Open Access Research Article
GERIATRIC HEALTH CARE ISSUES IN INDIA- DETERMINANTS, CHALLENGES AND JUDICIAL INTERVENTION
Published Paper
Article Details
GERIATRIC HEALTH CARE ISSUES IN
INDIA- DETERMINANTS, CHALLENGES AND JUDICIAL INTERVENTION
Authored By - Ms. V.R. Uma
Research Scholar, Department of Law,
Sri Padmavathi Mahila Viswa Vidyalayam
(Women’s University), Tirupathi And
Assistant Professor in Law, DR.
Ambedkar Government Law College, Puducherry.
Co-Author - DR. T. Sita Kumari
Research Supervisor,
Professor in Law,
Department of Law,
Sri Padmavathi Mahila Viswa Vidyalayam
(Women’s University), Tirupathi.
Abstract:
The elderly population is increasing
exponentially in our country and thus changing the demography. Maintenance by
their offspring or relatives, pension, healthcare, economic insecurity &
reemployment are some of the issues that the senior citizens face today.
Unavailability of geriatric services, especially in primary and secondary
levels of treatment is a taking a heavy toll on the health of the poor rural
elderly. The insensitivity and callousness attitude of the government in
reaching out to the healthcare needs of the aged population has drawn the ire
of the Courts. The paper suggests that realistic and practical healthcare
insurance schemes by both public and private insurers will help the elderly to
tide over their financial pains in the treatment cost. The paper also envisages
that a comprehensive care that includes physical, psychological, financial and
social aspects will enable the elders not to be left behind in the progress of
the nation.
Key words: elderly, geriatrics, healthcare,
insurance.
Introduction:
Aging is a continuous or ongoing
biological process. Reduced biological functions, more vulnerability to
ailments and death, declining natural healing process and reproductive capacity
are some of the features of normal aging. In India, the
people who are aged 60 and above are called senior citizens[1]. Elderly population in India is poised to increase to
11.1% in the year 2025. Though it may seem trivial, but is large in absolute
numbers. It is expected to exceed the
population of children of below 14 years in the year 2050, for the first time.
The senior citizens face multifarious issues related to their health, familial,
societal, legal and financial problems. Coupled with physical ailments, the
elderly suffer from psychological disorders like depression, mental anxiety and
cognitive impairment. The treatment expenses for the various illnesses that the
elders are prone to are prohibitively high and calls for good fortune, causing
huge financial burden on the family, as a result of which the children tend to
abandon or neglect the parents. They start to consider the parents as an
albatross around their neck. In spite of many policies and projects that were
launched by the successive governments, the economic plight and healthcare
issues of the elderly remain a serious concern to the society and the nation. There
are many bottlenecks in reaping the benefits of many of the healthcare schemes
and programs.
International Perspective and Ageing:
Universal Declaration of Human Rights
which was adopted in 1948 by the United Nations enunciated that all the people,
which includes mentally ill, have equal rights and dignity. International Covenant on Economic, Social
and Cultural Rights, in its art. 12[2],
asserts the right of all to the highest standard of physical as well as mental
health. Several international covenants
and regional human right declarations
such as , art. 5 (e)(iv)[3] of
International Convention on Elimination of All Forms of Racial Discrimination
in the year 1965, European Social Charter in the year 1996, African Charter on
Human and People’s of Rights in the year 1981, Additional Protocol to the
American Convention on Human Rights in the year 1988, arts. 11.1 (f)[4]
and 12[5] of
the Convention on the Elimination of All Forms of Discrimination against Women
of 1979, and art. 24[6] of
the Convention on the Rights of the Child of 1989 etc. have acknowledged the
existence of the fundamental right to health to everyone. Committee on Economic, Social and Cultural
Rights has affirmed that the health rights include freedom, entitlements and
the right to control one’s health. In tune with the above covenants and
conventions, India has right to health as one of its fundamental rights.
India has one of the most dynamic and organic constitutions, the document
of governance, guarantying the fundamental rights of its citizens. The preamble
of the constitution emphasizes social justice to the entire population which
comprises public welfare, order, health and convenience. The right to life and liberty of a person
which comes under the purview of art. 21 is the most cherished and widely
interpreted among all the rights enshrined in the constitution. The right to life does not mean to lead an
animal life, but to live with dignity and safely. The doctrine of right to life under the said
art. 21 has been amplified in its ambit to cover right to work for subsistence
and to lead a dignified safe life. One of the most important facets of right to
life is the right to health. These entitlements enable a person to have access
to the best feasible healthcare. It is duty of the government to come up with
facilities to provide decent medical care to its citizens and residents. The
criteria for a good healthcare system is that it should be efficient, patient
oriented, efficacious, cost effective, unbiased, easily available, prompt, prudent
and safe.
