MME-104

Basic Geriatrics
Indira Gandhi National Open University
School of Health Sciences

VOLUME-2
Block 4
National and International Programmes
for Elderly 05
Block 5
Rehabilitation Geriatrics 87
Block 6
Ethical and Legal Issues in Geriatrics 143

1
 CURRICULUM DESIGN COMMITTEE (PRE-REVISED)
Dr. Kalyan Bagchi Dr. Sanjogta Dr. A. B. Dey Dr. Ruchika Kuba
President Sachdeva Additional Professor Programme
Society for Former Professor Deptt. of Medicine Coordinator
Gerontological and Head Deptt. of AIIMS, SOHS, IGNOU,
Research, Medicine Ansari Nagar New Delhi
New Delhi Lady Hardinge New Delhi
Medical College,
Dr. V.S. Natarajan New Delhi Prof. [Link]
Former Professor Director
and Head Deptt. of Dr. Kamala Ganesh SOHS, IGNOU,
Geriatric Medicine Former Director, New Delhi
Madras Medical Professor and Head
College, Deptt. of Obst. And
Chennai Gyane Maulana Azad
Medical College,
New Delhi

CURRICULUM DESIGN COMMITTEE (REVISED)

Ms. Anupama Datta Prof. Ruchika Kuba
Head Policy Research and Programme Coordinator
Advocacy SOHS, IGNOU
HelpAge India, Maidan Garhi,
New Delhi New Delhi

Prof. T. K. Jena Dr. Biplab Jamatia

Professor Assistant Professor
SOHS, IGNOU (Selection Grade),
Maidan Garhi, SOHS, IGNOU
New Delhi Maidan Garhi,
New Delhi

BLOCK PREPARATION TEAM - BLOCK 4

Unit 1 Unit 3 Block Editor
Dr. Atreyi Ganguli (Pre-revised) Dr. Prasun Chatterjee
National Professional Mrs. Simrita Choudhary Additional Professor,
Officer (Mental Health and Coordinator Geriatric Medicine
Substance Abuse) WHO Vimhans No.1, Institutional (AIIMS), New Delhi
India Area, Nehru Nagar,
New Delhi Prof. Ruchika Kuba
Unit 2 Programme Coordinator
Dr. Gowri. N. Sengupta (Revised) SOHS, IGNOU
ADG-NPHCE Ms. Anupama Datta Maidan Garhi,
Dte. GHS, MOHFW, Head Policy Research and New Delhi
Government of India, Advocacy Help Age India,
New Delhi New Delhi

2
BLOCK PREPARATION TEAM - BLOCK 5
Unit 1 Unit 3 Block Editor
(Pre-revised) (Pre-revised) Dr. Shobhalakshmi S
Dr.S.L. Yadav Dr. Shabben Ara Associate Professor
Assistant Professor B-770, Ansal Department of
Department of Rehabilitation Palam Vihar, Gurgaon Physiotherapy, Ramaiah
AIIMS, Ansari Nagar Medical College, Bangalore
New Delhi (Revised)
Dr Prakash Kumar Prof. Ruchika Kuba
(Revised) Assistant Professor-III Programme Coordinator
Dr Prakash Kumar Amity Institute of SOHS, IGNOU
Assistant Professor-III Occupational Therapy, Amity Maidan Garhi,
Amity Institute of University NOIDA (UP) New Delhi
Occupational Therapy, and
Amity University Dr. Meena Gupta
Noida, Uttar Pradesh Assistant Professor-II
Amity Institute of
Unit 2 Physiotherapy Amity
Dr. Ritu Sharma University Noida, (UP)
Associate Professor
Psychology
Aditi Mahavidyalaya,
University of Delhi
New Delhi

BLOCK PREPARATION TEAM - BLOCK 6

Unit 1 Unit 3 Block Editor
Dr. Mala Kapur Shankardass Dr. Aarti Dr. Sue C. Jacobs
Sociologist, Professor Professor, School of
Gerontologist and Health Department of Anatomy, Community Health Sciences,
Social Scientist International Pt. B. D. Sharma, PGIMS, Counseling and Counseling
Consultant, Rohtak, Haryana Psychology,
Retd. Associate Professor, Myron Ledbetter/Bob Lemon
Maitreyi College, Counseling Psychology
University of Delhi, Diversity Professor
New Delhi Fellow, American
Psychological Association,
Unit 2 Division 17 Licensed
Dr. Savita Verma Psychologist,
Professor ND 273
Department of College of Education and
Pharmacology, Human Sciences,
Pt. BD Sharma, Postgraduate Oklahoma State University
Institute of Medical Sciences
Rohtak, Haryana Prof. Ruchika Kuba
Programme Coordinator
SOHS, IGNOU
Maidan Garhi, New Delhi

3
 COORDINATION
Prof. Ruchika Kuba
Director, SOHS and
Programme Coordinator
SOHS, IGNOU,
Maidan Garhi, New Delhi

PRINT PRODUCTION
Ms. Promila Soni
Assistant Registrar,
MPDD, IGNOU, New Delhi
July, 2022
© Indira Gandhi National Open University, 2022
ISBN: 978-93-5568-295-6
All rights reserved. No part of this work may be reproduced in any form, by mimeograph or any
other means, without permission in writing from the Indira Gandhi National Open University.
Further Information on Indira Gandhi National Open University courses may be obtained from
the University’s office at Maidan Garhi, New Delhi-110068 or visit University website http://
[Link].
Printed and published on behalf of the Indira Gandhi National Open University,
New Delhi by the Registrar, MPDD, IGNOU.
We acknowledge artwork for cover design provided by Ms Abhilasha Kuba, Class XII, Amity
International School, Saket, New Delhi.
Laser Typeset by: Hi-Tech Graphics, D-4/3, Okhla Industrial Area, Phase-II, New Delhi-110020.
Printed by: Hi-Tech Graphics, D-4/3, Okhla Industrial Area, Phase-II, New Delhi-110020.

4
 MME-104
Basic Geriatrics
Indira Gandhi National Open University
School of Health Sciences

Block

4
NATIONAL AND INTERNATIONAL
PROGRAMMES FOR ELDERLY
Unit 1
Programmes at Global Level 07
Unit 2
Programmes at National Level 37
Unit 3
Provisions and Schemes for Elderly 62

5
 BLOCK INTRODUCTION
The geriatric population is a special group since the health care needs are multi
disciplinary and different form the rest of the population. Efforts are being made
both at Global and National Level to look into and provide the multi faceted
benefits to this group.
The first unit of this block deals with the concept of healthy Ageing and the
history of the contributions at international level to the well being of the older
persons. Uniter Nations has declared 2021-2030 as the decade of Healthy
Ageing. You will read more about the initiatives under this plan. You will also
learn how the health systems can be strengthened and the strategies and plans
endorsed by the World health Assembly and United Nations with reference to
Healthy Ageing.
In the second unit you will read about the National Programme for Health Care
of Elderly, its objectives, strategies and services offered under this programme.
You will also learn about its implementation plan and achievements till date and
the future plans. You will also be acquainted with few other related programmes
which contribute towards well being of elderly.
The third unit covers the various provisions and schemes for the elderly. Some
of these are the Rashtriya Vayoshri Yojana (RVY), Indira Gandhi National Old
Age Pension Scheme (IGNOAPS), Annapurna Scheme, Pradhan Mantri Jan
Arogya Yojana, reverse mortgage scheme etc. You will also read about the
privileges and benefits. The facilities in the form of old age homes, day care
centres, long term care have been also explained.
In the subsequent Block you will learn about the principles and types of
Rehabilitation available for the older persons.

6
UNIT 1 PROGRAMMES AT GLOBAL LEVEL
Structure
1.0 Objectives
1.1 Introduction
1.2 Health Ageing
1.2.1 Healthy Ageing and Functional Ability
1.2.2 Key Considerations of Healthy Ageing
1.2.3 Healthy Ageing and Active Ageing

1.3 Global/Regional Guidance on Healthy Ageing

1.3.1 Vienna International Plan of Action on Ageing (1982)
1.3.2 United Nations Principles for Older Persons (1991).
1.3.3 Second World Assembly on Ageing (2002)
1.3.4 World Health Day 2012
1.3.5 Global Strategy and Action Plan on Healthy Ageing and Health (GSAP)
2016-2020
1.3.6 Regional Framework on Healthy Ageing (2018-2022)
1.3.7 UN Decade of Healthy Ageing 2021-2030

1.4 Health Systems Strengthening to Meet the Needs of Older People:

Integrated Care of Older People
1.5 Strategies and Plans Endorsed by the World Health Assembly and
United Nations having Relevance to Healthy Ageing
1.6 Let Us Sum Up
1.7 Glossary
1.8 Answers to Check Your Progress

1.0 OBJECTIVES
After reading this unit, you should be able to:
• Enumerate global guidance on healthy ageing
• Explain the policy decisions by the UN and WHO on Healthy Ageing
• Describe the role of global events in promoting Healthy Ageing
• Rainforce the need for strengthening health systems to cater to the needs of
older people and deliver integrated care for older people

1.1 INTRODUCTION
So far you have already read about the demographic changes in older people
and its significance. Further you have already been acquainted with the
epidemiological transition in older people, leading to the dual burden of
communicable as well as noncommunicable diseases. 7
National and Presently, there is no United Nations standard numerical criterion, but the UN
International agreed for cutoff of 60+ years to refer to the older population .
Programmes for
Elderly The changing lifestyles have ushered in a surge of chronic diseases, which
usually need longer period of treatment follow up. In India, as the proportion
of older people with health insurance back-ups are limited, and mostly have
superannuated from formal employment, it is imperative that the existing heath
systems be strengthened, to address the health needs of older people, particularly
at the community level. These initiatives will contribute towards preventing
meaning older peoples’ financial hardships, due to high cost of treatments.
While health promotion and prevention are community-based interventions,
these must be supplemented by person-centric approach for early diagnosis and
management. WHO has been providing global guidance for quality healthcare
in resource-limited settings. Drawing from these strategies, countries have
crafted their national and subnational guidelines, for optimum outcomes.
In this unit we will obtain better understanding of “Healthy Ageing” and
“Active Ageing” mean, along with key considerations of Healthy Ageing.
Upon obtaining clarity on these key words, you will be able to better appreciate
the global guidance on Healthy Ageing, with United Nations and WHO. You
will also be familiarised with the Integrated Care of Older People (ICOPE) and
the strategies and plans endorsed by the World Health Assembly and United
Nations with respect to Healthy Ageing
In the next two units, you will read more about programmes, schemes, and
provisions, at the national level
Did you know?
1.2 HEALTHY AGEING
• Between 2015 and
2050, the proportion of A longer life implies that the older person is being given another
the world's population
opportunity to pursue newer avenues, higher education, or a passion,
over 60 years will nearly
double from 12% to 22%. which the individual had not been able to pursue earlier. Older people
• By 2020, the number
are a ‘resource’ due to their rich experience. This should be optimally
of people aged 60 tapped and utilized, to usher-in development of the individual in
years and older will specific and the community in general
outnumber children
younger than 5 years. The extent to which people can benefit from these extra years depends on the
• In 2050, 80% of older key parameter- healthy ageing.
people will be living in
low- and middle-income Let us understand the factors which influence ageing
countries.
• The pace of population The factors influencing ageing can be grouped into-
ageing is much faster
than in the past. • Genetic;
• All countries face
major challenges to • Physical and social environments like homes, neighbourhood and
ensure that their health communities etc;
and social systems are
ready to make the most • Personal characteristics like sex, ethnicity and socioeconomic status etc.
of this demographic
shift. Ageing results due to the interplay of many factors. The changes at molecular
Source: WHO 2020. https:// and cellular levels, cause decrease in physical and mental capacities, leading to
[Link]/news-room/fact-
sheets/detail/ageing-and-health growing risk of diseases and ultimately death. However, beyond the biological
8 1
[Link]
changes, ageing is also affected by other transitions, like retirement, relocation Programmes at
to more appropriate housing, death of friends and spouse etc. Global Level

Thus, we see that the health of older people is dependent on varied factors, which
encompass physical, mental, environmental and personal factors. It is important
to understand these at an individual level, before proclaiming a diagnosis and
prescribing treatment.
Ageism - WHO defines ageism as the Points to Ponder
stereotyping and discrimination against Before we take a deep
individuals or groups on the basis of dive into the specificities
their age. of Healthy Ageing, can
you think of the key
Ageism can include prejudicial attitudes, changes in society that
have a bearing on the
discriminatory practices, or institutional health of older people.
policies and practices that perpetuate
Some of the changes
stereotypical beliefs. could be
- Migration (rural to
urban)/national to
[Link]
default-source/campaigns/ international
global-campaign-to-combat- - Joint family to nuclear
ageism/ageism-is-harmful.
family system
jpg?sfvrsn=be1c4035_11
Fig. 1.1: Ageism is harmful - Feminization of older
Source: WHO 2021. Combat ageism population
- Ageism etc.
Fig. 1.1 shows the harms caused by ageism, which impacts all aspects of
life of an older person.

Socially ingrained ageism can become

self-fulfilling by promoting in older
people stereotypes of social isolation,
physical and cognitive decline, lack of
physical activity and economic burden.
In March 2021, WHO, Office of the
High Commissioner for Human Rights
(OHCHR), United Nations Department
of Economic and Social Affairs (UN
DESA) and United Nations Population
Fund (UNFPA), calls for urgent action to
combat ageism, by releasing the Global
report on ageism. This report outlines
a framework for action to reduce ageism Fig. 1.2: Global Report on Ageism
through specific recommendations for Source: WHO 2021. Global report on Ageism.
different actors, namely the government, UN agencies,
civil society organizations, private sectors, etc, and
brings together the best available evidence on the nature,
magnitude, determinants and impact of ageism. It provides
global guidance on evidence-based implementable
strategies to prevent and counter ageism. The report (Fig.
1.2) identifies gaps and proposes future areas of research
[Link]
int/publications/i/
for better understanding of ageism.
item/9789240016866 9
National and What is Healthy Ageing (HA)?
International
Programmes for WHO defines Healthy Ageing (HA) as “the process of developing and
Elderly maintaining the functional ability that enables wellbeing in older age.”
Human beings are living longer, the reason may be attributed to decrease in
fertility rate and increased longevity. This has brought about a demographic
change, leading to the increase in the population above 60 years of age.
Healthy ageing also is a consequence of healthy lifestyle, which the individual
has been following throughout his/her life -this is called lifecourse approach.
Maintaining healthy lifestyles like eating healthy diet (low in salt, sugar, trans
fats and high in fruits and vegetables), adequate physical activity, avoiding
tobacco alcohol and stress, improves physical and mental capacities.
Emphasis is being given to maintaining muscle mass and good nutrition. This
helps to preserve cognitive function, delay care dependency and reverse frailty.
Supportive environments like availability of safe and accessible public buildings
and transport, wherein they can easily walk around, encourage older people to
do what is important to them, inspite of loss in their capacities.
The three components of healthy ageing are:
• functional ability,
• intrinsic capacity and
• environment.
Ageing is a result of interplay amongst different factors. There are changes at
the molecular and cellular level, causing decrease in physical and cognitive
capacities, increased morbidity and mortality.
You will appreciate that beyond the biological changes, ageing is also is
dependent on other life-events like retirement, death of friends and spouse,
relocation to more appropriate housing, access to age-friendly transport means
and communication facilities. Further globalization, urbanization and migration
also have a great bearing on healthy ageing.
So, to sum-up, HA is about creating sale and supportire environments and
providing them with opportunities, that enable older people to live a healthy
life, and they can do what they value. This can only be possible when the focus
is shifted from merely ensuring absence of disease to ensuring the functional
abilities that will enable older people to lead a healthy and productive life.
Check Your Progress 1
1. What are the factors affecting health of older people?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
10
2. What is healthy lifestyle? Programmes at
Global Level
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
Before we learn in detail about the different aspects of HA, let us understand
some basic concept on HA.

1.2.1 Healthy Ageing and functional ability

Functional ability is about having the capabilities that enable all people to be
and do what they have reason to value.
This includes a person’s ability to:
– meet their basic needs;
– learn, grow and make decisions;
– be mobile;
– build and maintain relationships; and
– contribute to society.
Let us now understand the meanings of certain terms-
Functional ability:
Functional ability (FA) consists of the intrinsic capacity of the individual,
relevant environmental characteristics and the interaction between them.
Intrinsic capacity:
Intrinsic capacity (IC) comprises all
the mental and physical capacities that
a person can draw on and includes
their ability to walk, think, see, hear,
and remember. The level of intrinsic
capacity is influenced by several
factors such as the presence of diseases,
injuries and age-related changes.

Fig.1. 3: Key domains of Intrinsic

Capacity
Source: WHO 2021. Integrated care for older
people (‎ICOPE)‎: guidance for person-centred as- [Link]
sessment and pathways in primary care item/WHO-FWC-ALC-19.1

Fig.1.3 shows the key domains of IC include vitality, visual capacity, hearing
capacity, cognitive capacity, psychological capacity, and locomotor capacity. 11
National and Environment
International
Programmes for Environment includes the home, community and broader society, and all the
Elderly factors within them such as the infrastructure, people and their relationships,
attitudes and values, health and social policies, the systems that support them
and the services that they implement. Being able to live in environments that
support and maintain one’s IC and FA are the key to healthy ageing.

1.2.2 Key considerations of Healthy Ageing

Think and Reflect Hope you have been able to identify the key considerations…Box 1.1 includes
From what you have
the key considerations for Healthy Ageing.
learned so far, can
you identify the key
Key considerations for Healthy Ageing:
considerations which – Diversity: There is no typical older person. Some 80-year-olds have levels of
you will keep in mind
while catering to the
physical and mental capacity that compare favourably with 30-year-olds. Others
health needs of the older of the same age may require extensive care and support for basic activities like
population. dressing and eating. Policy should be framed to improve the functional ability
of all older people, whether they are robust, care dependent or in between.
– Inequity: A large proportion of the diversity in capacity and circumstance
observed in older age is the result of the cumulative impact of advantage and
disadvantage across people’s lives. Importantly, the relationships we have with
our environments are shaped by factors such as the family we were born into,
our sex, ethnicity, level of education and financial resources
Box 1.1: Key considerations for Healthy Ageing
Source: WHO 2021. Ageing: Healthy ageing and functional ability

[Link]
the%20key%20considerations,activities%20like%20dressing%20and%20eating.

