HelpAge India Brings Urgent Attention to Elder Income and Health Security with Special Consideration to Needs of Older Women

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India: As the government envisions India of 2047 and plans for Amrit Kaal, building an age-friendly society is imperative. HelpAge India, a non-governmental organisation that works for the needs and concerns of the elderly, submitted its budgetary recommendations to the Hon’ble Finance Minister, Smt. Nirmala Sitharaman with an ask to set up a special Ministry for the elderly and considering measures for immediate relief in areas of income, health security, caregiving and inclusion of older persons in exiting govt. schemes with a special focus on older women and the oldest old.

“The need for immediate action, inclusion and implementation towards elder care measures is now more than ever crucial in the post-pandemic context, which brought elder vulnerability to the fore. India with a current estimated elder population of 140 million, will be bracing for rapid ageing in the next three decades, with its elderly population set to explode by 20 per cent by 2047. Immediate measures need to be put in place, to address their socio-economic and health needs, which require a substantial allocation of resources.We request enhancing of old age pension to a minimum of Rs. 3000per month, with priority on universal coverage for older women and oldest old, incentivise caregiving by providing tax benefits to family caregivers, strengthen existing financial, healthcare and social care systems with the sufficient allocation of funds and urge the government to set up an Ayushman (Longevity) Ministry for Elderly for addressing the multifarious elder issues and managing the programmes of elderly,” said Rohit Prasad, CEO, HelpAge India.

The pandemic identified elders as one of the most vulnerable segments of the population, the governments’ vaccination drive which prioritised elders is highly commendable. It also highlights the immediacy of putting effective healthcare systems in place for this vulnerable section.

The recently published findings of Longitudinal Study of Ageing in India (LASI) highlighted the hard reality elders face viz-a-viz health security. Around 70 per cent of elderly faced chronic diseases, around a quarter of those 60 and above, suffer from multi-morbidities (23 per cent) and 11 per cent have at least one form of impairment. This makes them more susceptible to new diseases and viruses, and they require continued care. Some form of health insurance in India covers just about 26 per cent of households.

The recommendations made by HelpAge to enhance elder health security include:

Pradhan Mantri Jan ArogyaYojna (PMJAY) enrolment drive for the elderly, particularly elderly women, the oldest adults, and the disabled elderly. While PMJAY is an inclusive health assurance scheme and covers the elderly, a special focus/campaign on covering eligible elderly may be considered, as they face a much higher risk of hospitalisation, which is the main focus of PMJAY. Except for income tax payers, all the nation’s 80+ elderly population to be covered by PMJAY.

The National Programme for Health Care of the Elderly (NPHCE), which is the only geriatric care programme (launched in 2010) for elderly, needs immediate attention. With the need for accelerated and prioritised implementation of the programme across all districts, it would perform better if the budgetary allocation was done specifically for this unique initiative rather than putting funds in a “flexi-pool.”

The organisation also made a strong case for incentivising care giving for elderly within the family fold by recommending introduction of additional limits beyond the basic tax exemption for family caregivers such as an amount of Rs.3.5 Lakh (beyond the exemption limit of Rs.2.5 Lakhs) for those tax payers taking care of parents/in-laws up to 80 years and an amount of Rs 5.5 Lakhs for taking care of those above 80 years. This is to be claimed by any one of the adult children taking care of the elderly.

The recommendation was made for a new provision for special care allowance for the women who take care of elderly parents and older women who care for the family. Women from low-income families may be selected for this scheme.  

On the income and livelihood side, as per LASI, 36 per cent of the elderly were working – much higher in rural areas (40 per cent) than urban areas (26 per cent), and mostly in-unorganised sector. Only about 30 per cent of the rural elderly from BPL households were recipients of old-age pension benefits.

“Two major areas this year’s budget needs to address is the growing feminisation of the ageing population and disproportionate increase in the numbers of the oldest old with a focus on older women, who need to be enrolled in some of the landmark schemes such as PMJAY and given priority coverage within the Old Age Pension scheme. There is also an urgent need to put long-term care systems in place. Women in particular contribute disproportionately to caregiving. They remain major caregivers but struggle in later years. It is time that we recognise the fact and take steps to enable them to contribute successfully to society and live independently,” says Anupama Datta, Head – Policy Research & Advocacy, HelpAge India.

‘Poverty in old age’ is a major challenge that has been further impacted by the pandemic. The earlier SECC report of the Ministry of Rural Development had identified 50 per cent of the elderly as poor. HelpAge’s report during the pandemic revealed that 65 per cent poor elder livelihoods were impacted and they had no work or faced a drastic loss in their wages.

The recommendations made by HelpAge to enhance elder income security therefore included:

Universalise Old Age Pension to include older women and oldest old. The desirable monthly allowance to be Rs 3000 per month, with the Central Government taking the lead in defining a basic minimum social pension floor across the country. A minimum increase in the Central Government contribution to the National Social Assistance Programme (NSAP) is required from the current Rs 200-500, which has not been revised over the last 14 years, to Rs. 1000 per month per beneficiary for those 60 and older and Rs 1500 per month per beneficiary for those 80 and older. Currently, the old-age pension averages around Rs 500 in most States.

Raise income tax exemption limit for Senior Citizens up to Rs 10 lakhs, currently being Rs 3 Lakhs for those 60 plus and Rs 5 Lakhs for those 80-plus. Higher limits to be particularly considered for older women (60+) and all senior citizens in the oldest old segment.

To ensure standard of living for the middle-class elderly, bank fixed deposit (FD) interest rates should be enhanced for senior citizens, and their income should be tax-exempt as this is their mainstay in many cases. Currently under Section 80TTB, interest up to Rs 50,000 earned by the senior citizen is eligible for deduction. The limit may be increased to Rs 1,00,000.

Considering that some segments of elderly have to work to survive, include poor older persons in MGNREGA (the Mahatma Gandhi National Rural Employment Guarantee Act, 2005, which gives guarantee of a hundred days of wage employment in a financial year to adult members of a rural household who demand employment and are willing to do unskilled manual work) and keep a reservation of at least 5 per cent of the jobs for them. Make special budgetary allocation for inclusion of older persons particularly older women. Consider tax incentives to employers who continue to employ workers over 65 years.

Therefore, there is a need to urgently put in place necessary socio-economic and health security umbrellas, which will need enhanced allocation of resources under existing Government Schemes such as under the NAPSrC (National Action Plan for Senior Citizens) with addition of a special scheme for Multi-Service Day Care Centres in all districts with facilities for day care, medical, physical fitness, recreation and reskilling.

Allocate substantial funds for effective implementation of the provisions and increase in public awareness about the landmark Maintenance and Welfare of Parents and Senior Citizens’ Act ensuring the security and dignity of elder lives.

Meanwhile, strengthening Elder-Self-Help-Groups (ESHGs) a concept pioneered by HelpAge India to provide livelihood and income opportunities for the poor elderly, with enhanced allocations made available for poor older persons in rural areas.

Post pandemic, the digital divide has starkly increased for the elders. While all systems (banking, utility, and health, financial and other transactions) are getting digitally enabled under the Digital India/eGovernance programme, elders are left struggling to cope with the new technology. HelpAge strongly recommends a digital empowerment initiative especially for elders be launched under the Digital India/CSC/Ministry of Electronics & Information Technology (MeitY) with requisite allocation of funds.

Post the pandemic elder vulnerability has heightened and the need to take immediate action for long term sustainability of elder lives so they can live life with dignity and care, is now imperative more than ever.