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Living Arrangementsof Elderly in IndiaPolicy and Programmatic Implications

K.M. Sathyanarayana

Sanjay Kumar

K.S. James

Building knowledge base on

Population Ageing in India

Working Paper: 7


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Editors Note

Dear readers,

In most countries of the world, including India, population ageing is likely to become a serious policy

and programmatic issue in the coming decades. UNFPA in collaboration with the Institute for Socialand Economic Change, Bangalore and the Institute of Economic Growth, Delhi has launched a major

research project to build a knowledge base on population ageing in India (BKPAI). The study focuses

on social, economic, health and psychological aspects of elderly. This peer reviewed publication is

one in the series of working papers. We are sure that the finding of this publication will help in

generating a healthy debate and policy response amongst a wider cross-section of scholars,

professionals, policy makers and civil society.

Editorial Team

BKPAI Editorial Team

G. GiridharExpert

Frederika MeijerUnited Nations Population Fund (UNFPA), New Delhi

Moneer AlamInstitute of Economic Growth, Delhi

K.S. JamesInstitute for Social and Economic Change, Bangalore

K.M. SathyanarayanaUnited Nations Population Fund (UNFPA), New Delhi

Sanjay KumarUnited Nations Population Fund (UNFPA), New Delhi

Citation Advice:

Sathyanarayana, K.M., Sanjay Kumar and K.S. James. 2012. Living Arrangements of Elderly in

India: Policy and Programmatic Implications, BKPAI Working Paper No. 7 United Nations Population

Fund (UNFPA), New Delhi.

Disclaimer

The study has been supported by the United Nations Population Fund - UNFPA and reviewed by awider group of demographers and researchers prior to its finalization. The contents, analysis, opinions

and recommendations are solely of the author/s, and do not necessarily reflect the views of UNFPA.


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Living Arrangements of Elderly in India:Policy and Programmatic Implications

K.M. Sathyanarayana

Sanjay Kumar

K.S. James

Institute for Social and Economic Change, BangaloreUnited Nations Population Fund, New Delhi

Institute of Economic Growth, Delhi

September 2012


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Living Arrangements of Elderly in India


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K.M. Sathyanarayana, Sanjay Kumar and K.S. James

Living Arrangements of Elderly in India:

Policy and Programmatic Implications

Abstract

Of late, studies on living arrangements of senior citizens as a marker of vulnerability have assumed

importance in view of their expanding numbers due to declining fertility and mortality and

increasing longevity. This has been a concern in the developed world for many years both from the

social policy and programming perspectives in order to respond adequately to the ever increasing

costs of providing care to the elderly. In developing countries like India, where social pensions are

meagre and health insurance is not yet widespread, the traditional support system of physical,

emotional and economic security is often provided by the younger generation. With changes in the

demographic and economic fabric, family structure has undergone changes that significantly impact

the living arrangements of the elderly in India. Such changes have profound implications for

provision of care and support to the elderly. It is for this reason that researchers have used living

arrangements of the elderly as one of the proxy measures of their well-being.

This paper attempts to study changes in the pattern of living arrangements among the elderly in

India on the basis of two rounds of the National Family Health Surveys (1992-93 and 2005-06).

The paper investigates differentials by residence, social, economic and demographic characteristics.

The trends reveal that there is feminisation of ageing happening in the country. While the proportion

of the elderly (80+ ages) has declined for males, an opposite trend has been witnessed for females;

particularly urban females. As regards education status, the percentage of illiterates has come

down for males and females, yet there has been no significant improvement in educational attainment

at secondary level and above. Further, 60 percent of women and 20 percent of men were widowed

and nearly 40 percent belonged to the two lowest wealth quintiles with remarkable urban-rural

differentials. The old-age dependency ratio and single and two/three-member households have

increased and conversely have resulted in declining social support base for the elderly.

