— By Dr. Arun Varma
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Once a poet famously described a time when the God of Death himself was slayed thus pushing the world into chaos, making the law of natural justice – all living things have to die – redundant. World, in general, is ageing. India, as a society, is ageing faster than the earlier assumptions. We call a society aged, when the balance between young and old population tilt towards the latter. No doubt, China is also ageing. Japan has already aged.
Ageing brings along a number of challenges – especially for developing and under developed economies. United Nations Population Fund estimates that the approximate number of elderly people in India – who are beyond the age of 65 – could touch 380 million by 2030. This is a fifth of the total population then or more than the current population of the United States. More than the numbers, old age brings about a bunch of physical and psychological adversities that need to be addressed constantly. Prevalence of osteoporosis or dementia or depression along with other possible combination with lifestyle diseases are just common place.
This sure-to-happen scenario has to be approached at two levels simultaneously. One is the social level. The second, economic. Faster urbanization in India has also resulted in shrinking of the residential space faster in an inter-generation comparison. From the clans to joint families and now to nuclear ones, average Indian has lesser space to live – especially for the urban middle class. Living with parents and children together as a single unit becomes impractical for the average two-income urban middle-class family. Challenges related to fulfilling the psycho-social support to the elderly becomes a burden. Often this leads to neglect or abuse of the old people.
Realtors have already identified this as a sunrise business. Rapid growth of old age homes and retirement shelters are an indicators towards this. Though still in infancy, several such efforts are only skin deep in their application of features that would help the old people in their assisted daily living (ADL). Many of them are just another residential complex project with anti-skid flood tiles and railings fitted on the walls. Shifting of an elderly person from his home to a Shelter is rehabilitation. Rehabilitation of a person advanced in age has to be planned well. There is a need for better understanding about geriatrics and gerontology.
Second aspect is of course, financial. Ageing is a phase of life and not a medical condition. Yet, with age, the need of assisted daily living (ADL) grows. For the same reasons of urban lifestyle, it may be unrealistic to expect the members of the family to extend this support. This is one of the principal out of pocket expense (OPE) the family has to deal with. Expenditure on care givers, consumables like diapers, mobility aids are to be budgeted in the days ahead. Longitudinal Studies in Ageing (LSA) have particularly focused on the Out of Pocket Expenses (OPE) and Catastrophic Health Expenses (CHE) as the two large and commonly applicable cases among the elderly people. While much of the OPE is derived from the Non-Communicable Diseases (NCD), CHE happens at an advanced stage of continuous NCD or a terminal effect of the combination of several factors related to ageing. These situations are financially extracting.
Footing the bill for one’s own longevity becomes compelling. Therefore, it is time to introduce suitable financial products that serve as a long-term care insurance that offers flexible options. Developed societies like Singapore and Japan have introduced such instruments long ago. Long Term Care Insurance (LTCI) schemes in Japan is mandatory for all people when they cross Forty. For an average premium equivalent to seventy US dollars, each citizen ensures that they have been well funded to enable them walk easily into their sunset.
India, has its own complexities to grapple with and expecting an easy solution to these would be unrealistic. Yet, we must recognize the gravity of the situation and begin to look for ways and means right away. The country, still nascent to these emerging challenges, needs to trigger an active dialogue among stakeholders to justify its culture of blessing each other with “Aayushman Bhava:” or May You Live Long.
(Dr. Varma is the Managing Director Winage™)