Geriatric Health care issues in India
Normally,
the senior citizens are prone to suffer from both communicable and
non-communicable diseases and also from chronic maladies necessitating
prolonged medication, even till the end of their life. Dwindling immune
capacity increases the chances of contracting communicable diseases like
Tuberculosis. There has
been a shift in the disease pattern. Earlier, the communicable diseases used to
be major cause of worry on the health front of elderly. However, these have
been replaced by non-communicable chronic diseases and have proved to be very
expensive and out of reach of ordinary man on the street, particularly elderly.
As per a survey, about 8% of senior citizens were confined to their homes or
bed[7]. It has been found that the elderly
more prone and suffer from chronic illness rather than acute illness. They
suffer from chronic maladies such as
pulmonary diseases including bronchitis, asthma, pulmonary fibrosis, pneumonia,
and lung cancer, urological maladies, diabetes,
gastrointestinal infections, hypertension, ocular maladies, hearing
impairments, rheumatism,
accidents, skin diseases and dental impairments, depression, incontinence, to name a few. Due to varied socio economic conditions, on
which morbidity is dependent to certain extent, across the width and breadth of
the country, the nature of the maladies of the aged in different regions are
not uniform. This makes it difficult for the government to formulate a uniform
plan to address the healthcare needs of the senior citizens. Presence of co-morbidities
further complicates the treatment process and it requires an across the board
and collaborative treatment procedure.
It is not uncommon to find that the
elderly suffer from more than a single disease.
This takes a heavy toll on the health care system of the country. It
also causes huge economic burden on the families. It is sad to note that the poor elderly do
not have access to proper aid and care. If they are able to get an access to
it, the costs are prohibitive and beyond their means. In spite of increased financial independence
and changes in familial structure, the familial care decides the access to
health care of the elderly. The joint
family system which was the bedrock of the support to the elders is
disintegrating and this is causing an impediment in accessing health care. It is seen that poor and indigent elderly are
more likely to live alone or in old age homes compared to that of their wealthy
peers. This lack of care from children
is offset, to certain extent, by the community help for accessing health care.
However, the issues and regular health care requirements of these neglected
elders largely remain invisible to people who offer support during a health
crisis. It is the quality of care rather than the quantity of it has a bearing
on the health of elderly. It is sad to
note that the elderly poor have to surmount two issues viz. access and
affordability, while seeking health care.
Accessibility:
One of the most important obstacles in accessing health care is the diminished
mobility due to weakness or ill health. This curtailed mobility aggravates the
already existing health issues and this becomes a vicious circle repeating
itself ad infinitum.
According to a data, 28.3% of the elderly in rural areas, while the figures are
36.8% in urban areas, are estimated to suffer from ailment[8].
This does not be construed that rural elderly are healthier. Since geriatric
services are concentrated in urban areas, health seeking is more compared to
rural areas. Even in those places, where geriatric services are at hand, it has
been found that there exists a lack of awareness among the people on the
availability of such welfare services. Added to this, around 9.5% of rural
elderly does not have access to regular medicines and it is 4.2% in the case of
their urban counterpart, as per a survey report[9].
This is almost twice to that of lack of access to food and clothing.
Affordability: The comparatively unreliable, inept
and ineffectual public healthcare system is the genesis of a strong, unmonitored,
but efficient private health care system in India which accounted for around
83% of the total medical expenses during the past decade. However, the latter
is expensive, rendering the poor elderly not able to afford. Accessing the
service of private sector leads the already poor elderly into utter penury.
Thus they are caught between Scylla and
Charybdis. Hence the informal workforce face the
conundrum of trying to remain healthy as well as continue to be employed for a
longer years. Even for those persons
with a pension, the spiralling inflation provides a meagre leeway to spend on
healthcare. For those with neither a
pension or government social welfare measures, their assets or
whatever little nest eggs that they have built over the years will be the only sources of insurance
for healthcare. The insurance policies cover a few numbers of diseases and
maladies and are also limited by low coverage conditions. The insurance sector
blackballs the elders on varied reasons of age limit or pre existing morbid
conditions. It is an irony that the companies shut out the people, who needs
insurance most, from its purview. More
over the insurance cover does not include medicines, but covers inpatient
hospital expenses only. Even those
elderly who just manage to purchase an insurance cover left stranded because of
the crippling and unbearable medicine and outpatient treatment expenses.
Executive,
Legislative & Judicial Intervention on Geriatric Health care:
Welfare
measures for Elderly:
The National policy on Older Persons
was set in motion in the year 1999 to assure monetary and food security,
shelter and medical care along with other necessary wants of the senior
citizens. Equitable share in development of the society and the nation, safe
guarding from abuse, neglect and exploitation, social security,
intergenerational dependence, manpower training, ensuring the availability of
quality services are some of the objectives of this policy. The
urgency of reforms in national health policy was contemplated by the Planning
Commission and it formed a high level expert group, in the year 2010, to formulate necessary changes in purchase of
medicines, stipulate norms for human resources (that comprise doctors, nurses,
support staffs), role of the community and financing of health care
system. It was recommended to employ
more trained staff at the sub-health centre level and community workers in
village and low-income urban areas. The
importance of placing the non-communicable diseases under control was stressed.