Although familial care of the elderly seems to be strong in India, with around three-fourths of the

elderly co-residing with their spouse, children and grandchildren, the trend in either living alone

or with spouse only, has increased from 9 to 19 percent over the period and has resulted in increase

in headship rate. The intensity of changes is seen more for urban elderly, compared to their rural

counterparts, implying that the elderly have to fend for themselves in future. Nonetheless, the fact

remains that there is an increased nuclearisation of families and a substantial majority are from

the two lower wealth quintiles. Enormous inter- and intra-state variations in living arrangement

could also be seen. To conclude, the government policies and programmes will therefore have to

gear up and specifically address the social, economic and health security of the elderly. For this to

happen, political commitment at the highest level is essential, as the present institutional engagement

of various government departments working in vertical silos may not yield the desired results.

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1. Introduction

Living arrangement of senior citizens in India is of increasing concern in view of the expanding

cohort of older ages resulting from increasing longevity. Moreover, with the rapid decline in

fertility, there is substantial reduction in the number of children to take care of the elderly. The

increasing number of the elderly has been of concern in the developed world for many years, both

from the individual and social policy perspectives and for effectively responding to the increasing

costs of providing care. In developing countries like India, where social pensions are meagre and

access to health insurance is still very limited, the traditional support systems from family and

community becomes important to uphold the Indian tradition of respect and care of the elderly.

As a result, elderly members of the family have normally been taken care of within the family

itself. The family and social networks provided an appropriate environment in which the elderlyspent their lives, engaging in religious activities, participating in the rearing of grandchildren, and

following other pursuits. This way, the institution of family fulfilled the needs of the elderly in

providing social, psychological and economic security. In addition, the family took care of the

physical welfare as well as the psychological well-being of the older family members, and in turn,

the elderly contributed by dispensing their acquired wisdom and prudence, distributing their

wealth and belongings, and maintaining family harmony resulting in symbiosis and reciprocity

(Siva Raju 2011).

The most crucial aspect of living arrangements of the elderly is co-residence with adult children in

extended families or multi-generational households, where kin provide income, personal care

and emotional support to the elderly (Nandal 1987, Rajan and Kumar 2003). Scholars and policy

makers working in this area view the living arrangements of the elderly as a measure of their

wellbeing. It has been a common assumption that co-residence with children and grandchildren

in multi-generational households benefit the elderly, and that the elderly who live with at least

one adult child are better off and better provided for than those who live alone or with non-

relatives (Teng 2007). Thus, Cogwill (1986) concludes that co-residence of the elderly and young

has been in the spirit of life time reciprocity. Though co-residence is an important criterion for

the well-being of the elderly, Chan (1997) and Irudaya Rajan et al (1999) argue that it may not

always ensure a healthy relationship between successive generations and economic, emotional,and social support from the younger generation can still be provided even without co-residence.

However, they believe that the level of social and economic development becomes an important

determining factor. Further, it is said the co-residence does not always indicate flow of support

from the younger to the older generation; co-residence may also imply child-care or help in

household chores by the elderly.

The Indian economy, demography and society are in a major transition. The economic development

gains are not equitably shared across different geographical regions and sections of the society.

These social and economic changes have brought in cultural changes as well as changes in individual

characteristics. With the demographic transition under way, there are only a few children to take

care of the elderly. They are now more educated, mobile, aspire for a higher standard of living,

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and as such, changes in their individual behaviour and attitude are observed. These, in turn, are

expected to bring changes in the living arrangements of the elderly with implications for their

well-being.

