Support care for senior citizens must be ensured. Further, a needs
assessment can be carried out to identify the specific needs of senior citizens
and gaps in the current emergency infrastructure. Based on that assessment, a
comprehensive geriatric emergency response plan should be mapped out that
outlines the emergency response infrastructure and services to be put in place to
support senior citizens during emergencies.
37 ICMR-NIN Expert Group on Nutritional Requirements for Indians, Recommended Dietary Allowances (RDA) and Estimated Average
Requirements (EAR). ICMR-National Institute of Nutrition. 2020 Senior Care Reforms in India 53
38 Indian Guidelines for Vaccination in Older Adults. Geriatric Society of India. 2015
39 Expert Group of the Associaton of Physicians of India on Adult Immunization in India. The Association of Physicians of India Evidence-
based Clinical Practice Guidelines on Adult Immunization. J Assoc Physicians India. 2009; 57:345-356
40Tandon, RN, Ravindra, W, Monga, VK. Life Course Immunization Guidebook. A Quick Reference Guide. Indian Medical Association
e) Harness the potential of technology for enhancing the accessibility and affordability
of health care services. Assistive devices, medication reminders, emergency alarm
systems, fall detectors, virtual assistants, and smart health monitoring services
through wearables to track individual health and its linkage to ambulance and
hospital services, in order to deliver adequate healthcare interventions without
losing time.
f) Ensure the availability of rehabilitation services like physiotherapy along with
palliative and end-of-life services. There is a need to improve the infrastructure
needed for providing these services, like rehabilitation centers, equipment, etc.,
along with the training and capacity building of healthcare professionals such as
physiotherapists, nurses, etc., in specialized areas of care such as palliative care and
end-of-life care.
7. Incentivize preventive health – health checks, annual health assessments, vaccinations, etc.
a) Periodic screening to assess the levels of decline in functional ability & mental
capabilities, along with regular check-ups to screen for common geriatric issues.
Efforts like educating the elderly about the benefits of these screenings, providing
them with regular reminders, family involvement, and transportation services to
the screening centres should be used to ensure that the elderly can attend these
screening appointments.
b) Elderly immunization for vaccine-preventable diseases is also an important area
that requires immediate attention. Strengthen immunization under the NPHCE
for preventable diseases like pneumonia, influenza, pneumococcal diseases,
herpes zoster, tetanus, diphtheria, pertussis, etc., as per the recommendations and
guidelines of various leading societies in India, such as the Geriatric Society of
India,
38
the Association of Physicians in India
39
, Indian Medical Association
40
, etc.
(see Annexure 10 for details).
c) Harness the potential of Ayush for the prevention of diseases and wellness
interventions. Ayush practices can be integrated into the conventional medicine
system and treatment plan to promote its use among the elderly. Further, there
is a need to conduct thorough research on the effectiveness of Ayush treatments
for preventing various NCDs and other chronic conditions among the elderly by
partnering with various research institutions.
d) Promote a healthy lifestyle through physical activities, yoga practices, Ayurveda
Aahar, and a nutritious diet for maintaining their physical health, functional
independence, mobility, mental health, and overall well-being.
8. Strengthen research & setting up research institutions to enhance the knowledge
repository of geriatric healthcare.
a) A national senior care resource center, to focus on research. Such a center could Senior Care Reforms in India 54
be used to feed in continuous data for the formulation of evidence-based strategies
and policies and to provide knowledge and technical assistance for implementation.
b) Robust data repositories for capturing age-specific health issues, age disaggregated
NCDs screening and management, and OOPE data to serve as a solid evidence
base for formulating policy actions and plans.
3.2 Efforts to Ensure Social Empowerment and Inclusion
An integrated and comprehensive social support system must be envisaged by the
government for the social inclusion of seniors within the wider society. Although the
government has taken foundational steps by framing various enabling acts and welfare
schemes, their utilization remains low due to various socio-economic barriers. Thus,
tailored strategies need to be designed as per the social needs assessment of seniors, an
indicative list of which is given in Table 3.2 .
Table 3.2. An Indicative List for Social Needs Assessment
Information category Objective
Patient demographics
Capture information like patient name, age, gender, place of residence,
access to healthcare services, etc.
Family and Caregiver
situation
Evaluate family information (home support available) - the patient’s place
of residence, family members & caregivers, relevant family medical history
Activities of daily
living
Identify information on assistance required for activities of daily routine,
hygiene & grooming, mobility-related challenges, meal preparation & in-
take, getting in & out of bed, and patient’s main method of commuting
Social interactions and
patterns
Capture patient’s information on smoking habits, alcohol consumption,
and any other addictions, socialization patterns
Awareness levels
Assess awareness levels among seniors regarding various social and legal
provisions available for their welfare and protection
Based on the above assessment, a comprehensive social protection and inclusion
landscape, with the following focus areas need to be prioritized:
1. Awareness: Efforts need to be made to sensitize the larger community on the needs and
challenges experienced by the elderly, to facilitate their social inclusion. Concurrently,
efforts to empower the elderly through awareness of existing legal safeguards and
available welfare schemes, which specifically cater to their needs, are required to be
undertaken through workshops and seminars, legal clinics, online orientations, peer
support groups, flyers, and brochures, etc. Legal professionals or community leaders
can undertake these measures.
2. Elder for the elderly model: Establishing peer support groups where seniors can
exchange experiences and information about various issues. This can be a wonderful
way to create a community of support. Further, various participatory and inclusive
models of Self-Help Groups must be encouraged to address the various needs such as: Senior Care Reforms in India 55
a) Non-medical (mental health, emotional support, psycho-social support)
b) Age care (helplines, senior citizen care homes, daycare centers, physiotherapy)
c) Livelihoods (elder-self-help groups; linkages with government schemes)
d) Disaster Response (e.g., COVID19 relief response)
e) Advocacy and Awareness (on rights and policies relating to elders)
3. Legal reforms for the elderly concerns
a) Strengthening the existing Welfare and Maintenance Act to encompass the
components of abuse, harassment, protection, maintenance, and other support
specific to the elderly population. The amendments proposed in the Maintenance
and Welfare of Parents and Senior Citizens (Amendment) Bill, 2019, especially
regarding maintenance, maintenance amount, abandonment or abuse of senior
citizens, home care services, healthcare, police protection, and so on, are in line
with the recommendation described above. There is a need to expedite the process
of its notification.
b) The States need to ensure the availability of sufficient human resources, training,
and infrastructure for the disposal of pending cases in maintenance tribunals in a
time-bound manner.
For instance, the National Legal Services Authority (NALSA) under the NALSA
(Legal Services to Senior Citizens) Scheme, 2016 has made various enabling
provisions for ensuring legal aid and advice to senior citizens, but the senior citizens’
eligibility for these free legal aids depends on the rules framed by the respective
State Governments in this regard. Thus, states need to be encouraged to set up the
required legal aid institutions or legal services clinics to ensure legal justice for all
senior citizens in a time-bound manner.
4) The elderly-friendly living/housing sector reforms
a) A participative regulatory framework should be developed to support the
development of the private sector and provide necessary market stewardship while
ensuring the highest quality of service delivery.
b) To widen the discussion on standards and accreditation and have a framework for
Quality Certifications and Accreditation of senior care facilities
c) Draft model bye-laws for the development of senior living in India
d) Availability of at least one care home and one multi-service day centre in each
district, along with defined minimum standards and provision for registration of
these facilities with defined regulatory authorities at the State level, is an immediate
requirement.
e) Support informal caregiving and encourage ‘ageing in place’ by enabling home
and community-based services and community-managed caregiving (example of
Palliative Care Societies of Kerala, Elders Self Help Groups in Tamil Nadu, Pondicherry,
Bihar, and West Bengal) for destitute elders. Senior Care Reforms in India 56
f) A single window approval for senior living projects: will expedite the pace of execution,
resulting in faster completion and possession, which is the prime need of seniors.
Typically, a 4–5-year development cycle is not a desirable condition for seniors.
5. A ‘one stop’ centralized portal: A national portal for senior care - must be developed
for senior citizens to provide easy access of services to them. The portal would act
as a citizen charter to disseminate important information to the population about
the available services, infrastructure, collection of data, conduct needs and means
assessments, provide training modules for caregivers, and create a grievance redressal
mechanism. The portal could also be used for filing online applications related to
maintenance. Further, provisions for tracking the progress of such applications need
to be given.
6. Promoting care economy for senior care: There is a need to recognize care work as
well as care workers in the senior care sector by ensuring their rights, emoluments,
and entitlements, especially for women, who continue to bear most of the burden of
care activities. Further, there is a need to bring the care economy under the regulatory
ambit for improving care policies, care service provisions, and ensuring decent working
conditions for care workers. Skilling activities and certificate courses for care workers
must be expanded to utilize the full potential of the care economy.
3.3 Efforts to Ensure Economic Empowerment and
Inclusion
An ideal financial inclusion landscape must include a robust pension and insurance
system, financial literacy, and enabling employment opportunities for the elderly. While
we have several financial security nets in place for seniors, their scope and coverage
remain limited. Therefore, the government should intensify and consolidate its financial
empowerment strategies to achieve the complete inclusion of seniors within the financial
sphere. Further, these strategies should be based on the financial needs assessment of
seniors, an indicative list of which is given below in Table 3.3 .
Table 3.3. An Indicative List for Financial Needs Assessment
Information Category Objective
Work StatusInformation on the occupational status, income levels, and retirement
benefits among seniors
Financial independence Identify the levels of financial independence among seniors and evalu-
ate the magnitude of their financial independence/dependence
Insurance penetration Assess insurance penetration among seniors to evaluate their vulnera-
bility to financial distress in case of an adverse health event
Based on the above assessment, an integrated and comprehensive financial protection and inclusion
ecosystem must be designed with the following focus areas:
1. Reskilling of the elderly population:
a) Initiatives to foster age-friendly labor markets and employment opportunities,
incentivizing the elderly population by reforming pension schemes and public Senior Care Reforms in India 57
benefits systems to stay in the labor markets, and utilizing reskilling platforms.
b) Incentivizing the private sector to introduce age-friendly employability opportunities,
especially in tech-based roles.
c) Encourage non-governmental organizations to focus on reskilling the elderly
population in technology-based roles.
d) Support to senior-owned businesses – easy financing, tax benefits & concessions.
2. Increase coverage of public funds and infrastructure –
a) Increase coverage of the PMJAY scheme to cover the entire elderly population and
increase its coverage to various non-medical and at-home needs.
b) Extending pension support to the elderly population from the unorganized sector
as well. There is a need to revise the pension amounts to account for inflation.
c) Mandatory needs and means the assessment for referral to high-cost institutional
care.
3. Mandatory savings plan for the affording segment: Since the social security framework
in India is limited, most seniors depend on the income generated from their savings.
Variable interest rates result in the erosion of their income, sometimes even below
sustenance levels. Therefore, a regulatory mechanism is required to set a viable base
rate for the interest accrued on senior citizen deposits. Giving a further concession to
older women will contribute to their financial well-being.
4. Encourage the private sector to design a targeted and comprehensive geriatric health
insurance product, including OPD consultation, diagnostic services, assistive devices,
dental and ophthalmological services, rehabilitative services like physiotherapy, Ayush-
based services, counselling services, telemedicine and telehealth services, home-based
care, palliative care, etc.
5. Increase liquidity and capital allocation to the senior care industry
a) Reverse Mortgage mechanism – The Government should reassess the Reverse
Mortgage mechanism to increase liquidity for seniors and by making necessary
amendments to the current reverse mortgage rules.
b) Tax and GST reforms, etc., on senior care products to increase the ease of adoption
and safeguard the elderly population from the financial burden.
6. Protection from financial fraud - There is a need to increase awareness regarding
different types of financial fraud that the elderly population may be more susceptible
to using various means. Further, ensuring accessibility to safeguards against the
possibilities of such financial fraud and expedited redressal mechanisms is critical.
3.4 Efforts to Ensure Digital Empowerment and Inclusion
Recognizing the opportunity in digital disruption & fostering innovations that help scale
big & fast will help make the Indian senior care ecosystem truly future-ready. Governments,
private companies, and non-profit organizations can play a crucial role in providing Senior Care Reforms in India 58
digital devices, internet connectivity, and digital literacy training to seniors. Inspired
by innovations in the global senior consumer market, large companies and startups in
India have begun to design innovative solutions for this market. Further interventions and
strategies for digital empowerment and inclusion of seniors should be designed as per the
needs assessment, an indicative list of which is given in Table 3.4.
Table 3.4. An Indicative List for Digital Needs Assessment
Information Category Objective
Digital literacy levels Assess and capture digital literacy levels among seniors
Digital penetration Record information related to the adoption, access, use, and penetra-
tion of digital tools and devices by seniors
Based on the above assessment, a robust digital inclusion ecosystem must be designed
with the following priority areas:
1. Improving access to digital devices for seniors by making them affordable through
various means like senior discounts. Further, the hesitancy and reluctance of senior
people concerning digital technologies need to be addressed. Additionally, developers
can design digital products and services that are accessible and user-friendly for
seniors. By addressing the digital needs of seniors, we can ensure that they are not left
behind in the digital age and can lead healthy and fulfilling lives.
2. Focus on increasing digital literacy, especially among the elderly population, through
targeted campaigns, workshops, self-help groups, and non-governmental organizations
to improve digital adoption.
