This report was published in The Malabar Journal on 19/11/2022
A major feature of the acclaimed Kerala human development experience is the attainment of life expectancy comparable with much more developed regions; the average life expectancy for males in the state being 72 years, and that of females, 78 years. Attributed to this, Kerala has the highest proportion of the aged (60+) in the population among the states in India. It is estimated that one in every five persons in the state is an elderly and by the next decade, the elderly would outnumber the children in the state.
The increase in the proportion of the old age dependent group, accompanied with the decrease in the working age group on account of decrease in the feeder child population, will entail higher social security expenditure. With the increasing trend of migration among the younger generation, Kerala is seeing an increasing number of houses with only elderly occupants. While many other regions in India are struggling with first generation problems like lowering infant mortality and maternal mortality, these problems in front of Kerala are that of a “second generation” nature, including high incidence of non-communicable disease, of which population ageing is a major causative factor.
As is known, old age comes with its very own set of problems. Many of the elderly will no longer be employed or be in a physical state of health to be employed. Meeting their day-to-day expenses will be a major challenge for those without sufficient economic resources or pension, forcing them to be dependent on others. Expenses, especially related to health will increase. Multiple morbidities and disabilities will also occur. Apart from physical disabilities, elderly also suffer from various mental health issues caused due to loneliness, stress, loss of spouse and other loved ones, etc. Other developed regions in the world have implemented policies and programmes that address various needs of the elderly such as health care, employment, companionship, support services, etc. It is imperative that the state responds to the needs of this vulnerable section.
It is high time that the state launches a flagship programme for the elderly with the involvement of multiple agencies/departments including Local Governments, Health Services, Social Justice Department, Police, etc., addressing the various needs of the elderly. The Integrated Child Development Services (ICDS) programme has been successful in meeting multiple needs of children including nutrition, development, health care and growth monitoring. Similarly, an umbrella programme catering specifically to the elderly should be instituted in the state. Given that elderly outnumber children who are beneficiaries of the ICDS programme (children aged 0-6 years constitute 10 per cent of the state population), it is high time that the state recognises the demographic transition in the state and dedicates resources proportionate to the elderly in the population.
It is also important to understand that the elderly is not a homogenous group and comprises of different types of elderly, such as the oldest old, elderly living alone, elderly with disabilities, widowed, elderly women, etc. Each varied condition entails a different vulnerability profile with difference in needs. It is thus important to cater to the varied types of needs across different categories of elderly.
It is also felt that the Kerala society is yet to become conscious of these changes in the demography and the changes that need to be brought in. A major campaign focusing on creating awareness about the rights of the elderly, sensitisation of family members and the society at large about the vulnerabilities and support needs of the elderly, training of family and community members to undertake caregiving roles, creation of a barrier-free environment for the elderly in public spaces as well as within homes, about various services and programmes for the elderly, etc. needs to be launched.
Health care is a major need of the elderly and the nature of care required is of varied types from regular medication and tests to hospital visits to hospital-based interventions to home-based palliative care. It is observed that , public health care functionaries, Kudumbashree functionaries and palliative care workers cater to the needs of the elderly. Programme such as Non-Communicable Diseases Clinics and Vayomithram also meet varied health needs of the elderly. A comprehensive Health Care Programme for the Elderly streamlining and integrating the activities undertaken by multiple agencies is the need of the hour, especially at the local level.
The role played by local governments is crucial. What is observed is that the local governments largely limit their role in elderly welfare to construction of Pakalveedu and the distribution of beds and cots. This is not enough and effective planning of programmes is possible only with authentic and relevant data. Local governments should have a detailed database on the elderly population in their jurisdiction with details such as their morbidity and disability profile, their living arrangements, income source, etc. Support systems and programmes should be designed at the local level depending on the composition of the elderly and their needs. The initiatives undertaken at the local level during COVID such as community kitchen/provision of food to elderly who are unable to cook, regular visits to elderly households by ASHA to enquire on their well-being, delivery of medicines, ration and other essentials at the doorsteps by volunteers, etc. need to be sustained to ensure the welfare of the elderly.
It is often seen that local governments spend a significant amount on construction of day care homes or Pakalveedu for elderly, which in many cases are underutilised. Instead of constructing a new building for the pakalveedu, the local governments could identify unused residences or government buildings in easily accessible locations for the purpose and take them on lease or rent. Ward level elderly forums or clubs should be constituted and the activities of the pakalveedu could be managed by such elderly forums. Such forums could also function in places such as Anganwadis, Government schools, etc. The socialisation needs as well as health care needs of the elderly can be met through organising activities including health check-ups at the ward level. These ward level forums shall also function as Jagratha Samithis and can intervene in cases of elderly abuse.
Elderly, especially those living alone often need persons to support them while going out to the hospital/bank/panchayat, to buy medicines and other essentials, or to simply talk to them. Even in the case of elderly with family and caregivers, there could be a caregiver burnout and inability to engage in jobs or attend social functions, due to the responsibility of caring for the elderly. Local level labour bank could be created by identifying potential people. Such support systems are mushrooming in the private sector on a commercial basis, but local level initiatives will be very helpful and more reliable for the general public.
The absence of a grassroot level worker specially for the elderly, is a major lacuna. It is important that at the local government level a Vayojana Coordinator, akin to persons such as SC/ST promoter, who are responsible for the management of the programmes of the state government and local government for the elderly, is appointed. He/she can liaison with different agencies and departments at the local level.
The involvement of the key stakeholder, i.e., the elderly themselves, in the planning, decision-making and implementation process is crucial. Programmes should be based on assessed needs and demand from the elderly than following a top-down approach. The state must also make use of the huge “retirement dividend”. Retired elderly with good health who are willing to actively participate in various activities should be given the charge of organising programmes at the elderly institutions. The wealth of their experience could also be used by engaging them to train the younger generation in their respective domains and activities.
There should be a thrust to use of technology for improving the life of the elderly. New technologies may be developed, and technological solutions employed in developed country settings may be adapted to suit the local context, for the elderly, their care givers and in care homes. Delivery of institutional care can be improved by use of facilities such as emergency alarms and bells, fall alerts, beds fitted with easily raisable levers, easy to move wheelchair, etc. Similarly, medicine dispensers with motion sensors and voice recorded reminders, CCTVs, tracking devices, app-based support systems for regular monitoring of vitals, etc. would be helpful for elderly and their family members and caregivers. The state through the start-ups under the Kerala Start-up Mission should strive towards development of such technologies and ensure access to such facilities across socio-economic groups. To bridge the digital divide and to improve the access of elderly to technology, use of students and volunteer from colleges can be done.
Population ageing is the result of the success that the state achieved in human development. The local governments have a major role to play in addressing this second-generation problem. The state needs to gear up and launch a flagship programme for the elderly, for which sufficient funds need to be allocated..
Note: Based on the CSES Study titled “Assessment of Government Schemes and Programmes for Elderly in Kerala conducted for the Department of Social Justice, Government of Kerala http://sjd.kerala.gov.in/DOCUMENTS/Report/General%20Report/36661.pdf