However, with all these major changes, a study by Kumar (1996) comparing the living arrangements

of the elderly in two Indian states of Kerala and Uttar Pradesh found that an overwhelming majority

of the elderly in both states live with their off-spring. The study also showed that the traditional

value system of the family and younger generations taking care of the elderly continues to persist

through demographic transitions and cultural norms appear to be the same in the two

demographically divergent states. At the same time, the study also revealed that the number of

surviving children is positively correlated with co-residence after controlling for social and economic

variables, while income is found to be significantly reducing the possibility of living with children.This, perhaps, indicates the possibilities of rapid changes in the living arrangement with economic

and demographic changes. This finding is in sync with what has been observed by Knodel and

Chayovan (1997) in Thailand. The study found that a widespread and functioning familial system

of support and care for the older population had been maintained despite rapid social and

demographic changes in recent decades. The study, however, indicated that co-residence of elderly

parents with at least one child in the same dwelling unit is declining yet did not reflect erosion of

the support system, since daily contact between parents and non-co-resident children almost fully

compensated for this decline. Instead it reflected more privacy for both generations as a result of

rise in income by establishing nearby households and retaining sufficient proximity to permit

maintaining essential aspects of traditional inter-generational obligations of care and support.

Nonetheless, cultural variations to a large extent also affect the living arrangement of the elderly

with sons or daughters or with elder son or younger son (Goode 1963). Further, the living

arrangement is affected by the perception of costs and benefits by both older and younger

generations manifested in preferences and constraints (United Nations 2001). The older generation

may perceive costs in terms of taking care of the siblings or grandparenting and taking care of the

households when the young couple is out of home to take up jobs, while the young generation

might perceive costs in terms of taking care of the aged and their health and living expenses. The

older people may own their house which is used by the younger generation. The young generationmay face constraints in terms of living space, while the older generation may feel shrinkage in

their space in decision-making in the household. Living arrangement reflects the balance between

costs and benefits.

On the other hand, several studies in the Western countries have shown that there are substantial

changes in the pattern of living arrangement as the economy moves from the pre-industrial family

economy to the wage economy (Ruggles 2001). There is evidence of such changes in East Asian

economies. The changes in living arrangements are also a result of personal preferences over time

and changes in attitudes of the younger generation who favour nuclear families (Ogawa 1994).

The state of health also affects the pattern of living arrangement. Those who need more help inactivities of daily living tend to live in joint families rather than living alone or in nuclear families.

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The age pattern of living of the elderly is influenced by life cycle and cultural factors. Further, it

was pointed out that among the life cycle factors, level and timing of fertility largely determines

the degree of overlap of life stages of parents and children. In case of those where the child-bearing

has been completed relatively later in life, they may still be caring for young children and are in

families. On the contrary, those who completed their family formation earlier, may now be in

empty nest stage, and in case of widows, they may be living alone (United Nations 2005). Thus,

with changes in the demographic and economic fabric, family structure too is undergoing changes

thus impacting the living arrangements of the elderly in India. Such changes have profound

implications on social security, provision of care and support to the elderly. Researchers have

therefore used living arrangements of the elderly as one of the proxy measures of their well-being.

2. ObjectivesThe study focuses on the changing pattern of living arrangements of older persons and the extent

to which the Indian elderly are co-residing with their family members. The paper analyses the

trends and differentials in living arrangement by selected characteristics, either of the households

or of the individual elderly. Further, it deals with the status of widowed elderly separately in

terms of their living arrangements and explores the extent to which multi-generational families

are living together.

3. Data and Methods

The present study is based on the National Family Health Survey, First (19921993) and third(20052006) rounds and the District-Level Household Survey III (DLHS-III). The National Family

Health Surveys (NFHS) are large-scale, multi-round surveys conducted with a representative sample

of households throughout India. These surveys are not exclusively meant to study the situation of

the elderly; however, various characteristics of the household population (especially for those

aged 60+ years) provide scope to study the living arrangement patterns. NFHS I had an overall

sample size of 88,562 households of which 38,285 persons above 60 years of age were identified

and in NFHS III, from a sample of 109,041 households, 44,759 elderly persons were identified.

The paper is divided into three sections. In order to understand the sample population

characteristics, a general discussion on the socio-demographic profile of the sample population is

presented followed by a discussion on the living arrangement pattern and its major determinants.

The last section summarises the findings and the major conclusions of the study.