Efforts such as setting up community-based centers in rural and urban areas to
provide such workshops at the community level may be undertaken. Identification
of Digital Champions is a highly effective and sustainable way of delivering digital
skills – an individual who is a registered member of the program at respective Centers,
has undertaken the required online courses, and volunteers to engage, support, and
encourage older people to develop their digital skills and confidence. The themes of
these workshops could encompass –
»Mobile phone essentials, such as apps and settings
»Voice control of mobile devices
»Using map apps
»Social media apps
»Photo and video apps
»Making safe and secure digital operations
»Tele-consultation
»Online shopping
3. Efforts should be made to harness the potential of modern technology like artificial Senior Care Reforms in India 59
intelligence, the internet of things, big data, and machine learning to take charge of
routine procedures. Adequate support should be extended to startups, innovations &
entrepreneurship in the senior care space to create a digital-ready workforce & seniors
should be among the priority areas of the government to promote and further digital
transformation in the elderly care segment.
3.5 Engaging the Private Sector and CSR Avenues in
Increasing Coverage
Bringing in the private sector players will play a crucial role in ensuring that the government’s
objectives in the eldercare area are met effectively, efficiently, and economically. It will
create opportunities for the development of the private sector for strengthening eldercare,
contribute to the development of the local economy and employment, and ensure the
interests of the elderly population are served.
Areas for the involvement of the private sector could be –
1. To add new capacity – building new facilities, institutions, and solutions, and
introducing innovative models of care integration & service delivery
2. To augment existing capacity – building specialized services in conjunction with
public facilities, refurbishing, equipping, and operating existing public facilities, or
elevating public capabilities with digital tools, expertise, etc.
3. In areas where public facilities are limited – such as emergency response services,
digital services, education, and training services, etc.
Various modes and mechanisms to incentivize the involvement of the private sector in the
senior care ecosystem could be:
1. Strengthening the PPP model for senior care: The PPP model in India needs a
robust implementation framework and governmental support to ensure a balanced
division of risks & rewards, and to boost participation by non-governmental players.
The collaboration between private, government, and financial bodies like the existing
healthcare PPP model could support the development of private infrastructure and
enhance access to senior care facilities for all economic segments of seniors.
2. Channelizing CSR funds for elderly care: Earmarking CSR funds as a contribution
to national funds or for care provided to the non-affording category of seniors in
their facilities in lieu of concessional land, utilities, tax rebates, etc. E.g., the Hospital
scheme under Maharashtra Public Trusts Rules 1951.
Private sector synergies through Public Private Partnership (PPP) models and Corporate
Social Responsibility (CSR) funds can be explored in the following areas:
1. Elder care homes: Private companies can partner with the government to set up
elder care homes that provide accommodation, medical care, and other support
services to the elderly. CSR funds can be used to support the construction and
operation of such homes.
2. Mobile medical units: Private companies can sponsor mobile medical units that Senior Care Reforms in India 60
travel to remote and rural areas to provide medical care and screening services to
the elderly. These units can be staffed by trained medical professionals and equipped
with medical equipment and supplies.
3. Private sector Insurance: The possibility of integrated insurance for seniors, including
clinical and non-clinical needs, can be explored. International best practices on
bundled insurance products need to be explored to develop similar products in
partnership with insurance firms and the IRDA. Further, healthcare players are to
be engaged to define an internal “Senior Care master plan” to create inclusive,
affordable, and customized products and services for seniors. There is a need to
remove the insurance rider of a minimum waiting period to cover NCD for senior
citizens.
4. Health camps: Private companies can organize health camps for the elderly, where
they can receive free medical check-ups, screenings, and consultations. These
camps can be held in partnership with local hospitals or clinics and can be funded
by CSR funds.
5. Technology-enabled care: Private companies can develop and deploy technology-
enabled care solutions that help elderly people monitor their health, stay connected
with their caregivers, and access medical care remotely. These solutions can be
funded by CSR funds and can be developed in partnership with healthcare providers
and technology companies.
6. Skill-building programs: Private companies can sponsor skill-building programs for
caregivers and healthcare professionals who work with the elderly. These programs
can be developed in partnership with training institutes and can be funded by CSR
funds.
7. Advocacy and awareness campaigns: Private companies can launch advocacy and
awareness campaigns to raise awareness about the needs and challenges of the
elderly and promote policies and programs that support their well-being. These
campaigns can be funded by CSR funds and can be developed in partnership with
advocacy groups and healthcare organizations.
3.6 Fueling Innovations
Setting up incubation support to facilitate disruptive digital solutions: Prioritized support
to startups in the sector should be planned to pave the way for disruptive technology-
based solutions in terms of products and services.
In enhancing the institutional funding ecosystem, collaboration should be sought for
seeking patient capital (through Impact Funds) with a senior care focus rather than
traditional private equity routes. Social entrepreneurship is a vital component for achieving
the silver economy, and public policy should build enabling frameworks to help these
efforts flourish.
New, flexible models for careers and pensions can encourage people to work longer and
plan better for the future. If coupled with life-long reskilling and the adoption of smart and Senior Care Reforms in India 61
ANNEXURES
ANNEXURE 1: CONCEPT OF AGEING AND
SENIOR CARE
Global Perspective
The ageing of the population can be described as an increase in the number and
proportion of older adults in a population. Ageing is linked to physiological changes and
illnesses and has socio-economic and political consequences. Moreover, the experience
of ageing is diverse at an individual level due to different socio-economic backgrounds,
gender, place of residence, education level, family, and social support.
The diversified and varied experience of ageing across the nations makes it important to
take into account the global perspective around the concept of ageing.
WHO’s Framework for Healthy Ageing
The World Health Organization (WHO) defines health as “a state of complete physical,
mental and social well-being and not merely the absence of disease or infirmity.”
Along similar lines, WHO presented the concept of “healthy ageing,” according to which
“Healthy Ageing is developing and maintaining the functional ability that enables well-
being in older age.” Besides focusing on the absence of disease or illness, the concept
of healthy ageing places more emphasis on physical and mental capabilities, and the
creation of environments that support them.
The concept of healthy ageing is built on the concept of “Intrinsic Capacity and Functional
Ability,” as defined below.
Important Definitions with respect to Healthy Ageing Concepts
• Functional ability: It comprises the health-related attributes that enable people to be and to
do what they value. It is made up of the intrinsic capacity of the individual, relevant environ-
mental characteristics, and the interactions between the individual and these characteristics.
It includes a person’s ability to:
a) meet their basic needs;
b) learn, grow, and make decisions;
c) be mobile;
d) build and maintain relationships and;
e) contribute to society.
• Intrinsic capacity: It is a multidimensional indicator of health, which is defined as the combi-
nation of one’s physical and mental abilities, which enables the elderly population to continue
doing what they value most. It comprises cognition, mobility, psychological, vitality, and sen-
sory functions.
• Environment: It is understood in the broadest sense and includes physical, social, and policy
environments. It includes home, communities, and the broader society along with the people
and their relationships, attitudes, values, health and social policies, and the systems that sup-
port them.
41
41 WHO CLINICAL CONSORTIUM ON HEALTHY AGEING, NOVEMBER 21-22, 2017, GENEVA, SWITZERLAND. https://www.who.int/ageing/
health-systems/clinical-consortium/CCHA2017-backgroundpaper-1.pdf Senior Care Reforms in India 62
Unpacking key dimensions of Intrinsic Capacity, Functional Ability & Environmental Response
The interaction between intrinsic capacity, functional ability, and the prevailing environment
defines the experience of ageing for an individual. For instance, the ageing experience
related to mobility restrictions experienced by an urban elder would be different from a
rural elder with similar functional ability, as their environment would be diverse.
Concept of Senior Care in India
Recognizing the issues around population ageing, the MOHFW’s definition of ageing
promoted the concept of Active and Healthy Ageing, which is reflected in the operational
guidelines for the Elderly Care under the Health & Wellness Centres Initiative. The guidelines
envisage a mobility-based classification of the elderly people into three categories: Mobile
elderly, Restricted elderly (mobility only with personal assistance/device), and Bed bound
elderly (assistance required in some form/home-bound elderly for any reason and those
requiring palliative care or end of life care). Similar classifications are being used in the
assessment of high-risk elderly, who would be prioritized accordingly for service delivery
42
.
The “National Program for the Health Care of The elderly, 2010”, uses the term ‘senior
citizen’ and ‘the elderly’ for people aged 60 or more. NPCHE is a comprehensive plan for
health service delivery to seniors in India. It seeks to provide accessible, affordable, and
high-quality long-term dedicated care services to senior citizens. It aims to create a new
“architecture for ageing”, and build a framework to create an enabling environment for a
“Society for all Ages”.
Furthermore, “ageing in place” or “home-based care” is another policy response that has
emerged and gained prominence. It refers to an older person’s ability to live in their own
home and community safely, independently, and comfortably regardless of age, income,
or level of intrinsic capacity. This home-based care system is viewed as a better alternative
for the care of the elderly and has significant financial benefits in terms of healthcare
costs. Additionally, the global experience of living under a pandemic has led to the
widespread emergence of digital technologies, especially those related to telemedicine,
communication, and connectivity.
• Cognitive
• Psychological
• Sensory
• Neuromusculoskeletal
• Voice and speech
• Cardiovascular
• Haematological
• Respiratory
• Immunological
• Digestive
• Metabolic
• Endocrine
• Reproductive
Intrinsic Capacity Functional AbilityEnvironment
• Learning and applying
knowledge
• Communication
• Mobility
• Self-care
• Domestic life
• Interpersonal interactions
and relationships
• Major life areas
• Gainful employment and
financial security
• Community, social and civic
life
• Products and
technology
• Natural and built
environment
• Social support and
relationships
• Attitudes
• Services, systems and
policies to strengthen
financial and health
inclusion
42 https://nhsrcindia.org/sites/default/files/2021-06/Operational%20Guidelines%20for%20The elderly%20Care%20at%20HWC.pdf Senior Care Reforms in India 63
ANNEXURE 2: PRIVATE INSURANCE
PRODUCTS FOR SENIORS
S.
No.
Health Insurance
Package
Benefits
1.
Star Health Red
Carpet
• Offering extensive coverage with an increased entry cap of 65-75 years
• Premium: `4450-18000 (service tax excluded)
• Insurance Cover includes:
- In-patient hospitalization charges like ICU expenses, nursing ex-
penses, surgeon’s fees, specialist fees, cost of blood, oxygen, cost
of drugs, diagnosis, etc. are covered
- Pre and post hospitalization expenses of up to 7% are covered
- Emergency ambulance charges covered
- Treatment at network hospitals only
- Domiciliary treatment is covered
- No medical screening is required, and pre-existing diseases get
covered right from the first year
- 30 days initial waiting period with no coverage
- 24/7 toll-free helpline
- Direct in-house settlement
2.
National Insur-
ance Varistha
Mediclaim
• 60-80 years entry allowance
• Premium: For Mediclaim: `4180-6890 and for critical illnesses: `2007-
2288
• Insurance Cover includes:
- Hospitalization expenses, including nursing expenses, boarding
expenses, ICU expenses, nursing expenses, surgeon’s fees, cost of
blood, oxygen, cost of drugs, pacemaker, etc., are covered
- Domiciliary expenses covered
- Organ donor’s expenses covered
- Optional critical illness coverage
- Pre-existing diseases are covered right from the start with a 10%
extra premium Senior Care Reforms in India 64
S.
No.
Health Insurance
Package
Benefits
3.
Oriental Insur-
ance HOPE
• This insurance policy is designed for all senior citizens above the age of 60
• Premium: `4500-29000
• Provides a discount on the premium on voluntary co-payment
• Insurance cover includes:
- Hospitalization expenses, including boarding and nursing expenses
and ICU charges, doctor, surgeon, anesthetist, consultant or spe-
cialist’s fees, are covered
- Emergency ambulance charge is covered
- The cost of anesthesia, blood, oxygen, operation theatre charges,
surgical appliances, and diagnostic tests like X-rays are covered
- The cost of medicines, drugs, consumables, artificial limbs, and
prosthetic devices like a pacemaker is covered
- The benefit of domiciliary hospitalisation
4.
New India As-
surance Health
Insurance
• The entry-exit age gap is 60-80
• Premium: `3850-7650
• Insurance cover includes:
- Pre-hospitalisation expenses are covered for 30 days
- Post-hospitalisation expenses of 60 days are covered
- Hospitalisation expenses covered for treating injuries/illnesses
- Ambulance charges are covered
- Coverage is limited if the patient is hospitalised in a registered ho-
meopathic/Ayurvedic and Unani hospital or government hospitals
- Pre-existing disease coverage can be availed only if the patient has
continued the policy for at least 18 months with the company
- Pre-existing illnesses like diabetes mellitus and the issues associ-
ated with it, hypertension, etc., get covered after the policy has
continued for a minimum of 18 months, provided the additional
premium has been paid
• The sum assured can be either `1 lac and/or `1.5 lakhs depending upon
the preference of the customer. Senior Care Reforms in India 65
S.
No.
Health Insurance
Package
Benefits
5.
Bajaj Allianz
Silver Health
• Entry-age for the applicants is 46 to 70 years
• This is an annual plan with lifetime policy renewal
• The sum insured is on an individual basis
• Insurance coverage includes:
- Covers hospitalization expenses
- Pre and post hospitalization expenses equal to 3% of permissible
hospitalization expenses
- Ambulance charges up to `1000 per claim
- Pre-existing diseases are to be covered from the second year. Up to
50% of the sum assured amount will be reimbursed
- 130 daycare procedures are covered
- After 4 years policy period, free health-checkups at designated
diagnostic centers- including ECG, fasting glucose test, physician
consultation, lab tests, blood glucose test, cholesterol, chest X-ray,
and complete blood count
6.
HDFC ERGO
Health Optima
Senior Plan
• Entry – Any time after the age of 61 years.
• Once covered, the plan can be renewed for lifetime
• Cashless treatment facility
• Insurance coverage includes:
- In-patient Treatment
- Post Hospitalization
- Pre-Hospitalization
- Day Care Procedures
- Domiciliary Treatment
- Organ Donor
- Emergency Ambulance
- E-opinion Senior Care Reforms in India 66
ANNEXURE 3: KEY LEARNINGS FROM ACROSS THE WORLD
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Japan
-
Healthcare policy includes both Medical care (MC) & long-term care (LTC)