It was emphasised that the social and physical impediments to access healthcare
should be obliterated in conjunction with the village (and urban) health and
sanitation committees. It stressed the utmost importance of strengthening the
primary health centres, the first port of call for poor elderly. The introduction of national health
card was suggested so as to promote cashless services at all points of service.
The recommendations prioritized early
detection of diseases, promotion of healthy living, and regular testing for the
aged to avoid institutionalization. The Ministry of Social Justice and
Empowerment has launched The Integrated Programme for Older Persons scheme with
an aim to improve the life style of elderly population by providing them basic
facilities including food, shelter and healthcare. For the aged people
belonging to below poverty line category, the government provides physical aids
and assisted living devices through Rashtriya Vayoshri Yojana scheme. The
policies purchased till 31st March, 2022 under the Pradhan Mantri
Vaya Vandana Yojana scheme, a retirement and pension plan, had earned the
senior citizens a pension of 7.4% payable on monthly basis[10].
The
Maintenance and Welfare of Parents and Senior Citizens Act, 2007 has enabled
the elderly, who are unable to maintain themselves to obtain maintenance from
their children/ relatives. The Act has made provision for the establishment of
old age homes in every District in order to provide shelter for indigent senior
citizens. It also covered the issues regarding the healthcare[11]
of the senior population. An amendment in the year 2019 was enacted to cover
the lacunas in the original Act. Added to this, the government launched the National Program for the
Health Care of the Elderly with a vision to provide smooth access to
prophylactic, conducive, restorative, recuperative and rehabilitative
healthcare at the point of delivery. It laid a special emphasis on the training
of medical professionals and care takers for both long and short term care[12]. The
visions of the NPHCE are:
(1)To provide accessible, affordable,
comprehensive, dedicated and high quality long term care services to an ageing population; (2)
Creating a new “architecture” for Ageing; (3) To build a framework to create an
enabling environment for “a Society for all Ages;” (4) To promote the concept
of Active and Healthy Ageing.
They say that there is nothing new under the sun, but this might be a new
one. It was proposed under this programme to shore up
healthcare systems in around 100 districts and to establish geriatric
departments in all regional geriatric centres. These regional institutions will
provide support to district level geriatric units which in turn will provide
support, coordinate and monitor the functioning of the geriatric activities at
primary health centre, community health centres and rural sub centres. Till the
year 2017, about 930 CHCs, 4438 PHCs and 28,767 sub centres have been brought
under this programme. The program is disruptive, but could not yet be
called definitive in its performance in ending the healthcare issues of the
elders.
Universal health coverage:
To alleviate the concerns of the poor
elderly about their exclusion from the private insurance companies, the central
government has launched some insurance schemes to provide them sufficient
health coverage[13].
1. Pradhan Mantri Jan Arogya
Yojana or PMJAY (Ayushman Bharat Scheme): This scheme is known as bellwether
of all other insurance schemes since it took initiative to safeguard all the
poor people from having to spend a fortune on their health issues. It envisages universal health coverage as
advocated by National Health Policy 2017 and is of the latest and largest
health schemes initiated by the state for the below poverty line elders. It
offers a healthcare coverage up to 5 lakhs for a family in a year for secondary
and tertiary level hospitalization in public and private hospitals. The scheme
provides cashless access to healthcare at the point of service, i.e. the
hospital. The notable point is that all the pre-existing conditions are also
get covered by the scheme. All the family members are eligible to access health
care under this scheme.
2. United India Senior Citizen
Health Insurance: This scheme is provided by the United India Insurance Company, a state
run company. Senior citizens of age between 61 to 80 years old are eligible to
get health cover from 1 lakh to 3 lakhs under this scheme. In cases of
hospitalization for more than a day, the expenses are covered by this scheme
for both treatment and surgeries. In cases of domiciliary hospitalization for
more than 3 days, the expenses are covered by this scheme.
3. Varistha Mediclaim for Senior
Citizens:
National Insurance Company, another state run agency, offers mediclaim policy
for the elderly of 60-80 years old. Under this policy, expenses up to 1 lakh
occurred during hospitalization and critical sickness treatment expenses up to
2 lakhs get covered. Another salient
feature is that pre-existing maladies of diabetes and hyper tension are also
covered. Unlike private mediclaim policies, this scheme covers the expenses as
a fall out of pre and post hospitalization.