4. Results and Discussions

4.1. Social and Demographic Aspects of the Elderly

The percentage of elderly population in India culled from various NFHS rounds has marginally

increased and the quantum of increase was similar in rural and urban areas (Table 1). Along with

this increase, the ageing index and the old-age dependency ratio have also increased implying

that the young population is coming down and the percentage of the elderly is increasing. Ageing

index, that is 21 old persons per 100 persons (0-14) years, in NFHS-I has increased to 25 in NFHS-

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III and likewise old-age dependency ratio has increased from 14.2 to 15.1 old persons per 100

persons in 15-59 ages.

Table 1: Increasing Percent of Elderly Population in India, 1992-93 and 2005-06

While the percentage of older persons (60 years and above) increased from 7.7 percent in 1992-93

to 8.6 percent in 2005-06, a higher pace of growth of women in both rural and urban areas is

observed. The percentage of elderly men has increased from 8.0 to 8.7 between the first and third

rounds of NFHS; the percentage of women increased from 7.4 to 8.5.

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The overall sex-ratio of the elderly

population (Table 2 and Figure 1) has

increased in the last 13 years from 874

elderly women per 1,000 elderly men to

968. Such rapid changes in the sex ratio

would definitely have implications for the

changes in living arrangement pattern as

well. The urban sex ratio has already started

favouring females indicating that

feminisation of ageing in urban India has

already started. This finding gets reinforced

when sex ratio trends are analysed at laterages, particularly 80+ age groups.

Table 2: Feminization of Elderly Population in India

Undoubtedly, the sex ratio at older ages is the result of differential mortality pattern between men

and women which can be understood by considering marital status distribution of the elderly

(Table 3 and Figure 2). At the aggregate level, six out of 10 elderly persons are currently married

and this proportion has remained similarover the period. More importantly, six out

of 10 women are widows as against 2 out

of 10 men. The percentage of widowhood

increases considerably with age. While

widowhood ranged from less than 10

percent for men aged 60-64 years to 35

percent at 80+ ages in 2005-06, it is as high

as 45 percent and 87 percent for women in

the respective age groups.

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Table 3: Higher Percent of Elderly Widows in India, 1992-93 and 2005-06

The widowhood and poor educational attainment lead to perpetuation of gender discrimination

even at the older ages in the country. It is observed that a majority of the women are illiterate and

there has been marginal decline in illiteracy over the time-period (Table 4). The percent of the

elderly in 1992-93, that is around 71 percent, had come down to 64 percent and the quantum of

change is similar between men and women.

Table 4: Higher Percent of Illiterate Elderly in India, 1992-93 and 2005-06

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The percent of the elderly who had studied

more than primary school has increased three-

fold and those with more than secondary or

higher education had increased two-fold.

Gender differentials across all education

categories are apparent. As compared to gender,

the rural-urban differential in illiteracy rate is

rather narrow in the country (Figure 3).

Figure 4 depicts that over a quarter of rural

elderly are from SC/ST households and an

equal percent are from the poorest or lowest wealth quintile in 2005-06. Furthermore, only aboutthree out of 10 rural elderly resided in pucca households. In contrast to rural elderly, the condition

of urban elderly seemed to be better. Not

only did a higher percent of urban elderly

reside in pucca households, more than half

of them are from the richest wealth quintile

while it is one-tenth in case of rural elderly.

The foregoing analysis on the social,

economic and demographic characteristics

of the elderly in the country indicates thatnot only the elderly population has started

increasing but a majority of them are

illiterate, belong to SC/ST and OBC households and are from poor families also. In a nutshell, the

rural/urban and men/women differentials and disparities appear to be glaring, particularly among

later ages (old-olds), and this segment needs special attention. All these have considerable

implications for their pattern of living arrangement.

4.2. Living Arrangements of the Elderly

This section elucidates trends and differentials in household headship rate and in type of livingarrangements as well as the major social and economic determinants of current living arrangement.

NFHS collected information on head of household in household questionnaire. It defined head of

household as one who is aged over 15 years and responsible for taking major decisions in the

household, irrespective of whether he/she is an earning member or not. The analysis has been

carried out using the relationship code available in the household questionnaire (Table 5).