You must have experienced in your clinical practice, that these issues
influence your diagnosis and the outcome of your treatment. Therefore, it is
always advisable to have these issues well- considered before you take up the
management of the case.
Check Your Progress 2
1. How will you define functional ability?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
2. What are the key considerations of Healthy Ageing?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
12
1.2.3 Healthy Ageing and Active Ageing Programmes at
Global Level
Healthy ageing is the focus of WHO’s work on ageing between 2015 – 2030.
This replaced the previous focus on active ageing, which has been explained in
a policy framework developed in 2002.
Healthy ageing, like active ageing, emphasizes the need for action across
multiple sectors and enabling older people to remain a resource to their families,
communities and economies.
Now that you have been able to familiarize yourself on the important domains
of HA, let us travel back in time, to understand how global guidance on HA has
evolved. Figure 4 shows the chronological order of global guidance on Healthy
Ageing.(Fig 1.4)

Fig. 1. 4: Chronological order of global guidance on Healthy Ageing

1.3 GLOBAL/REGIONAL GUIDANCE ON

HEALTHY AGEING
Hope you have been able to understand different concepts of Healthy Ageing.
Now let us learn more about the global guidance on Healthy Ageing, which has
been guiding different countries to initiate pro-Ageing initiatives. As a part of
the United Nations and WHO (which is a specialized agency for health under
UN), India has been a signatory to all global and WHO guidance.
Global guidance includes the strategies and action plans from UN and WHO
(including those from WHO South-east Asia Region). Policies, strategies and
programmes in India for older people has taken consideration by these global
developments. These have been instrumental in the emergence of age-friendly
policies/strategies/programmes worldwide, including India. Therefore, it is
important for us to understand the clauses included in them.
13
National and In this section, we will proceed in a chronological order, to understand how
International different initiatives evolved, and including the underlying principles which
Programmes for
Elderly
were addressed.

1.3.1 Vienna International Plan of Action on Ageing (1982)

The first global guidance on Healthy
Ageing dates back to 1982, inspiring
countries to frame policies and
programmes on ageing. The Vienna
International Plan of Action on Ageing
(1982), called for strengthening
the capacities of Governments and
civil society to deal effectively
with the ageing of populations
and address the developmental
potential and dependency needs of
older people. Further, it promoted
Fig. 1.5: Vienna International Plan international cooperation and included
of Action on Ageing. recommendations for action addressing
Source: United Nations. Vienna International Plan research, data collection and analysis,
of Action on Ageing. training and education etc.
The Plan is part of an international framework of
standards and strategies developed by the international
community.
It should, therefore, be considered in relation to agreed
standards and strategies in the areas of human rights,
advancement of women, families, population, youth, [Link]
disabled persons, sustainable development, welfare, desa/ageing/resources/
vienna-international-plan-of-
health, housing, income security and employment, [Link]#:~:text=The%20
and education. The recommendations include areas Vienna%20International%20
Plan%20of,policies%20
of health- health and nutrition, protection of elderly and%20programmes%20
consumers, housing and environment, family social on%20ageing.&text=More%20
frequently%2C%20
welfare, income security and employment, and however%2C%20it%20is-
education. ,relevance%20for%20all%20
world%20regions

The Vienna International Plan of Action on Ageing (Fig 1.5) is the first
international instrument on ageing, guiding thinking and the formulation of
policies and programmes on ageing.
The next important milestone is the United Nations Principles for Older People
(1991), which reiterated the clauses of Vienna International Plan of Action on
Ageing. Progressive policies for older people started emerging in India since
1999, this has been indicated later in the chapter. United Nations Principles for
Older Persons (1991) had great influence in the formulation of policies for older
people in India.
Let us understand what the salient features are…

14
1.3.2 United Nations Principles for Older Persons (1991) Programmes at
Global Level
In pursuance of the International Plan of Action on Ageing, the United
Nations encouraged Governments globally, to incorporate the principles of
independence, participation, care, self-fulfilment and dignity into their national
programmes wherever possible.
The UN General Assembly, in appreciation to the contributions of older persons
to their societies, recognized that older persons should have access to adequate
food, water, shelter, clothing and health care through the provision of income,
family and community support and self-help.
They should have the opportunity to work or to have access to other income-
generating endeavours and be able to access appropriate educational and training
programmes and in all planning processes.
Older people should be able to live in environments that are safe and adaptable
to their personal preferences and changing capacities and be able to reside at
home for as long as possible. Finally, this was adopted by General Assembly
resolution 46/91 of 16 December 1991 as the United Nations Principles for
Older Persons.
Details on United Nations Principles for Older Persons (1991) can be accessed
from [Link]
India was inspired by the above and the Integrated Program for Older Persons
(IPOP) came into being in 1999. The main goal of this policy is to improve the
quality of life of senior citizens, by providing them with various basic amenities
such as food, shelter, medical care, and even entertainment opportunities.

Did You Know?

WHO Brasilia Declaration on Ageing and Health
in 1996
With the rapidly growing number of older people,
WHO, launched a new programme on Ageing and
Health in 1995 to ensurea global response on this
issue. Needs of an ageing populatoin must take place
within the context of broader social policy and issues
and take a life course perspective. Its perspectives Fig 1.6: World Health
1997
and activities are described in July-August 1997 Source: WHO 1097. Active
issue of the World Heath. (Fig 1.6). ageing. World Health 1997;
50(4):3-30

Health is generally felt to be of paramount importance for

the quality of life, There are many more ways of protecting
and improving health than people generally realize, and
these articles provide valuable insights into the possibilities
that exist.
[Link]
handle/10665/54909

15
National and
International Year of Older People 1999
International
Programmes for Investing in health and promoting it at every stage in life, taking a lifespan approach
Elderly to health care, will help more than anything else to ensure that people grow old
in good health, and continue to enjoy living and contributing to the happiness of
others. To make people more aware of these opportunities, the United Nations
declared 1999 as the International Year of Older Persons. Consequently, the theme
for World Health Day that year was dedicated to Healthy Ageing.
Details can be accessed from [Link]
resources/[Link].

In Indian context
In parallel with global developments, the National Policy on Older Persons
(NPOP), was launched in 1999. It envisages State support to ensure financial
and food security, health care, shelter and other needs of older persons, equitable
share in development, protection against abuse and exploitation, and availability
of services to improve the quality of their lives. The policy also covers issues
like social security, intergenerational bonding, family as the primary caretaker,
role of Non-Governmental Organizations, training of manpower, research and
training.
Thus, you can see that India also has been proactive in bringing about national
guidance to improve the life of older people.
Further understanding the historical events, let us read about the Second World
Assembly on Ageing (2002), which led to the Madrid Plan of Action. This has
further inspired countries like India to include more progressive clauses in their
existing/ developing national policies for older persons.
In India, the Ministry of Social Justice and Empowerment, were inspired and
many schemes/initiatives were devised based on the guidance from this.

1.3.3 Second World Assembly on Ageing and Madrid Plan of

Action (2002)

The Second United Nations World Assembly on Ageing in 2002, led to the
adoption of the Madrid International Plan of Action on Ageing (MIPAA) and
the Political Declaration. It marked a turning point on how the world has been
addressing the key challenge of “building a society for all ages”.
The Madrid Plan of Action focuses on three priority areas:
– older persons and development;
– advancing health and well-being into old age; and
16 – ensuring enabling and supportive environments.
For the first time in history, Governments Programmes at
agreed to link questions of ageing Global Level
to other frameworks for social and
economic development and human
rights. The Political Declaration and
Madrid International Plan of Action on
Ageing came into being (Fig 1.7)
The ultimate goal is a continuum of
care ranging from health promotion and
disease prevention to the provision of
primary health care, acute care treatment,
rehabilitation, community care for
chronic health problems, physical and
mental rehabilitation for older persons.
Effective care for older persons needs
to integrate physical, mental, social,
Fig 1.7: Political Declaration and Madrid
spiritual and environmental factors. International Plan of Action on Ageing
Source: United Nations. Madrid Plan of Action
It also calls for equality of opportunity and its Implementation.
throughout life with respect to
continuing education, training and
retraining as well as vocational guidance
and placement services.
Emphasis has been given on
strengthening solidarity through equity
and reciprocity between generations.
[Link]
On health and wellbeing, it calls [Link]
for health promotion and wellbeing
throughout life, reduction of cumulative effects of factors that increase the risk
of disease and consequently potential dependence in older age.
Involvement of older persons in the development and strengthening of primary
and long-term care services. Similarly training of care providers and health
professionals are needed to adders, mental healthcare needs of older persons.
Ensuring enabling and supportive environments, care and support of caregivers,
elimination of all forms of neglect, abuse and violence of older persons, are
emphasized.
For implementation and follow-up, it recommends national action, international
action, research, global monitoring, review and updating.
Thus, we can see how the MIPAA has been a great milestone in shaping the
future work on Healthy Ageing globally.
In India, the National Programme for Health Care of the Elderly (NPHCE)
is an articulation of the International and national commitments of the
Government as envisaged under 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 and Section 20 of “The Maintenance and
Welfare of Parents and Senior Citizens Act, 2007” dealing with provisions for
17
National and medical care of Senior Citizen. Launched in 2010, The programme has envisaged
International to provide promotional, preventive, curative and rehabilitative services in an
Programmes for
Elderly
integrated manner for the Elderly in various Government health facilities.

Did You Know?

Active Ageing: A policy Framework
“Active Ageing: A policy Framework” is intended
to inform discussion and the formulation of action
plans that promote healthy and active ageing. It
was developed by WHO’s Ageing and Life Course
Programme as a contribution to the Second United
Nations World Assembly on Ageing, which was
held in 2002, in Madrid, Spain. There are dramatic Fig 1.8: Active Ageing: A
Policy Framework.
variations in health status, participation and levels Source: WHO 2002. Active
of independence among older people of the same Ageing: A Policy Frame-
age. Decision-makers need to take this into account work.

when designing policies and programmes for their

“older” populations. Enacting broad social policies based
on chronological age alone can be discriminatory and
counterproductive to wellbeing in older age.
The WHO document Active Ageing: A Policy Framework
[Link] (Fig 1.8), which approaches health from a broad perspective
int/iris/bitstream/ and acknowledges the fact that health can only be created
handle/10665/67215/
WHO_NMH_NPH_02. and sustained through the participation of multiple sectors.
[Link]?sequence=1&isAl
lowed=y It suggests that health providers and professionals must
take a lead if we are to achieve the goal that healthy older persons remain
a resource to their families, communities, and economies, as stated in the
WHO Brasilia Declaration on Ageing and Health in 1990.

1.3.4 World Health Day 2012

As the ageing population grew in
numbers, WHO took up the issue of
Healthy Ageing in the right earnest.
In 2012. With “Ageing and health” as
the theme, and the slogan "Good health
adds life to years", the campaign aimed
at generating stronger public health
response on how good health throughout
life course can facilitate a productive
life, for older people, wherein they
can be a resource and contribute to
their families and communities. ‘Good
health’ is the mantra of Healthy Ageing,
and health and social spheres should
work in unison. WHD 2012 was able to Fig. 1.9: Global brief for World Health
generate the much-needed prominence Day 2012. Good Health Adds Life to
Years.
of Healthy Ageing globally, with Source: WHO 2021. Global brief for World
18 Health Day 2012. Good Health Adds Life to
Years.
government and other stakeholders, pledging more commitment. For this Programmes at
occasion, a global brief was prepared (Fig 1.9) Global Level

All WHO Member States (countries) globally observe

World Health Day every year, with heightened visibility to
the theme dedicated to that year. India also observes WHD
every year. In 2012, there were various activities to promote
Healthy Ageing.
[Link]
handle/10665/70853

Yogyakarta Declaration on Ageing and Health 2012

So far, we have been discussing the global initiatives on Healthy
Ageing. Let us understand how our own WHO South east Asia
Region have been able to make progress on the area of Heathy
Ageing.
Acknowledging that Healthy Ageing
is a major public health challenge
in the WHO South-East Region, the
Health Ministers from eleven Member
States (countries), met in Yogyakarta,
Indonesia, in September 2012, and
committed themselves to improve
national response on Ageing and Health
through stronger policies.
Yogyakarta Declaration, which is an
important landmark as it echoes the
sentiments of the World Health Day
2012 theme (Fig 1.10). Through this
declaration WHO advocates for a life-
course approach to promote active and
health ageing. It is observed that people
who get the right start in life, follow
healthy lifestyles, and take good care of
Fig 1.10: Yogyakarta Declaration on
Ageing and Health 2012 their health can expect to remain active
in their old age.
Source: WHO South-East Asia Regional Office
2012.

The declaration further underscores

that the economic effects of ageing
will impact the existing health care
and social support systems, if a person-
centric approach for older people is not
adopted in the right spirit. The need
for optimizing opportunities for the
physical, social and mental health of
[Link] older people.
2012-health-ministers-commit-to-stronger-policies-for-
the-elderly

19
National and
World Health Day 2012 – relevant weblinks
International
Programmes for – World Health Day 2012 - Good health adds life to years ([Link])
Elderly
– [Link]
commit-to-stronger-policies-for-the-elderly
– [Link]
healthy-ageing-focus-of-who-activities-on-world-health-day

More developments:
The Sixty-ninth World Health
Assembly adopted the “Multisectoral
action for a life course approach to
healthy ageing: global strategy and
plan of action on ageing and health”.
The World Report on Ageing and Health
(Fig 1.11) put forth recommendations
in this regard. The goals included
maximizing functional ability, filling
the evidence gaps and establishing
partnerships to ensure a Decade of
Healthy Ageing from 2020 – 2030.
The strategy Fig 1.11: World Report on Ageing and
Health
emphasized on
commitment to Source: WHO 2015. World report on ageing
and health.
action; developing
age-friendly environments; aligning health systems to
the needs of older populations; developing sustainable
and equitable systems for long-term care; and improving
[Link]
handle/10665/186463 measurement, monitoring, and research on healthy ageing.
It further reinforced principles of human rights, equity, equality and non-
discrimination, gender equality, and intergenerational solidarity.

Let us further understand how the World Report on Ageing and Health further
influenced the Healthy Ageing global guidance.
Following the release of the report, WHO took the lead to draft a global Strategy
and Action Plan (GSAP) for putting into practice the recommendations of the
report. The duration was 2016-2020.
GSAP provided the much-needed grooming of the available systems to prepare
the world for the UN Decade for Healthy Ageing.

1.3.5 Global Strategy and Action Plan on Healthy Ageing and

Health (GSAP) 2016-2020
Global Strategy and Action Plan on Ageing is a framework for coordinated
global action by the World Health Organization, Member States, and Partners
across the Sustainable Development Goals. The vision of the Strategy is a world
20 in which everyone can live a long and healthy life.
 The Global Strategy and Action Plan on Programmes at
Ageing and health (2016-2020) is aimed Global Level
at achieving five strategic objectives,
while underpinning the principles of
human rights, equity, equality and
non-discrimination (particularly on
[Link]
the basis of age), gender equality, and
intergenerational solidarity (Fig 1.12).
The objectives are as follows:
Commit to action Fostering Healthy
Ageing requires leadership and
commitment
There is a need to ensure effective
political and operational platforms
for executing multisectoral action.
Collaboration is needed between
government (health and non-health)
and non-government actors, including
service providers, policy makers,
implementers, academia, civil society/
faith-based organizations, etc.
Fig 1. 12: Global Strategy and Action
Plan on Ageing and health (2016-2020)
Source: WHO 2017. Global strategy and action
plan on ageing and health.

Key actions include:

1. Establishing national frameworks towards Healthy Ageing
2. Strengthening national capacities to formulate evidence-based policies
3. Combatting ageism
Align health systems to the needs of older populations
The health needs of older people are more chronic and complex, as compared to
other population sub-groups. This calls for reorientation and transformation in
the approach of the health systems to ensure affordable and accessible integrated
services, catering to the needs of older people, delivered through a rights-based
approach.
Key actions include:
1. Orienting health systems around intrinsic capacity and functional ability
2. Developing and ensuring affordable access to quality older person-centred
and integrated clinical care
3. Ensuring a sustainable and appropriately trained, deployed, and managed
health workforce

21
National and Develop age-friendly environments
International
Programmes for Creating age-friendly environments necessitates collaboration and coordination
Elderly across multiple sectors and with diverse stakeholders, including older people.
Age-friendly environments promote health, remove barriers, and provide
support for people experiencing losses in capacity, while ensuring the safety
and their rights, thus enabling them to contribute to their communities while
retaining autonomy and health.
Key actions include:
1. Fostering older people’s autonomy
2. Enabling older people’s engagement
3. Promoting multisectoral action
Strengthen long-term care
With the growing number of older people requiring care and support, effective
long-term care is the need of the hour. The systems in place should help older
people maintain the best possible level of functional ability, allow them to live
with dignity and enjoy their basic human rights and fundamental freedoms.
Key actions include:
1. Establishing and continually improving a sustainable and equitable long-
term-care system
2. Building the long-term care workforce and supporting informal caregivers
3. Ensuring the quality of person-centred and integrated long-term care
Improve measurement, monitoring, and research
It is not possible to gauge the effectiveness of the ongoing interventions,
without a measuring system in place. The current metrics and methods used in
the field of ageing are limited, they need to be strengthened. Focused research
and improved measurement are essential for better understanding of Healthy
Ageing.
Key actions include:
1. Agreeing on ways to measure, analyse, describe, and monitor Healthy
Ageing
2. Strengthening research capacities and incentives for innovation
3. Building and synthesizing evidence on Healthy Ageing

22
 Global Age-friendly Cities: A guide Programmes at
Global Level
Older people are a resource for their families, communities and economies in
supportive and enabling living environments.
In the 21st century, urbanization and
population ageing are the common
trends globally. This has led to cities are
growing rapidly, often in an unplanned
manner. With the number of older
people increasing, WHO advocates for
Healthy Ageing through Age-friendly
cities, thus optimizing opportunities
for health, participation and security
in order to enhance quality of life as
people age.

Fig. 1.13: Global Age-friendly Cities: A

guide
Source: WHO 2007. Global Age-friendly Cities: [Link]
A Guide. age_friendly_cities_Guide_English.pdf

In practical terms, an age-friendly city adapts its structures and services

to be accessible to and inclusive of older people with varying needs and
capacities.
The Guide (Fig 1.13) provides guidance on how cities may become more age-
friendly, thus optimizing the potential of the older people.

