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Best practices in managing LTC of elderly in developed European nations: evolving strategies for India

2012 Conference Presentation

(Inter)national systems India

7 September 2012

Best practices in managing LTC of elderly in developed European nations: evolving strategies for India

Sudhir Kumar Jain, Indian Institute of Technology, New Delhi, India
Sunil Kumar Gulati, Indian Institute of Technology, New Delhi, India


By 2051, India will have over 13% elderly numbering 202 million. The number of elderly in India would be about 33% more than those in Europe. But with a Human Development Index of 0.612 (ranked 134 out of 182 nations in 2007) the elderly in India can hardly expect a golden sunset. There is clearly a socio-economically marginalized class emerging in the society which is the elderly people, more so the elderly women. Further unlike the West, India has 69% rural population to which the access to modern health amenities is itself an issue. Then there is the joint family system facing the pressures of economic reforms wherein the young workers migrate out leaving the elderly behind.

Objective: In such a situation it is prudent to look at the best practices that have emerged in the formal and informal care of elderly in European countries and see if there can be any lessons for India. In this context this paper looks at whether people plan for long term care(LTC), when do they do so and what provisions do they make, if at all? Whether institutional options are preferred or home care? Does the LTC planning vary over communities? Rural /Urban context and why?

Data & Methods: The paper takes a detailed literature review, desktop studies followed by field visits and discussions with experts and senior citizens in Europe and India to take a hard look at the various Care Models.

Results and Policy Implications: It is inferred that generally in both places home care is considered fiscally less burdensome and preferred over institutional care. Strategies to use the Indian demographic dividend to provide LTC for elderly are explored along with implementation plans. Efforts required for advocacy, research, involvement of voluntary agencies, training different levels of gerontological workers, catalyzing the community, awareness building, organizing older persons themselves and networking with international agencies in order to empower older Indians are listed. The strategic options for the state and non-state players for care of elderly in the organized and the unorganized sector have been evolved. To what extent the social policy and program interventions help deliver LTC has been evaluated and possible strategies for LTC of elderly in various socio-economic segments have been listed, taking lessons from what has worked and what has not been so successful in European settings. In the rural areas for instance the model of village youth being trained as Geriatric Care giving and being employed for that work by Village Local Bodies for looking after a group of male and female elderly under the National Rural Employment Guarantee program and partly supported by the elderly themselves in cash and kind is looked at. A similar model is proposed to be tuned for elderly living in the urban slums. Whereas for rest of the urban middle class, wherever joint family option is not available a community /Resident Welfare Association supervised home care giver model is proposed as one of the options.