In India, about a third of the households have an elderly person and this proportion is reducing.

However, elderly persons are still accorded higher status in the family, as four out of five elderly

men are regarded as household head while it is one in five, in case of elderly women. Although

there is a significant difference in household headship rate between elderly men and women,

household headship rate for elderly women has witnessed a substantial increase as against a

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nominal increase for elderly men between 1992 and 2006. Rural and urban areas also conform to

this increasing trend as headship rate of both rural and urban elderly women has increased with

urban households showing a two-fold increase (from 12% to 24%).

Table 5: Increasing Household Headship Rate among Elderly Women in India

Age-wise analysis of elderly headship rate indicates an inverse relationship between advancing

age and elderly headship. In other words, as the age of the elderly increases, the percentage of the

households headed by the elderly tends to reduce. While this explanation suffices for age-wise

analysis, on the other hand, if trends between 1993 and 2006 are observed, the elderly men and

women headship rates for all age-groups have increased. One plausible explanation is that the

elderly life-expectancy is increasing and furthermore with women outliving men in older ages,

women household headship rate has increased at higher pace than that of men. This finding also

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reaffirms that in extended family households, age of the eldest person is still a significant factor in

determining or rather reporting as the head of the household in census or surveys despite the fact

that other earning members might still be the decision makers.

One of the possible ways of understanding the

co-residence pattern of the elderly is to analyse

the mean number of household members in

the elderly households as it measures the

extent of co-residence (Figure 5). If there are

more members in a household, it is an

indication of co-existence of household

members with the elderly. The mean numberof rural and urban household members has

reduced between the first and the third rounds

of NFHS. The extent of decline has been more or less similar in rural and urban areas. Reduction

in family size could be a major reason for this decline in addition to migration and disintegration

of joint families. This finding gets reinforced when analysed by the number of members in the

elderly household. It is observed that there are only 2 percent single-member elderly households

in NFHS-I and has increased to 5 percent in NFHS-III. Likewise, two- and three-member households

have increased from 8 to 15 percent and 7 to 9 percent between NFHS-I and III respectively. There

has been a substantial reduction in four or more elderly member households they reduced from

84 percent to 72 percent during the time-frame (Tyagi 2010).

Further, the 2011 Census results on housing data have also clearly pointed out that the number of

households has increased substantially in the last decade and the number of persons per household

too has come down. A combination of declining fertility, migration and nuclearisation of families

are three possible reasons for such reduction in the household size implying the need for ensuring

appropriate systems to address the declining support base.

Analysis of data in Table 6 reveals that the percentage of elderly men and women living alone too

has increased and has doubled in the 13 years with a larger percent of elderly women living alone.

Concerning co-residence with other family members, a differential gender pattern is observed.

While a large percentage of elderly men live with spouse, children and grandchildren, it is found

that elderly women live with children and grandchildren only (minus spouse). Since a majority of

elderly women are widowed, perhaps, a higher proportion is found in this category. Rural and

urban areas confirm to the overall trend but percent of those living alone was higher in rural areas

than in urban areas. The finding is reinforced even when household is treated as unit of analysis as

it shows that a higher proportion of the elderly females live as single members as compared to

males (Tyagi 2010).

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Table 6: Increasing percent of the Elderly Population has started living alone in India

While these differentials in living arrangements of Indian elderly are prominent at the national

level, there exist considerable differentials in elderly living alone in states of India and the trends

depict increasing proportion of elderly living alone (Table 7). The percent of elderly living alone

varied from a minimum of one percent in Jammu and Kashmir to 14 percent in Tamil Nadu in2005-06 and five states of Nagaland, Meghalaya, Andhra Pradesh, Madhya Pradesh and Karnataka

had a higher than national percent of elderly living alone.

Furthermore, these states had witnessed substantial change in percent living alone since 1992-93

and in case of Nagaland; the percent living alone had increased from zero in 1992-93 to 11 percent

in 2005-06. Likewise, observations could be made in the two states of Tamil Nadu and Meghalaya.