The WHO Global Network for Age-

friendly Cities and Communities
was established in 2010 to connect
cities, communities and organizations
worldwide with the common vision of
making their community a suitable place for people to live in their old age.
This global network focuses on action at the local level that fosters the full
participation of older people in community life and promotes healthy and active
ageing.
The mission of the Network is to
stimulate and enable cities and
communities to become increasingly
age-friendly at it seeks to inspire change
by demonstrating feasible options
to connect cities and communities
[Link] worldwide wider knowledge and
experience sharing; and to support cities and communities to find appropriate
innovative and evidence-based solutions in line with SDGs perspective of U 23
leaving on one behind.
National and The WHO Global Network for Age-
International friendly Cities and Communities, which
Programmes for
Elderly
was published in 2018, encourages
other cities and communities to adopt
successful initiatives with growing
urbanisation and increased population
of older people, this Network will
influence the planners as well as the
older people themservles to contribute
towards creaing an age-freindly
environment. (Fig 1.14)

Fig 1. 14: The Global Network for Age-friendly Cities and Communities: Looking back
over the last decade, looking forward to the next
Source: WHO 2018. The Global Network for Age-friendly Cities and Communities

1.3.6 Regional Framework on Healthy Ageing (2018-2022)

WHO South-East Asia (SEA) Region consists
of eleven countries, namely India, Nepal,
Bangladesh, Myanmar, Bhutan, Timor-
Leste, Maldives, Thailand, Indonesia, Sri
Lanka and Democratic Republic of Korea.
In 2012 the Health Ministers of these
countries adopted the “Yogyakarta
Declaration on Ageing and Health,” which
led to the development of the Regional
Strategy for Healthy Ageing 2013–2018.
Since the World Health Assembly in 2016
endorsed the Global Strategy and Plan of
Action on Ageing and Health, the existing Fig 1. 15: Regional Framework
on Healthy Ageing (2018–2022)
regional strategy was reviewed and aligned
to the global strategy. The focus of the Source: Regional Framework on
Healthy Ageing (2018–2022). New
regional framework is to improve the quality Delhi: World Health Organization,
of life and well-being of older people and Regional Office for South-East Asia;
2018
promote healthy ageing and care through the
life-course.
Seven strategic elements
have been identified, which
include health systems,
measurement, monitoring,
research, and sustainable
& progressive financing
[Link]
towards universal health
24 [Link]?sequence=1&isAllowed=y coverage. The Framework
lays down concrete actions that are evidence-based, comprehensive and Programmes at
Global Level
progressive and suited for the WHO SEA Region.
As we are striding forward to achieve the 2030 Sustainable Development
Goals (SDGs), addressing healthy ageing is vital. It cuts across many
the SDG goals, namely poverty eradication, good health for all, gender
equality, economic growth and decent work, reduced inequalities and
sustainable cities.
This Framework on ageing (Fig 1.15) has the potential to advocate
and transform the way policymakers and service-providers perceive
population ageing.
1.3.7 UN Decade of Healthy Ageing 2021-2030

In August 2020, the Decade of Healthy Ageing was endorsed by the 73rd World
Health Assembly and the United Nations General Assembly proclaiming the
Decade of Healthy Ageing (2021-2030). The Decade builds on and responds to
global commitments and calls of actions. It supports the realization of Agenda
2030 and its 17 Sustainable Development Goals, which pledges to “leave no
one behind”.
The Decade will be addressing four areas of action:
– change how we think;
– feel and act towards age and ageing;
– ensure that communities foster the abilities of older people; and
– deliver person-centred integrated care and primary health services responsive
to older people; and provide access to long-term care for older people who
need it.
Further, it will provide opportunities for making appropriate investments for-
– integrating health and social care and age-friendly environments;
– fostering healthy ageing, harnessing technological, scientific, medical,
assistive technologies, digital innorations;
– engaging civil society groups, communities and private sectors in policy
and programme delivery.
For monitoring the progress of Decade of Healthy Ageing, a set of indicators,
have been agreed upon by countries globally and endorsed in 2020, within the 25
National and context of the Decade for Healthy Ageing 2021-2030. The reporting on these
International indicators by countries demonstrate their commitment towards healthy ageing.
Programmes for
Elderly The Baseline report, released in December 2020, will serve as a useful reference
for promoting learning across countries and measure progress towards healthy
ageing during the next decade. This report showcases the experience of countries
implementing successful initiatives on healthy ageing and will serve as ready
reckoner for other countries.
Best practices from India, like ensuring healthcare for older people at the
community level, through Ayushman Bharat, is included in the report.
[Link]

1.4 HEALTH SYSTEMS STRENGTHENING

TO MEET THE NEEDS OF OLDER PEOPLE:
INTEGRATED CARE OF OLDER PEOPLE
By now, you are already familiar with the WHO World report on ageing and
health.
For the health-care system, the key to supporting healthy ageing for all is
optimizing people’s intrinsic capacity and functional ability, even as ageing
gradually reduces capacity. Care-dependency can be prevented if priority
conditions associated with declines in intrinsic capacity are promptly diagnosed
and managed.
Conditions associated with declines in intrinsic capacity are interrelated
and so require an integrated and person-centred approach to assessment and
management.
The WHO Guidelines on Integrated Care for Older People (ICOPE) (Fig
1.16) proposes evidence-based recommendations for health care professionals
to prevent, delay or if possible, reverse declines in the physical and mental
capacities of older people.
It is a package of tools that offers an approach by facilitating key stakeholders
in health and social care to understand, design, and implement a person-centred
and coordinated model of care, by strengthening existing health systems to
support Healthy Ageing and maximize older people’s intrinsic capacity and
functional ability.
The capacities of all stakeholders, inclusive of the older people and their
caregivers, to be strengthened, to ensure smooth transition through each step.
The ICOPE care pathways have five steps Include QR code:
1) screen for losses in intrinsic capacity;
2) person-centred assessment in primary care;

26
3) develop personalized care plan; Programmes at
Global Level
4) ensure referral pathway and monitor
the care plan; and
5) engage communities and support
caregivers.

KEY POINTS
• The identification of older people
in the community with priority
conditions associated with declines
in intrinsic capacity can be done
with the help of the integrated
care for older people (ICOPE)
screening tool.
• Those identified with these
conditions are referred to a
primary health-care clinic for in- Fig 1. 16: Integrated Care of Older
depth assessment, which informs People
the development of a personalized
care plan. Source: WHO 2017. Integrated Care of Older
people
• The care plan may include
multiple interventions to manage
declines in intrinsic capacity and
to optimize functional ability,
such as by physical exercises, oral
supplemental nutrition, cognitive
stimulation, and home adaptations
to prevent falls.
[Link]
item/9789241550109
Box 1.2: Key points for ICOPE
Source: WHO 2017. Integrated Care of Older people. ([Link]
item/9789241550109)

Person-centred care addresses individuals’ health and social care needs rather
than being driven merely by isolated health conditions or symptoms. This
embraces the context of individuals’ daily lives, including the impact of their
health and needs on those close to them and in their communities. There are five
steps to meeting older people’s health and social care needs with an integrated
care approach, as shown in the following general pathway.
Person-centred care addresses individuals’ health and social care needs
rather than being driven by isolated health conditions or symptoms. This is
an integrated approach which embraces the context of individuals’ daily lives,
including the impact of their health and needs on those close to them and in
their communities. There are five steps to meeting older people’s health and
social care needs with an integrated care approach, as shown in the general
pathway (Box 3 and 4).

27
National and
International
Programmes for
Elderly

Box 3-4: Generic care pathway. Person -centred assessment and

pathways in primary care
Source: WHO 2019. Handbook. Guidance on person-centred assessment and pathways in primary care
([Link]

ICOPE proposes care for older people based on:

– an assessment of individual needs, preferences and goals;
– the development of a personalized care plan;
– coordinated services, driven towards the single goal of maintaining intrinsic
capacity and functional ability and delivered as much as possible through
primary and community-based care.
The details of the different pathways are being included in the practical
section.

The WHO mobile health for ageing (mAgeing) initiative can complement
health-care professionals’ routine care by supporting self-care and self-
management. By delivering health information, advice and reminders
through mobile phones, it encourages healthy behaviours and helps older
people to improve and maintain their intrinsic capacity. For information
about how to set up an mAgeing programme and suggested text messages,
visit the handbook [Link]
[Link]?ua=1
28
Now that you have been able to familiarize yourself, let us conclude this section Programmes at
with the list of strategies and plans which have been endorsed by the World Global Level
Health Organization and the United Nations

1.5 STRATEGIES AND PLANS ENDORSED BY

THE WORLD HEALTH ASSEMBLY AND
UNITED NATIONS HAVING RELEVANCE
TO HEALTHY AGEING:
Global Action Plan on physical activity 2018-2030

Physical activity is defined as any bodily

movement produced by skeletal muscle
that requires energy expenditure. All
forms of physical activity can provide
health benefits if undertaken regularly
and of sufficient duration and intensity.
Regular physical activity is proven to
help prevent and treat noncommunicable
diseases (NCDs) and prevent their risk
factors like hypertension, overweight,
obesity etc. Further
it can improve
mental health, thus
uplift the quality of
life and well-being.
Fig 1. 17: Global Action Plan on physical Older adults, in
activity 2018-2030
particular, can [Link]
Source: WHO 2018. Global Action Plan on benefit from bitstream/handle/10665/2727
physical activity 2018-2030 22/[Link]

regular physical activity to maintain physical, mental and social health and
enable healthy ageing. The Global Action Plan on physical activity 2018-2030,
which details out how to make the population more active for a healthier world
(.Fig 1.16)
WHO guidelines and recommendations provide details for different age groups
and specific population groups on how much physical activity is needed for
good health. Details for people over 60 years can be accessed from https://
[Link]/news-room/fact-sheets/detail/physical-activity
Comprehensive mental health action plan 2013-2020 (Resolution
WHA/66.8)
In 2013, the 66th World Health Assembly, adopted the
WHO’s Comprehensive Mental Health Action Plan 2013-
2020. It has now been extended to 2030.
A Comprehensive Mental Health Action Plan 2013-2020
(Fig 1.17) has been formulated (Fig 1.17) that recognizes
the essential role of mental health in achieving health for [Link]
int/publications/i/
all people. It is based on a life-course approach, aims to item/9789241506021 29
National and achieve equity through universal health
International coverage and stresses the importance of
Programmes for
Elderly
prevention.
The action plan has the following
objectives:
– to strengthen effective leadership
and governance for mental health;
– to provide comprehensive,
integrated and responsive mental
health and social care services in
community-based settings;
– to implement strategies for
promotion and prevention in mental
health; and
– to strengthen information systems,
Fig 1.18: Comprehensive mental health
evidence and research for mental
action plan 2013-2020 (Resolution
health. WHA/66.8)
Therefore, we can see that it is important Source: WHO 2013. Comprehensive mental
to have a lifecourse approach to bring health action plan 2013-2020 (Resolution
WHA/66.8)
down the burden of mental health
disorders in older people. Further, providing services at the community level
will increase the uptake of services.
Global action plan on the public health response to dementia 2017-2025
Dementia is an umbrella term for several
diseases that are mostly progressive,
affecting memory, other cognitive
abilities and behaviour, and that interfere
significantly with a person’s ability to
maintain the activities of daily living.
Dementia is a major cause of disability
and dependency among older adults
In 2015, dementia
affected 47 million
people worldwide
(or roughly 5% of
the world’s elderly
population),
Crucially,
[Link]
although age is the bitstream/handle/10665/25
strongest known 9615/9789241513487-eng.
pdf?sequence=1
Fig 1.19: Global action plan on the public risk factor for the
health response to dementia 2017-2025 onset of dementia, it is not an inevitable
Source: WHO 2017. Global action plan on the consequence of ageing. Further,
public health response to dementia 2017-2025 dementia does not exclusively affect
30
older people, with young onset dementia (defined as the onset of symptoms Programmes at
before the age of 65 years) accounting for up to 9% of cases. Global Level

A Global action plan on the public response to dementia 2017-2025 (Fig 1.18)
signals an important step forward in achieving physical, mental and social
wellbeing for people with dementia, their carers and families. The goal of the
global action plan is to improve the lives of people with dementia, their carers
and families, while decreasing the impact of dementia on them as well as on
communities and countries.
The World Health Organization looks forward to fulfilling the ambitious targets
presented in the action plan by working alongside Member States and Non-
state actors, including people with dementia and their families, to improve the
health and wellbeing of those affected by dementia, both for present and future
generations.

Resources on Ageing and health in the South-East Asia Region

With the objective of strengthening capacities of differ-
ent cadres of healthcare human resource, working in the
area of Healthy Ageing, WHO South-East Aia Office has
prepared training resources to cater to the different cadres.
These will enable the relevant healthcare staff to provide
quality health services for older people.
These resources include:
For primary-care physicians:
- Integrated Care for Older People: A
manual for primary care physicians
(Facilitator’s Guide)
- Integrated Care for Older People: A
manual for primary care physicians
(Trainee’s handbook)
Fig 1.20: Integrated Care for Old People-
Facilitator Guide and Trainee handbook
for primary care physicians

For nurses:
- Integrated Care for Older People
(ICOPE): A manual for nurses (Facili-
tator’s Guide)
- Integrated Care for Older People
(ICOPE): A manual for nurses (Train-
ee’s handbook)

Fig 1.21: Integrated Care for Old People-

Facilitator Guide and Trainee handbook
for nurses)

31
National and For frontline workers:
International
Programmes for - Training package for Frontline Health
Elderly Workers in South-East Asia Region
(Facilitator Guide)
- Training package for Frontline Health
Workers in South-East Asia Region
(Participant’s Manual)

Fig 1.22: Training package for Frontline

Health Workers in South-East Asia
Region (Facilitator Guide and participant’s
manual)

Health systems are trying to incorpo-

rate issues related to long-term care of
dependent older populations in their
homes and in institutions, as highlight-
ed by the WHO Decade of Healthy
Fig 1.23: Training package on long-term Ageing, and as outlined in the Region’s
care in home or institutional settings in Framework for Healthy Ageing 2018-
South-East Asia Region (Facilitator's 2022. Training resources are been de-
Guide and Participant's manual) veloped in this regard.
These include:
- Training package on long-term care in home or institutional settings in South-
East Asia Region (Facilitator’s Guide)
- Training package on long-term care in home or institutional settings in South-
East Asia Region (Participant’s Manual)
All these resources can be accessed from WHO SEARO website:
[Link]

Food for thought

By now you have learned about the different global guidance that is
available for ensuring healthy Ageing, both from a health system and
a social perspective.
As a medical practitioner, you will be catering to the older population. Can you
enumerate the key considerations you will be applying during patient care, to ensure
person centric, affordable and acceptable services.
Hints:
– How will you customize your communication skills?
– What should be the qualities displayed by you to ensure that your patient is
comfortable and has faith in you?
– What are the key changes you need to imbibe in your patient care protocol
32
 Programmes at
Check Your Progress 3 Global Level
The wordscape below has ten words which are closely related to this section
and you have just completed. Search for these words and fill in the blanks in
the sentences below.
1) The process of developing and maintaining the functional ability that
enables wellbeing in older people is called _____________ Ageing.
2) As there more females than males amongst older people, therefore it is
referred to as __________ of older population.
3) The first international instrument on ageing is the _________ International
Plan of Action on Ageing
4) Addressing the needs of an ageing population must take place within the
context of broader social policy and issues and take a life course perspective,
was the outcome of WHO _______ Declaration of Ageing and Health.
5) The United nations have declared 2021-2030 as the _____________ of
Healthy Ageing.
6) WHO advocates for _____________ Care of Older People.
7) ___________________ action for a life course approach to healthy ageing
was emphasized under global strategy and plan of action on ageing and
health.
8) The focus of WHO’s work on Ageing was __________ Ageing.
9) The stereotyping and discrimination against individuals or groups on the
basis of their age is called __________.
10) Prior to 2015, the focus of WHO’s work on ageing was ______ Ageing.

N E I A K H E E F G Z S M Y A B C R E V
Y K G L B E V V I E N N A Z Z K A I W G
F O N C M A G A N H Y K D L A L E N O S
O R C N D L X B T S I J R I B B Q Y C X
C J S A C T I V E J W G I H C R B F J L
J W T O E H Y C G V K F D E C A D E F T
F O U Q P Y K X R L U E M D F S K M O U
M P B P Q A O S A A T U A L E I O S B O
F A M I N I Z A T I O N N D R L B I Q O
A G X S I O C E E N S C P R S I Y C X Y
Z E W J T N M D D R O B B Q V A G V B M
U I R O U D B O Q T V A I U M L O V G A
B S L U E M B F G A E C L S U Y L M L Y
L M U L T I S E C T O R A L Q B I Q L E
33
National and
International
1.6 LET US SUM UP
Programmes for As we have come to the end of the unit, let us sum-up.
Elderly
People are living longer- with decrease in fertility rate and increased longevity.
This has brought about a demographic change, leading to the increase in the
population above 60 years of age.
A longer life is expected to herald greater opportunities by giving the older
people another chance to pursue newer avenues. Further, older people are a
resource, especially due to their rich experience. They can contribute to the
workforce, families and communities. The paramount factor is good health.
The extent to which people can benefit from these extra years depends on the
key parameter- healthy ageing.
There has been various global guidance from United Nations and World Health
Organization to ensure a respectable and fulfilling lives for older people. India
too have been proactively putting in place initiatives, that would contribute to
towards betterment of the lives of older people.
According to WHO, the three components of Healthy Ageing are functional
ability, intrinsic capacity and environments. Functional ability consists of the
intrinsic capacity of the individual, relevant environmental characteristics and
the interaction between them. Intrinsic capacity includes the mental and physical
capacities of a person. Environments include the home, community and broader
society, and all the factors within them such as the built environment, people and
their relationships, attitudes and values, health and social policies, the systems
that support them and the services that they implement.
Thus “Healthy ageing” is about creating the environments and opportunities
that enable people to be and do what they value throughout their lives.
As a clinician, it is worthwhile to understand the salient features of these
global guidance and how India has adapted them to the benefit of the country.
Thereafter, you can incorporate relevant sections into your clinical practice, to
bring about innovations in clinical care.

1.7 GLOSSARY
Age-Friendly Cities and : Age-friendly cities and communities work
Communities to improve the relationship between the
environment and the people who live there,
regardless of their age. Every city and
community can take steps to become more
age friendly.
Ageism : Ageism refers to the stereotypes (how
we think), prejudice (how we feel) and
discrimination (how we act) directed towards
people on the basis of their age. It can be
institutional, interpersonal or self-directed.
Environments : Environments are where people live and
34 conduct their lives. They shape what older
 people with a given level of intrinsic capacity Programmes at
can be and do. Global Level

Functional ability (FA) : FA consists of the intrinsic capacity of

the individual, relevant environmental
characteristics and the interaction between
them.
Healthy Ageing (HA) : HA is the process of developing and
maintaining the functional ability that enables
wellbeing in older age
Intrinsic capacity (IC) : IC comprises all the mental and physical
capacities that a person can draw on and
includes their ability to walk, think, see, hear
and remember.
Integrated Care of Older : WHO guidance for person-centred assessment
People (ICOPE) and pathways in primary care. and the domains
of intrinsic capacity
Multisectoral approach : Multi-sectoral approach refers to the
collaboration between organisations in
different areas of policy (e.g. health, social,
environment) and different sectors (e.g. public,
private, third), as well as communities and
people, working together to achieve policy
outcomes.