4. Health of Privileged Elders
(HOPE): A
medicover scheme exclusively for the elderly is offered by the Oriental
Insurance Company. It also covers expenses occurred for alternate medicine
treatments such as Ayurveda, Siddha, Unani, Homeopathy, Naturopathy and Yoga in
AYUSH hospitals. Any elderly of 60 years old and beyond can avail the policies
for expenses between 1-5 lakhs. However,
the drawback of scheme is that it covers specific diseases only. The notable
feature is that telemedicine expenses are taken care by the policy.
5. The New India Assurance Senior
Citizen Mediclaim Policy: This is another exclusive scheme for elders between 60-80
years old. The sum assured is 1 lakh or 1.5 lakh per person. Also, it offers limited coverage for
hospitalization during homeopathic and unani treatments in public
hospitals. In this scheme also,
conditional coverage is provided for pre existing conditions and maladies like
diabetes, hyper tension, mellitus and other complications related to them.
Judicial Intervention:
The right to live with dignity, as
assured by the art. 21 of the constitution includes, inter alia, nutrition,
health, clothing and shelter[14].
The said article draws its élan vital from the arts. 39, 41 and 42 in the
Directive Principles of State Policy. Of course, it has not mentioned the right
to health of elders specifically. But it includes them since they make mention
of right to health and strength of people, it should be taken that they
incorporate the elderly also. Art. 41, in particular, dictates that the state
should provide assistance in the arenas of unemployment, old age, sickness and
disablement, among a host of other needs, to its people. Recognizing the agony,
humiliation and misery of the senior citizens, the Courts have tried to ameliorate
their sufferings by expanding the scope of the arts. 21, 39, 41 and also the
scope of the Maintenance and Welfare of Parents and Senior Citizens Act. It has
been liberal in interpreting the various clauses of the Senior Citizens Act to
provide protection to the fullest extent possible. Apart from health care
issues, it has given its views and rulings extensively on implications and
implementations of various other sections in the Act. Maintenance of elders by their children or
relatives, establishment and functioning of old age homes, eviction of sons and
daughters from their property etc. are some of the other areas in which the
judiciary has shown its keen interest, concern, anxiety and care in the well being, safety of life and
protection of property of the elderly
community. It went even to the extent of ruling that the
doctrine of alternative remedy, as mentioned in the Act, need not be rigorously
exerted on the elderly and any writ Court should come to the aid of elderly in
a given case. Where the provisions of the Senior Citizens Act is in
conflict with the interests of others who themselves are protected by other
similar welfare Acts, the Court emphasized the necessity of harmonizing both
the laws and to create a balance between the conflicting provisions. In many
cases, the Court ruled that the senior citizens Act and Protection of women
from domestic violence Act of 2005 should not override each other since both
cater to the interests of afflicted segments of the society. Depending on the
circumstances of each case, it should be determined which carries preponderance
over the other and is specific to each case[15].
Admittance
of two successive PIL petitions before the Apex Court is a pointer to the
annoyance of the Court over the inept and inapt implementation of senior
citizens Act and the lackadaisical attitude of centre and state governments by not providing
appropriate healthcare, non-establishment of old age homes, undue behindhand in
pensions payments and failure in securing the life and property of the elderly
population. Mr. Sanjeeb Panigrahi, an advocate, filed the first petition, in
August 2015 seeking a directive by the Court to the centre and state
governments to draw up a befitting plan and legislation for “taking care of the
thousands of the aged on the verge of starvation and reduced to begging, either
deserted by their families or left to fend for themselves because of
poverty”. He reasoned that since India does not have a social security
policy as in western nations, it is the duty of the government to reach out to
the poor, downtrodden and indigent elderly.
Mr. Ashwini Kumar, former Union Law Minister filed the second
petition in April 2016 urging for the implementation of the Act. The petitioner contended that the art. 41 of the constitution
makes it obligatory on the part of the government to secure the welfare of the
aged persons. He solicited the Court to issue directions to the government to
enforce the Integrated programme for Older Persons scheme to safeguard the
interests of the elderly. He
cited the number of Court rulings in which the Court asserted that the meaning
of right to life embodied in the art. 21 is much more than a mere survival or
existence. The right encompasses all aspects that make a life worthwhile,
purposeful, meaningful and positive. The petitioner had argued that no
serious and sincere efforts were made by the governments to achieve the desired
medical facilities and geriatric treatment to the needy elderly, in spite of
the fact that it had been more than a decade since the Senior Citizens Act was
passed. The government
is duty bound to protect the fundamental right to health as well as enforce it
and make sure that it is made available to all its citizens, especially elders.