Given the enormous difference, a validation exercise was carried out from Census 2011 wherein

the results indicate that number of households has increased substantially between 2001 and 2011

censuses. It therefore appears that overall there is an increasing trend in elderly living alone.

Hence there is a need to understand the characteristics of those living alone in order to enhance

their safety and security as well as to design effective policies and programmes.

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Table 7: Changes in elderly living alone across states in India

Note: The 1992-93 figures for Bihar, Madhya Pradesh and Uttar Pradesh includes the newly formed states of

Jharkhand, Chhattisgarh and Uttara Khand respectively

It is also important to note large variations across districts in this respect. There are nearly 137

districts out of a total of 640 districts in the country where more than five percent (more than

national average) of elderly live

alone and Tamil Nadu figures

prominently among the ten topdistricts where higher percent of

elderly live alone (Figure 6). If a

cut-off of 12 percent elderly and

more than five percent living

alone in the district are

considered together then 12

districts figure in the list and are

spread across the states in the

country (DLHS, 2007-08).

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Given the huge variations in the percent of the elderly and those living alone, it is imperative to

understand how the emerging socio-economic and demographic changes are likely to alter the

living arrangement pattern in the country. Such an analysis of the elderly living alone with socio-

economic background is carried out in Table 8.

Table 8: Higher Percent of Women, Illiterate, Widowed and Poor living alone, India

Majority of 60-79 year olds are living with spouse and other family members. In case of 80+ aged

elderly, obviously a higher percent are living alone (6%). The percent of elderly women living

alone is three times more than older men. Further analysis by other background characteristics

indicate that a higher percent of the elderly who are from rural setting, belonging to scheduled

caste/tribe and are poor are living alone in comparison to others (Table 7). Pertaining to education,a clear-cut trend was not visible but the two extreme categories of illiterates and those with more

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than higher secondary education tended to live alone. The findings, while conforming to the patterns

observed by other researchers in India and elsewhere, reinforce the vulnerable aspects of the elderly.

Thus, it can be deduced that there is an increasing trend in percent of those living alone, more

specifically women, and the likelihood of poor, rural and illiterate elderly living alone is higher

than their counterparts.

The fact that social, economic and health security are major concerns, there is a need to understand

better the living arrangements of this heterogeneous group more from a programmatic perspective

to ensure need-based services. In addition, their awareness, perceptions and coverage of social

security schemes will have to be reviewed for understanding the ground realities. Further, the

views of the elderly on old-age homes and their expectations are critical, as the government is

planning to make huge investments in developing old-age home infrastructure in the country.

In order to substantiate the findings and understand the relative contribution of these variables, a

logistic regression analysis has been carried out using the dichotomous variable of living alone (1)

or in co-residence (0) as the dependent variable. Age of the elderly, their sex, place of residence,

caste, education and the wealth index have been included as explanatory variables. Table 8 shows

the odds ratios for each variable and if odds ratios are greater than 1, it shows a positive association

within the categorical variable and vice versaif less than 1.

The key findings of the analysis indicate that the older elderly are more likely to live alone than

the youngest old (60-64 years) after controlling for other variables in the regression analysis.

Likewise, elderly women are three times more likely to live alone than their male counterparts.

Controlling for education, wealth index and other relevant factors, elderly in urban areas are found

more likely to live alone as compared to those in rural areas. Further, the analysis indicates that

the Scheduled Tribe elderly are less likely to stay alone than those of the Scheduled Castes, while

the regression coefficients for the elderly belonging to other Backward Caste or general caste are

not significant. Education showed strong positive association with elderly living alone and the

odds of elderly with more than higher secondary education living alone is five times higher than

illiterate elderly. On the other hand, wealth index showed negative association; wherein the odds

of the elderly from higher quintiles co-residing is substantially higher than that of the poor.