1.8 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
• The factors affecting health of older people are:
– Genetic;
– Physical and social environments like homes, neighbourhood and
communities etc;
– Personal characteristics like sex, ethnicity and socioeconomic status
etc.
• When an individual is eating healthy diet (low in salt, sugar, transfats and
high in fruits and vegetables), adequate physical activity, avoiding tobacco
alcohol and stress, it is called healthy lifestyle.
Check Your Progress 2
• Functional ability consists of the intrinsic capacity of the individual, relevant
environmental characteristics and the interaction between them.
• The key considerations of Healthy Ageing include
– Diversity
– Inequity 35
National and Check Your Progress 3
International
Programmes for
N E I A K H E E F G Z S M Y A B C R E V
Elderly
Y K G L B E V V I E N N A Z Z K A I W G

F O N C M A G A N H Y K D L A L E N O S

O R C N D L X B T S I J R I B B Q Y C X

C J S A C T I V E J W G I H C R B F J L

J W T O E H Y C G V K F D E C A D E F T

F O U Q P Y K X R L U E M D F S K M O U

M P B P Q A O S A A T U A L E I O S B O

F A M I N I Z A T I O N N D R L B I Q O

A G X S I O C E E N S C P R S I Y C X Y

Z E W J T N M D D R O B B Q V A G V B M

U I R O U D B O Q T V A I U M L O V G A

B S L U E M B F G A E C L S U Y L M L Y

L M U L T I S E C T O R A L Q B I Q L E

36
UNIT 2 PROGRAMMES AT NATIONAL LEVEL Programmes at
Global Level
Structure
2.0 Objectives
2.1 Introduction
2.2 National Program for Health Care of Elderly (NPHCE)
2.2.1 Objectives

2.2.2 Strategies

2.2.3 Package of Services

2.2.4 Implementation Plan of the Programme

2.2.5 Achievements of the Programme

2.2.6 Bottle Necks in Implementation

2.2.7 Future Plan of Action

2.4 Other Related Programmes for the Elderly

2.5 Let Us Sum Up
2.6 Check Your Progress
2.7 Answers to Check Your Progress
2.8 Glossary
2.9 References and Further Readings

2.0 OBJECTIVES
After reading this unit you should be able to –
• Explain the conceptual framework on how the various programs for elderly
will lead to specific health outcomes and their impact
• Describe the elements that provide the context or monitoring and evaluation
activities
• Discuss the benefits of the programs to the elderly you come across in your
practice

2.1 INTRODUCTION
Population ageing is an inevitable result of the demographic transition associated
with declining birth and death rates. You have already read about the global
trends of the demographic transition in unit 2 block 1 MME 104. You have also
read about the global initiatives for safeguarding the interests of the elderly in
the previous unit. This trend holds true in India too. Population ageing in India
is taking place at a far faster pace than has happened in developed countries in
the West. The increasing share of older persons in the Indian population is due
to the fact that the growth rate of the older-aged population in India exceeds
37
National and that of the overall population. You have already read about the demographic
International transition and its manifestations in the units 1 and 3 of the Block 1 MME 104.
Programmes for
Elderly Over the past decades, India’s health programs and policies have been focusing
on issues like population stabilization, maternal and child health, and disease
control whereas issues pertaining to elder care are yet to receive due importance.
Therefore the urgent need for highlighting the medical and socio-economic
problems being faced by the elderly people in India, and strategies for bringing
about an improvement in their quality of life led to the development and
implementation of national program for health care of elderly(NPHCE).
In this unit we shall focus on the National Programme for the health care of
Elderly, its objectives, pogramme strategies and status of implementation.
You will also learn about the various other programmes and policies of the
Government of India for the elderly.

2.2 NATIONAL PROGRAM FOR HEALTH CARE

OF ELDERLY (NPHCE)
The Ministry of Health & Family Welfare had launched the “National Programme
for the Health Care of Elderly” (NPHCE) during 2010-11 to address various
health related problems of elderly people. The National Programme for the
Health Care for the Elderly (NPHCE) is an articulation of the International
and National commitments of the Government as envisaged under 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 Senior Citizen. The
programme is State oriented and basic thrust of the programme is to provide
dedicated health care facilities to the senior citizens (>60 year of age) at various
level of primary, secondary and tertiary health care.

2.2.1 Objectives
The national programme has been put in place with the following objectives
• To provide accessible, affordable, and high-quality long-term, comprehensive
and dedicated care services to an ageing population;
• Creating a new "architecture" for ageing; to build a framework to create an
enabling environment for "a Society for all Ages";
• To promote the concept of Active and Healthy Ageing;
• Convergence within National Rural Health Mission, AYUSH , line
departments like Ministry of Social Justice and Empowerment MOUD etc,
NGO’s ,CBO’s and private sector etc.

2.2.2 Program strategies

The strategies for implementing the programme are listed below
• Community based primary health care approach including domiciliary
visits by trained health care workers.
38
• Dedicated services at PHC/CHC level including provision of machinery, Programmes at
equipment, training, additional human resources (CHC), IEC, etc. National Level

• Dedicated facilities at District Hospital with 10 bedded wards, additional

human resources, machinery & equipment, consumables & drugs, training
and IEC.
• Strengthening of Regional Geriatric Centers to provide dedicated tertiary
level medical facilities for the Elderly, introducing PG courses in Geriatric
Medicine, and in-service training of health personnel at all levels.
• Information, Education & Communication (IEC) using mass media,
folk media and other communication channels to reach out to the target
community.
• Continuous monitoring and independent evaluation of the Programme and
research in Geriatrics and implementation of NPHCE.

2.2.3 Package of services:

The program has two components for provision of geriatric health care services
i.e: district & sub-district level component and tertiary level component.
The package of services provided to elderly people at both levels is as given
below.
A. Package of services at district and sub district level
• Sub Centre:
– Health Education related to healthy ageing, environmental modifications,
nutritional requirements, life styles and behavioral changes.
– Special attention to home bound / bedridden elderly persons and provide
training to the family health care providers in looking after the disabled
elderly persons.
• Primary Health Centre:
– A weekly geriatric clinic at PHC level by trained Medical Officer,
Conducting health assessment of the elderly persons and simple
investigation including blood sugar, etc.
• Community Health Centre
– Biweekly geriatric Clinic and Rehabilitation services to be arranged by
trained staff and rehabilitation worker at CHCs.
– Domiciliary visits by the rehabilitation worker will be undertaken for
bed-ridden elderly and counseling to family members for care such
patients.
• District Hospitals:
– Dedicated Geriatric OPD services, In-door admissions through 10
bedded geriatric ward, laboratory investigations and rehabilitation
services.
39
National and – Provide services for the elderly patients referred by the CHCs/PHCs
International etc and refer severe cases to tertiary level hospitals
Programmes for
Elderly B. Package of services at tertiary level.
• Regional Geriatric Centers (RGCs):
– Provide tertiary level services for complicated/serious Geriatric Cases
referred from Medical Colleges, District Hospitals and below.
– Conduct post graduate courses in Geriatric Medicine. Each RGC to
produce 2 post graduates (MD geriatrics) every year.
– Providing training to the trainers of identified District hospitals and
medical colleges
– Developing/and updating Training modules, guidelines and IEC
materials.
– Research on specific elderly diseases.
• National Center for Ageing (NCAs):
– High level tertiary care with multidisciplinary clinical services involving
medical and surgical disciplines.
– OPD care in various clinical disciplines. Special clinics like memory
clinic, fall and syncope clinic, frail elderly clinic, aids and appliances
clinic, implants and cosmetic clinic.
– Day care centre for : Investigations, rehabilitation, respite care, dementia
care ,continence care
– In patient care for: Intensive care, acute rehabilitation, diagnostic and
therapeutic services, long term rehabilitation service. Human resources
development in all sub-specialties of Geriatric Medicine Each NCA to
produce 15 post graduates (MD geriatrics) every year.
– Developing evidence based treatment protocols for Geriatric diseases
prevalent in the country.
– Special focus on care for 75+ aged population
VIII. Research: A Longitudinal Ageing Study in India (LASI) project: -
The project initiated under tertiary level activities of the programme to
assess the health status of the elderly (age45-60). It is a comprehensive
ageing survey covers all 30 states and 6 Union Territories of India with a
panel sample size of 72,250 older adults aged 45 years including 31464
people above 60 years of age and above and their spouses regardless
of age. The first wave of LASI has been completed and the final report
of LASI wave-I released by Hon’ble Union Health Minister on 6th
January 2021.
Longitudinal Ageing Study in India- LASI Wave-1 Report along with India &
States/UTs Fact Sheets – Web Link- [Link]
publications
40
 Programmes at
Check Your Progress 1
National Level
Find the most correct answer in the following questions
Q1. National Center for ageing includes the following except;
1. In patient care
2. Special focus on care for below75year aged population
3. High level tertiary care with multidisciplinary clinical services
4. Post graduates (MD medicine) Training
Q2, What is the full form of LASI?
5. Longitudinal ageing Study in India
6. Longest ageing study in Inia
7. Longitudinal action study in India
8. Longitudinal action strategy in India
Q3. When was the NPHCE launched ?
9. 2013-14
10. 2010-11
11. 2012-13
12. 2014-15
Q4. How many seats of MD geriatric medicine are to be created every year by
the program(one NCA and one RGC).?
13. 10
14. 15
15. 5
16. 17

2.2.4 Implementation Plan of the programme

The program is state oriented with program implementation plans submitted by
states every financial year. The plan of activities is discussed in the MoHFW in
the national program coordination committee .On approval, the funds and key
deliverables are released to the states.

2.2.5 Achievements of the Programme

National programme for Health Care of Elderly was launched in last year of the
11th plan period in 100 districts of 21 [Link] on March2021, all 718 districts
have been sanctioned for geriatric care services of OPD, IPD, Physiotherapy
and laboratory. The Regional Geriatric Centres which provide tertiary level of
geriatric care services along with training, research have been established in 18
out of the 19 sanctioned medical colleges. The two National Centres for Aging 41
National and at AIIMS Delhi and MMC Chennai are in the process of development. MMC
International Chennai is in the advanced stage of construction while AIIMS Delhi is in the
Programmes for
Elderly
initial stage of construction.
Status Districts RGCs NCA
Sanctioned as on march 2020 713 19 02
Recommended for sanction during 5 00 00
2020-21
Total 718 19 02

a) Progress in Operationalization of the Programme activities

S. Institutions Sanctioned Operational
No. OPD Indoor Physiotherapy Laboratory
wards services services
1 RGCs 19 18 16 14 13
2 District hospitals 718 584 507 445 539
3 CHCs 4869 3111 - 1131 2408
4 PHCs 18407 10180 - - -
5 SCs providing 90719 14201
home based care
& supportive
appliances

Daily Geriatric OPD services are being provided in 584 DH, 3111 CHCs and
10180 PHCs along with special OPDs in 18 RGCs. Inpatient services are being
provided in 507 DH, along with 16 RGCs. Physiotherapy services are being
provided in 445 DH, 1131 CHCs along with 14 RGCs. Laboratory services are
being provided in 539 DHs, 2408 CHCs, along with 13 RGCs
b) Services provision:
The paradigm of elderly care services provided in 2020-21 are as given below.
Progress in Operationalization of the Programme activities 2020-21
(As per Progress Report- April 20 to March, 2021)
S. Institutions Sanctioned Operational
No. OPD Indoor Physiotherapy Laboratory
wards services services
1 RGCs 19 18 16 14 13
2 District hospitals 718 584 507 445 539
3 CHCs 4869 3111 - 1131 2408
4 PHCs 18407 10180 - - -
5 SCs providing 90719 14201
home based care
& supportive
appliances

Daily Geriatric OPD services are being provided in 584 DH, 3111 CHCs and
10180 PHCs along with special OPDs in 18 RGCs. Inpatient services are being
provided in 507 DH, along with 16 RGCs. Physiotherapy services are being
provided in 445 DH, 1131 CHCs along with 14 RGCs. Laboratory services are
42 being provided in 539 DHs, 2408 CHCs, along with 13 RGCs
Geriatric care service provision in 2020-21 Programmes at
National Level
(As per Progress Report- April 20 to March, 2021)
S. Services RGCs Distt. CHCs PHCs SCs Total Points to Ponder
No. Hospitals If all 718 district
1 OPD care 26793 4500307 5668156 16001879 2676228 28873363 hospitals , 5335 CHC’s
services ,23391 PHC’s and
2 In-door 6495 456763 110442 573700 1,50,000 HWC deliver
admissions requisite primary and
3 Physiotherapy 7413 436322 428657 872392 secondary geriatric
care care services as outlined
in the program only
4 Lab Tests 34894 2801916 1721497 3984510 8542817 those elderly requiring
5 No of Elderly 829783 625755 515946 614363 2585847 specialised services
Screened & would reach RGC and
given Health card NCA.
6 No of Elderly 8274 395921 130327 181309 715831
Provided Home
care services
7 No of Elderly 1814 7496 14450 2540 26300
Provided
supportive
devices
8 Cases referred 21704 25581 20111 20119 87515
9 Cases died in 14060 1510 250 15820
hospitals

National Programme for Health Care of the Elderly (NPHCE)

Fig. 2.1 (a) Fig. 2.1 (b) Fig. 2.1 (c) Fig. 2.1 (d)

VI. 1st October - International Day for Older Persons: This year it also
coincided with the launch of “Decade of Healthy Ageing 2020-2030.”
Hence the month of October 2020 was commemorated as month of elderly
with various activities conducted by states and centre. (Fig. 2.1)
Activities Conducted by Central Programme Division:
1. Dissemination of messages through Social Media

Fig. 2.2 (a) Fig. 2.2 (b) Fig. 2.2 (c) 43

National and
International
Programmes for
Elderly

Fig. 2.2 (d) Fig. 2.2 (e)

i. Awareness Programme on Healthy Ageing, NCD Screening, Demonstration

of Physical exercise/Yoga, Distribution of Elderly Diaries, Counselling
sessions etc.
ii. Felicitation the elderly person who had suffered from COVID 19 and
recovered in various States including NGOs & Institutions.

Fig. 2.3 (a) Fig. 2.3 (b) Fig. 2.3 (c)

iii. Month long campaign to broadcast awareness messages regarding available

services of NPHCE, Awareness Activities at old age homes and PHC level
ex: Ophthalmic check up done at old age home.
I. NPHCE Website: - An interactive and dynamic website cum MIS of the
NPHCE program has been initiated through Center for Health Infomatics
(CHI) to provide comprehensive information along with data regarding
Geriatric facilities and services available through-out the country. Hands
on Training of State Program officer & State MIS personnel for entering
data on MIS portal has been successfully completed during all 4 Regional
Review cum Capacity Building Workshops. [Link]

Fig. 2.4 (a) Fig. 2.4 (b) Fig. 2.4 (c)

Fig. 2.4 (d) Fig. 2.4 (e) Fig. 2.4 (f) Fig. 2.4 (g)

2.2.6 Bottlenecks in implementation of the programme

44 As the program is state oriented the following bottlenecks have been observed:
1. Lack of focus on elderly issues by the states Programmes at
National Level
2. Lack of expansion of geriatric care services to all primary,secondary and
tertiary facilities
3. Lack of trained manpower for institutional and home based care.
4. Capacity building for MD geriatrics insignificant compared to the
requirement.

2.2.7 Future plan of action:

• To operationalise all district hospitals of the country for provision of
geriatric care services.
• Dedicated services deliveries at CHCs and PHCs
• Home based care services through peripheral staff
• To operationalise19 Regional Geriatric Centers for provision of geriatric
care services, training and research.
• Development of Manpower & Capacity building though RGCs.
• The two National Centers for ageing i.e.: Madras Medical College Chennai
& AIIMS Delhi to be operationalised.
• Develop multistakeholder initiatves and platforms.
Check Your Progress 2
Find the most correct answer in the following questions
Q1. Proposed National Centres for ageing are?
a) MAMC, Delhi
b) NIMHANS, Bangalore
c) MMC, Chennai
d) JIPMER, Puducherry
Q2. What are the Bottlenecks in implementation of the programme?
e) Lack of expansion of services to all primary,secondary and tertiary
facilities
f) Lack of trained manpower
g) Capacity building for MD geriatrics insignificant to the requirement.
h) All of the above.

2.3 INTEGRATED PROGRAMME FOR OLDER

PERSONS (IPOP)
An integrated Programme for Older Persons (IPOP) is being implemented since
1992 with the objective of improving the quality of life of senior citizens by
45
National and providing basic amenities like food, shelter, medical care, and entertainment
International opportunities and by encouraging productive and active ageing. Under this
Programmes for
Elderly
scheme financial assistance up to 90 percent of the project cost is provided
to Non-Governmental Organizations for running and maintenance of old age
homes, day 226 care centres and mobile medicine units. The scheme has
been made flexible to meet the diverse needs of the older persons including
reinforcement and strengthening of the family, awareness generation on issues
pertaining to older persons, popularisation of the concept of lifelong preparation
for old age etc. Several innovative projects have also been added which are as
follows:
 Maintenance of respite care homes and continuous care homes.
 Sensitizing programmes for children particularly in schools and colleges.
 Regional resource and training centres for caregivers of elderly persons.
 Volunteer Bureau for elderly persons
 Formation of associations for elderly.

Think and Reflect  Helplines and counselling centres for older persons.
The National policy of  Awareness Generation Programmes for elderly people and caregivers.
older persons NPOP
1999 entails almost all  Running of day care centres for patients of Alzheimer’s Disease/Dementia,
sectors activities for
provision of holistic and physiotherapy clinics for elderly people.
geriatric care services.
If a strong collaboration  Providing disability and hearing aids for the elderly people.
is established between
health, social, legal  The eligibility criteria for beneficiaries of some important projects supported
etc sectors for service under IPOP Scheme are:
delivery how easy it
would become for all  Old age homes – for destitute elderly persons.
elderly across india.
 Respite care homes and continuous care homes – for elderly persons who
are seriously ill and require continuous nursing care and respite
 Mobile Medicare units – for older persons living in slums, rural and
inaccessible areas where proper health facilities are not available.
The scheme has been revised in April, 2008. Besides an 227 increase in
amount of financial assistance for existing projects, Governments/Panchayati
Raj institutions/local bodies have been made eligible for getting financial
assistance.
Check Your Progress 3
Q1)What is the objective ofIPOP?
a) Improving the quality of life of senior citizens
b) providing basic amenities
c) Both a and b
d) None of the above
46
 Programmes at
Q2) when was the scheme last revised? National Level
a) May, 2008
b) April, 2008
c) June, 2008
d) July, 2008

2.4 NATIONAL POLICY FOR OLDER PERSONS

(NPOP) 1999
The National Policy on older Persons was announced by the Central Government
of India in the year, 1999 to reaffirm the commitment to ensure the well-being
of the older persons. It was a step to promote the health, safety, social security
and well-being of elderly in India. The policy recognizes a person aged 60
years and above as elderly. This policy enables and supports voluntary and
nongovernmental organizations to supplement the care provided by the family
and provide care and protection to vulnerable elderly people. It was a step in
the right direction in pursuance of the UN General Assembly Resolution 47/5
to observe 1999 as International Year of Older Persons and in keeping with the
assurances to elderly people contained in the Constitution. The policy envisages
state support in a number of areas – financial and food security, healthcare and
nutrition, shelter, education, welfare, protection of life and property etc. for the
well being of elderly people in the country.

2.4.1 Objectives
The primary objectives of this policy are to:
• ensure the well-being of the elderly so that they do not become marginalised,
unprotected or ignored on any count.
• encourage families to take care of their older family members by adopting
mechanisms for improving inter generational ties so as to make the elderly
a part and parcel of families.
• encourage individuals to make adequate provision for their own as well as
their spouse’s old age.
• provide protection on various grounds like financial security, health care,
shelter and welfare, including protection against abuse and exploitation.
• enable and support voluntary and non-governmental organizations to
supplement the care provided by the family and recognising the need for
expansion of social and community services with universal accessibility.
• provide care and protection to the vulnerable elderly people by ensuring for
the elderly an equitable share in the benefits of development.
• provide adequate healthcare facility to the elderly.
• promote research and training facilities to train care givers and organizers
of services for the elderly.
47
National and • create awareness regarding elderly persons to help them lead productive
International and independent life.
Programmes for
Elderly
2.4.2 Schemes under the policy
This policy has resulted in the opening of new schemes such as –
 Promotion of the concept of healthy ageing.
 Setting up of Directorates of Older Persons in the States.
 Training and orientation to medical and paramedical personnel in health
care of the elderly.
 Assistance to societies for production and distribution of material on elderly
care.
 Strengthening of primary health care system to enable it to meet the health
care needs of older persons.
 Provision of separate queues and reservation of beds for elderly patients in
hospitals.
 Extended coverage under the Antodaya Schemes especially emphasis for
elderly people.