»
LTC services available 24/7 are assisted by trained & licensed care workers

»
Both MC & LTC are offered separately through distinct insurance systems. MC services are financed through the National Health Insurance (NHI) system; & LTCI was introduced in 2000, as a mandatory social program, where each person over 40 makes a contribution & all the people above 65 are eligible for benefits
43
-
“Healthy Japan 21 Program” to promote active ageing through smart walk, smart diet, smart breath (non-smoking) & smart check-ups
-
Launched Asia Health and Wellbeing Initiative (AHWIN) in 2016 in collaboration with other Asian nations to build an active & healthy society where people can live long, fruitful lives
-
“Community-based Integrated Care System” (CbICS), to build comprehensive up-to-the-end-of-life support services, including key elements of self-help, mutual aid, social solidarity care, & government care
-
Employment-tili-65 law for ensuring employment for the elderly to increase their productive years
-
Employees’ Pension Insurance program & National Pension Program with pension amount adjusted depending on the age at which payments begin. 44
-
Digital healthcare system that seamlessly combines technology & medical data.
-
New-age technologies like AI and Virtual reality, such as AI-driven wheelchairs that move on a pre-select
-
ed path; body sensors, and communication tools are driven by virtual reality, etc. to help elderly people live more independently
43 http://japanhpn.org/en/longtermcare/
44 https://cepr.org/voxeu/columns/japans-age-wave-challenges-and-solutions Senior Care Reforms in India 67
ANNEXURE 3: KEY LEARNINGS FROM ACROSS THE WORLD
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Japan
-
Healthcare policy includes both Medical care (MC) & long-term care (LTC)