The petitioners found fault with the government’s excuse of financial crunch
for non-implementation of many healthcare facilities to the elders, as
envisaged in the Act. The government would have been aware of and taken into
account of the financial implications of the Act when it was tabled in the
Parliament. Now, it could not defend for non- implementation and inaction
hiding behind the veil of financial restraints. Even if it was unable to
safeguard the fundamental rights, the statutory rights of the aged people had
to be recognized and put into force. The petitioners claimed that the medical
facilities and geriatric care were not conferred the requisite attention by the
government. If the elderly, who are in need of healthcare than any other
segment of the society, are not provided with health assistance and care, it is
a breach of their constitutional right. He also pleaded for the establishment
of old age homes in every district as intended in the Act. The petitioners
further lamented that there was no authentic data on the number of beds
reserved exclusively for geriatric treatment both in government and private
medical sector. There was lack of information on establishment of exclusive
geriatric centres.
The government informed the Court
that it has instituted the National Programme for Healthcare of the elderly
during the year 2010-11. It aims to dispense committed, specialised and
separate healthcare services to the elderly at the all levels of healthcare
delivery system, including outreach service.
Outreach services mobilize health workers to impart services, away from
the places where they perform their duty, to the people at their dwelling
places. The government argued that the programme is being implemented and an
ongoing one and it is difficult to achieve the objectives overnight. The petitioners were fain to concede the
positive aspects of the programme, but their grouse was that it was not being
convincingly and efficiently administered and questioned the extent of
implementation. Like many ill managed schemes, it foundered on the rocks of
practicality.
The Apex
Court ordered the
central government to collect data on healthcare facilities and geriatric care
facilities available to the elderly in each district from the respective state
governments and UTs and held that NPHCE had to be executed with all the fervour
it needs, by both the central and state governments by working in tandem, to
avoid being another government scheme just on paper alone. The Court noted that
there was a requirement to constantly keep watch on the progress on the
implementation of the right to health of elders as mandated in the constitution
and in the senior citizens Act. Hence, it issued a continuing mandamus to the
government to ensure the geriatric care and medical facilities are made
available to the elderly. It was of the opinion that it is the only way to
ensure the rights are recognized, respected, enforced and social justice which
is mentioned in the Preamble is provided with a meaning and teeth.
The Allahabad High Court[16]
was severe in its criticism on the state of affairs of rural medical centres
and apathy of the higher officials over its functioning. The pernicious apathy
and prejudice of the bureaucracy was making the lives of poor and elders
miserable. It was of the opinion that the reason for their indifferent attitude
was due to the reason that they are not affected by the inefficiency of those
centres. These bureaucrats do not access these centres for their health care
and they believe that these are for a class of people different from them. It may not be impudent or a stretch of wild
imagination to call their insouciance as a class discrimination. Their
negligence and utter disregard for the sufferings of the indigent and elders is
the reason for the stalemate in the system. The bias in the
system has affected the most disadvantaged in the society and has robbed off
their rights. The Court lamented
that the people are at the mercy of poorly run,
ill maintained and quintessential extract of mediocre state run
hospitals, looked down as guinea pigs,
become victims and losing their
lives in the process. The agony of the
Court was visible when it opined that the lives or death of an indigent poor or
elderly is merely a statistics in the eyes of an unmindful government.
The Supreme
Court has reiterated that social justice, the foremost and crucial form of
justice, has been given the prime place in the Preamble of our constitution and
is the touchstone of nation building.
The organic nature of our constitution and the dynamic functioning of
the Court have resulted in many momentous progresses in the realm of social
justice[17]. The
negligent attitude of governments in handing out the pensions in time
has been censured by Courts[18]. The Court strongly opined that the pensions are given for
the services rendered by the employees in past and they are entitled to receive
them without undue delay. The Court ordered the government to remit the
payments with interest. Thus, the judiciary has come innumerable times
to the rescue of senior citizens on noticing their plight in the hands of their
own children, relatives, government and bureaucracy. It had the backs of the
elders whenever they were handed out a raw deal. The duty
of Court is not yet done yet, not by a long shot. It still needs to turn
a lot more rocks to achieve anything substantial and has to
keep vigil over the rights of elders not getting trampled.
Lacuna in the
implementation of programs, schemes & providing Geriatric
Healthcare:
It is heart rending to know that
India ranks very low in its care for the elders when compared to other
countries. It ranked 71 out of 96 nations on the question of how the elderly
cope with the prevailing circumstances. And it is much worse on the topic of
elderly healthcare and was placed at a
pathetic 87th rank of out of the said 96 nations[19].
The NPHCE has not really solved the issues of the elderly. The modus operandi
of the scheme has not really helped to get over the crisis. Only a miserable 7% of the budget allocated,
under this programme, has been spent.
Most of the patients prefer private sector for their healthcare than
public hospitals. The private sector accounts for 75% of outpatients and 50% of
inpatients in providing healthcare, in spite of massive amounts spent on public
healthcare system. Though the pension schemes are laudable ones, it is found
that the government is flat footed in proper implementation of the schemes.