2.4.3 Principal areas of intervention and action strategies

Let us learn about the action strategies of the Policy
1. Financial security:
It recognizes fragile financial situation of 2/3rds of persons 60+, provide them
some level of income security and need to develop policy instruments for this.
Old age pension scheme for the poor below poverty line will be expanded,
delays in disbursement will be checked, and pension will need revision based on
inflation. Public distribution system will reach out to all persons below poverty
line and aged 60+. There is a need for prompt settlement of pension, provident
fund, gratuity, other retirement benefits for the retired employees in government,
quasi government or industrial workers specially for widows. Pension schemes
will be expanded in both private and public sector, for self-employed, salaried in
non-governmental employment will be provided contribution from employers.
Pension funds will be under strong regulatory authority in this regard. Tax
policies will consider reduction of tax burden on superannuated old persons
and benefits of rebate on medical expenses. It will promote long term savings
instruments in both rural and urban areas for financial security in old age.
Employment of the old persons in income generating activities will be promoted
in non-governmental organizations.
Few legislations have been passed for rights of parents without any means to
be protected by their children such as: section 125 of the Criminal Procedure
Code , The Hindu Adoptions and Maintenance Act, 1956, Himachal Pradesh
Maintenance of Parents and Dependents Bill, 1996, similar bill by Maharashtra.
States will be encouraged to pass such legislation for the old persons.

48
2. Health care and nutrition: Programmes at
National Level
Priority will be given for health care of the older persons by providing affordable,
subsidized for the poor, graded system for the user charger for others through a
mix of public health services, health insurance, non-governmental organizations,
and private medical care. The primary health care system will be strengthened to
provide preventive, promotive, curative, restorative and rehabilitative services,
geriatric care facilities at secondary and tertiary levels.
Trusts, charitable societies, voluntary agencies will be promoted by grants, tax
relief and land at subsidized rate for free beds, medicine and treatment of the
very poor elder citizens and reasonable user charges for others. Private medical
care with land provided at lesser rate will be requested for discounts to older
patients and orientation to private practitioners will be extended for geriatric
care. Public hospitals will ensure separate counters, short waits, convenient
timings on specified days and set up geriatric wards.
Training and orientation will be given to medical, para medical personnel for
health care of the elderly. Specialization in geriatric medicine will be facilitated
in medical colleges, nursing training will include geriatric care. Mobile health
services, camps will be conducted to cater to the needs of the elderly who
cannot come to hospitals or health centres. Hospitals will be encouraged to
have separate welfare funds with donations and grants for free treatment and
medicines to the poor elderly patients.
There is a need for hospices supported or assisted by states, public charity,
voluntary organizations to look after old chronically ill, deprived of family
support. Support will be given to geriatric care societies for preparation,
distribution of materials on self-care by older persons, guidance materials on
health and nursing care by family care givers. Education materials on diet,
nutrition, diet recipes will be given to older persons and their families. Concept
of healthy ageing will be promoted. Health education will be strengthened
through various mass media, folk media, other communication channels for life
style changes starting in the young for exercise, nutrition, stress reduction, yoga,
meditation, recreation activities etc. Mental health services will be expanded
and counselling will be provided to families on care and treatment of older
persons. NGOs will be encouraged to provide ambulatory services, day care
and health care services to the older persons through grants, training.
3. Shelter
Recognising the need, housing will be increased, and 10% earmarked for
allotment to older persons in both rural and urban areas. Schemes such as Indira
Awas Yojana will be promoted. Older persons will be given easy access to
loans, with easy repayment options for purchase of house and major repairs.
Lay out of housing colonies will include a multi purpose centre for older
persons, shopping complex, community centres, and parks. Lifts should be
made available in three or four storied housing complexes. Preference will be
given to allot ground floor flats to older persons .
4. Education
Focus will be given to education, training and information needs of the older
persons. Continuing education programmes will be encourages and supported 49
National and related to career development, art, culture, social heritage, skills in community
International work and welfare. Open universities will be encouraged to develop packages
Programmes for
Elderly
using distance learning techniques. Educational curriculum will incorporate
materials to strengthen intergenerational bonds and support to older persons.
5. Welfare
Welfare services will be given on priority to vulnerable older persons such as
disabled, inform, chronically sick, without family support. Institutional care will
be considered as last resort to the care of elderly. Non-institutional services by
voluntary organizations will be promoted and assistance will be given to them
through grants-in-aid for construction and maintenance of old age homes.
Voluntary organizations will be encouraged and assisted to organize services
such as day care, multi service citizen’s centres, supply of disability related
aids and appliances, short stay home services, friendly home visits by social
workers, help in communication with friends, relatives, neighbours, escorting
to hospitals, shopping complexes etc.
A welfare fund for older persons will be set up with support from the government,
corporate sector, trusts, charities, individual donors and others.
6. Protection of life and property
There is a need to protect the older persona against abuse, assault, forceful
grabbing of property, assets from either household members or criminals.
Introduction of special provisions in IPC to protect older persons from domestic
violence will be considered. Tenancy legislation will be reviewed so that rights
of the occupancy of older persons are restored.
Voluntary organizations will be assisted to provide helpline services, legal aid,
and other measures. Police will be directed to keep a vigil on older persons
living alone and promote interaction with neighbours. Information will be
given to older persons to prevent unauthorized entry of other persons, hiring of
domestic help, visits of repair and maintenance persons, vendors, handling of
cash and valuables.
7. Other areas of action
States will ensure policies such as grant of identity cards, fare concessions in
all modes of transport, seat preference, design of public transport vehicles for
easy entry and exit, enforcement of traffic rules at zebra crossings, priority in
telephone and gas connections etc.
Issues of the older persons will be highlighted on national older person’s day,
declare 2000 as the National year of the older persons.
8. Non-governmental organizations (NGOs)
The national policy recognises role of NGOs for provision of user-friendly
affordable services to the older persons. They will be supported for orientation
and training of manpower and other services. Grants will be provided grants to
support their activities.
Support will be given for developing volunteer programmes to mobilize
50 participation of older persons in community affairs, interactions with elders and
resolve their problems. Trade unions, employer organizations and professional Programmes at
bodies will be approached for sensitization programmes on ageing issues and National Level
organize services for superannuated workers.
9. Realizing the potential
The policy recognizes persons 60+ as potential resources in contribution to
transmit socio-cultural heritage aspects to grandchildren and other areas.
10. Family
The policy recognizes role of family as a non formal social security for the older
persons. Programmes will be developed to promote family values, sensitize
the young on the necessity of inter-generational bonding, care and support
to the elderly. Children will be encouraged to co-reside with their parents by
providing tax-relief, allowing rebates in medical expenses, giving preference in
allotment of houses. Counselling services will be provide for resolving inter-
familial stresses.
11. Research
Research activity on ageing will be promoted by universities, medical colleges,
research institutions by setting up centres of gerontological studies and geriatrics.
Funding support will be provided to academic institutions for research projects
on ageing. Interdisciplinary coordinating body on research will be set up.
Policy recognises the necessity of a national institute of research, training and
documentation.
12. Training of manpower
Medical colleges will be assisted in training of manpower by offering
specialization in geriatrics. Nursing and paramedical training will also include
curriculum on geriatric care. Assistance will also be given to NGOs for training
and orientation of personnel on providing services to older persons.
13. Media
Policy aims to involve mass media in orientation programmes on ageing issues
and provide opportunities to media personnel to have access to information and
reporting of field situations.

2.4.4 Implementation
An action plan will be developed for wide dissemination to the public. Ministry
of Social Justice and Empowerment will act as nodal ministry to coordinate all
matters related to implementation of the policy. An inter-ministerial committee
will coordinate the activities. States will be encouraged to set up Directorates
of Older Persons for coordination and monitoring. Five year and annual action
plans will be developed by each Ministry to implement the activities. Detailed
review on implementation will be prepared every three years.
An autonomous National Council for Older Persons will be set up to coordinate
concerns of older persons with representatives from relevant Central Ministries
and Planning Commission now Niti Aayog, states, NGOs, academic bodies,
media and experts.
51
National and An autonomous registered National Association of Older Persons will be
International established to mobilize senior citizens, promote and undertake programmmes
Programmes for
Elderly
and activities for their well-being.
Panchayati Raj institutions will be encouraged to participate in implementing the
policy, discuss concerns of the older persons and activities to be undertaken.

2.5 NATIONAL SOCIAL ASSISTANCE

PROGRAMME (NSAP)
It was launched on 15th August 1995 as a fully funded centrally sponsored
scheme targeting the destitute (having little or no regular means of subsistence
from his/her own source of income or through financial support from family
members or other sources). Initially it had three components:
a) National Old Age Pension Scheme (NOAPS), now Indira Gandhi National
Old Age Pension Scheme
b) National Family Benefit Scheme (NFBS)
c) National Maternity Benefit Scheme (NMBS), transferred to Department of
Family Welfare, GoI on 1.4.2001.
Later, the following schemes were added:
d) Indira Gandhi National Widow Pension Scheme
e) India Gandhi National Disability Pension Scheme
f) Annapurna scheme (discussed in pillar 4 above)
NSAP was expanded in February 2009 to cover pension to widow below
poverty line in the age group 40-64 years. This scheme was named Indira
Gandhi National Widow Pension Scheme (IGNWPS).
Another pension group was approved for persons with severe (80% or more one
or more disability) or multiple disabilities, known as Indira Gandhi National
Disability Pension Scheme (IGNDPS) for those aged 18-64 years.
NSAP became a centrally sponsored scheme again since 1st April 2014 under
Ministry of Rural Development, GoI. Under this scheme, pension is disbursed
directly into the bank account /post office account or through electronic money.
Every beneficiary being below poverty line are also enrolled under Rashtriya
Swasthya Bima Yojana (RSBY).
Eligibility Rs 500 per month per beneficiary aged 80 years and aboveand rate of
pension: Under all schemes, persons below poverty line (BPL) are considered.
1. Indira Gandhi National Old Age Pension Scheme (IGNOAPS): The person
should be 60 years or above. Pension is given at the rate of Rs.200 per
month per beneficiary in age group 60-79 years,. It excludes BPL widows
and BPL persons with severe and multiple disabilities.
2. Indira Gandhi Widow Pension Scheme and Indira Gandhi Disability
Pension scheme (IGNDPS): Rs300 per beneficiary per month and age from
52 59 years to 79 years with effect from 1.10.2012, and Rs500 per beneficiary
 per month after attaining age of 80 years. Dwarfs are also eligible under Programmes at
IGNDPS. National Level

Priority is given to identify applicants with BPL who are vulnerable, suffering
from long term or terminal illness es like leprosy, Tuberculosis, AIDS, cancer,
etc. except widows suffering from AIDS (considered irrespective of BPL or
not if they do not have a job, not own 5 acres of land or more, not own a
four wheeler for use). Similarly, transgenders, women victims of crimes and
harassment, manual scavengers, deserted women are given priority.
Check Your Progress 4
Q1) What are the components of National Social Assistance Programme?
a) Indira Gandhi National Widow Pension Scheme
b) India Gandhi National Disability Pension Scheme
c) Annapurna scheme
d) All of the above
Q2) which one is not correct among the following for the Eligibility and rate
of pension under Indira Gandhi National Old Age Pension Scheme?
e) Pension is given at the rate of Rs.200 per month per beneficiary in age
group 60-79 years
f) Pension is given at the rate of Rs.200 per month per beneficiary in age
group 50-69 years
g) The person should be 60 years or above
h) Rs 500 per month per beneficiary aged 80 years and above.

2.6 OTHER NATIONAL PROGRAMS WITH

SUPPORTIVE OF ELDER CARE
There are other national programme which have emphasis on the elderly. Let us
read more about some such programmes in the following subsections.

2.6.1 National Mental Health Program

The elderly are most vulnerable to mental health problems. Feelings of loneliness
and of being socially isolated rank high on the list of risk factors for poor
mental and physical health. Isolation can cause health effects such as increased
incidence of depression, anxiety symptoms and cognitive decline, which can
outlast the duration of isolation itself. Thus, it seems important currently to
address social isolation in the elderly by finding ways to offer support and
emotional connection.
The Government of India launched the National Mental Health Programme
(NMHP) in 1982, with the following objectives:
1. To ensure the availability and accessibility of minimum mental healthcare
for all in the foreseeable future, particularly to the most vulnerable and
underprivileged sections of the population; 53
National and 2. To encourage the application of mental health knowledge in general
International healthcare and in social development; and
Programmes for
Elderly 3. To promote community participation in the mental health service
development and to stimulate efforts towards self-help in the community.
The District Mental Health Program (DMHP) was launched under NMHP in
the year 1996 (in IX Five Year Plan). Some recent initiatives of DMHP are:
• Newly incorporated promotive and preventive activities for positive
mental health:
• School Mental Health Services: Life skills education in schools,
counseling services.
• College Counselling Trained Services: Through teachers and counselors.
• Work Place Stress Management: Formal & informal sectors, including
farmers, women etc.
• Suicide Prevention Services: Counselling centre at District level,
Sensitization workshops, IEC, Helplines etc
Starting with 4 districts in 1996, the program has been expanded to241 districts
by the end of the 10th [Link] 690 districts are sanctioned of which
around 500 are functional.
Presently the NMHP has the following components/schemes:
1. District Mental Health Programme (DMHP) to be extended to 500
districts.
2. Manpower Development Schemes - CentersOf Excellence And Setting Up/
Strengthening PG Training Departments of Mental Health Specialities
3. Modernization Of State Run Mental Hospitals
4. Up gradation of Psychiatric Wings of Medical Colleges/General Hospitals
5. IEC
6. Training & Research
7. Monitoring & Evaluation Manpower Development Schemes - Centers of
Excellence and Setting Up/ Strengthening PG Training Departments of
Mental Health Specialities are the new schemes/components.
2.6.2 National Cancer Control Programme (NCCP)
Men and women aged ≥ 60 years are at high risk for cancers. Men have a risk
15 times greater risk and in women8 times greater risk than the persons having
age < 60 years. Lung and prostate cancers are most prominent cancer in men
having age ≥ 60 years while in women breast is the leading site followed by
cervix and ovary in the same age group.
GOALS & OBJECTIVES OF NCCP
1. Primary prevention of cancers by health education specially regarding
hazards of tobacco consumption and necessity of genital hygiene for
54 prevention of cervical cancer.
2. Secondary prevention i.e. early detection and diagnosis of cancers, for Programmes at
example, cancer of cervix, breast and of the oro-pharyngeal cancer by National Level
screening methods and patients’ education on self-examination methods.
3. Strengthening of existing cancer treatment facilities, which are woefully
inadequate.
4. Palliative care in terminal stage of the cancer.
Keeping in view the preventable common risk factors of cancer and other
noncommunicable diseases (NCDs), the ministry has formulated a National
Program for prevention and control of cancers, diabetes, cardiovascular
diseases and stroke (NPCDCS) after integrating the NCCP with other NCDs.
The major components of this program have been to strengthen 100 districts in
21 states for cancer care services, strengthen 65 centers as tertiary cancer care
centers (TCCCs) throughout the country, establish NCD cells for monitoring
the program implementation at the selected States/Districts and promote
information, education and communication for creating awareness generation
among the community about cancer and its available services. Under the
NPCDCS (in 12th 5 year plan), 120 crores each shave been sanctioned for the
establishment of 20 state-level cancer centers. 50 TCCCs will be established
in different parts of the country, which include strengthening of existing 27
regional cancer centers and setting up or strengthening of 23 tertiary cancer care
centers at medical colleges, district hospitals, state govt. or nongovernmental
organizations Institutions.

2.6.3
National Program for Control Of Deafness, National Program For Control Of
Blindness, National Oral Health Program, National Palliative Care Program Etc
are some health programs which also cater to elderly although they don’t have
any targeted interventions in it.

2.7 LET US SUM UP

The National Programme for the Health Care for the Elderly (NPHCE) is an
articulation of the International and national commitments of the Government as
envisaged under the UN Convention on the Rights of Persons with Disabilities
(UNCRPD) dealing with provisions for medical care of Senior Citizen. The
programme is State oriented and basic thrust of the programme is to provide
dedicated health care facilities to the senior citizens (>60 year of age) at various
level of primary, secondary and tertiary health care.
Objectives of NPHCE:
• To provide easy access to promotional, preventive, curative and rehabilitative
services to the elderly through community based primary health care
approach
• To identify health problems in the elderly and provide appropriate health
interventions in the community with strong referral backup support.
• To build the capacity of the medical and paramedical professionals as
well as the care-takers within the family for providing health care to the 55
elderly.
National and • To provide referral services to elderly patients through district hospitals,
International regional medical institutions
Programmes for
Elderly • Convergence with National Rural Health Mission, AYUSH and other line
departments like Ministry of Social Justice and Empowerment.
National mental health Program(NMHP)
Objectives of NMHP:
• Mental health care (preventive and curative services) at district level.
• Availability, applicability, accessibility of mental health care at all levels.
• Strategies:
PTRP strategy as per Bellary model
 Promote mental health
 Treat
 Rehabilitate
 Prevent mental health disorders
Check Your Progress 5
I. what are the Objectives of NPHCE:
a) To build the capacity of the medical and paramedical professionalsas well
as the care-takers within the family for providing health care to the
elderly.
b) To provide referral services to elderly patients through district hospitals,
regional medical institutions
c) To identify health problems in the elderly and provide appropriate health
interventions
d) All of the above
II. PTRP strategy as per Bellary model includes all except?
a) Promote mental health
b) Targeted
c) Rehabilitate
d) Prevent mental health disorders
III. The term ageism was coined by
a. Robert Butler
b. Ignatz Leo Nascher
c. Dr. D sengupta