»
LTC services available 24/7 are assisted by trained & licensed care workers

»
Both MC & LTC are offered separately through distinct insurance systems. MC services are financed through the National Health Insurance (NHI) system; & LTCI was introduced in 2000, as a mandatory social program, where each person over 40 makes a contribution & all the people above 65 are eligible for benefits
43
-
“Healthy Japan 21 Program” to promote active ageing through smart walk, smart diet, smart breath (non-smoking) & smart check-ups
-
Launched Asia Health and Wellbeing Initiative (AHWIN) in 2016 in collaboration with other Asian nations to build an active & healthy society where people can live long, fruitful lives
-
“Community-based Integrated Care System” (CbICS), to build comprehensive up-to-the-end-of-life support services, including key elements of self-help, mutual aid, social solidarity care, & government care
-
Employment-tili-65 law for ensuring employment for the elderly to increase their productive years
-
Employees’ Pension Insurance program & National Pension Program with pension amount adjusted depending on the age at which payments begin. 44
-
Digital healthcare system that seamlessly combines technology & medical data.
-
New-age technologies like AI and Virtual reality, such as AI-driven wheelchairs that move on a pre-select
-
ed path; body sensors, and communication tools are driven by virtual reality, etc. to help elderly people live more independently
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
China
-
Increased healthcare spending over past years,
45
focussed on building
hospitals, clinics, community cen
-
ters, and facilities for meeting the needs of retirees throughout their retirement
-
Specialized university programs to train elderly care professionals in geriatric nursing, for improving av
-
erage skill base & quality of service
-
Introduced Long Term Care Insur
-
ance to finance major LTC costs of the elderly
-
Established ‘National Centre for Gerontology’ in 2016 for integrat
-
ing scientific research, clinical care, rehabilitation services, public health policies, and health management into one
-
Rule of ‘90-7-3’, i.e. 90% of the elderly are cared for by family, 7% receive com
-
munity care & 3% live in institutional facilities.
-
The Chinese tradition of “filial piety”, where adult children are expected to care for their ageing par
-
ents
-
Various laws like the Elder’s Protection Law to maintain a traditional family support system for the elderly
-
Development of new elderly care infrastructure with elderly home care as a foundation, community elderly care as support; and state institutional care as a supplement
-
Day-care; and recreational & cultural activities to keep the elderly engaged
-
A boom in the senior care sector, with the 11th FYP suggesting simultaneously “cultivating the consumer market for senior products and services” & “guiding the elderly to rational consumption.”
46
-
Planning to establish about 10 industrial parks dedicated to the silver economy.
-
Creation of ‘smart home care’ by leveraging digital technologies like smart monitoring, call-service platforms, virtual nursing systems, robotics, IoT, etc.
45 https://www.coresponsibility.com/wp-content/uploads/2016/06/The elderly-in-China.pdf
46 https://encyclopedia.pub/entry/23328 Senior Care Reforms in India 68
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
USA
-
Medical care through private in
-
surance funds, a large portion of which is financed by govt. through Medicare, covering hospital care for people above 65 years; & Medicaid, covering long-term care insurance plans.
-
Needs assessment of eligible patients to use Medicare, making services accessible to those in need & to curb overutilization & contain costs.
-
Integration across medical & long-term care providers with the launch of new models of care like PACE (Program of All-Inclusive Care for the elderly)
-
Adult daycare to ease the burden on caregivers
-
- Senior Care Reforms in India 69
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
USA
-
Medical care through private in
-
surance funds, a large portion of which is financed by govt. through Medicare, covering hospital care for people above 65 years; & Medicaid, covering long-term care insurance plans.
-
Needs assessment of eligible patients to use Medicare, making services accessible to those in need & to curb overutilization & contain costs.
-
Integration across medical & long-term care providers with the launch of new models of care like PACE (Program of All-Inclusive Care for the elderly)
-
Adult daycare to ease the burden on caregivers
-
-
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
UK
-
Free public healthcare to all citi
-
zens through the National Health Service (NHS), (including ambu
-
lance, and mental health care), which is funded primarily through general taxation.
-
Structured financing mecha
-
nisms, for both medical (NHS) and non-medical LTC (through Clinical Commissioning Groups or local bodies). NHS pays for long-term care for people with care needs. In terms of non-medical care, 60% is financed by local bodies/NHS and 40% from OOPE.
-
Vertical integration from hospital to home and horizontal integra
-
tion across multidisciplinary teams (composed of medical staff, care coordinators, community nurses, occupational therapists, physiother
-
apists, and social workers)
-
Enabling environment for local governments and organizations to deliver services independently to the elderly
-
The proactive role of NGOs and the private sector to improve the quality of life for older adults
-
Reforming the pension and public benefits sys
-
tem to provide incen
-
tives to stay in the labor force
-
Policies that aid older adults go back to work like the New Enterprise Allowance (NEA), which aims to help unem
-
ployed, low-income, or disabled individuals start their businesses.
-
The digital strategy priori
-
tizes continued investment in digital infrastructure
-
Digital skill development through access to free training. NGOs deploy models such as setting up a Digital Champions Network, undertaking the required online courses, and volun
-
teers to engage, support and encourage older peo
-
ple to develop their digital skills.
-
Organizations working with tech companies to help them develop user-friendly technologies and practical solutions for seniors. Senior Care Reforms in India 70
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Germa
-
ny
-
Healthcare coverage is largely driven by private insurance, with the government playing a policy-mak
-
ing role.
-
A robust and structured healthcare financing system for non-medical needs, though OOPE is quite high and long-term care expenses are expected to rise
-
There is an excessive burden on young people as they indirectly finance elderly care through taxes
-
From Health Care to Health: empha
-
sizing health, inclusive of an ageing population
-
Senior Activity Centres (SACs) are drop-in cen
-
tres for low-income and vulnerable seniors living in subsidized public housing apartments. They offer so
-
cial and community space, information and referral services, manage emer
-
gency alert response and monitor frail and/or home
-
bound older people.
-
Senior Group Homes enable assisted living for the elderly with care needs through a supportive environment by bringing vulnerable older people with the same physical impairments together in a cluster of rental units.
-
Approximately 85% of the population is covered by compulsory public health schemes, and the remaining 15% has private insurance.
-
Mandatory contribu
-
tion by employees and employers towards State health insurance funds and long-term care insurance programs to reduce the burden on government funds.
-
Employees and their employers make con
-
tributions towards a Retirement pension fund, which is used to provide cash benefits to the elderly.
- Senior Care Reforms in India 71
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Germa
-
ny
-
Healthcare coverage is largely driven by private insurance, with the government playing a policy-mak
-
ing role.
-
A robust and structured healthcare financing system for non-medical needs, though OOPE is quite high and long-term care expenses are expected to rise
-
There is an excessive burden on young people as they indirectly finance elderly care through taxes
-
From Health Care to Health: empha
-
sizing health, inclusive of an ageing population
-
Senior Activity Centres (SACs) are drop-in cen
-
tres for low-income and vulnerable seniors living in subsidized public housing apartments. They offer so
-
cial and community space, information and referral services, manage emer
-
gency alert response and monitor frail and/or home
-
bound older people.
-
Senior Group Homes enable assisted living for the elderly with care needs through a supportive environment by bringing vulnerable older people with the same physical impairments together in a cluster of rental units.
-
Approximately 85% of the population is covered by compulsory public health schemes, and the remaining 15% has private insurance.
-
Mandatory contribu
-
tion by employees and employers towards State health insurance funds and long-term care insurance programs to reduce the burden on government funds.
-
Employees and their employers make con
-
tributions towards a Retirement pension fund, which is used to provide cash benefits to the elderly.
-
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Singa
-
pore
-
Largely self-financed healthcare infrastructure as individuals pay for their healthcare
-
Funding mechanism based on government subsidizing part of the medical expenses (financed through taxes/ government budget). The remaining costs are covered by pa
-
tients using the mandatory savings schemes (Medisave) with com
-
prehensive coverage, along with mandatory co-payments to prevent misuse.
-
A regulated healthcare marketplace with an advanced healthcare deliv
-
ery system. Public hospitals offer high-quality services, thus forcing private health providers to maintain prices at public levels to avoid pric
-
ing themselves out of the market.
-
The Integrated Care for the elderly (SPICE) program was developed by the Agency for Integrated Care (AIC) to provide compre
-
hensive, integrated Centre and home-based services or non-medical services to support caring for the elderly.
-
- Senior Care Reforms in India 72
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
South
Korea
47
-
Social Insurance (for all)

»
National Health Insurance

»
National Long-term Care Insur
-
ance for Elders
-
Tax based services

»
Center for dementia support

»
Service for early detection of dementia

»
Support for treatment for demen
-
tia

»
Support for the old-age-related optical surgery
-
Universal Social Insurance for Social Care services through the Comprehen
-
sive Welfare Program, launched in 2016
-
The elderly welfare com
-
munity care program by local governments for assistance in everyday routine activities. Later extended to include public silver housing equipped with safety devices; and the elderly day-care
-
Meal service(Free or low-price)
-
Social activity programs to ensure social engagement and entertainment
-
National Basic Liveli
-
hood Security System (NBLSS) guarantees a minimum standard of living to the elderly who earn less than the mini
-
mum cost of living and those with no immediate family members capable of supporting them
-
Re-employment for job-seeking elders through the ‘Aged Em
-
ployment Promotion Act 2003’
-
National Pension service for the elderly pension to people above 65 and basic old age pension system providing 5% of Koreans’ average wage for 70% of the elderly
48
-
Unemployment insur
-
ance
-
Senior discounts
47 https://www.unescap.org/sites/default/files/Session1_Mr.KimChanWoo_RoK.pdf
48 http://www.ijssh.org/papers/355-A10040.pdf Senior Care Reforms in India 73
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
South
Korea
47
-
Social Insurance (for all)

»
National Health Insurance

»
National Long-term Care Insur
-
ance for Elders
-
Tax based services

»
Center for dementia support

»
Service for early detection of dementia

»
Support for treatment for demen
-
tia

»
Support for the old-age-related optical surgery
-
Universal Social Insurance for Social Care services through the Comprehen
-
sive Welfare Program, launched in 2016
-
The elderly welfare com
-
munity care program by local governments for assistance in everyday routine activities. Later extended to include public silver housing equipped with safety devices; and the elderly day-care
-
Meal service(Free or low-price)
-
Social activity programs to ensure social engagement and entertainment
-
National Basic Liveli
-
hood Security System (NBLSS) guarantees a minimum standard of living to the elderly who earn less than the mini
-
mum cost of living and those with no immediate family members capable of supporting them
-
Re-employment for job-seeking elders through the ‘Aged Em
-
ployment Promotion Act 2003’
-
National Pension service for the elderly pension to people above 65 and basic old age pension system providing 5% of Koreans’ average wage for 70% of the elderly
48
-
Unemployment insur
-
ance
-
Senior discounts
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Thailand
-
Institute of The elderly Medical Science, Department of Medical Service, Ministry of Public Health is the nodal agency for the elderly healthcare
-
National Strategy on Long-Term Care and Policy on Develop
-
ing Long-Term Care in 2006 to strengthen the capacity of house
-
holds to care for the elderly
-
Policy by the Ministry of Public Health for providing intermediate care by community hospitals in acute conditions of stroke, brain & spinal trauma, etc.
-
The Buddy Home Care model was developed in 2012 by NGOs for pro
-
viding cost-effective & high-quality healthcare services at home, with disadvantaged youths support
-
ing the elderly through a volun
-
teer-based approach
-
Joint management of long-term care by SAOs & local hospitals as well as communities emerged as the best practice model of local long-term care
-
National Plan for Older Persons & 2
nd
National Plan
on the elderly to promote dignified & quality ageing
-
National Agenda on Aged Society (2018) acknowl
-
edges active ageing & focuses on 6 sustainable goals for improving their lives, including:1.
Establish a System of Welfare and Social Protection for Older Adults (MSDHS)
2.
Promote Elder Employ
-
ment and Sustainable Income (MOL)
3.
Develop Health Sys
-
tem for Aged Society (MOPH)
4.
Modify Housing and Public Spaces for Elder Safety (MOI)
5.
Set-up Time Bank Sys
-
tem (MSDHS)
6.
Educate the Young Generation for Prepa
-
ration in All Aspects (MOE)
-
Social Pension Policy – Old Age Allowance was made universal in 2009
-
Senior Citizens Council of Thailand(SCCT) de
-
vising new & innovative mechanisms to ensure better occupational opportunities for the elderly
-
12
th
National Economics &
Social Development Plan (2017-21) started initiatives like Thammasat Model & schools for reskilling older people, particularly direct
-
ed towards improving dig
-
ital literacy among senior people Senior Care Reforms in India 74
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
-
The Elderly Act (2003) for the social, economic & health protection of the elderly
-
Established the National Committee of Senior Cit
-
izens to promote a posi
-
tive attitude towards the elderly
-
Older adults clubs & health promotion temples to ensure engagement of the elderly in society Senior Care Reforms in India 75
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
-
The Elderly Act (2003) for the social, economic & health protection of the elderly
-
Established the National Committee of Senior Cit
-
izens to promote a posi
-
tive attitude towards the elderly
-
Older adults clubs & health promotion temples to ensure engagement of the elderly in society
49 https://sweden.se/life/society/the elderly-care-in-sweden
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Sweden
-
Decentralized national health care system
-
Emphasis on 5 focus areas pertain
-
ing to elderly care
a.
Preventive care
b.
Priority to ageing in place