Often the pensions are the only economic source to indigent elderly persons
past their working age. Inordinate delays in availing the pension and
unavailability of pension assistance to deserving candidates make the lives of
those pitiable souls, miserable.
The
caregivers and basic medical care providers generally view ill health of the
aged people as a part of aging process. Treatment is often found to be mechanical
without taking account of their age factor in mind. Due to the
paucity of geriatricians, general physicians attend to the sick elderly persons
in the inward solution section of the most hospitals. General support staff
like nurses, who are ill equipped to provide care to the elderly due to lack of
training, are made to attend to the needs of them. This results in more deterioration
and complication of their sickness and thus, probably, a restorable geriatric
condition goes untreated. The country’s healthcare system has limited experience and
knowledge in acute clinical care for the elders and needs the
services of geriatricians. India has not woken up to this
reality. Study of geriatric care is not a much sought after occupation or field
of medical study and is fairly a new branch in the field of medicine
in our country. In fact, a very few institutions offer this programme as a
specialisation as a result of which the number of practicing geriatricians both
in government and private sector is very less, thus appallingly insufficient to
assure a fair healthcare system for the afflicted aged persons. Apart from the
hospitals, nursing homes, long care homes, old age homes, rehabilitation centres for the aged are located only in the urban
centres. The urban-rural disparity in
socioeconomic factors coupled with the dearth of geriatric facilities in
hinterland will make it a daunting task to provide equitable healthcare system,
as envisaged in the directive principles of our constitution.
Non or under utilization of funds,
shortage of medical personal, indifferent attitude of the human resource
persons, wide spread corruption almost
at all levels, absence of supervision, lack of infrastructure etc. are few of
the reasons for the malfunctioning of our health care system. As fate would have it, the people who endure
the hardship of this system are the ones who need it most - the impoverished
and the elderly. One cannot shut those people out: that is not the best way of
governance. Government, on the other hand,
has turned a blind eye to the trauma of the poor and elderly. Judiciary has
noted that India has become as a medical hub and offering world class treatment
at a fraction of expenses that would occur in western countries for the similar
treatment. Unfortunately, all these
developments are happening in private sector. People from neighbouring and
other countries are visiting India under the name of ‘medical tourism’ to
attend to their health issues. However, the cost of treatment in these private
hospitals, though cheaper compared to western nations, is beyond the wildest
dreams of a man in the street or a proletariat or a plebeian. Government, on the other hand, has chosen to
give the cold shoulder to the problems of poor and sick people, including the
elderly for the reason best known to it. And in India, the Court lambasted
that, the public health has become a twin class service. The progress of a nation should be
synchronised with the welfare and development of all the sections of its
population, particularly the elderly and they cannot be left out[20].
Way Forward:
When much of the world was heading
down the Corona virus rabbit hole, the outbreak of
the infection has made the policy makers and health care professionals to give
a thought about the efficacy of existing system in dealing with the healthcare
issues of elderly. The aged people were more susceptible to the viral
infection. It resulted in hospitalization, necessitating intensive care with
ventilators and finally to death in many cases. About 65% of the deaths in
first wave and majority of those in the second wave were attributed to the old
age and its associated factors.
Regrettably, the afflicted elders, whose respiratory infections were the
major cause of their demise, were treated in the same way as a younger man with a similar malady. The
inherent healthcare system viewed the whole set of patients from a general
point of view rather than based on the age factor that contributed to the
intensity of the sickness. The
pandemic was an eye-opener to the limitations that exists in our system to
treat the frail elders who are more prone to such infections and pandemics[21]. It is a wakeup call for the healthcare system to correct its
course; it may be all doom and gloom for the elderly if another pandemic, God
forbid, strikes the country again. A positive aspect was of the pandemics was the
possibility of providing homecare to the elders. The concept of “ageing in place” took its
roots during this tough period. Elders yearn to stay at home, an atmosphere
they are accustomed to, rather than in a hospital. The ability to stream in
resources for their well being like medical advice, delivery of drugs etc. to
their home made the concept a reality. Technological developments enabled the
elders to access even the physicians from their home itself. It showed that technological developments,
strong community bonding and wilful participation of healthcare professionals
will make long term home care a possibility, in our country.
Ex facie, most of the government
programs and initiatives are good and satisfactory, in general. The
administration needs to double down in their implementation. The existing wide
and strong public healthcare infrastructure should be augmented by a strong
force of specially trained medical professionals in geriatric care. The old age dependency ratio which is a pointer to the
number of senior citizens to the number of working age people stood at 0.132 in
the year 2012 and is expected to rise to 0.20 in the year 2050. It means that
more people will be obliged to support and provide care to the elderly at home
and in the community[22]. Another statistics reveals that in the coming years, the
number of elderly people of more than 65 years old would be double to that of
children of age of 5 years old or below. This in turn means that the country
would require more geriatricians than paediatricians. There is no need
to read the tea leaves to know what lies ahead if imminent action is not taken.