56 d. Dr Sharad Gokhale
 Programmes at
IV. Which of the following statements regarding Definition of Old age is not National Level
true:
a. Most developed countries have accepted the chronological age of 65 years
as a definition of 'elderly' or older person
b. In contrast to the chronological milestones which mark life stages in the
developed world, old age in many developing countries is seen to begin
at the point when active contribution is no longer possible."
c. Government of India adopted 'National Policy on Older Persons' in
January, 1999. The policy defines 'senior citizen' or 'elderly' as a person who
is 60 years of age or above.
d. The United Nations generally uses 75+ years to refer to the older
population.
V. The elderly population (>60 years) accounted for what percent of total
population of India in 2011.
a) 6.2% b) 7.4 %
c) 8.3% d) 9.3%
VI. Which of the following statements regarding Dementia is not true
a. Dementia is a normal part of ageing and it is not possible for persons with
dementia to continue to engage and contribute within society and have a good
quality of life.
b. Dementia is overwhelming for the caregivers and adequate support is
required for them from the health, social, financial and legal systems.
c. Countries must include dementia on their public health agendas. Sustained
action and coordination is required at international, national, regional and
local levels.
d. People with dementia and their caregivers often have unique insights to
their condition and life. They should be involved in formulating the policies,
plans, laws and services that relate to them.
VII. About 64 /1000 elderly (>60 years) persons in rural areas and 55/1000
in urban areas suffer from one or more disabilities. The Most common
disability among the elderly in India is
a. Locomotor disability
b. Visual disability
c. Hearing disability
d. Speech disability
VIII. The population projection is required for preparation of perspective
plan for the future. Which of the statements below is not true as per the
population projections in India
57
National and
International a. India's population above 60 years in 2026 will be 15 % of total
Programmes for population.
Elderly
b. By 2026, North India's population would be younger compared to the
South.
c. By the year 2026 Kerala will have highest educated working people with
average age hovering above 35 years
d. By 2026 Uttar Pradesh will have highest uneducated and less educated
working population with average age below 30 years.
IX. In India, organized sector provides pension for retired persons. But
for others, The Ministry of Rural Development has implemented the National
Old-Age Pension Scheme (NOAPS) - for persons above 65 years belonging
to a household below poverty line. The amount paid per month is:
a) Rs 150 per month.
b) Rs 200 per month.
c) Rs 250 per month.
d) Rs 300 per month.
X. Currently the DMHP is being implemented in the country in
i. 690 districts
ii. 520 districts
iii. 412 districts
iv. 70 districts
XI. In which district was the model of community based mental health
care fled tested by NIMHANS
a. Bangalore
b. Thirussar
c. Ernakulam
d. Bellary
XII. The components of the National Mental Health program are:
a. Treatment of mentally ill
b. Only prevention
c. Prevention and promotion of positive mental health
d. All of the above
XIII. Which of the following are the services provided under the DMHP
a. Daily OPD services
58
 Programmes at
b. OPD services along with 10 bedded IPD National Level
c. Referral and follow up services
d. Creating community awareness for stigma of mental illnesses
e. All of the above
Fill in the Blanks
1. A scientific discipline which deals with the phenomenon of ageing
and all issues related to this process is called……………………. While
the management of old age issues a,diseases and conditions is called as
............................
2. Across the world, what has jointly resulted in higher numbers and
proportions of olderpersons……………………………………
3. Present age specific mortality rate for persons aged 75 to 79 years is
………………………………………………….
4. The old-age dependency ratio in 2018 for India as a whole was
………………………………….
5. The Ministry in India that focuses on policies and programs for the
Senior Citizens in collaboration with State governments, Non-Governmental
Organizations and civil society is ………………………………..
6. The Maintenance and Welfare of Parents and Senior Citizens Act was
enacted in India in the year…………………………………………..
7. In India, the index of ageing in 2011 was
…………………………………………
8. Ministry of health launched NPHCE in ...................................
Mark True or False
1. Elderly persons need less calories as compared to young adults
2. Stomach Cancer is one of the leading causes of death in the elderly
3. National Policy on older person(NPOP) was the first policy for the Welfare
of the Elderly to be Implemented in India
4. As per the Census 2011 Kerala has the highest proportion of elderly
population (>60 years) in India .
5. NPHCE envisages only curative care for elderly
6. The ideal number of psychiatrists required in our country is 2 per lakh
population
7. The main strength of NMHP document drafted in 1982 was that it envisaged
the integration of mental healthcare with the general primary healthcare.
8. Under NPHCE 10 bedded geriatric ward is to be established at each district
hospital.
59
National and
International 2.8 ANSWERS TO CHECK YOUR PROGRESS
Programmes for
Elderly 1d,2a,3b,4d
1c,2d
1c,2b
1d,2b
1d,2b
MCQ’s
I. D
II. B
III. (a) Robert Neil Butler (January 21, 1927 - July 4, 2010) was a physician,
gerontologist, psychiatrist, and Pulitzer Prize-winning author, who was the
first director of the National Institute on ageing. Butler is known for his
work on the social needs and the rights of the elderly and for his research
on healthy ageing and the dementias. He coined the term ageism.
IV. (d) The UN generally uses 60+ years to refer to the older population
V. (d), Source: Registrar General & Census Commissioner of India
VI. (a) Dementia is not a normal part of ageing. Source: Dementia a public
health priority by World Health Organization 2010
VII. (a) 3% (30/1000) suffer from locomotor disability.
VIII. (a), (Projected population >60 Years: 12.17%); Source: Registrar General
& Census Commissioner of India
IX. (a) 690 districts
X. (d) Bellary
XI. (d) All the above
XII. (d) All the above
XIII. (e) All the above
Fill in the Blanks
1) Gerontology,geriatrics.
2) declining fertility and increasing longevity
3) (80 per 1000).
4) 9.26% in 2018 down from 13.1% in 2001. The old-age-dependency ratio
is the ratio of the number of elderly people (>60 years), compared to the
number of people of working age (i.e. 15-60 years old).) Source: Situation
Analysis Of The Elderly in India: Central Statistics Office, Ministry of
Statistics & Programme Implementation Government of India.
60
5) Ministry of Social Justice and Empowerment Programmes at
National Level
6) 1986
7) 28.4 persons >60 years / 100 children < 15 years. Index of ageing is the
number of persons >60 years per 100 children < 15 years.
8) 2010-11
True or false
1) True some eldely may need fewer calories to maintain their weight, since
they tend to move and exercise less and carry less muscle. If they continue
to eat the same number of calories per day they may develop obesity
2) False Lung and prostate cancers are most prominent cancer in men having
age >60 years while in women breast is the leading site followed by
cervix
3) False Central Sector Scheme of Integrated Program for Older Persons
(IPOP) was the first policy to be implemented in 1992 whereas NPOP was
implemented in 1999
4) True Kerala has maximum proportion of elderly people in its population
(12.6 per cent) followed by Goa (11.2 per cent) and Tamil Nadu (10.4 per
cent) as per Population Census 2011.
5) False
6) FalseThe ideal number of psychiatrists required in our country is 1 per lakh
population
7) True
8) true

2.9 REFERENCES AND FURTHER READINGS

1. Operational guidelines of national program for healthcare of elderly,
Ministry of Health and family welfare; 2010
2. Operational guidelines of National mental health program.
3. Operational guidelines of national program for cardiovascular
disease,diabetes,cancer and stroke(NPCDCS), Ministry of Health and
family welfare;
4. [Link]
5. [Link]
6. United Nations Department of Economic and‫ٴ‬socialaffairs ,Population
Division (2008) World Population Prospects.
7. WHO India. Development of models for community based health care for
the elderly.

61
National and
International
UNIT 3 PROVISIONS AND SCHEMES FOR THE
Programmes for ELDERLY
Elderly
Structure
3.0 Objectives
3.1 Introduction
3.2 National Action Plan for Senior Citizens (NPASrC)
3.2.1 Sub Schemes under NPASrC
3.2.2 The Status of Implementation of the Annual Plan

3.3 Schemes
3.3.1 Rashtriya Vayoshri Yojana (RVY)
3.3.2 Indira Gandhi National Old Age Pension Scheme (IGNOAPS)
3.3.3 Annapurna Scheme
3.3.4 Pradhan Mantri Jan Arogya Yojana
3.3.5 Senior Citizens’ Welfare Fund
3.3.6 Vayoshresshtha Samman
3.3.7 Pradhan Mantri Vaya Vandana Yojana
3.3.8 Varishtha Mediclaim Policy
3.3.9 Varishtha Pension Bima Yojana
3.3.10 Reverse Mortgage Scheme

3.4 Privileges and Benefits

3.4.1 Travel Concessions
3.4.2 Banking Facilities and Special Interest Rates

3.5 Institutional Care

3.5.1 Old Age Homes
3.5.2 Day Care Centres
3.5.3 Long Term Care
3.5.4 Current Status, Challenges and Future of Long Term Care

3.6 Older Persons in Emergencies

3.7 Let Us Sum Up
3.8 Glossary
3.9 Answers to Check Your Progress
3.10 References and Further Readings

3.0 OBJECTIVES
After reading this unit, you should be able to

62 • describe the National Action Plan for Senior Citizens

• enumerate and discuss the schemes that are available in the country for the Provisions and
older persons Schemes for Elderly

• explain the Privileges and Benefits for older persons

• describe the institutional care facilities available in the country
• discuss the need for providing support to older persons in emergencies

3.1 INTRODUCTION
We all know that India is a young country with the famed demographic dividend. Did you know?
The mean age of the population is still 28.4 years. However, like many other The Constitution
low and middle income countries we are also experiencing rapid greying of our mentions the right to
population. You have already read about the demographic and epidemiological social security in old age
in Article 41.
transition and it’s manifestations in the block 1 of this course. The section on
demographic facts familiarised you with the broad trends that show the increase
in number of older persons (60+), longevity mainly due to decline in birth and
death rates. This trend is expected to continue and pose challenges of population
ageing. For a country that has all the systems geared to dealing with children
and youth is expected to deal with the challenges of population ageing.
You already have read about the National Policy on Older Persons (NPOP) that
our government launched in 1999 and the initiatives at the international level
to deal with ageing in the previous two units of this block. It is important to
understand here that the international instruments emanate from a conceptual
perspective. They treat older persons as full and independent members of society
with specific needs. The older persons require assistance and enabling like any
other segment of the population to be productive and inclusive members of
any society. The sentiment and thinking resonates in our NPOP. The schemes,
privileges and benefits that accrue to the older person are guided by the
framework that NPOP provides. It underlines the importance of income, health
and emotional security in old age and has provisions for welfare and creation
of enabling conditions for the older persons. The NPOP takes its ideological
inspiration from the international instruments and bases its provision on the
demographic facts and estimated trends. The most important being poverty
in old age, feminisation, longevity, ability of older persons to be productive,
living arrangements and informal care structures. However, for a segment
of population that is expected to experience highest growth rates in future,
government intervention is important. Therefore, many schemes were designed
to address the income, health and care of older persons. A student of geriatrics
that has to deal with common people so closely as a medical doctor may be able
to help if he/she has information on such provisions.
In this context, this Unit will have basic information on the schemes, privileges
and benefits that government and private service providers offer to the older
persons. The important national schemes that should be mentioned at the outset
are National Plan of Action for Senior Citizens (operated by nodal Ministry),
Indira Gandhi National old Age Pension Schemes (operated by Ministry of Rural
Development) and National programme for Health Care of Elderly (Ministry of
Health and family Welfare). This Unit will deal in some detail with the first
two and only touch upon the third as that is discussed in full length in the other
Unit. 63
National and The National Action Plan on Senior Citizens focuses on 4 broad themes
International including institutional care, capacity building, research and awareness. It
Programmes for
Elderly
intends to involve states government as major partners and also convergence at
the level of central ministries to achieve an age friendly society.
Ministry of Social Justice and Empowerment is the nodal central ministry dealing
with the issues of ageing. The other relevant ministries are Rural Development
and Health and family Welfare that is dealing with social pensions and geriatric
health care respectively. The schemes that these ministries and some other
ministries operate are mentioned in this Unit for information which range from
distribution of disability aids to health insurance. It also has information on the
monetary and non-monetary privileges and benefits that private service providers
like banks, airlines, transport companies, hospitals provide to older persons.
These provisions are for older person during normal peace times. But as India
experiences natural disasters and emergencies frequently, it is important for the
student to also have basic knowledge and understanding on the needs of older
person during such episodes.

3.2 NATIONAL PLAN OF ACTION ON SENIOR

CITIZENS (NPASrC)*
*
The new nomenclature for the scheme is Atal Vayo Abhyuday Yojana
(AVYAY).
On 1st April 2020 Ministry of Social Justice and Empowerment adopted a
comprehensive National Plan of Action for Senior Citizens. It provides the
thematic, budgetary and structural design for implementing the chosen areas
from the 10 stated objectives of the National Policy. The Action Plan would
focus on financial security, food, health, social security, social integration,
safety, security sensitisation and wellbeing of older persons.
It would also promote Silver Economy i.e. elderly friendly industrial goods and
services in the society.
NPASrC will be led by the Central Govt. It could also partner with other
stakeholders like NGOs, CSR bodies or any reputed organisation approved by
Secretary MoSJE.
Rs 200 crore is the proposed budget for the implementation of the Action plan
and it is to be followed by an equal amount each year. The year-wise allocation
shall be shared among the sub schemes as per requirements and availability of
funds with the approval of the Secretary Department of SJE.

3.2.1 Sub Schemes under NPASrC:

Let us learn more about some of the sub schemes covered under NPASrC:
1. Scheme of Integrated Programme for Senior Citizens (IPSrC): Setting up
of old age homes for indigent senior citizens by providing shelter, food,
medical care and entertainment opportunities and encourage productive
and active ageing. The details of the precursor to this scheme integrated
programme for older persons (IPOP) are mentioned in section 2.5 of the
64 previous unit.
2. State Action Plan for Senior Citizens (SAPSrC): Each state is encouraged Provisions and
to make a five year and annual plan according to the needs of the older Schemes for Elderly
person in the respective states. Central ministry will fund this Action Plan,
but the state govt. is expected to also use its own funds wherever required.
Thematically, the state are free to add appropriate elements of age care to
this but central funding will be available only for the approved areas of
action under the NAPSrC.
3. Convergence with Initiatives of other Ministries/ Departments in
Government of India in the field of Senior Citizens welfare.(CWMSrC): As
the name suggests NAPSrC has identified initiatives to be taken by different
Departments at the central level for the benefit of senior citizens. These
initiatives would be collated, department-wise and communicated to them
for proposing Annual Action Plans in collaboration with this department.
4. Media, advocacy, Capacity building, Research and Study, Pilots and any
other project aimed towards the welfare of the senior citizens and falling
under the scope and coverage of the NAPSrC through NISD (NISDSrC):
National Institute of Social Defence (NISD), will be equipped to implement
directly any project in furtherance of the objectives of the NAPSrC.

3.2.2 The Status of Implementation of the Annual Plan

Efforts have been made at the level of the nodal ministry to implement the
NPASrC under clear and measurable targets with pre-set timelines and budgetary
allocations, so that there is no laxity on making an impact on the ground. For
this purpose we must know the annual plan in some detail.
The Annual plan 2020-21, the proposed outlay for NPASrC is Rs 365 crore.
Components wise outlay:
(i) Sub scheme of Integrated Programme for Senior Citizens(IPSrC):Rs
189.80Cr
(ii) Sub scheme of State Action Plan for Senior Citizens (SAPSrC):Rs 147.00
Cr
(iii) Convergence with Initiatives of other Ministries/ Departments in
Government of India in the field of Senior Citizens welfare.(CWMSrC):Rs
1 Cr
(iv) Media, advocacy, capacity building, research and study, pilots and any
other project aimed towards the welfare of the senior citizens and falling
under the scope and coverage of the NAPSrC through NISD (NISDSrC):
Rs 27.20 Cr
Sub Scheme I: Under the IPSrC ongoing projects are in the category of old
age homes, continuous care homes, physiotherapy centres, Regional Resource
Training Centres (RRTC), Mobile Medicare units and Sr. Care homes for
women.
The Plan proposes to sanction 250 residential care facilities and 12 RRTCs.
State wise allocation is available on the website of the Ministry.

65
National and Sub Scheme-II: State Governments/ UT Administrations may seek funds from
International the Department after forwarding their State Action Plan for the following
Programmes for
Elderly
activities/ programmes:
(a) Support of 15000 AGRASR/ Elders Self Help Groups @Rs 55000/ SHGs
– Total cost Rs. 82.5 Crore, covering apporx. 3 Lakh Senior Citizens
(b) Support to 50 Mobile Medicare Units for senior citizens@ 11.2 Lakh per
programme - Total cost Rs. 5.6 Crore, covering apporx. 25000 Senior
Citizens
(c) Support to 50 Physiotherapy clinics for senior citizens @Rs.6.48/Centre -
Total cost Rs. 3.24Crore, covering apporx. 30000 Senior Citizens
(d) Support to 100 Day Care Centres for Senior Citizens @ Rs 10 Lakh per
programme - Total cost Rs. 10 Crore, covering apporx. 60000 Senior
Citizens
(e) Organising of 100 training programmes for creation of a pool of trained
geriatric care-givers @ Rs.21.3 Lakh, - Total cost 21.3 Crore, covering
apporx. 1.2 Lakh Senior Citizens,
A State can seek 20% additional funds over and above the funds required for
activities/programmes mentioned at (a) to (e) above for implementation of their
State Specific Activities.
Sub Scheme-III: Convergence with Initiatives of other Ministries/ Departments
in Government of India in the field of Senior Citizens welfare.(CWMSrC). A
token provision of Rs. 1 Crore is made for this purpose.
Advocacy, advisories and conferences/meetings with the ministries/departments,
schemes/ programs may have to be devised and implemented for taking the
strategies forward. All such convergence activities shall be taken up under this
sub scheme with the approval of the Government on a case to case basis.
Concerned Departments/ Ministries/State Governments formulate programmes/
packages etc through convergence of various schemes for the welfare of
senior citizens, including the activities mentioned in the Plan like tourism
packages, data and dissemination on morbidity and mortality, collection of age
disaggregated data in Sample Registration System of RGI, collection of data in
national census, data on crimes against the older persons and research on the
same including abuse.
Sub Scheme-IV: National Institute of Social Defence, an autonomous body of
this Department shall undertake following Activities/ programmes, in addition
to its own mandate, under the NAPSrC in accordance with the cost norms for
model indicated in the scheme of NAPSrC 1 per state and UTs on awareness
generation and sensitization, training and geriatric care; regional level seminars
and workshops and conferences
The ongoing pilots projects on any area aimed towards the welfare of the senior
citizens are study in 12 aspirational districts of Jharkhand, national helpline and
celebration of International day of Older Persons and Vayoshrestha Samman.