Accessibility to home health & prac
-
tical health services
c.
Physician prescribed physical activ
-
ity
d.
Timely Treatment, ensuring doc
-
tor’s appointment within 7 days & not exceeding 90 days in case of specialist
-
Subsidized healthcare costs for the elderly
-
The elderly Care Policy is based on local deci
-
sion-making with emphasis placed on the quality of life for the elderly & their families
-
National Action Plan on Policy for the Elderly contains about 20 mea
-
sures for the welfare of the elderly
-
Social Services Act governs elderly care, and the elderly care is largely funded by municipal taxes & government grants
49
-
Municipality-funded home-help services
-
Adel Reform (1992) shifted the onus of providing home health services to local mu
-
nicipalities; ensuring com
-
munity involvement, citizen empowerment & public accountability. There is a provision of pre-cooked meals for the elderly under this.
-
Senior Housing by Swedish municipalities considering the needs of the elderly and people with disabilities
-
Legal right to remain in the workforce till 69
»
National Retirement Pension System through Swedish Pensions Agency and other agencies like:

»
National Pensioner’s Organization (PRO)

»
Swedish Pensioner’s Association (SPF)

»
Swedish Municipal Pensioners’ Association (SKPF) Senior Care Reforms in India 76
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Den
-
mark
-
National Action Plan on Dementia (2025)
-
Nursing homes are typically run by municipal councils, with even private facilities subject to local inspections and subsidies to bring costs in line with those of public facilities
-
The Danish long-term care (LTC) system is a universal program, which includes home assistance services for the elderly and the dis
-
abled, institutional care, and infor
-
mal care
-
The elderly care policy ensures that senior people maintain an independent life and are healthy in their own homes as long as possible
-
Senior Citizen Council in each municipality looks af
-
ter the rights of the elderly
-
Every three years, local au
-
thorities and practitioners gather with leaders from Denmark’s five geographi
-
cal regions to plan service improvements.
-
The pension system is funded by heavy taxa
-
tion on salaries, which the majority of retirees will have paid for 40 years
50
-
Technology-driven solution for the elderly to empower & encourage them to be active through information sharing & joint decision making
-
ColumnaCura, an electron
-
ic citizen record, provides mobile support and engag
-
es citizens in the treatment of the elderly

50 https://www.theguardian.com/world/2016/feb/02/for-pensioners-something-is-spot-on-in-the-state-of-denmark Senior Care Reforms in India 77
Country
Dimension
Healthcare
Social Support
Economic Support
Digital Inclusion
Norway
-
Spends around 2.2% of its GDP on the elderly care
-
Decentralized elderly Care Model where local municipalities are re
-
sponsible for primary healthcare
-
Secondary healthcare, including ambulance services, is owned & run by the government through regional health authorities
-
Municipalities invest in-home care or at-home nursing stations instead of relying upon institutional care
-
An extensive public long-term care (LTC) program that is funded by national taxes but implemented locally, and depending on the level of care required, co-payments may be decided
51

»
Services include home practical care, home medical care, institution
-
al day and night care, daytime relief for infor
-
mal caregivers, provision of assistive devices and technology, economi
-
cal support to informal caregivers, social contact assistance, and personal assistance for disabled
-
Provision of specially constructed ‘smart’ apart
-
ments, especially for those suffering from dementia
-
The elderly care services contribute a large share in the services sector, accounting for a quarter of the total municipal budget, which is almost 3% of the GDP
-
Universal pension cover
-
age for everyone above 65
.
51 https://www.oecd.org/norway/47877969.pdf Senior Care Reforms in India 78 Senior Care Reforms in India 79
ANNEXURE 4: EXISTING PACKAGE OF SERVICES AT VARIOUS
LEVELS FOR GERIATRIC CARE IN INDIA UNDER THE NATIONAL
PROGRAM FOR THE HEALTH CARE OF THE ELDERLY
Structure of Geriatric Healthcare in India
At present India has three National Centres for Ageing at the central level of administration,
followed by points of care at regional hubs, district hospitals, community health centres,
primary health centres, and sub centres. The following illustration depicts the structure
of geriatric healthcare in India, with the number of such facilities given in parenthesis
alongside.
National Centre for Ageing (3)
Regional Geriatric Centre (18)
District Hospitals (718)
Community Health Centres (4869)
Primary Health Centres (18407)
Sub - Centres (90719)
The various service areas in the existing package of healthcare services for geriatric care
under the Government of India’s National Program for the Health Care of the Elderly are
described as follows:
Existing comprehensive healthcare package for the elderly
Sr.
No
Service AreasPackage of Services
1.Nutritional Assessment • Nutritional history
• Screening using a Geriatric Assessment Tool
• Mini-Nutritional Assessment Scale
2.Mental Health Assessment • History of mental health disorders
• Screening for mental health diseases
3.NCD Management• Screening for hypertension and diabetes
• Management and follow-up of hypertension and diabetes
4.Oral Assessment• Oral care examination and screening for dental caries
• Assisted oral care
5.Ophthalmic Assessment • Visual acuity testing
• Near vision testing
• Screening for cataracts
6.Cardiovascular Risk Assess-
ment
• History of smoking, alcohol
• Health education to prevent cardiovascular diseases Senior Care Reforms in India 80 Senior Care Reforms in India 81
ANNEXURE 5: SCHEMES, PROGRAMS, AND ACTIVITIES OF
MINISTRIES AND DEPARTMENTS OF THE GOVERNMENT OF
INDIA FOR THE WELFARE OF THE SENIOR CITIZENS
The schemes, programs, and activities of Ministries and Departments of the Government
of India for the welfare of the senior citizens are categorized as per Ministry and detailed
below. (Sources of scheme details are included in the References)

1. Ministry of Social Justice and Empowerment
Name of the Scheme/
Program/ Activity
Goal/Benefits
Atal Vayo Abhyudaya
Yojana (AVYAY), for-
merly known as Na -
tional Action Plan for
Senior Citizens (NAPS-
rC)
AVYAY targets the four basic needs of senior citizens: financial security, food,
health care, and human interaction/life of dignity. Basic amenities, shelter, food,
entertainment opportunities, etc., are provided free of cost to indigent senior
citizens. It also covers matters related to seniors’ safety and protection, along
with awareness generation and sensitization of society. AVYAY is an umbrella
scheme that has been in existence since April 1, 2021, and includes the following
schemes:
• Scheme of Integrated Program for Senior Citizens (IPSrC) *
• State Action Plan for Senior Citizens (SAPSrC) *
• Rashtriya Vayoshree Yojana’ (RVY) **
• National Helpline (Elderline) **
• Seniorcare Ageing Growth Engine (SAGE)- Promoting Silver Economy**
* Source of funding: Budget
** Source of funding: Senior Citizens’ Welfare Fund Senior Care Reforms in India 82
Name of the Scheme/
Program/ Activity
Goal/Benefits
Scheme of Integrated
Program for Senior Cit-
izens (IPSrC)
Provision of financial assistance to eligible organisations for running and main-
tenance of Senior Citizen Homes/Continuous Care Homes to improve the qual -
ity of life of the senior citizens, especially indigent senior citizens by providing
basic amenities like shelter, food, medical care, clothing and entertainment op-
portunities and by encouraging productive and active ageing.
Following Projects are admissible for assistance under the IPSRC:
a. Maintenance of Senior Citizens Homes for 25 beneficiaries to provide food,
care and shelter for a minimum number of 25 indigent Senior Citizens.
b. Maintenance of Senior Citizens’ Homes for 50 beneficiaries to provide food,
care and shelter for a minimum number of 50 indigent Senior Citizens (male
only/male and female combined).
c. Maintenance of Senior Citizens Homes for 50 elderly women only: Deeply
concerned that the situation of older persons in many parts of the Nation has
been negatively affected by the poverty, financial and economic crisis, and
noting with concern the high incidence of poverty particularly among older
single women.
d. Maintenance of Continuous Care Homes and Homes for senior citizens af-
flicted with Alzheimer’s disease/ Dementia for a minimum of 20 Senior Cit-
izens who are seriously ill requiring continuous nursing care and respite or
those who are afflicted with Alzheimer’s disease/ Dementia.
e. Maintenance of Regional Resource and Training Centres: Regional Resource
and Training Centres (RRTCs) will work as key nodal agency on aged care
and coordination under the overall direction & supervision of Department of
Social Justice and Empowerment, providing overall technical support and
inputs on senior citizens programs in their assigned States allocated by the
Ministry. The main role and responsibility is to provide mentoring, hand-hold-
ing support to the SrCHs in their jurisdiction to ensure that they all maintain
the standards laid down under these guidelines. They would also be respon-
sible for carrying out advocacy, awareness generation, training of stakehold-
ers, database generation, inspections, monitoring, research and liaising with
the Governments of the States assigned in the field of old age care.
f. Maintenance of Mobile Medicare Unit (MMU) for Senior Citizens and Phys-
iotherapy Clinics for Senior Citizens: Renewal/Ongoing projects of MMU and
Physiotherapy Clinics for senior citizens henceforth will continue to be sup-
ported by the Ministry of Social Justice and Empowerment under the IPSRC.
No new MMU shall be supported under the scheme.
Additionally, the Department of Social Justice and Empowerment has pre -
scribed norms pertaining to Old Age Homes including land, living space, facil-
ities and operational standards such as nutrition, medical facilities/ medicare,
recreation, security, clothing, rooms, bathroom and toilet, hygiene and sanita-
tion, etc. Senior Care Reforms in India 83
Name of the Scheme/
Program/ Activity
Goal/Benefits
State Action Plan for
Senior Citizens (SAPS-
rC)
Grant-in-aid is provided to States/UTs for State-specific activities for the welfare of
senior citizens. Grant-in-aid is provided on the basis of the demand of the States/UTS
and requisite documents provided by them. SAPSrC was launched in 2019- 20. Funds
are released for the following activities:
(i) Maintenance of Mobile Medicare Units (MMU) for Senior Citizens: To provide
medical care to the senior citizens living in rural, isolated and backward areas. The
Mobile Medicare Unit is meant for Senior Citizens living in slums, rural and inacces-
sible areas where proper health care facilities are not available. Under this, grants
would be provided to the District level hospitals in the Aspirational Districts for
improving the healthcare facilities in the underserved areas. This grant would be
in addition to and would operate in synchronisation with the efforts for healthcare
facilities under the NHM. The project aims to enable Senior Citizens to assume
an active role in maintaining and improving their own health and in encouraging
others to do the same. Each Medicare Unit should cover minimum 400 Senior Cit-
izens per month. Each MMU should make at least 10 trips per month to such areas.
Grant-in-aid to organisations/NGOS/VOS for the programme of Mobile Medicare
Units for senior citizens shall henceforth be given by the State Government.
(ii) Physiotherapy Clinics for Senior Citizens: Grant-in-aid under this project to be giv-
en to agencies that have shown a credible track record in running projects for the
welfare of the Senior Citizens for running of physiotherapy clinic for a minimum of
50 Senior Citizens per month. This is permitted only in the Govt District Hospitals.
(iii) Creation of a pool of trained Geriatric Caregivers for senior citizens: Grant- in-
aid is to be given to the agencies, which have shown good track records in health
care especially in Geriatric care, for providing training for the creation of a pool
of trained Geriatric Caregivers or to provide bedside assistance to needy elderly.
(iv) Special drive for cataract surgeries for senior citizens to achieve the vision
of Cataract/Blindness-Free State for Citizens: Senior Citizens Rural Outreach
Programme for Cataract Surgery is an effort to assist the National Program for
Control of Blindness. This is to be done, by envisaging easing of the burden of the
continuing rise in the prevalence of cataract blindness due to the increase in the
population of senior citizens by arranging special drives for Cataract Surgeries’.
Cataract Surgeries will be carried out in all districts in Government Hospital or at
suitable places like community health centres every year in such a way that every
district may achieve the vision of cataract blindness free districts for senior citi-
zens. Surgery of Senior Citizen BPL card holder shall be done free of cost including
providing medicines etc. In this regard, necessary funds may be demanded by
submission of the State Action Plan every year through E-Anudaan portal.
(v) State-specific activities for the welfare of senior citizens, especially who
are indigent in the States/UTS: As far as possible 20% of the funds allocated
to the State, may be utilised by the State Governments for innovative pro-
grammes, as per requirement, for the welfare of the elderly. Senior Care Reforms in India 84
Name of the Scheme/
Program/ Activity
Goal/Benefits
Seniorcare Ageing
Growth Engine (SAGE)
-Promoting Silver
Economy
To encourage youth to think about the problems of the elderly and come out
with innovative ideas for elderly care and promoting them into start-ups by
providing equity support. Industrial Finance Corporation of India (IFCI) Venture
Capital Ltd. will hold the equity support given to the innovative startup projects,
on behalf of the Ministry (not exceeding 49%). Each selected startup is provid-
ed a maximum of 1 crore as equity share.
Channelizing CSR
funds for elderly care
This is also a new scheme to direct CSR funding to aged care projects in the
most efficient way possible. Under Schedule VII of Section 135 of the Compa-
nies Act, setting up old age homes, daycare centres, and such facilities for Se-
nior Citizens is an approved item for CSR funding.
Scheme for Aware-
ness Generation and
Capacity Building for
the welfare of Senior
Citizens
• Components like the National Helpline for Senior Citizens, research,
awareness, sensitization, etc., for the welfare of senior citizens, spreading
awareness and sensitizing the youth and other sections of the society
towards the issues related to the elderly.
• The National Helpline: National Helpline for Senior Citizens - Toll-free
No. 14567 - for all senior citizens of the country. It was launched on 1st
October 2021 to provide free information, guidance, emotional support,
and field intervention in cases of abuse and rescues in order to improve
the quality of life of senior citizens. Elderline is operational from 8 a.m.
to 8 p.m., all 7 days of the week. The National Institute of Social Defence
(NISD) has been nominated as the Central Nodal Agency for Elderline.
Rashtriya Vayoshri Yo-
jana (RVY)
• This scheme aims to provide physical aids and assisted living gadgets to
senior citizens who are BPL and have age-related disabilities or infirmities
to restore near-normalcy in their bodily functions. The Scheme is being
funded by the Senior Citizens’ Welfare Fund (SCWF).
• The Scheme has been revised w.e.f. F.Y. 2020-21. Under the revised Scheme,
the criteria for selecting beneficiaries under the amended Scheme have
been expanded to cover not just senior individuals who fall into the BPL
category but also senior citizens who have a monthly income of less than
`15000/- and who suffer from age-related disabilities/infirmities.
• The number of devices previously provided has been enhanced under the
updated RVY Scheme. At present, the following items have been included
for distribution:
» Generic Items: Walking sticks, Elbow crutches, Walkers/Crutches,
Tripods/Quad pods, Hearing Aids, Artificial Dentures, and Spectacles
» Special Items: Wheelchairs, Wheel Chairs with Commode, Chair/
Stool with Commode, Silicon Foam Cushion, Knee Brace, Spinal Sup-
port, Cervical Collar, Lumbosacral Belt (LS), Walker/Rollator with
Brakes, Walking Stick with Seat, Foot Care Kit.
• The Scheme is fully financed (100% funded) by the Central Government
from Citizens’ Welfare ‘Senior Fund’. The extent of support free of cost
distribution of “Physical Aids and Assisted-Living Devices” commensu-
rates with the extent of disability/ infirmity that is manifested among the
eligible senior citizens. In case of multiple disabilities /infirmities, the as-
sistive devices will be given in respect of each disability /impairment that
is manifested in the same person. The Implementing Agency shall pro -
vide one year of free maintenance of the aids and assisted living devices
supplied by them. The maximum cost of devices will not be exceeding
` 7,000/-per beneficiary Senior Care Reforms in India 85
Name of the Scheme/
Program/ Activity
Goal/Benefits
Senior Citizens’ Wel-
fare Fund
In pursuance of the Budget Announcement 2015-16, this welfare fund has been
created to be utilized for the promotion of the welfare of senior citizens. The
fund is administered by an Inter-Ministerial Committee, comprising of Depart-
ment of Financial Services, the Ministry of Health and Family Welfare, the Min-
istry of Rural Development, the Ministry of Housing & Urban Affairs, and the
Ministry of Labour and Employment, with the Ministry of Social Justice and
Empowerment as the Nodal Ministry for the administration of the Fund.
National Council of Se-
nior Citizens (NCSrC)
• In pursuance of the National Policy for Older Persons (NPOP), the Nation-
al Council for Older Persons (NCOP) was constituted in 1999 to oversee
the implementation of the Policy and to advise the Government in the
formulation and implementation of policy and programs for the aged.
• It was reconstituted and renamed as National Council of Senior Citizens
(NCSrC) in 2012 with a mandate to advise Central and State Governments
on the entire gamut of issues related to the welfare of senior citizens and
the enhancement of their quality of life.
Vayoshreshtha Sam -
man
• To recognize the efforts made by eminent Senior Citizens and Institutions
involved in rendering distinguished services for the cause of the elderly
persons, the Ministry of Social Justice and Empowerment started cele-
brating the International Day of Older Persons (IDOP), since 1
st
October
2005.
• Further, to showcase the Government’s concern for senior citizens and its
commitment towards them, the Vayoshrestha Samman was upgraded to
National Award, and the Scheme of National Awards for Senior Citizens
was notified in the Gazette of India on 22.01.2013. The Awards are given
under thirteen categories.
• The National Awards were presented for the first time in 2013, on 1
st
Octo-
ber, on the occasion of International Day of Older Persons (IDOP).
Accessible India
Campaign (Sugamya
Bharat Abhiyan; Dept.
of Empowerment of
Persons with Disabil-
ities)
The Campaign was launched in 2015 as a nationwide campaign for achieving
universal accessibility for Persons with Disabilities (PwDs). This includes the
creation of elder-friendly, barrier-free environments in buildings, public toilets,
buses, bus stands, airports, and other public places to create age-friendly cities.
e-Anudaan portal e-Anudaan is an initiative by the Ministry of Social Justice and Empowerment to
enable Non-Government Organizations (NGOs) to register online and log in to
apply for Grant-in-aid to help implement various schemes of the Ministry. Senior Care Reforms in India 86
2. Ministry of Finance
Name of the Scheme/
Program/ Activity
Goal/Benefits
Pradhan Mantri Vaya
Vandana Yojana’
(PMVVY)
• The scheme aims to protect elderly persons aged 60 years and above
against a future fall in their interest income due to the uncertain mar-
ket condition and provide social security during old age. It is being
implemented through the Life Insurance Corporation (LIC) of India.
It provides an assured return of 8% per annum, payable monthly for
10 years. A loan facility is available after the completion of 03 policy
years. The differential return, i.e., the difference between the return
generated by LIC and the guaranteed return of 8% per annum, would
be borne by the Government of India as a subsidy on an annual basis.
• The scheme was open for subscription for one year, i.e., from 4
th
May
2017 to 3
rd
May 2018. The minimum purchase price under the scheme
was ` 1.5 lakh per family for a minimum pension of ` 1,000/- per
month, and the maximum purchase price was ` 7.5 lakh per family for
a maximum pension of ` 5,000/- per month.
• In pursuance of Budget Announcement 2018-19, Cabinet approved
the extension of PMYVY up to 31st March 2020 and a maximum pur -
chase price limit of ` 7.5 lakhs per family under the scheme has also
been enhanced to ` 15 lakhs per senior citizen.
• The Union Cabinet approved a further extension of PMVVY up to 31
st