Nonetheless, from the foregoing analysis it can be inferred that older persons, women in particular,

poor, illiterate and those living in urban areas are vulnerable in terms of their living arrangements.

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Table 9: Logistic Regression of Living Alone vs. Co-residence among the Elderly

in India, 2005-06

*** p < 0.001; ** p < 0.01; * p < 0.05

5. Conclusions and Future Implications

The trends depicted in this paper clearly point to the fact that the population of India is ageing, the

proportion of old-older population is also increasing and the urban increase has been marginally

higher than the rural increase. Furthermore, with women living longer than men particularly in

older ages, population ageing is getting older and feminised. Due to these changes in age-structure,

widowhood, old-age dependency ratio has increased and has resulted in declining support base

for the elderly. The declining support base is not only in terms of the demographics but is also due

to the changing social fabric of society. This is because the living arrangement of the elderly has

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changed and the percentage of the elderly living alone and/or with spouse only has increased

between the two NFHS rounds. Moreover, when household is treated as a unit of analysis and

analysed by single-member, two-member households and so on, there is an increasing trend of the

elderly living alone and with spouse only, though majority co-resided with children. Enormous

variations in living arrangement between and within states could also be witnessed.

With a majority of the elderly illiterate belonging to the SC/ST and OBC households and from

poor families, particularly from rural households, the nature and degree of vulnerabilities it presents

are different. For that matter, the elderly represent a very heterogeneous group with rural/urban

and men/women differentials and disparities.

Additionally, emotional aspects, transfer of resources and transactions with children and remittances

made and received etc. and the hypotheses that it may not always ensure a healthy relationship

between successive generations and economic, emotional, and social support from the younger

generation can still be provided even without co-residence, and the fact that co-residence does not

always indicate flow of support from the younger to the older generation are all important

aspects that have to be studied to get a holistic perspective of the elderly.

Despite the positive and negative arguments put forth by researchers on living arrangements and

co-residence, the common inference that co-residence with children and grandchildren in multi-

generational households benefit the elderly, and that the elderly who live with at least one adult

child are better off and better provided for than those who live alone or with non-relatives. On the

contrary, as we see from the results, the trend of living alone or with spouse only is bound to

increase and more women are likely to live alone. It is therefore suggested that social, health and

economic security aspects that are of utmost importance from policy and programmatic perspectives

will have to be considered along with living arrangements. Nonetheless, extrapolating the results

that a large majority of the elderly and the different segments within are vulnerable with the

assumption that the reach of social pension and the amount given is limited and the health insurance

scheme is yet to scale up, the emerging picture seems to be gloomy.

As a basic human right, a policy decision of universalisation of social pension indexed to inflation

and health insurance for all the elderly by modifying the existing Rashtriya Swastha Bhima Yojana(RSBY) preferably to those aged over 65 and above irrespective of whether they are below or

above the poverty line should be promulgated. Concurrently, there is a need to establish old-age

homes for the destitute; especially women, given their vulnerabilities. In doing so, there is a need

to learn and adapt to standards and protocols developed in countries in the region. No doubt, this

is going to cost the exchequer but with inclusive growth being the motto of the XI as well the

upcoming XII Five-Year Plan, necessary budgets and appropriate implementation structures have

to be created for identifying and rendering the services.

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BKPAl Working Paper Series

1. Demographics of population Ageing in India

Lekha Subaiya and Dhananjay Bbansod

2. Studies on Ageing in India: A Review

S Siva Raju

3. Elderly Health in India: Dimension, Differentials and Deterninants

Moneer Alam and Anup Karan

4. Elderly Workforce Participation, Wage Differentials and

Contribution to Household Income

Sakthivel Selcaraj, Anup Karan and S Madheswaran

5. The National Policy for Older Persons: Critical Issues in ImplementationS Irudaya Rajan and U S Mishra

6. Policy Initiatives on Population Ageing in Select Asian Countries and

Their Relevance to the Indian Context

Mala Kapur Shankardass

7. Living Arrangements of Elderly in India: Policy and Programmatic Implications


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