66
NISD to submit its Action Plan to the Ministry by 30th April, including the Provisions and
activities/programmes mentioned above along-with requirement of funds from Schemes for Elderly
the NAPSrC or other heads.
For all the above components there is a prescribed time schedule for application
and screening process.
Check Your Progress 1
1. List the thematic Areas under National Action Plan for Senior Citizens
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
2. What is the role of National Institute of Social Defense in implementation
of NPASrC?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
3. What role will the State Government play in implementation of NPASrC?
How will it help the older persons in the state?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
4. List the Projects for which the state/UT may ask funds from the nodal
ministry for the under Sub- Scheme II of NPASrC?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
5. Fill in the blanks
a. Silver Economy includes……. And…….. for older persons.
b. The Annual Plan 2020-21 proposes to sanction …… residential care
facilities and ……RRTCs in ……states

67
National and
International
3.3 SCHEMES
Programmes for This section lists out the welfare schemes that are designed to cover aspects of
Elderly
lives of older person living below the poverty line and require special attention.
These schemes are designed to provide subsistence allowance, food, disability
aids, health insurance to poor older person so that they do not fall below the
subsistence level and are able to maintain some semblance of dignified life in old
age. These schemes like any other government schemes are facing challenges of
design and delivery, the most important being that they are not universal. They
are not available to any and all older persons, as these are means tested they are
fraught with inclusion and exclusion errors. The older persons are subject to
many privations to access these schemes right from filling up the form to getting
the benefits, the more vulnerable being always at a disadvantage to get benefits
of such schemes. However, the consolation is that at least partial benefits to the
older persons who would otherwise be left to lead a life of penury and neglect.
The other information pertains to the older persons in the middle income
category and may be able to finance their own pensions and medical expenses
through insurance. There are schemes operated by the public sector companies
that provide pension and medical schemes of that nature. Government, as a
means to encourage people to subscribe to these schemes, gives tax incentives,
expanded cover and liberal terms of joining and surrender. The Schemes that
we shall be discussing are :
1. Rashtriya Vayoshri Yojana
2. Indira Gandhi National Old Age Pension Scheme
3. Annapurna
4. Pradhan Mantri Jan Arogya Yojana
5. Senior Citizen Welfare Fund
6. Vayoshreshtha Samman
7. Pradhan Mantri Vaya Vandana Scheme
8. Varishtha Mediclaim Policy
9. Varishta Pension Bima Yojana
10. Reverse Mortgage Scheme
Let us read more about these schemes in the subsequent subsections

3.3.1 Rashtriya Vayoshri Yojana (RVY)

Under this Central sector Scheme physical Aids and assisted-living devices are
provided to older persons in the BPL category age suffering from low vision,
hearing impairment, loss of teeth and locomotor disability. This is a Central
Sector Scheme, fully funded by the Central Government. At present, a total of
325 districts have been selected for the implementation of RVY. The devices are
provided free of cost and Artificial Limbs Manufacturing Corporation of India
(ALIMCO) takes responsibility of free maintenance for a year. Beneficiaries
68 for the scheme are identified by a Committee headed by the District Collector/
Deputy Commissioner as the case may be. 30% of the beneficiaries should be Provisions and
women. Schemes for Elderly

As per the information available, till January 2019, the assessment camps to
identify the beneficiaries have been completed in 135 districts, 77 distribution
camps have been organized benefitting 70,939 senior citizens belonging to
BPL Category. This scheme may prove very useful for the older persons by
providing aids that may improve mobility, independence of the individual
thereby improving the quality of their life, helping social integration and earn
a living.

3.3.2 Indira Gandhi National Old Age Pension Scheme

(IGNOAPS)
IGNOAPS is a component of National Social Assistance Programme (NSAP) Did you know?
under Ministry of Rural Development, Govt. of India. The details of NSAP are UP was the first state to
mentioned in section 2.5 of the previous unit. Eligibility Criteria for Inclusion introduce social pension
in the Scheme are given below: in India.

Age: 60+
Economic Status: Below Poverty Line
Amount of Pension
The IGNOAPS assists with money up to Rs 200 p.m., and Rs 500 p.m., for
people between 60 and 79 years and above 80 years, respectively. The state
governments top it up with the amount decided by them. So the amount ranges
from Rs 350 pm to Rs 2000 per month. The money is disbursed through bank
and post office accounts or postal money order.
Administrative Machinery:
Different Departments implement this schemes at the state level:
• Rural Development Department :Andhra Pradesh, Assam, Goa, Meghalaya
and West Bengal;
• Department of Women & Child Development: Odisha and Puducherry;
• Revenue Department: Karnataka and Tamil Nadu
• Department of Labour Employment & Training: Jharkhand.
Any eligible person may apply for the scheme at any time of the year to the
appropriate authority.
Grievance:
Nodal Secretary dealing with NSAP in the State or the concerned District/block
level Welfare Officer.
Reviewing Authority: Vigilance & Monitoring Committee (V&MC) constituted
at the District Level, along with other Rural Development Schemes. MPs are
represented in the V&MC in the District.
There are about 2.76 crore beneficiaries of this scheme whereas according
to the government estimates there are 53 crore older person in need of such 69
National and interventions. This assumes significance in the light of the fact that age decreases
International the employability of a person whereas the expenditures do not decreases
Programmes for
Elderly
proportionately. Then there are those who are destitute who are in dire need
to basic minimum. There is also no social security scheme in our country that
covers majority of the workers in unorganized sector. There are vulnerable
groups like women who even in families with moderate means may be at a
disadvantage in old age. Then there are those in the above poverty line category
who may be pushed under the line just by one episode of stress in the family
like prolonged illness or loss of employment wages for some time.
In some states there are some good practices that may be followed by others
to fulfil the goal of life with dignity in old age some such states are Haryana,
Odisha. The former has near universal coverage of older person below poverty
line. The latter has developed a practice of delivery of pension in the panchayat
offices on a pre decided date and medical screening camps are also organized
along with the distribution. Delhi, Andhra Pradesh, Telangana and Goa have
raised the amount of pension under the scheme to over Rs 2000 per month,

3.3.3 Annapurna Scheme

This scheme was launched in the year 2000 to cover those poor older person
who though eligible could not get benefits under the (IG)NOAPS and provide
food security to such people. Under the scheme 10 kg food grains were provided
free of cost per month to the beneficiary. However, In view of the Supreme
Court order stating that no scheme including Annapurna shall be discontinue or
restricted in any way without prior approval of the Court, all the beneficiaries of
Annapurna will for the present remain excluded from the preview of IGNOAPS
and they will continue to get the benefit under Annapurna till the orders of the
Court are modified.

3.3.4 Pradhan Mantri Jan Arogya Yojana

This scheme was launched in 2018 by the Ministry of Health and Family Welfare
for covering up to 10 crore people belonging to poor and vulnerable families.
Under this scheme, coverage of up to Rs. 5 lakhs per family for secondary and
tertiary hospitalization is provided. As age disaggregated data is not available
we do not know how many older person have benefited from enrolment under
this scheme.

3.3.5 Senior Citizens' Welfare Fund

Launched by the Ministry of Social Justice and Empowerment, this fund
includes unclaimed amounts from small savings and savings accounts in the
Central government schemes. It aims to make seniors financially stable for their
overall welfare and health care.

3.3.6 Vayoshreshtha Samman

This is designed to recognition of contribution of older persons in various fields
along with institutions that have concern for ageing population and have worked
for their benefits. It is a national acknowledgement of the ageing and aged as an
important social issue. It was upgraded to the National Award in 2013, and since
70 then, awards have been granted under thirteen categories for individuals and
institutions. This is managed by Ministry of Social Justice and Empowerment. Provisions and
It carries a citation and cash award. It is a way to recognize the contribution of Schemes for Elderly
the older persons in categories as diverse as iconic mother to that in sports. It
also recognizes the state government that has made outstanding contribution
in implementation of Maintenance and Welfare of Parents and senior Citizens
Act besides private and voluntary organizations that provide services to older
persons along with the panchayats and local bodies.

3.3.7 Pradhan Mantri Vaya Vandana Scheme

This scheme is designed for regular income for senior citizens above 60
years of age. The subscriber may deposit up to Rs 15 lakh in the scheme. The
pensioner can choose the frequency of the payment - monthly/quarterly/half-
yearly/annually. The minimum monthly pension of Rs 1000 and maximum of
Rs 10,000 can be earned in this scheme by investing Rs 1.5 and Rs 15 Lakh
respectively. Life Insurance Corporation operates this scheme. The Union
Cabinet has extended the scheme to 31st March 2023.

3.3.8 Varishtha Mediclaim Policy

Varistha Mediclaim Policy operated by National Insurance Company comes
with the option of covering critical illness treatment expenses. Senior citizens
can also avail coverage against pre-existing hypertension and diabetes by paying
extra premium. This policy aids seniors by covering the cost of medicines,
blood, ambulance charges, and other diagnosis related charges. Designed for
senior citizens between the age of 60 and 80 years, this helps meet the health-
related expenses of senior citizens. Moreover, income tax benefits are allowed
for payment of premium under Section 80D. Although the policy period is for
one year, you can extend the renewal up to the age of 90 years. Premium is
eligible for tax exemption.

3.3.9 Varishta Pension Bima Yojana

This pension scheme, launched by the Ministry of Finance, is for senior citizens
above 60 years. The LIC of India has the authority to operate this scheme. It
offers assured pension. The subscriber can opt for monthly, quarterly, half-
yearly, and yearly pension – depends on how you’d like to receive it. It offers
tax benefits on premium not on the income. It is a single term plan. There is no0
age of policy maturity and its like money back. It can continue after the death of
the subscriber to benefit the surviving spouse. Minimum return is Rs 6000 per
month and maximum Rs 60,000. Surrender of policy before 15 years entitles
the subscriber to get 90% of the single premium and after 15 years 100%.

3.3.10 Reverse Mortgage Scheme

This scheme was launched in 2007 by the Ministry of Finance to benefit senior
citizens. They can mortgage their residential property against a loan of the
value of the house with a minimum tenure. Different banks have varying terms
of pertaining to amount of loan vis a vs the estimated value of the property
and varying term period. The bank may revise the periodic annuity if lump
sum is taken by the older person or at interval of 5 years. The loan becomes
payable after the surviving borrower dies or wishes to sell the property. Loan
and interest accumulated is settled by selling the property. The borrower and 71
National and the heirs are given the first right to settle the loan without sale of the property.
International This scheme is designed to help older persons with immovable property to ease
Programmes for
Elderly
their challenges of liquidity to meet general expenses or exigencies.
Check Your Progress 2
Fill in the Blanks
1. ………… districts have been selected for the implementation of RVY.
2. …………of the beneficiaries under RVY should be women.
3. Central Govt. contributes Rs….. p.m., and Rs ….. p.m., for people between
60 and 79 years and above 80 years under IGNOAPS.
4. ………million older persons are estimated to be eligible to get benefit
under IGNOAPS.
5. Under PM Vaya Vandana Yojana and elderly may get minimum monthly
pension of Rs…….and maximum of Rs……… by investing Rs 1.5 and Rs
15 Lakh respectively.
6. …………….. is the agency that operates this scheme.
7. List all the benefits an elderly gets under the Varishtha Mediclaim Policy.
Questions
1. What role does NISD play in implementation of National Plan of Action
for Senior Citizens?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
2. What does Rashtriya Vayoshri Yojana provide to older persons ? How
many people have benefited so far?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
3. List 3 main health insurance schemes available for older persons and
examine the benefits of each for older persons. How can it be made more
useful for older persons?
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
72 .....................................................................................................................
 Provisions and
4. Do you think that reverse mortgage is a good option for older persons? Schemes for Elderly
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................

3.4 PRIVILEGES AND BENEFITS

Apart from the schemes that provides various paid and free benefits to the older
persons there are some privileges are offered to the older persons that are not
in the nature of entitlements but gifts/aids that facilitate their life. The two
most important examples are travel concessions that help older person remain
socially connected and also travel for emergency and treatment purposes. The
other is a marginally increased rate of interest on their bank deposits. For many
older person this may be the only source of income and additional interest may
help them tide over the challenge posed by inflation.

3.4.1 Travel Concessions

25% to 50% concession on intra-city public road transport is available in some
cities. Most city buses and interstate buses have reserved seats for seniors
including the metro rails.
Indian railways offer concessions to older person over the age of 55 for women
and 60 for men. It also allots lower berths to older persons.
Airlines offer 50% discount on base fare for older persons.

3.4.2 Banking Facilities and Special Interest Rates

Many banks offer special facilities to seniors who hold accounts in the banks:
succession planning to help protect their wealth, discounts at hospitals, natural
therapy centres, and assistance for travel bookings, special desks. Some banks
offer higher interest rates on fixed deposits to older persons of 0.5%, personal;
loan schemes for pensioners with some concessions on interest rates, special
savings account where older person may deposit up to Rs 15 lakhs with income
tax rebate and monthly income.

3.5 INSTITUTIONAL CARE

Traditionally older persons live in their own homes with or without support of
their adult children or paid help. However, some older persons due to functional
disabilities, loneliness and other factors may choose to live in institutions
where their housing, personal, functional, social and medical needs are met
by professionals. Depending on their specific needs, older persons may like
to decide the type, quality and duration of care in the institutions e.g. those
requiring care and supervisor during the day time may just opt for a day care
centre, older person with acute care may choose a nursing home. But, the
most commonly found institutions in age care are old age homes and day care
centres. The former provides residential facilities for the older persons with a
73
National and combination of other facilities ranging from those that provide clubs and spas
International to those that provide only food clothing, shelter and basic medical treatment.
Programmes for
Elderly
Day care centres are institutions that provide non residential care and facilities
may range from a basi reading room to the one that acts as a hub for providing
all services, medical to recreational to livelihood opportunities, specialised
services for Alzheimer’s patient etc. This sub-section will familiarise you with
design and service aspects of such facilities for older persons.

3.5.1 Old Age Homes

Traditionally family gives care to the older persons in India. It is under strain
due to changing nature and structure of family and increasing longevity and
also increasing poverty and consequent inability of the children to take care of
the elderly parents. NPOP also underlines the importance of family in providing
care and support of the older persons. It is legally enforced by the provisions of
Maintenance and Welfare of Parents and Senior Citizens Act 2007 (currently
under review). As per the law one mode old age homes should be established
by the government in each district to house at least 125 residents. Ministry of
Social Justice and empowerment under its Integrated Program for Older Persons
and now under National Action Plan for Sr. Citizens gives grants to various
voluntary bodies and PRIs to build and manage such facilities for the poor older
persons. The Ministry is also open to PPP model for running such institutions
on a national level as outlined in the National Action Plan for Senior Citizens.
Institutional care which until recently was thought of as a last resort of care for
abandoned and or destitute older persons and many such facilities are available
in the paid home segment as well. There is a Confederation of Indian Industries
(CII) Task Force report that is available on how middle and higher middle class
elderly are making use of such retirement resorts in various cities like Delhi
NCR, Bhopal, Dehradun, Pune, Bengaluru, Chennai, Hyderabad, Mumbai etc.
These facilities cater to the special needs of older persons, but, mainly for the
able bodied and those with good paying capacities. These homes and resorts
also come at various levels of service delivery and charges accordingly. As on
now there are no special regulations as to the pricing and facilities and rights
of elderly consumers availing these facilities. As per the estimates of the CII
task Force Report the demand for such services including that of home care
services are likely to increase in future. If we look at the trends in the living
arrangements it may be a reality in the near future. However, it is necessary
to point out here that the more advanced western countries who followed this
model have eventually found it unsustainable, both, financially and in terms of
wellbeing of the older person, Therefore, many countries have experimented
with the concept of ‘Ageing in Place’ with involvement of local community
and family members. There are ways devised to incentivise the members who
take care of older adults living in their own homes rather than paid facilities.
For a country like India with the population it has this cannot be thought of as
a mainstay of care of older persons in future. It is likely to be unsustainable and
too artificial.
With increase in institutional care need and facilities for older persons a strong
need was felt to regulate the services available or to be set up. The current
amendment to the Maintenance and Welfare of Parents and Senior Citizens
74
Act 2007 has provisions for such regulations. Many states have prescribed such Provisions and
regulations in the Rules for the current legislation. Schemes for Elderly

The basic guiding principles on which such institutions should be built are
dignity, independence, care, self-fulfilment and participation. The homes meant
for abandoned and poor destitute older persons should not be treated as facility
that provide food, clothing and shelter and keep destitute elderly away from
vagrancy; but institutions where elderly get appropriate care, dignity in life
and death, independence and opportunities for self-fulfilment in the form of
recreation, social inclusion and participation. It should be ideally a home away
from home.
There are recommended age friendly designs of old age homes that HelpAge
India developed with the support of Department of Science and Technology,
Govt. of India. It recommends design that provides technical specifications for
use of area, ground plan for adequate space and facilities that allow residents
to build and live like in any organic community. It also has recommendations
for treatment of residents, additional facilities like medical, mental and physical
wellbeing and productive engagement of the residents. The old age home may
be designed as a hub that can house besides residential facilities other facilities
like helpline, physiotherapy centre, and training centre for capacity building
of the residents in terms of livelihoods, reskilling for employment including
digital skills.

3.5.2 Day Care Centres

Another important component in age care is day care centre for older persons
that may range in services from simple recreation room to those with specialised
care for dementia patients. These centres provide the much needed support to
families who may be employed hence unable to take care of their older family
members but are willing to live with them and share the care responsibility. Day
care centres in many states were a boon to the poor older persons who could
assemble in these centres that provided a place to socialise with others like
them, get free services like one meal, physiotherapy, skilling and partial earning
opportunities. In the middle class neighbourhoods it could act as a recreation
cum medical facility providing services of a doctor, a specialist once in a while,
information gathering and opportunity to be socially included rather than facing
lonely routine at home.
In almost all cases it acts as a local hub for providing services to the older
persons. Ministry of Social Justice and Empowerment provided grants
for such centres under the IPOP and there were special centres for women.
Government of some states also took special interest in developing such multi-
facility centres for older persons. Some corporates partnered with the voluntary
organisations to develop top end wellness centres that provided modern gadgets
for entertainment and exercise for the older person who would like to use such
facilities and lead healthy lives.
For both, old age homes and day care centres there are guidelines for age
friendly universal design buildings, facilities, features, manpower (numbers,
qualifications, standard procedures) required to run such facilities which are
fairly comprehensive. Many old age homes and day care centres are operational
following these guidelines. 75
National and These facilities have to be registered with the District Social Welfare Officers
International in most states. Many state governments like in Kerala are actively engaging in
Programmes for
Elderly
running extensive programs for such facilities in local panchayats and municipal
wards. Transport facility is also provided to the residents who may come from
distances more than walkable to the centre.