March 2023 in May 2020 with some amendments in the interest rates
and minimum investment amount.
Pradhan Mantri Suraksha
Bima Yojana (PMSBY)
The Scheme of PMSBY is available to people in the age group of 18-70
years with a bank or post office account and give consent to join/enable
auto-debit. The risk coverage under the Scheme is ` 2 lakhs in case of
accidental death or total permanent disability and ` 1 lakh for partial per-
manent disability.
Atal Pension Yojana
(APY)
[Pension Fund
Regulatory and
Development Authority
(PFRDA)]
The scheme was launched on 9
th
May 2015, to create a universal social se-
curity system for all Indians, especially the poor, the underprivileged, and
the workers in the unorganized sector. It is open to all citizens of India be-
tween 18-40 years of age who have a bank account in a bank or post office.
Five pension plan slabs are available under the scheme, namely, ` 1000, `
2000, ` 3000, ` 4000, and ` 5000, guaranteed by the Government of India
to the subscriber at the age of 60 years.

Varishtha Pension Bima
Yojana (VPBY)
Under this Scheme, the subscribers on payment of a lump sum amount get
a pension at a guaranteed rate per annum (payable monthly). Any gap in
the guaranteed return over the return generated by the LIC on the fund is
compensated by the Government of India by way of subsidy payment in
the scheme. The scheme allows withdrawals of deposit amounts by the
annuitant after fifteen years of purchase of the policy. The scheme is ad-
ministered through the Life Insurance Corporation of India.
Senior Citizens’ Saving
Scheme (SCSS)
The SCSS is a retirement benefit program. Individuals over 60 years old
can opt for the SCSS scheme by making an individual or joint investment.
The installment amount ranges between 1,000 and 15 lakhs. This amount
is constricted to the retirement benefits. This Scheme also provides tax
benefits. Senior Care Reforms in India 87
Name of the Scheme/
Program/ Activity
Goal/Benefits
Higher rate of Interest With respect to senior citizens having savings accounts in banks and post
offices, higher interest rates are given to such senior citizens.
Door-step Banking As per the directions of the Reserve Bank of India, all banks are to provide
separate basic banking facilities such as door-step banking including with-
drawal of cash, pick up of cash delivery for Demand Drafts, submission of
KYC documents and life certificates at the residence of customers who are
senior citizens and individuals with disabilities.
Income Tax Rebate Ministry of Finance provides Income Tax Rebates to Senior Citizens
Income.
• Tax exemption for senior citizens is up to ` 3 lakhs, and only 5% is
levied on income between ` 3 lakhs and 05 lakhs as per the existing
tax regime.
• Senior citizens above 80 years are exempted from paying income
tax up to ` 05 lakhs.
• Deduction in the case of every senior citizen u/s 80DDB of the In-
come Tax Act on expenditure on account of specified diseases has
been increased.
• Section 80TTB of the Income Tax Act has provisions relating to
tax benefits available on the interest income from deposits with
a banking company, post office, or co-operative society engaged
in carrying on the banking business of an amount up to ` 50,000
earned by the senior citizen (i.e., an individual of the age of 60
years or above)
• Existing provisions of section 207 of the Income-Tax Act, 1961 ex-
empt individual resident senior citizens (60+ years) at any time
during the previous year from payment of advance tax which does
not have any income chargeable under the head ‘Profits and gains
of business or profession.’
To incentivize the younger generation to look after their parents’ medical
needs, section 80D of the I.T. Act provides a deduction to keep insurance
on the health of the parents or parents of the assessee. A similar deduction
is also available to a Hindu Undivided Family (HUF) in respect of health
insurance premiums to effect or to keep in force insurance on the health of
any member of the HUF.
Service TaxUnder the Service Tax laws of the Ministry of Finance, activities relating to
the advancement of education programs or skill development relating to
persons over the age of 65 years residing in a rural area by an entity reg-
istered under Section 12AA of the Income Tax Act, 1961 are exempt from
Service Tax. Concerning Savings Accounts in Banks and Post Offices, high-
er interest rates are given to senior citizens.
Scheme for Reverse
Mortgage
The Scheme was launched in 2007 by the Ministry of Finance. Under the
Scheme, senior citizens can mortgage their property with Bank and get a
maximum loan amount of up to 60% of the value of the residential prop-
erty. The maximum tenure of the mortgage is 15 years, and the minimum is
10 years. Some banks are now also offering a maximum tenure of 20 years. Senior Care Reforms in India 88
Name of the Scheme/
Program/ Activity
Goal/Benefits
Health Insurance Insurance Regulatory Development Authority (IRDA), under the Ministry
of Finance, vide letter dated 25.5.2009, issued instructions on health insur-
ance for senior citizens to CEOs of all General Health Insurance Companies,
which, inter-alia, include:
• Allowing entry into health insurance scheme till 65 years of age
• Transparency in the premium charged
• Reasons to be recorded for denial of any proposals on all health in-
surance products catering to the needs of senior citizens
• Likewise, insurance companies cannot deny renewability without
specific reasons. Senior Care Reforms in India 89
3. Ministry of Health & Family Welfare
Name of the Scheme/
Program/ Activity
Goal/Benefits
National Program for
Health Care of the
Elderly (NPHCE).
NPHCE, launched during 2010-11, is a State oriented program with the ba-
sic thrust to provide comprehensive and dedicated health care facilities to
elderly persons above 60 years of age at various levels of primary, second-
ary, and tertiary health care.
I. Primary & Secondary Geriatric Care Services: The program com-
menced with 100 districts in the 11
th
plan period. Presently 718 Health
districts have been sanctioned for geriatric primary & secondary
care services of OPD, 10 bedded Geriatric Ward, Physiotherapy, and
laboratory services.
I. Tertiary level activities of NPHCE: Renamed as ‘Rashtriya Varisth
Jan Swasthya Yojana’ in 2016-17. Regional Geriatric Centres (RGCs)
in selected Medical Colleges of states have been sanctioned for ter-
tiary care service delivery under NPHCE in the form of specialized
OPDs, geriatric wards, earmarked beds in various specialties like
urology, orthopedics, ophthalmology, etc., human resources de -
velopment & research activities. Presently OPD services are being
provided through 18 RGCs, inpatient services in 16 RGCs, physio-
therapy in 14 centers & laboratory services in 13 centers. Two Na-
tional Centres for Ageing (NCA) have also been developed as the
Centre of Excellence for Geriatric Care services. Two hundred bed-
ded NCA at Madras Medical College, Chennai, and another NCA at
AIIMS, New Delhi.
II. Training Modules: Three sets of Training modules for Medical Of-
ficers, Nurses, and Community-based workers to deliver Compre -
hensive Geriatric care have been developed. State-level Training of
Trainers of Medical Officers for Comprehensive Geriatric Care has
been conducted in various states.
NPHCE Website: An interactive and dynamic website cum MIS of the
NPHCE program has been initiated through the Center for Health Informat-
ics (CHI) to provide comprehensive information along with data regarding
geriatric facilities and services available throughout the country. Senior Care Reforms in India 90
Name of the Scheme/
Program/ Activity
Goal/Benefits
Longitudinal Ageing
Study in India (LASI)
Project
The Ministry of Health and Family Welfare launched this project in 2016
to assess the health, economic, and social status of the elderly (aged 45-
60). LASI is a full–scale national survey of scientific investigation of the
health, economic, and social determinants and consequences of popula -
tion ageing in India. Ministry of Health & Family Welfare has undertaken the
Longitudinal Ageing Study of India, through the International Institute for
Population Sciences (IIPS), Mumbai, in collaboration with Harvard School
of Public Health, University of Southern California, USA, Dt.GHS, United
Nations Population Fund (UNFPA), and National Institute on Ageing.
• The LASI, Wave 1 covered a baseline sample of 72,250 individuals
aged 45 and above and their spouses, including 31,464 elderly per-
sons aged 60 and above and 6,749 oldest-old persons aged 75 and
above from all States and Union Territories (UTs) of India (excluding
Sikkim).
• A unique feature of LASI is the coverage of comprehensive bio -
markers. No other survey in India collects detailed data on health
and biomarkers, together with information on family and social net-
works, income, assets, and consumption.
• LASI will provide an evidence base for national and state-level pro-
grams and policies for the elderly population.
Ayushman Bharat
PMJAY
GoI has launched ABPMJAY to cover over 10 crore poor and vulnerable
families (approx. 50 crore beneficiaries), providing coverage up to ` 5 lakhs
per family per year for secondary and tertiary hospitalization.
• With the launch of the PMJAY, RSBY, and SCHIS have been sub -
sumed in it. All enrolled beneficiary families of RSBY and SCHIS are
entitled to benefits under PMJAY.
Health and Wellness
Centres (HWCs)
More than 1,50,000 Ayushman Arogya Mandir (Erstwhile Health & Well -
ness Centres) are being operationalized. These centres have a provision for
the elderly and Palliative Health Care Services.
Senior Citizen Health
Insurance Scheme
(SCHIS)
This Scheme, implemented since 2016, provides insurance coverage to se-
nior citizens as a top-up over the existing RSBY Scheme. It provided a
health insurance cover of ` 30,000/-, which was available to senior citi-
zens, in addition to the coverage of ` 30,000/- under RSBY. If in any RSBY
enrolled family, there were more than one senior citizens, then the addi-
tional cover was in multiples of ` 30,000/- per senior citizen.
• Treatment packages were covered under SCHIS, in addition to 1516
packages under RSBY.
• This scheme was subsumed into PMJAY. Senior Care Reforms in India 91
Name of the Scheme/
Program/ Activity
Goal/Benefits
Central Government
Health Scheme (CGHS)
CGHS has been providing comprehensive medical care to the Central Gov-
ernment employees and pensioners enrolled under the scheme for the last
six decades. CGHS is the model health care facility provider for Central
Government employees and pensioners and is unique of its kind due to the
large volume of beneficiary base, and open-ended generous approach of
providing health care. As of 29.08.2023, a total of 17,68,717 pensioners are
getting the benefits of this scheme.
4. Ministry of Rural Development
Name of the Scheme/
Program/ Activity
Goal/Benefits
National Social Assis-
tance Program (NSAP)
It is a Centrally Sponsored Scheme, under which the elderly, widows, and
disabled persons belonging to BPL and fulfilling eligibility criteria pre-
scribed in the NSAP guidelines, are provided financial assistance ranging
from `200/- to `500/- p.m. Further, in the case of the breadwinner’s death,
lump sum assistance of `20,000/- is given to the bereaved family. The
scheme is implemented by States/UTs, and a Top-up, over and above the
Central assistance, is also provided by State Governments/UT Administra-
tions. The schemes under NSAP for the elderly and divyangs are detailed
below:
• Indira Gandhi National Old Age Pension Scheme (IGNOAPS): A
monthly pension of `200/- is given to the elderly aged 60-79 years
belonging to the BPL category. The pension increases to `500/-per
month upon attaining the age of 80 years. The total beneficiaries
under the scheme are 221 lakhs.
• Indira Gandhi National Disability Pension Scheme (IGNDPS): A
monthly pension of `300/- is given to BPL persons aged 18-79
years with severe and multiple disabilities (80% disability level). The
pension increases to `500/- per month upon attaining the age of
80 years. The total beneficiaries under the scheme are 10.58 lakh. Senior Care Reforms in India 92
5. Ministry of Ayush
Name of the Scheme/
Program/ Activity
Goal/Benefits
Medical Facilities for Se-
nior Citizens
The Ministry is providing the following facilities to senior citizens:
• Free consultation and yoga therapy under Yoga and Naturopathy.
• OPD services are being provided in various Government Hospitals in
Delhi, Haryana, Tripura, Kerala, Madhya Pradesh, Andhra Pradesh, and
Jharkhand.
• Free Yoga training at 50 Yoga Parks is being run through NGOs in var-
ious states.
• In addition, other programs such as Health Promotion Programs, Yoga
Therapy Training Programs, Individual Yoga Therapy Sessions, Weekend
Yoga Training Programs, and Monthly Clinical Yoga Therapy Workshop
are also being imparted.
• Ayurveda, Homoeopathy, and Siddha Research Councils functioning
under the Ministry of Ayush through its peripheral research and clinical
units are providing health services to the elderly through special Geriat-
ric Clinics throughout the country.
AYURSWASTHYA Yojana Ayush and Public Health (PHI), a sub-component of this scheme, is man-
dated to provide Ayush intervention on common public health issues relat-
ed to communicable diseases, non-communicable diseases, MCH, Geriatric
care, mental health, etc.
Vayo Mitra- Ayush Geri-
atric Healthcare Services
National Ayush Mission has provision for Ayush Public Health Programs;
one of the recently approved programs under its ambit is Vayo Mitra, which
is mandated to provide specialized and comprehensive Ayush Geriatric
Health Care Services to create awareness within the community on differ-
ent aspects of ageing and measures to reduce morbidity during old age
and to promote the value of the healthy the elderly persons to the commu-
nity and need for maintaining the Quality of life.
6. Ministry of Consumer Affairs, Food & Public Distribution
Name of the Scheme/
Program/ Activity
Goal/Benefits
Annapurna Scheme Department of Food and Public Distribution allocates food per requirements
projected by the Ministry of Rural Development under the Annapurna
Scheme, wherein indigent Senior Citizens, who are not getting a pension
under IGNOAPS, are provided 10 kg of food grains per person per month
free of cost. Senior Care Reforms in India 93
Antyodaya Anna
Yojana(AAY)
Under this scheme, rice and wheat are provided at a heavily subsidized
rate to homes headed by widows/terminally ill/disabled persons/senior
citizens, with no assured means of maintenance or societal support.
7. Ministry of Textiles
Name of the Scheme/
Program/ Activity
Goal/Benefits
Financial assistance The Ministry of Textile has a scheme through which financial assistance
of `3,500/-per month is given to handicrafts awardee artisans above 60
years of age with an annual income of less than `50,000/-.
8. Department of Pension & Pensioners Welfare
Name of the Scheme/
Program/ Activity
Goal/Benefits
Retiring Benefits and
Pension
The Department of Pensions and Pensioners Welfare supervises and
ensures that retiring Central Government employees receive retirement
benefits, including pensions so that they can live an active and dignified
life after retirement.
9. Ministry of Home Affairs
Name of the Scheme/
Program/ Activity
Goal/Benefits
Safety and Security The Ministry has issued two detailed advisories to all State /UT governments,
dated 27-3-2008 and 30-8-2013, advising them to take immediate measures to
ensure safety and security, as well as to eliminate all forms of neglect, abuse,
and violence against old people through various initiatives such as senior
citizen identification, police personnel sensitization on the safety and security
of older people, regular beat staff visits, and the establishment of toll-free
senior citizen helpline; setting up of senior citizen security cell; verification of
domestic helps, drivers, etc. Senior Care Reforms in India 94
10. Indian Railways
Name of the
Scheme/
Program/
Activity
Goal/Benefits
Measures for
the welfare of
senior citizens
Indian Railways have taken various measures for the Welfare of senior citizens, some of which are:
»In the computerized Passenger Reservation System (PRS), there is a provision to allot lower
berths to Senior Citizens, automatically, even if no choice is given, subject to the availability of
accommodation at the time of booking.
»In all trains having reserved sleeping accommodation, a combined quota of six (6) lower
berths per coach in Sleeper class and three (3) lower berths per coach each in AC 3 tier and
AC 2 tier classes has been earmarked for Senior Citizens, female passengers of 45 years of
age above and pregnant women. In the case of Rajdhani, Duronto, and fully Air Conditioned/
Express trains, the number of berths to be earmarked under this quota in 3 AC is 4 (four) lower
berths per coach as against 3 (three) lower berths per coach in normal Mail/Express trains.
»Accommodation is also earmarked for Senior Citizens during specified hours on suburban
sections by Central and Western Railways.
»Instructions exist for the provision of wheelchairs at stations. Moreover, Zonal Railways have
also been advised to provide free-of-cost ‘Battery Operated Vehicles for Disabled and old
Aged passengers’ at Railway Stations. In addition, passengers can book e-wheel chairs online
through the IRCTC portal “www.irctc.co.in.”
»To help old and disabled passengers requiring assistance at the stations and strengthen the
existing services, “Yatri Mitra Sewa’ is being provided through IRCTC at major stations to
enable passengers to book wheelchair services cum porter services, etc.
»After the departure of the train, if there are vacant lower berths available in the train and if
any person with a disability or a senior citizen, or a pregnant woman, who has been allotted
an upper/middle berth, approaches for allotment of vacant lower berths, the onboard Ticket
Checking Staff has been authorized to allot the vacant lower berth to them making necessary
entries in the chart.
»Separate counters are earmarked at various Passengers Reservation System (PRS) centres
for dealing with the reservation requisitions received from physically disabled persons, Senior
Citizens, and other specified persons if the average demand per shift is not less than 120 tickets.
»Electric Multiple Unit (EMU) local trains have a compartment earmarked for differently-abled
persons (Divyangjan).
»Unlike other compartments, the doorway Centre pole is relocated to the sides to enable entry
of wheelchairs.
»Disabled-friendly Integral Coach Factory (ICF) designed SLRD (Second class cum Luggage
cum Guard Van & Disabled Friendly Compartment) coaches have been incorporated. It is
endeavored to have at least one coach in each Mail/Express train having ICF-type coaches.
At present, 3519 ICF-type SLRD coaches (as of 31.03. 2021) are in the fleet of Indian Railways.
»Production units have already started manufacturing LHB Second Luggage, Guard & Divyangs
Compartment (LSLRD) type coaches for Divyangs Passengers. These coaches are suitably
designed for the needs of disabled/wheelchair-borne passengers.
»All Production Units have been advised to provide at least two doors of 920 mm width,
one on each side of the coach in the future in all newly manufactured coaches for improved
accessibility.
»For the assistance of visually impaired travelers, integrated Braille Signage is being provided in