Geriatrics is not managing the diseases alone, but also to improve and
maintain the physiological well- being of the
elders. Before attending to the sickness of the aged patients, geriatric
physicians have to, first, promote basic health condition. The physician has to
continuously observe, monitor, evaluate and review the effects of the drugs and
their toxicity to minimise the side effects to the elderly patient. Geriatric
healthcare services have to be patient–centric. The peripheral and community
health workers in villages and primary health centres need to be schooled to
identify the problems of the elderly patients and refer them to geriatric
centres for a prompt and appropriate treatment. Qualified physicians of
alternative medical courses like Ayurvedha, Unani, Siddha, Homeopathy etc. can
be properly trained to supplement and
extend the geriatric services to the needy patients, where there is a dearth of
geriatric medical personal, particularly in rural areas. Suitable referral
chain arrangements in villages and tribal areas should be established with the
help of Ayush workers. A regional strategy of the NPHCE scheme should be
incorporated, in addition to the national vision, since the healthcare
requirements and the demography are not uniform throughout the country. Also
due to variations in socioeconomic conditions across the country, morbidity
statuses also vary and thus necessitating to have a regional approach in this
regard. It is important to initiate training of para medical people,
health workers and volunteers in geriatrics. Frequent screening camps for
common ailments like cataract and dental problems, in addition to the awareness
camps for cardiovascular and respiratory maladies and diabetes should be
organized. Both physical and psychological rehabilitation facilities and
physiotherapy care centres should be established in towns, at least.
There is an urgent need to include
geriatric pharmacotherapy as a branch of pharmacology in the undergraduate
medical courses to understand fully the effects of various drugs on the elderly
patients. The
elderly are yet to avail the services of mobile geriatric units which will
eliminate the necessity for the patients under home care to go hospitals, both
in rural and urban centres. Sufficient numbers of home care personals are not
being trained and there is a pent up requirement for these people. Hence, there is always a risk of untrained
people getting employed for this job, to fill the gap, which will put the life
of elders at risk. There is an urgent need to the establishment of hospices to
provide palliative care to those patients with severe functional and cognitive
disabilities. The hospices care services that are available in few urban centres admit only
terminally ill cancer patients. Also
separate facilities for dementia patients are required. The two
challenges to geriatric healthcare are the furtherance of general well being in
health leading to longevity of life and treatment and care for the sicknesses
that are associated with ageing.
Appropriate management of these two aspects will lead to a comfortable
and gracious ageing.
Conclusion:
The elders have been the backbone of
the economy during their hey days. It cannot be justified to neglect these
people, who constitute 10% of the population, deeply mired in the economic and
health issues while the balance people enjoy the fruits of their past hard
work. The country has to strive for the
improvement in the lives of every single individual which includes elderly also
and leave no one behind in nation building. Proper implementation of various
pension schemes, improving the working of the
National Council of Senior
Citizens, broadening the reach of
National Policy on Older Persons and creating wide spread awareness about the
NPHCE will help to realize the goals of
the government in augmenting the well being of elder persons. This will lead to
general improvement in geriatric healthcare. It must be accepted that there
have been astounding improvements in addressing the concerns of the elderly and
the country has come a long way since the days of independence. There is
clearly a fundamental shift in the perception of the government; a turn away
from ignorance and indifference to the bind the poor elderly are in. The
lengths and depths taken by the legislature to alleviate the sufferings of
elderly are notable, if not remarkable. And at the same, not sufficient enough.
There is a canyon of gap between what the government has intended and what it
did achieve. A gritty, no-nonsense approach is required
without giving into political expediencies. The
government needs to get its ducks in a row before being snowed under with other
issues, so as to ensure there are no further hiccups in the implementation of
various programs that are related to the welfare of elders. With the
positive transformation in the attitude and aptitude of ruling class, policy
makers and bureaucracy that exists now, it is possible to achieve the goals of
comprehensive healthcare to all the elders. The nation has to follow a
different strategy from the one it was used to. Last but not the least,
sustainable socio economic support mechanism for the senior citizens should be
put in operation to promote a healthy and active ageing. Climbing up the ladder
of life should be a joyful experience to them. Let them revel, savour their
past as well as enjoy the present, before shuffling off
their mortal coil.
[1] Maintenance
and Welfare of Parents and Senior Citizens Act, 2007 (Act 56 of 2007), s. 2(h).
[2] The
International Covenant on Economic, Social and Cultural Rights art. 12 states:
1. The States Parties to the present Covenant
recognize the right of everyone to the enjoyment of the highest attainable
standard of physical and mental health.