3.5.3 Long Term Care in India

Long term Care (LTC) service is a broad term used to describe a constellation
of services, including a continuum of both medical and non-medical services
designed to support the needs of older persons living with chronic health problems
that affect their ability to perform everyday activities (McCall, 2001).
LTC is an integral part of health and social systems. It includes activities
undertaken for people requiring care by informal caregivers (family, friends
and neighbours), by formal caregivers, including professionals and auxiliaries
(health, social and other workers), and by informal caregivers and volunteers.
The need for LTC is influenced by changing physical, mental and/or cognitive
functional capacities that are in turn, over the course of an individual’s life,
influenced by the environment. Many people regain lost functional capacities,
while others decline. The type of care needed and the duration of such care are
thus often difficult to predict. The goals for LTC present obvious conflicts. Most
apparent is the tension between safety versus choice, control, individuality and
continuity of a meaningful personal life (Kane & Kane, 2001).
However, the goal of LTC is to ensure that an individual who is not fully
capable of long-term self-care can maintain the best possible quality of life,
with the greatest possible degree of independence, autonomy, participation,
personal fulfilment and human dignity (World Health Organisation, 2000).
Appropriate LTC includes respect for that individual’s values, preferences and
needs; it may be home-based or institutional. People who require home-based
LTC may also need other services, such as acute physical or mental health care
and rehabilitation, together with financial, social and legal support. Informal
caregivers should therefore have access to supportive services, including
information on and assistance in securing help, training and respite (ibid.).
LTC services include assistance with activities of daily living [(ADLs) e.g.,
dressing, bathing, and toileting]; instrumental activities of daily living [(IADLs)
e.g., medication management and housework]; and health maintenance tasks
(Harris-Kojetin, Sengupta, Park-Lee & Valverde, 2013). LTC services assist
people in maintaining or improving an optimal level of physical functioning
and quality of life and can include help from other people and special equipment
and assistive devices. However, to have a comprehensive understanding of
LTC it is worth mentioning the definition by Pratt (2016). According to Pratt
(ibid.), LTC can be defined as a variety of individualized and well-coordinated
total care services that promote the maximum possible independence for people
with functional limitation and that are provided over a period of extended time,
using appropriate current technology and available evidence-based practices, in
accordance with holistic approach while maximizing both the quality of clinical
care and individual’s quality of life

76
3.5.4 Current Status, Challenges and Future of Long-term Provisions and
Schemes for Elderly
Care
In the Indian scenario, the elderly population is the fastest growing and will
equal the population of United States of America by 2050. Families have been
playing the major responsible role for providing necessary care. Most are able
to support a continuum of basic care only. Yet, LTC for older persons in India
has always been a family affair. At the policy level, the National Policy on
Older Persons (Ministry of Health and Family Welfare) was adopted in the year
1999 by the Ministry of Social Justice and Empowerment (Ministry of Social
Justice and Empowerment [MoSJE], 1999). Its mandate was derived from the
Constitution of India. Article 41, the Directive Principles of State Policy, that
stressed the State, “within the limits of its economic capacity and development,
shall make effective provision for securing the right of public assistance in
cases of old age”. Hence, the National Policy on Older Persons directs the state
to improve the quality of life of its citizens. The right to equality has been
guaranteed by the Constitution as a fundamental right and these provisions
apply equally to older persons. In spite of the policy measures, currently we do
not have a sophisticated system to integrate the specialized multi-disciplinary
psycho-geriatric/ gerontological care. This needs to cut across or intersect with
all the disciplines to incorporate all the necessary aspects of an old age home
or senior citizen accommodation that provides not only shelter to older people
with mental and physical disability but with required assistance in activities of
daily living and intense nursing care with multi–disciplinary approach. Only
a very few institutions such as the Tata Institute of Social Sciences (TISS)
offer professional courses in gerontological social work in India. This lack of
provision is testimony to its place as the least important and lowest priority
among social work professionals in the field. It reminds us to take serious steps
and measures to sort out the emerging LTC needs and the available professional
human resource labour force to take up this challenge. Further, there has been
limited research to address the hurdles from the gerontological social work
perspective. But the majority of the older population prefers to receive informal
care which is bound by the traditional value of being looked after by their
children, especially by sons rather than daughters. This caring exerts enormous
amount of stress and burden on the family, relatives and caregivers. People
who are primarily associated with elderly persons may experience economic
constraints and burdens in their lives, irrespective of economic status. Older
people living alone without any surviving caregivers also need long term care
at some point of time or the other – this is currently problematic.
The status of a large majority of older persons is by and large ignored. So the
time has come for serious thinking to create a provision of LTC funding in India.
This should also include a creation of an autonomous body to pool together all
the resources from diverse sources and utilise them for an older population
who are desperately in need of LTC. Otherwise, they will have no other means
to access and afford care by themselves. Recently, the central government
launched the National Programme for Health Care of the Elderly (NPHCE) to
address the health-related problems of elderly people (Government of India,
2011). This is intended to provide additional human resources and funding for
home care, screening for early diagnosis, vaccinations for high-risk groups
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National and and health education for caregivers. The Vision of the NPHCE is to provide
International accessible, affordable and high-quality long-term, comprehensive and dedicated
Programmes for
Elderly
care services to an ageing population. It intends to create a new “architecture”
for ageing; to build an enabling environment for “a society for all ages” and to
promote the concept of active and healthy ageing in the health system of India
(Ministry of Health and Family Welfare, 2011). The more specific objectives of
NPHCE are to provide easy access to health services through community based
primary health care; to identify health problems and manage them; to provide
referral services to district hospitals and regional geriatric centres; to build
the capacity of medical and paramedical professionals as well as caretakers
within the family and to coordinate services with the National Health Mission,
the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and
homoeopathy (AYUSH) and MoSJE.
Institutional care is neither affordable nor accessible to most of the elderly
because of economic concerns and poor social security schemes or assistance
for the elderly people in our country. Therefore, the home-based informal care
is seen as the best choice and the easiest way to offer long term care for elderly
people. Nevertheless, this over-dependence on familial care in this country
has to go a long way to meet the demands for sufficient LTC services. The
comprehensive policy framework that offers LTC as a fundamental right of
older people has to be reframed carefully by considering the current political,
socio-cultural and prevailing economic conditions. The priority for LTC
services in India is still very low and continues to be the least governmental
priority because most of the policy-makers think only in terms of investment
and returns or equity shares of growth. Thus, the past contributions of the older
population have been discounted and never thought of as an asset in terms of
knowledge or expertise, wisdom and their ability to actively participate in the
community as productive contributing members. However, an increasing life
expectancy, an expanding middle class, technological sophistication, cultural
fusions, the impact of globalization, free trade, the fast- growing workforce of
women–all these factors have paved the way for greater demands for LTC. This
is mainly because of the shrinking of the working population and the growing
numbers in old age. So there is a mismatch in regard to the people in the work
force. This is one of the major reasons why the private sector is providing more
home care for the elderly. This trend of privatization is currently blooming in
India, as a paid service, particularly noticed in states such as Kerala. Private
home care has emerged as a timely service for those who are able to afford to
hire such services. Then what about the rest of the elderly population? There
are various stakeholders: the Government, NGOs, voluntary organisations,
philanthropists, professionals, practice researchers and the whole society. It is
urgent to develop an effective model to offer holistic and integrated approaches
that include every aspect and dimension of LTC for an older population along
with the considerations of availability, affordability and accessibility. It is
important to maximize quality of care to emphasize elders’ quality of life.
Check Your Progress 3
1. Give a comprehensive definition of Long term Care.
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 ..................................................................................................................... Provisions and
Schemes for Elderly
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.....................................................................................................................
2. How does day care center help in lessening the burden of care on family
and help in maintaining physical and mental wellbeing of the older
person?
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3. What is the view of CII Task Force Report on need for institutional care in
India?
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4. What are the guiding principles of building an old age home?
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3.6 OLDER PERSONS IN EMERGENCIES

Until recently there were no specific provisions for the older person affected
by natural or manmade disasters. But it has come to light that on most of the
disasters older persons are affected disproportionately some examples are:
Of the 14, 800 deaths in France during the 2003 heat wave, 70% were of people
over 75 years. Of the estimated 1330 people who died in the wake of Hurricane
Katrina, most were older persons. In Louisiana, 71% of those who died were
older than 60 years; 47% of this group was over 77 years old.
According to the United Nations High Commissioner for Refugees (UNHCR)
older persons make up 8.5% of the overall refugee population, and in some
cases comprise more than 30% of caseloads. In 2005, approximately 2.7
million people over the age of 60 were living as refugees or internally displaced
persons.
The basic goal in dealing with older person in emergencies is that effort should
be made to minimize harm and help them maintain the highest possible level of
health and functional capacity or recover them as fast as possible. 79
National and Challenges faced by Older Persons during and after Disasters:
International
Programmes for • Pre existing Non Communicable diseases that require special care and
Elderly management
• Disability, Frailty, illiteracy
• Care Dependence
• Differential impact due to age related frailties and social isolation, loss of
family member
• Mental wellbeing: depression, dementia
• Access to goods, services and opportunities is limited due to neglect and
age discrimination
Those seeking to develop emergency preparedness, response and recovery
policies that will reduce health risks for older people may collaborate with
WHO’s programme Health Action in Crises and Ageing and Life Course that
seek to raise awareness on these issues.
The three broad priority directions while developing age friendly disaster
plans are: (1) enhancing visibility of older people and increasing awareness
of their needs and priorities in emergencies, (2) developing and implementing
guidelines and practices responsive to the needs of older people during and
following disasters, including participation in planning when relevant; and
(3) promoting cross-sectoral collaboration to mitigate determinants of older
people’s vulnerabilities in disasters.
Developing cross-sectoral partnerships can increase understanding of older
people’s needs and capacities to link older people’s vulnerability in disasters
with other frameworks oriented towards their livelihoods, social welfare,
protection and civil rights.
Among other tasks, this may include promoting the principles of active ageing,
encouraging policies to protect older people and to promote gender equality
in programming, and recognizing the importance of intergenerational ties and
social networks in maintaining personal and community resilience.
Emergency preparedness and response considerations must also be taken
into account as policies and programmes address the ageing population. For
example, institutions caring for frail or disabled older people can develop
practical evacuation and emergency care plans.
The following recommendations aim to enhance emergency health planning and
programming for older people. a) Health management e.g. ensuring evacuation
plans address mobility issues, including geriatric medicines and disability aids
in emergency medical stockpiles), b) others pertain to broader social and health
issues that require coordination across government departments and other
agencies e.g. encouraging subsidized medical care and social protection schemes.
c) The proposed actions within any phase i.e. preparedness, response, recovery
and transitions tend to be related and are not exclusive to one another.

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Another very important factor to be kept in mind, while dealing with the Provisions and
subject of elderly in disasters, is the availability of adequate opportunities for Schemes for Elderly
older person to be active participants in all the phases from preparedness to
rehabilitation. They should not be passive recipients but active participants in
the whole process.
Check Your Progress 4
1. What are the major needs of older persons affected by any natural
disaster?
.....................................................................................................................
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.....................................................................................................................
.....................................................................................................................
2. What are the stages of a disaster where older persons’ concerns should be
included?
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3.7 LET US SUM UP

This unit introduces you to the non-medical needs of the older persons like
income, pension, health insurance and and non-tangibles like respect, dignity.
Its main focus was on how the government and other agencies play a role in
responding to the needs listed above. Government is the main actor in this
case as it not only has to provide for the basic minimum of health, income and
emotional security for older persons but also encourage and regulate the other
stakeholders that can contribute to enriching the lives of older persons, whether
NGOs, banks, insurance companies or institutional care.
In this unit, you learnt about the schemes that are designed to provide direct
benefit to the poor older persons for income and health security. We also know
the various schemes that other agencies provide for those older persons who
can afford to contribute for getting income and health benefits.
The biggest effort of the nodal Central Ministry the National Plan of Action to
back up detailed actions on identified areas and involvement of state government,
other ministries and voluntary organisations is also discussed here to give an
idea of what all areas older person can benefit apart from the direct benefits.
The sub section on institutional care has been added as it is the emerging need
of older person in view of changed nature of informal care and increasing
longevity. It is important for us to know the design and servo elements of an
appropriate institutional care facility for the older person so that they can lead
comfortable and dignified life.
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National and
International
3.8 GLOSSARY
Programmes for Convergence : Initiative by the government to coordinate
Elderly
the efforts of various ministries that work for
similar segment of population (elderly, labour,
women)
Day Care Centre : Non residential facility designed to mind/ care
for the elderly whose family members have to
go for work or other errands during the day.
The services offered by these centres range
from simple indoor games, library and TV,
simple livelihood activities to specialised care
for dementia patients.
Disasters/ Emergencies : Any natural occurrence like cyclone,
earthquake, flood that cause massive material
and human loss in an area affecting majority
population
Long Term Care : The changing physical, mental, and/or
cognitive functional capacities of an elderly
changes the need for care. Long term care
ensures that an elderly who is losing his/
her ability for self-care is provided care by
a combination of informal, formal and care
workers to maintain a basic quality of life.
Old Age Home : Residential facility for older persons that
is managed by professional care givers and
managers. It is mainly used by older persons
who lack care facilities at home or destitute
and homeless
Plan of Action : Strategy adopted by the ministry to implement
the provisions of the Policy in a time bound
manner with defined goals, budget and
administratively responsible units.
Nodal Ministry : Ministry of the government that has overall
responsibility of ensuring that all other
relevant ministries take up schemes pertaining
to the specific segment of the population (e.g.
Ministry of Social Justice and Empowerment
has overall responsibility for the Elderly)
Action Groups Aimed At : Young-old from deprived households will be
Social Reconstruction encouraged to take up socially useful activities
(AGRASR) like helping school children, manging care
facilities for children, helping patients in
hospitals
Bima : Insurance
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Varishtha : Elderly Provisions and
Schemes for Elderly
Vayoshreshtha Samman : Respect for the Best Elderly
Yojana : Scheme
Abbreviations
AGRASR : Action Groups Aimed At Social
Reconstruction
CII : Confederation of Indian Industries
CWMSrC :Convergence of Ministries for Senior Citizens
IGNOAPS : Indira Gandhi national Old Age Pension
Scheme
IPSrC : Integrated Program for Senior Citizens
MoSJE : Ministry of Social Justice and Empowerment
NPASrC : National Plan of Action for Senior Citizens
NPHCE : National Plan for Health Care of Elderly
NPOP : National Policy on Older Persons
PPP : Public Private Partnership
PRI : Panchayat Raj Institution
SPASrC : State plan of Action for Senior Citizens

3.9 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1
1. The thematic areas under the National Action Plan for Senior Citizens are
Financial security, Food, Health care and Social integration, Safety and
security, Sensitization and General Wellbeing
2. National Institute of Social Defence (NISD), will be equipped to implement
directly any project in furtherance of the objectives of the NAPSrCNISD
(Media, advocacy, Capacity building, Research and Study, Pilots and any
other project aimed towards the welfare of the senior citizens and falling
under the scope and coverage of the NAPSrC) It will undertake one activity
per state and UTs on awareness generation and sensitization, training and
geriatric care; regional level seminars and workshops and conferences.
3. The activities under the NPASrC may be initiated by Govt. Of India in
collaboration with any state govt. There is a provision for State Action Plan
for Senior Citizens (SAPSrC) under the National Action Plan. The state
govt. is encouraged to make a five year and annual plan. Central ministry
will fund this Action Plan, but the central govt. will provide funds for areas
approved under the National Plan of Action. A state/UT govt. may seek
20% additional funds over and above the funds required for activities/
programmes mentioned under Sub Scheme II for implementation of their 83
State Specific Activities.
National and The state government becomes an active implementer in cases of collaborative
International projects with central govt. It can prepare 5 year and annual plans based on the
Programmes for
Elderly
specific requirements of its people. Thematically also the state govt. is free to
add any relevant item of age care to this plan.
4. Under Sub- Scheme II of NPASrC State/UT govt. may ask for funds for
support of :
• 15000 AGRASR/ Elders Self Help Groups
• 50 Mobile Medicare Units
• 50 Physiotherapy clinics
• 100 Day Care Centres
• 100 training programmes for geriatric care-givers
5. Fill in the blanks
a. Goods and Services
b. 250 residential care facilities and 12 RRTCs
Check Your Progress 2
Fill in the Blanks
1. 325
2. 30%
3. Rs. 200 p.m., and Rs 500 p.m.
4. 53 million
5. Rs 1000/- and Rs10,000/-
6. Life Insurance Corporation (LIC)
7. Benefits to older persons under Varishtha Mediclaim Policy are:
• coverage against pre-existing hypertension and diabetes by paying extra
premium
• covering the cost of medicines, blood, ambulance charges, and other
diagnosis related charges
• income tax benefits on premium under Section 80D of IT Act
• covers people up to 80 years
Questions
6. Physical Aids and assisted-living devices are provided to older persons
in the BPL category age suffering from low vision, hearing impairment,
loss of teeth and locomotor disability. Till January 2019, 70,939 poor older
persons benefited from the scheme.

84
7. Two types of health insurance schemes for older person are: (a) Pradhan Provisions and
Mantri Jan Arogya Yojana and (b)Varishtha Mediclaim Policy. The former Schemes for Elderly
is a health insurance scheme that may be availed by those who are living
below the poverty line. It offers secondary and tertiary hospitalization
benefits of up to Rs 5 Lakh per family. The cost is borne mainly by the
state and central government. The latter is a contributory scheme that offers
benefits of hospitalization, medicines, ambulance and diagnostic tests and
covers some preexisting diseases. Both options are advantageous to the
older persons in some way, they are better than having no coverage at all.
But, to be really meaningful for the older persons, more benefits should be
included in the design of the schemes. The basic expenditure on health care
of older persons is on care and management of NCDs so if the benefits are
only for hospitalization then it does not help much. The former does not
give any special benefits to the older members of the family, if the limit is
exhausted by the younger members, then the older person gets excluded.
In the latter, extra premium is charged for any additional risk, that makes
it beyond reach for many older persons who do not have any permanent
source of income in old age.
8. Reverse mortgage is a good option for older persons with landed property,
but not enough liquidity for day to day expenses and or emergency episodes.
Under the scheme they are allowed to borrow from the bank on lenient
terms. The borrower may take lump sum and annuity, which the bank may
revise at intervals. The loan becomes payable after the surviving borrower
dies or wishes to sell the property. Loan and interest accumulated is settled
by selling the property. The borrower and the heirs are given the first right
to settle the loan without sale of the property.
Check Your Progress 3
1. According to Pratt (ibid.), LTC can be defined as a variety of individualized
and well-coordinated total care services that promote the maximum possible
independence for people with functional limitation and that are provided
over a period of extended time, using appropriate current technology and
available evidence-based practices, in accordance with holistic approach
while maximizing both the quality of clinical care and individual’s quality
of life.
2. A day care center if designed as a care cum social hub can serves the
purpose of lessening the burden of care on family by providing the same
at the center with the help of professional staff and community volunteers.
Day care centers can range from those meant for older persons suffering
from dementia are requiring special care to healthy ageing centers where
older persons find opportunities for self-development, recreation and social
inclusion, fitness and wellness. It is a way of sharing responsibility of age
care with the family members, so that the elderly do not have to be moved
to institutions.
3. There is a Confederation of Indian Industries (CII) Task Force report that is
available on how middle and higher middle class elderly are making use of
such retirement resorts in various cities like Delhi NCR, Bhopal, Dehradun,
Pune, Bengaluru, Chennai, Hyderabad, Mumbai etc. These facilities cater 85
National and to the special needs of older persons, but, mainly for the able bodied and
International those with good paying capacities.
Programmes for
Elderly 4. The basic guiding principles on which old age homes should be built are
dignity, independence, care, self-fulfillment and participation. I should not
be treated as an asylum for the abandoned older person but a home away
from home.
Check Your Progress 4
1. Major needs of older persons affected by disasters is appropriate food,
medical treatment, medicine, physical and mental wellbeing as they suffer
from preexisting mental conditions that may get worsened by trauma of loss
of family or belongings, displacement etc. safety and security, opportunities
for livelihood, assistance to claim benefits.
2. Older persons should be included in the process from the preparedness stage
and continue to be participants in rescue, relief and rehabilitation process.
Participation of older persons will ensure that their specific concerns get
included in all the plans and also show that they are not passive recipients
of help but also active contributors according to their capacity.

3.9 REFERENCES AND FURTHER READING

1. Older Persons in Emergencies: An Active Ageing Perspective, WHO,
2008.
2. David Hutton, (2008) Older Persons in Emergencies: Consideration for
Action and Policy Development. WHO
3. Information on RYV available on [Link]
rashtriya-vayoshri-yojana and PIB
4. Information on IGNOAPS available on website of ministry of Rural
Development.
5. Information on National Action Plan on Sr. Citizens available on www.
[Link]
6. Caring for Our Elders: Early Responses: India Ageing Report 2017,
UNFPA. New Delhi.
7. Hal Kendig & James Nazroo; Life Course Influences on Inequalities in
Later Life: Comparative Perspectives; Published online: 28 December
2015 # Springer Science+Business Media Dordrecht 2015
8. Refer to Senior Citizens Guide 2016 for details on privileges and benefits.
Available on [Link]

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