all the newly manufactured coaches. Further, retrofitting the same in existing coaches is also
continuing in a phased manner. Senior Care Reforms in India 95
11. Ministry of Civil Aviation
Name of the Scheme/
Program/ Activity
Goal/Benefits
Measures for the welfare
of senior citizens
Various guidelines issued by the ministry for the welfare of senior citizens
are given below:
»The airline/airport operator shall ensure the provision of automated
buggies, free of charge, for all senior citizens in the terminal building
to facilitate their access to boarding gates located beyond reasonable
walking distance at all airports having annual aircraft movements of
50,000 or more.
»Airport operators shall adequately display information regarding the
availability of automated buggies and small trolleys in the terminal
building at prominent locations, including dos and don’ts. This shall
also be published on the website of the airport operator.
»Remove all physical barriers to facilitate easy entry and exit at all
airports and airlines.
»Change the design of the frisking booths in the security hold areas so
that the elderly are not required to climb and descend while undergoing
security checks;
»Pay special attention to provide help/assistance to them, particularly
after alighting from vehicles at the airports and until the person reaches
the check-in counters
»Pay special attention to the elderly and those needing assistance at the
booking offices of airlines
»Give preference in reservation and earmarking of seats in the airlines.
»Dedicated check-in-counter, departure gate/ lane.
»Priority is to be given to senior citizens at pre-queuing area and Pre-
Embarkation Security Check (PESC) points
Apart from these measures, the Ministry of Social Justice and Empowerment
provided budgetary support for the welfare of senior citizens from the
Senior Citizens Welfare Fund of `97.80 Lakhs to the Ministry of Civil
Aviation in the year 2018-19 for operating 30 Electric Operated Golf Cart at
8 designated Airports as well as to release funds to the Airports Authority
of India (AAI) to facilitate the Senior Citizens movement irrespective
of the class of their travel and to achieve the desired level of customer
satisfaction. 20 AAI Airports are now equipped with Ambu lifts to facilitate
flyers with reduced mobility. Senior Care Reforms in India 96
12. Ministry of Housing and Urban Affairs
Name of the Scheme/
Program/ Activity
Goal/Benefits
Elder friendly
environment
Various enabling guidelines by the ministry for creating an age-friendly
environment:
»Ministry of Housing and Urban Affairs, Department of Urban Development has
issued the Model Building Bye-Laws, 2016 (MBBL) prescribing standards for
the creation of an elder-friendly barrier-free environment related to buildings,
toilets, etc. Urban Local Bodies shall implement the Policy by adopting the
Model Building Bye-Laws, 2016.
»Further, under Urban Bus Specification-II issued in 2013, the emphasis
on buses financed by the Department of Urban Development is on the
procurement of low-floor buses with proper ramps for easy access of the
passengers and adequate space for wheelchairs to be placed in the bus for
the benefit of disabled persons and senior citizens.
»All metro rail projects implemented/under implementation in the country
have disabled and elder-friendly infrastructure, such as proper ramps/lifts
to the stations. There is a provision for the reservation of seats in metro rail
coaches for differently-abled persons and senior citizens.
Further, Housing for All Mission/Pradhan Mantri Aawas Yojana Guidelines has
been circulated to State/UT Governments to meet the demand for housing in
their States/UTs, which interalia incorporates that ‘while making the allotment,
families with senior citizens should be given priority for allotment on the ground
floor or lower floors.
The Ministry of Housing & Urban Affairs is implementing the Deendayal Antyodaya
Yojana-National Urban Livelihoods Mission (DAY-NULM) to reduce poverty and
vulnerability of urban poor households on a sustainable basis. The Mission, inter-
alia, aims to provide permanent shelter equipped with essential services to the
urban homeless in a phased manner under the Shelters for Urban Homeless,
irrespective of age.
13. Ministry of Road Transport & Highways
Name of the Scheme/
Program/ Activity
Goal/Benefits
Divyang/ elderly-friendly
environment
Ministry of Road Transport and Highways (MoRTH) vide GSR notification 959
(E) dated 27th December 2019 has notified amendments to the Central Motor
Vehicles Rules for providing Divyang-friendly features. Arrangements for
priority seats, signs, securing of crutches/canes/walkers, handrail/stanchions,
controls at priority seats, and wheelchair entry/housing/locking arrangement
for wheelchairs for differently-abled passengers or passengers with reduced
mobility to be checked and ensured at the time of fitness inspection.
The MoRTH issued the Accessibility Guidelines for Bus terminals and Bus Stops
on 29.08.2022. It covers the planning and design aspects of areas in bus ports/
bus terminals and bus stops so that these areas can be made accessible to all.
Special emphasis has been laid on ensuring ease of access for the use of these
facilities by end users. The aim is to ensure seamless inclusion of Divyangjan,
irrespective of their disability in the context of accessibility to any such
infrastructure. The above guidelines have been circulated amongst the SRTUs
of all States/UTs and are also placed on the website of MoRTH. Senior Care Reforms in India 97
14. Ministry of Culture
Name of the Scheme/
Program/ Activity
Goal/Benefits
Scheme for Financial
Assistance to Veteran
Artists
Ministry of Culture provides assistance of `6,000/- as a monthly allowance
to artistes aged 60 years and above, and `5,999 /- per month in case of
transfer of financial assistance to spouse on the death of initial beneficiary.
15. Ministry of Communications
Name of the Scheme/
Program/ Activity
Goal/Benefits
Concessions extended by
BSNL & MTNL
Bharat Sanchar Nigam Limited (BSNL) exempts senior citizens (65 years
&above) from payment of registration charges for Landline Telephone
Connection. Further, Mahanagar Telephone Nigam Ltd. (MTNL) provides a
concession of 25% in installation/activation charges and monthly services/
rental charges for Landline connections under Plan-250 in the Senior
Citizens Category, to Senior Citizens who are more than 65 years of age.
16. Ministry of Women & Child Development
Name of the Scheme/
Program/ Activity
Goal/Benefits
Home for Widows Ministry of Women and Child Development has constructed a Home for
Widows at Vrindavan, Uttar Pradesh, with a capacity of 1000 widows to
provide them safe and secure place to stay along with health services,
nutritious food, legal and counseling services etc. The design of the Home
is old age friendly with facilities such as ramps, lifts, supply of adequate
electricity, water, and other amenities for meeting the requirement of
senior citizens and persons with special challenges. Senior Care Reforms in India 98 Senior Care Reforms in India 99
ANNEXURE 6: LANDSCAPE OF NGOS, PRIVATE
SECTOR, AND INDUSTRY ASSOCIATIONS WORKING IN
SENIOR CARE
HelpAge India
»Founded in 1978, the organization’s programs are focused on direct
interventions in the areas of Healthcare (mobile healthcare units,
cataract surgeries), Age care (helplines, senior citizen care homes, and
day-care centres, physiotherapy), Livelihoods (elder-self-help groups;
linkages with government schemes), Disaster Response (e.g., COVID19
relief response), as well as advocacy and awareness on rights and
policies relating to elders.
»HelpAge is working with more than 5560 Senior Citizen Associations
(SCAs) across India with over 10 lakh members.
»HelpAge has started a ‘Digital Literacy’ program, introducing elders to
the online world by conducting workshops across the country with the
technical assistance of CSC Academy.
VridhCare
»Founded in 2019, VridhCare works towards the objective of serving the
underprivileged elderly community in both rural and urban areas.
»Established to provide dignity, and physical, emotional, and mental
well-being to the elderly population.
»The organization provides financial assistance and recognizes the
talent or skill of individuals to help them get dignified jobs, relevant to
them.
»VridhCare has partnered with and served over 50 NGOs, and works on
providing nutrition, rehabilitation, and livelihood to the elderly groups.
Age Well
Foundation
»Founded in 1999, Age Well has been set up to initiate better interaction
between generations. It aims to bring about a change in the perception
of old age. It also endeavors to create a senior citizens-friendly
environment, evolve a sense of moral and social responsibility towards
senior citizens, advocate for the needs and rights of senior citizens,
and extend a helping hand to senior citizens, wherever required.
»Age Well interacts with over 25000 older persons on daily basis
through its volunteers’ nationwide network.
ElderCare »Founded in 2014 with a vision to support the vulnerable elderly.
»Elder Care Trust provides medical /surgical support, social, educational,
and legal assistance to senior citizens; along with the delivery of
lectures for the benefit of everyone in the geriatric category.
»The Trust assists those elders who are physically dependent on others
for their daily living. Senior Care Reforms in India 100
Dignity
Foundation
»Dignity Foundation has been working for senior citizens since 1995,
offering an enriching set of opportunities to the elderly.
»It deals with their psycho-social challenges and helps them tackle their
loneliness and insecurities.
»Its programs are centered around the mental health and social well-
being of seniors (day care centres around loneliness mitigation,
dementia care, physical and spiritual well-being, etc.), along with
recreational activities (exploring hobbies and talents) and helping the
elderly groups to explore ‘Second Careers’.
Hindrise
Social Welfare
Foundation
»Founded in 2018, the Hindrise Foundation has listed various healthcare
activities and programs for senior citizens. It looks after the physical
and mental health of elders by enhancing the inter-generational
dialogue between the elderly and young adults.
»It extends its services in urban as well as rural areas, with all essential
resources such as high-quality food cooked in a healthy environment,
prescribed medicines, a wide range of information, counselling support,
and providing survival kits.
Nightingales
Medical Trust
»Nightingales Medical Trust (NMT) is a professionally managed not-
for-profit organization working for the well-being of the elderly and
persons with Dementia and Alzheimer’s since 1998.
»It strives to strengthen family bonds and promote community-based
support systems for Senior Citizens of all Socio-economic groups
through various innovative and need-based projects aimed towards
Dementia Care, Active Ageing, Social Integration, Empowerment,
Capacity Building, and prevention of Elder Abuse
»Its various programs for the elderly include dementia care, active
ageing, and social integration, empowering senior citizens, assisting
them in restarting their careers, addressing elder abuse, and providing
capacity-building programs.
ELDER CARE-
TATA TRUST
»Founded in October 2017, the Trusts’ elder-care initiatives were aimed
at serving the varied needs of the elderly in India with a major focus on
seniors residing in rural areas.
»It aims to play a transformational role in the geriatric sector by focusing
on the critical gap areas to create an empathetic senior care ecosystem.
»Their comprehensive elder-care initiatives covered preventive, curative,
promotive, and rehabilitative treatment for the overall well-being
of older people. They have initiated various activities and programs
towards improving the quality of life of seniors through caregiving,
decreasing their dependency, and generating social and economic
opportunities. Senior Care Reforms in India 101
All India
Senior Citizens
Confederation
(AISCCON)
»Formed in 2001, The All India Senior Citizens’ Confederation (AISCCON)
is a national-level organization of senior citizens.
»It devotes itself to networking, advocacy, and research on the issues
concerning the welfare and development of senior citizens with
governments at both the state and national levels. The organization
also provides service activities, including health care (physiotherapy
services, eye care services, and other advisories) services.
Broad Landscape of the Private Sector in Elderly Care
TriBeCa Care
»Founded in 2013, TriBeCa Care is an eldercare platform that assists
the elderly to live an independent life by offering a range of elderly
services, including emergency services and specifically designed
elderly care programs.
»It provides rehabilitative care to patients suffering from chronic
pain, depression, and mobility issues through the provision of expert
physiotherapists or psychologists.
»It also extends various other services like home-based services,
physiotherapy, senior travel services, dementia care, old age homes,
ambulance services, and help with hospitalization.
Antara
»Introduced in 2010 with the core philosophy to create an environment,
where senior citizens feel free to reflect and reconnect with themselves
while enjoying the company of like-minded people. Antara’s mission is
to respond to their evolving needs and desires through a perfect blend
of life care and lifestyle offerings that deliver a comprehensive and
seamless experience.
»Antara has launched Assisted Care Services which include-
a) Independent Living Residences for Seniors
b) Care Homes for Seniors
c) Care at Home services
d) Medicare Products
Emoha Eldercare »Emoha is a team of senior care experts, who aim to create the world’s
most comprehensive digital community of seniors.
»It is a connected community of 10000+ seniors, surrounded by care
givers who help simplify, secure, and energize their lives.
»It provides various services like remote health monitoring, daily
engaging activities, etc. to help them live a safer, healthier, more
convenient, and more active life in the comfort of their own homes. Senior Care Reforms in India 102
Life Circle Health
services
»Founded in 2013, its vision is to help seniors stay healthy in their homes
for as long as they want. Life Circle is a subscription-based home
healthcare service for seniors and has provided more than 500,000
hours of care services and 10,000 home visits till date.
»It provides home care services, where the professional caregiver assists
seniors with ADL like assistance in feeding, bathing, brushing, dressing,
and grooming. Homecare services consist of nursing services like blood
pressure monitoring, blood sugar monitoring, insulin administration,
oxygen administration, etc. It also provides medical equipment like
oxygen concentrators.
»The Senior Care Ageing Growth Engine Program of the Ministry of
Social Justice and Empowerment, Government of India, has chosen
Life Circle as the first step in promoting a “Silver Economy.”
Care 24
»Care24 is a home healthcare service provider that offers personalized
care plans for the elderly, including nursing care, physiotherapy, and
medical equipment rentals. They have various care packages starting
from ` 4,500 per month.
»Since its inception in 2014, Care 24 has offered professional care from
trained caregivers that help the patient recuperate at home. Some of
the major services offered by Care24 include caregiving services, nurse
services, and physiotherapy services.
»Its qualified clinical staff specializes in providing round-the-clock elder
care services along with assisting seniors with home exercises.
Elder Aid
»Founded in 2015, Elder Aid provides a range of at-home services.
»A designated Care Manager is assigned to every elder, whom they
can call for all their needs – ranging from emergency medical support,
arranging for a full-time caretaker, paying their bills, helping them use
their smartphone or just spending time chatting with them.
»They also conduct elderly wellness events, host common interest
groups, bring engaging talks, and provide other information to elders.
KITES Senior care
»KITES Senior Care is a geriatric care specialist brand set up in 2016,
with a vision to be the trusted out-of-hospital care continuum partner
to the elderly & their family.
»Kites Care provides the following services:
a) Transition and rehab care: Ensures total coordination and continuity
of care among elders during their transition from hospital to home
or other settings.
b) Palliative care and hospice: Comfort care, pain management and
counselling
c) Dementia and Alzheimer’s Care: Apart from the stay-in facilities,
they also provide daycare activities for neighborhood elders with
dementia.
d) Geriatric Home Care: Deliver high-quality geriatric care to seniors
in the comfort of their homes, covering post-hospitalization rehab
care, palliative care, and dementia care. Senior Care Reforms in India 103
Nemacare
»Founded in 2019, Nema Elder Care provides comprehensive hospitality
and healthcare services to seniors. Their services include healthcare
services, entertainment activities, food services, housekeeping, and
laundry.
»It also provides Assisted Living Care Homes, which is part of a
continuum of long-term care services that include housing, personal
care services, senior citizens assisted living facilities for dementia
care, and health care designed to respond to individuals who need
assistance with normal daily activities.
»It has also launched Continued Care Retirement Home/ Housing
(CCRH) with customized care services for seniors.
Portea
Portea is a home healthcare service provider that offers a range
of services for the elderly, including nursing care, physiotherapy,
and medical equipment rentals. They have various care packages
starting from ` 2,000 per month.
Anvayaa Anvayaa is a technology-driven home healthcare service provider
that offers various care services, including home nursing,
physiotherapy, and medical equipment rentals. They have various
care packages starting from ` 3,000 per month.
Eldercare Eldercare is a home healthcare service provider that offers
personalized care plans for the elderly, including nursing care,
physiotherapy, and medical equipment rentals. They have various
care packages starting from ` 5,000 per month.
Apollo Homecare Apollo Homecare is a home healthcare service provider that offers
various care services, including home nursing, physiotherapy,
and medical equipment rentals. They have various care packages
starting from ` 3,000 per month.
ElderEase ElderEase is a home healthcare company that provides elder care
services including nursing, physiotherapy, doctor consultations,
and medical equipment rental. They also offer specialized services
such as post-surgical care and cancer care.
Medwell Ventures
Medwell Ventures is a home healthcare company that provides
a range of elder care services including nursing, physiotherapy,
doctor consultations, and medical equipment rental. They also offer
specialized services such as palliative care and respiratory care.
Healers at Home
Healers at Home is a home healthcare company that provides elder
care services including nursing, physiotherapy, doctor consultations,
and medical equipment rental. They also offer specialized services
such as diabetes care and cardiac care. Senior Care Reforms in India 104
Industry Associations Working in the Area of Elderly Care
Federation of
Indian Chambers
of Commerce and
Industry (FICCI)