[3] The
International Convention on Elimination of All Forms of Racial Discrimination
art. 5 states that:
In compliance with the fundamental obligations laid
down in article 2 of this Convention, States Parties undertake to prohibit and
to eliminate racial discrimination in all its forms and to guarantee the right
of everyone, without distinction as to race, colour, or national or ethnic
origin, to equality before the law, notably in the enjoyment of the following
rights:
(e) Economic, social and cultural rights, in
particular:
(iv) The right to public health, medical care, social
security and social services.
[4] The
Convention on the Elimination of All Forms of Discrimination against Women,
1979 art. 11 states that:
1. States
Parties shall take all appropriate measures to eliminate discrimination against
women in the field of employment in order to ensure, on a basis of equality of
women and women, the same rights, in particular
(f)The right to
protection of health and to safety in working conditions, including the
safeguarding of the function of reproduction.
[5] The
Convention on the Elimination of All Forms of Discrimination against Women,
1979 art. 12 states that:
1. States Parties shall take all appropriate measures
to eliminate discrimination against women in the field of health care in order
to ensure, on a basis of equality of men and women, access to health care
services, including those related to family planning.
2.
Notwithstanding the provisions of paragraph 1 of this article, States Parties
shall ensure to women appropriate services in connection with pregnancy,
confinement and the post natal period, granting free services where necessary,
as well as adequate nutrition during pregnancy and lactation.
[6] The
Convention on the Rights of the Child, 1989 art. 24 states that:
1. States Parties recognize the right of the child to
the enjoyment of the highest attainable standard of health and to facilities
for the treatment of illness and rehabilitation of health. States Parties shall
strive to ensure that no child is deprived of his or her right of access to
such health care services.
[7] Ramesh
Verma and Pardeep Khanna, "National Program of Health-Care for the Elderly
in India: A Hope for Healthy Ageing" International Journal of Preventive
Medicine (2013) last visited on June 16, 2022.
[8] National
Sample Survey 52nd Round Report, "The Aged in India: A Socio-economic
Profile, 1995- 96" (Ministry of Statistics and Programme Implementation,
1996).
[9] DR.
S. Irudaya Rajan, "Population Ageing and Health in India" Centre for
Enquiry into Health and Allied Themes, Mumbai, 18 (2006).
[10] Somya
Jain, "Government’s lethargic attitude towards senior citizens in India
and the reparative role of the judiciary" available at: https://blog.ipleaders.in/governments-lethargic-attitude-towards-senior-citizens-india-reparative-role-judiciary
(last visited on July 7, 2022).
[11] Maintenance
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[12] Jaya
Prasad Tripathy, "Geriatric care in India: A long way to go" 5
Journal of Mid-life Health 205 (2014) available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4264287 (last visited on July 5,
2022).
[13] SBI
General Insurance, "Health Insurance Schemes for Senior Citizen from Government"
available at: https://www.sbigeneral.in (last visited on June 24, 2022).
[14] DR.
Ashwani Kumar v. Union Of India, Writ petition (C) No. 193 of 2016 (Supreme
Court of India).
[15] Vinay
Verma v. Kanika Pasricha, (2019); S. Vanitha v. Deputy Commissioner, Bengaluru
Urban District, Civil Appeal No. 3822 of 2020 (Supreme Court of India).
[16] Snehalata
Singh @ Salenta v. State Of U.P., PIL No. 14588 of 2009 (Allahabad).
[17] PTI,
"Rights of elderly must be recognised and implemented, says SC"
Business Standard, December 13, 2018 available at:
https://www.business-standard.com/article/pti-stories/rights-of-elderly-must-be-recognised-and-implemented-says-sc-118121300830_1.html
(last visited on July 4, 2022).
[18] State
of Andhra Pradesh v. Dinavahi Lakshmi Kameswari, 2021.
[19] Vipul
Kumar & Shireen Moti, "Protecting the Elderly in India: Hits and
misses under the recent legislative and judicial framework" Bar and bench
May 30, 2020 available at:
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(last visited on July 4, 2022).
[20] DR.
Sugan Bhatia, "Maintenance and Welfare of Parents and Senior Citizens’
Act, 2007, Need-to-undertake-a-decadal review" All India Senior Citizens’
Confederation 2016,
[21] Govindraj
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Health" India Spend, September 24, 2021.
[22] DR.
Bhupinder Chaudhary, DR. Rachna Kumar, “Issues in Geriatric care in India” 7 International
Journal of Research in Social Sciences (2017).
Article Information
GERIATRIC HEALTH CARE ISSUES IN INDIA- DETERMINANTS, CHALLENGES AND JUDICIAL INTERVENTION
Authors: MS. V.R. UMA, DR. T. SITA KUMARI
- Journal IJLRA
- ISSN 2582-6433
- Published 2023/04/12
- Volume 2
- Issue 7
About Journal
International Journal for Legal Research and Analysis
- Abbreviation IJLRA
- ISSN 2582-6433
- Access Open Access
- License CC 4.0
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