Elders in India: Navigating Policy Gaps and Social Challenges
Bihar CM Nitish Kumar, JLN Medical College Bhagalpur, Health Minister JP Nadda! (Images Social media)
NITI Aayog’s Senior Care Reforms in India: Policy Paper Stalls as Action Lags
By MANISH ANAND
NEW DELHI, June 21 – A private clinic in Bhagalpur, Bihar, is full of patients, mostly elders. The doctor is yet to arrive, but patients have already filled the waiting rooms on two floors to capacity. Each has paid a consultancy fee of ₹1,400.
After hours of waiting, patients begin seeing the doctor. They emerge with a prescription listing multiple tests to be conducted at the same clinic. For some, the total charges run as high as ₹14,000.
The doctor insists that all necessary tests must be conducted to fully diagnose the ailments. A few patients lament that some of the tests were already done just a few days earlier at other clinics. However, these reports are not accepted at this clinic, which also houses a pharmacy where patients are required to buy their prescribed medicines.
This clinic is among many in Bhagalpur, which also boasts a super-specialty government hospital. “We don’t wish to go to the government hospital because doctors are mostly unavailable, and the waiting time for treatment is too long,” said an elderly patient.
From Patna to Bhagalpur, Darbhanga to Sitamarhi, and from Muzaffarpur to Saharsa, Purnia to Siwan, Bihar presents an extraordinary healthcare scene—flourishing private clinics operated by doctors who also serve as professors at government-run medical colleges and hospitals.
Earlier this month, the Bihar Cabinet decided to acquire 25 acres of land to set up another medical college and hospital in Banka, Bihar’s border district with Jharkhand. Under Chief Minister Nitish Kumar’s nearly 20-year tenure, a network of medical colleges and hospitals has spread across most of the state’s districts. Yet, patients continue to crowd private clinics.
Elders in the Crosshairs of a Policy Vacuum
Elders—senior citizens above 60 years of age—constitute roughly 11 percent of India’s population. According to the 2011 Census, there were nearly 11 crore elders, and their population is now estimated to exceed 15 crore. Following a six-year delay, the next census in 2027 will reveal the updated status of India’s senior citizens.
Government policy largely emphasizes demographic dividends, focusing on a young population profile. Elders struggle to find space in policy advocacy, even among government think tanks such as NITI Aayog, which succeeded the Planning Commission.
Worse still, elders are often targeted by digital fraudsters, who fleece them of their life-long savings through scams involving threats of digital arrest, electricity disconnections, or bank account seizures. When one such victim visited a cyber police station, he found disinterested officers and a large pile of pending case files. Complaints to helpline numbers yield no results, and grievance portals send closure messages without addressing the issues.
Governments, both at the Centre and in the states, largely confine their interventions for elders to insurance-based schemes and pensions. Beyond such schemes, elders are often left to fend for themselves, especially as economic migration leaves many elderly people lonely in states like Bihar.
The Road Ahead for Elders
India’s population has begun ageing. Projections suggest that by 2050, one in five Indians will be a senior citizen. Yet, India appears unprepared with a comprehensive policy framework for its ageing population.
“India needs to learn from countries such as Denmark and South Korea to develop an institutional framework for a caring society that can address the needs of senior citizens,” said Shashank, India’s former Foreign Secretary, who served under the Atal Bihari Vajpayee government.
He stated that the government must begin working on plans to open hospitals, at least at the district level, exclusively for senior citizens. “At least one state should take the lead and set an example with an institutional framework to care for elders,” said Shashank, adding that remote locations, such as hilly states, should develop telemedicine networks for elders.
Citing Denmark, Shashank noted that old age homes there are linked with schools, enabling elders to connect with younger generations. He added that senior citizens are engaged in various activities to keep them busy, while homes are limited to two floors, with one caregiver attending to a maximum of eight elders.
“Sense of smell is often the last to diminish, even into the late 90s. Buildings are designed with distinct flowers to help elders identify their residences,” added Shashank.
He also cited Japan, where youth are trained by temporarily impairing their vision and restricting movement to simulate the physical challenges of the elderly. “This training helps sensitize youth to the challenges faced by elders. Similar institutional efforts are seen across East Asia, where a culture of respecting elders is actively inculcated,” he said.
Shashank further suggested that India could assign senior citizens responsibilities such as monitoring community parks, amenities, and resident welfare associations as part of official policy.
As cities and villages become increasingly lonely places for elders due to intense migration, states need to sensitize policymakers to prioritize the needs of senior citizens. Last year, NITI Aayog released a policy paper titled Senior Care Reforms in India. However, the paper has yet to translate into concrete action and was not even discussed in the last two Governing Council meetings of NITI Aayog.
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