»Established in 1927, FICCI is the largest and oldest apex business
organization in India. From influencing policy to encouraging debate, and
engaging with policymakers and civil society, FICCI articulates the views
and concerns of industry.
»FICCI provides a platform for networking and consensus building
within and across sectors and is the first port of call for the Indian industry,
policymakers, and the international business community.
NATHEALTH

»Nathealth along with ASLI, FICCI, and MTaI released a whitepaper
on catalyzing & reforming senior care in India in which FICCI suggested
introducing a dedicated ‘National Mission for Ageing and Senior Welfare’,
with the active participation of the central and state governments, industry
and the civil society.
»The paper was released during the 7th FICCI Health Insurance
Conference and aims to act as a catalyst of change to encourage
policymakers and stakeholders for working towards the much-needed
transformation in the area of elderly care financing.
Confederation of
Indian Industry
(CII)

»The CII works to create and sustain an environment conducive to the
development of India, partnering with the industry, Government, and civil
society, through advisory and consultative processes.
»CII organizes annual conclaves which focus on key areas that require
huge capacity in building the Senior Care ecosystem. CII also releases
the Senior Care Industry Report at each conclave to unlock the gap areas
pertaining to geriatric care.
Association of
Senior Living
India (ASLI)

»It is the first National Senior Living Association in India founded in
2011. It strives to advance excellence in senior living in India and champion
quality of life for the millions of Indian seniors who will benefit from
professionally-managed senior living communities.
»It aspires to create a model of self-regulation and work in tandem with
the government on the guidelines of minimum standards for attaining
operational excellence by its members in particular and the industry at
large. The members of ASLI exemplify the principles of choice, dignity, and
independence for seniors to thus enhance their quality of life. Senior Care Reforms in India 105
ANNEXURE 7: TECHNOLOGY FOR SENIOR CARE
1. Wearables for smart monitoring, including activity trackers, blood pressure and heart
rate monitors, continuous glucose monitoring devices, smart watches, wearable pain
relief technology, etc. Some of the popular wearables are given in the table below.
S.No. Wearable Features
1. Apple Watch The Apple Watch is a popular smart-watch that can be used by the
elderly to monitor their health and fitness, receive notifications, and
communicate with loved ones.
2. FitBitFitbit is a wearable device that tracks physical activity, heart rate, and
sleep patterns. It also has a feature for tracking food intake and water
consumption.
3. Lively Mobile PlusThe Lively Mobile Plus is a wearable device that can be worn as a pendant
or clipped onto clothing. It has an emergency button that can be used to
call for help in case of a fall or other medical emergency.
4. GreatCall Lively
Wearable:
The GreatCall Lively Wearable is a smart-watch that can be used to track
physical activity, heart rate, and sleep patterns. It also has an emergency
button that can be used to call for help in case of a fall or other medical
emergency.
5. Samsung Galaxy
Watch:
The Samsung Galaxy Watch is a smart-watch that can be used to track
physical activity, heart rate, and sleep patterns. It also has a feature
for monitoring stress levels and provides breathing exercises to help
manage stress.
6. Philips Lifeline Philips Lifeline is a wearable device that can be worn as a pendant or
bracelet. It has an emergency button that can be used to call for help in
case of a fall or other medical emergency.
2. Personal Emergency Response Systems (PERS): PERS devices are wearable gadgets
that help the elderly to call for emergency help in case of a fall or medical emergency.
They come with features like fall detection and GPS tracking.
3. Smart Home Automation: Smart home automation systems help the elderly to manage
their homes easily. These systems can control lighting, temperature, and security
features, and can be operated using voice commands or mobile apps.
4. Medication Management Systems: Medication management systems like medication
reminders or alarms help the elderly to take their medication on time. They can remind
users to take their pills, track medication usage, and even dispense pills automatically.
5. Assistive Aids and Devices: Assistive devices like wheelchairs, walkers, walking sticks,
elbow crutches, tripods, quadpods, artificial dentures, spectacles, orthosis, prosthesis
like artificial limbs, hearing aids, visual and communication aids, memory aids, etc. can
help the elderly to maintain their independence.
6. Virtual Reality: Virtual reality technology can help the elderly to experience new places
and activities, which can help to reduce social isolation and improve mental health.
7. Robotic Assistance: Robotic assistance devices like robotic vacuum cleaners
and robotic companions can help the elderly to manage their homes and provide
companionship. Senior Care Reforms in India 106
8. Digital Assistants: Digital assistants like Amazon Alexa and Google Home can help the
elderly to manage their daily routines and access information hands-free.
9. Social Networking: Social networking platforms like Facebook and WhatsApp can
help the elderly to stay connected with friends and family, reducing social isolation
and loneliness.
10. Other aids and devices: like adjustable shower tools/commodes, back/neck collar,
safety rails and bed rails, etc. Senior Care Reforms in India 107
ANNEXURE 8: EXISTING LANDSCAPE OF TRAINING
AND CERTIFICATION COURSES IN GERIATRICS
52

In India, there is a growing need for skilled workers in the field of elderly care. There are
several certification courses available for individuals interested in pursuing a career in
elderly care. Some of the popular courses and certifications include:
• The National Initiative on Care for the Elderly (NICE), which later on got subsumed
under the NPCHE, launched two academic programs on geriatrics - certificate course
and post graduate diploma program and they continue to be offered.
i. A post graduate diploma: It is a one year full-time course with subjects like
Gerontology, Public Policy and Planning, Clinical Geriatrics, Geriatric Management,
Psychology and Counseling, Research Methodology.
ii. A certificate course in geriatric care: It is a full-time six months course to develop
a cadre of skilled Geriatric Care Givers, specializing in home care in family and
community settings. The course covers subjects like Social Gerontology, Basic
Geriatrics, Applied Geriatrics, and Geriatric Nursing.
• Institutions offering Doctor of Medicine (MD) in Geriatrics
1. All India Institute of Medical Sciences, New Delhi
2. All India Institute of Medical Sciences, Rishikesh
3. Amrita Institute of Medical Science & Research Centre, Kochi, Kerala
4. Armed Forces Medical College, Pune
5. Bangalore Medical College and Research Institute, Bangalore
6. Christian Medical College & Hospital, Vellore, Tamil Nadu
7. Dr. SN Medical College, Jodhpur
8. Government Medical College, Kolkata
9. Government Medical College & Hospital, Aurangabad, Maharashtra
10. Institute of Medical Sciences Banaras Hindu University, Varanasi, Uttar Pradesh
11. JSS Medical College, Mysore
12. Madras Medical College, Chennai
13. Mahatma Gandhi Missions Medical College, Navi Mumbai, Maharashtra
14. Padmashree Dr. D.Y. Patil Medical College, Navi Mumbai
15. Shri B.M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka
16. Yenopoya Medical College, Mangalore
• Post Graduate Diplomas offered by various educational institutes.
1. Post Graduate Fellowship in Geriatrics – CMC Vellore
2. Post Graduate Diploma in Geriatrics (PGDGM) – CMC Vellore
3. Post-Graduate Diploma in Geriatric Medicine (PGDGM) – Indira Gandhi National
Open University, New Delhi
4. Krishna Institute of Medical Sciences Deemed University, Karad
5. Fellowship in Geriatric Medicine Training Program at KMC, Manipal
52 Pati S, Sharma A, Pati S, Zodpey S. Teaching of geriatric health in India: Mapping the terrain. Gerontol Geriatr Educ [Internet]. 2017;38(1):92–
103. Available from: http://dx.doi.org/10.1080/02701960.2016.1232590 Senior Care Reforms in India 108
6. Post Graduate Diploma in Health and Social Gerontology by Institute of Home
Economics (Delhi University)
7. Diploma in Gerontology by Tata Institute of Social Sciences
8. PG diploma in geriatric medicine program by DCM Institute, Amritsar
9. Post graduate diploma in geriatric care by KMM (Kochi)
10. Post graduate certificate course in geriatric care and management by the Institute
of Distance Education, Kerala University
11. Post graduate diploma by A.D.N. Institute of Paramedical Sciences and Hospital
• Other institutions that offer these courses and certifications include:
1. National Institute of Social Defence, Delhi
2. HelpAge India, Delhi
3. All India Institute of Medical Sciences, Delhi
• Geriatrics content in family medicine courses: At present, geriatric medicine and care
of the elderly are incorporated to varying extents in the twelve academic programs
offered under the family medicine courses.
• Geriatrics teaching in public health courses: Geriatric care has not been given a
priority in the Masters of Public Health (MPH) curriculum, and the teaching primarily
focuses on policy and program aspects and not detailed apart.
• Geriatrics component in undergraduate health professional curricula: During the
undergraduate period, medical students get 1–2 weeks of formal education and
training in Geriatric medicine; but that is, less than 1% of the total time in medical
school. Further, there is no geriatric dentistry and nursing specializations per se in
India. With respect to the nursing staff, the Graduate Nursing curriculum comprises of
medical-surgical nursing of adults including geriatrics. A one year Post basic diploma
in Gerontological Nursing has also been launched by the Indian Nursing Council.
• Other Courses:
1. Certified Nursing Assistant (CNA): This is a vocational training program
that prepares individuals to work as nursing assistants in hospitals, nursing
homes, and other healthcare settings. The course typically takes six to
twelve months to complete.
2. Bachelor of Science in Gerontology: This is an undergraduate degree
program that provides in-depth knowledge of ageing, health, and social
issues related to the elderly. The duration of the course is typically three
years.
3. Master of Science in Gerontology: This is a postgraduate degree program
that focuses on the study of ageing and its impact on society. The course
duration is usually two years. Senior Care Reforms in India 109
ANNEXURE 9: NUTRITIONAL REQUIREMENTS OF THE
ELDERLY
Need of Elderly Nutrition
53
Age-related changes in nutritional status can depend on a variety of factors like
physiological, metabolic, immunological, and cellular/molecular. Further, micronutrient
deficiencies are linked to a number of age-related disorders, which negatively impacts
the health of the elderly. Therefore, it is necessary to specify and ensure adequate nutrient
requirements for the elderly.
Nutritional needs of elderly people due to age-related changes:
SN DimensionAge-related changesNutritional Needs
1. Physiological Loss of muscle mass, bone mass and
body mass
Protein, Vitamin D,
Calcium
Reduced GI Tract function leading to
decreased nutrient intake
Iron, Vitamin B12,
Calcium and Zinc
Altered senses of taste and smell B Vitamins and Zinc
Impaired visionCarotenoids, Vitamin C
and E, Zinc, Copper
2. MetabolicDecreased physical activityProtein, Vitamin D,
Calcium
3. Immunological ImmunosenescenceVitamin B6, Zinc and
Selenium
4. Molecular and CellularIncreased oxidative stress due to cellular
ageing
Vitamin B12 and Folate
Micronutrient linked to age-related disorder:
SN Micro-nutrient DeficienciesRelated Disorder
1. ZincAge related Macular
Degeneration (AMD)
2. Vitamin C and ZincAlzheimer’s Disease
3. Vitamin B6, B12 and FolateCognitive impairment, Cardio
Vascular Disease (CVD)
4. Vitamin DObesity, CVD
5. Vitamin CCataract
6. Vitamin B6, B12 and SeleniumReduced immune response
7. Thiamine, Manganese and CopperGlucose intolerance
8. ThiamineDepression
9. Vitamin D and CalciumOsteoporosis
10. Protein, PUFA, Vitamins B6, B12, C, D, E, Folate, ß-carotene
and Selenium
Frailty
53 Tattari Shalini, Gavaravarapu SubbaRao M., Pullakhandam Raghu, Bhatia Neena, Kaur Supreet, Sarwal Rakesh, Rajkumar Hemalatha,
Reddy G. Bhanuprakash. Nutritional requirements for the elderly in India: A status paper. Indian Journal of Medical Research 156(3):p 411-420,
September 2022. Senior Care Reforms in India 110
Nutritional recommendation for the elderly:
NutrientsMenWomen
EARRDAEARRDA
Energy (Kcal) 1700--1500--
Dietary Fibre --30--25
Protein (g) 43.054.036.346.0
Vit-A (μg) 4601000390840
Thiamin B1 (mg) 1.21.41.11.4
Riboflavin B2
(mg)
1.62.01.61.9
Niacin (mg) 1214911
Vit-C (mg) 65805565
Vit-B6 (mg) 1.61.91.61.9
Folate (μg) 250300180200
Vit-B12 (μg) 2.02.22.02.2
Vit-D (IU) 400800400800
Calcium (mg) 1000120010001200
Magnesium (mg) 370440310370
Iron (mg) 11191119
Zinc (mg) 14171113.2
Iodine (μg) 9514095140 Senior Care Reforms in India 111
ANNEXURE 10: VACCINATION GUIDELINES FOR THE
ELDERLY
54
Vaccination Guidelines by Various National Societies for People Aged 60 and above
Vaccines Geriatric
Society of
India
Association of
Physicians of
India
Indian Medical
Association
Indian Association
of Occupation
Health
Influenza D D D D
Pneumococcal D D D D
Herpes Zester D D D D
Tetanus D D D D
Diphtheria D D D D
Pertussis D D D D
Measles D D D Up to 60 only
Mumps D D D Up to 60 only
Rubella D D D Up to 60 only
54 Life Course Immunization: Pulse of a Resilient Health System. USISPF Senior Care Reforms in India 112
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LIST OF CONTRIBUTORS
Core Technical Team
NITI Aayog
Dr. Vinod K. Paul, Hon’ble Member (Health)
Shri Rajib K. Sen, Senior Adviser (Health)
Dr. K. Madan Gopal, Former Senior Consultant (Health)
Mr. Shoyabahmed Kalal, Deputy Secretary (Health)
Ms. Rishita Mukherjee, Consultant (Health)
Dr. Shobhit Kumar, Research Officer (Health)
Ms. Shrestha Hazra, Consultant (Health)
Ms. Oshia Garg, Intern (Health)
IPE Global
Ms. Aali Sinha
Ms. Dipika Joshi
Mr. Himanshu Sikka
List of Other Contributors
NITI Aayog
Dr. Rajeshwara Rao, Former Special Secretary
Dr. Rakesh Sarwal, Former Additional Secretary (Health)
Dr. Sumita Ghosh, OSD (Health)
Brig. (Dr.) K. Venkatnarayan, OSD (Member- Health)
Dr. S. B. Muniraju, Deputy Advisor (SJE)
Ms. Vaishnavi Iyer, Young Professional (Health)
Mr. Anant Kumar Goel, Intern (Health)
Dr. Sivarchaka Omkarnath, MD (CHA) Resident, NIHFW
Ministry of Social Justice and Empowerment
Mr. Saurabh Garg, Secretary
Mr. R. Subramanyam, Former Secretary
Mr. Surendra Singh, Additional Secretary
Mr. Bharat Lal Meena, Director, Admn., Senior Citizens
Ministry of Health and Family Welfare
Ms. Rekha Shukla, Joint Secretary
Dr. Gowri N. Sengupta, ADG (Directorate General of Health Services)
Ministry of Ayush
Dr. N Srikanth, Deputy Director General, Central Council for Research in Ayurvedic
Sciences
Department of Financial Services, Ministry of Finance
Mr. Saurabh Mishra, Joint Secretary Senior Care Reforms in India 119
Association of Senior Living India
Mr. Ankur Gupta
Ms. Bani Jain
Mr. Jiji Philip
Ms. Neha Sinha
Mr. Rajagopal G
Aurum Senior and Assisted Living
Mr. Amit Gupta
Mr. Sanjoy Pasricha
FICCI
Dr. Arun Agarwal
Mr. Praveen Mittal
Ms. Sarita Chandra
Ms. Shilpa Sharma
Dr. Suneela Garg
Mr. Vikas Malhotra
HelpAge India
Dr. Rajeshwar Devarakonda
NATHEALTH
Ms. Anuradha Sriram
Dr. Arvind Lal
Mr. Ashok Kakkar
Dr. Harsh Mahajan
Dr. Karthik Narayan R
Mr. Mayank Bathwal
Ms. Nanki Singh
Dr. Om P Manchanda
Dr. Ranjit Mehta
PHDCCI
Dr. N Subramanian
Prof. Parag Singhal
Dr.Ravi Rathod
Dr. Sameer Gupta
Mr. Vivek Seigell
PWC
Dr. Rana Mehta Senior Care Reforms in India 120 Designed by: Printed by
Communication Cell, NITI Aayog

Senior Care Reforms in India- Reimagining the Senior Care Paradigm