The feminisation and ruralisation of ageing require a differentiated policy response. Discuss with reference to institutional and community-based elder-care in India.

The India Ageing Report 2023 projects the elderly at about 20.8% of India's population by 2050. It also projects the 80+ group to grow about 279% between 2022 and 2050 [1]. This ageing is increasingly female, widowed and rural, so a uniform model of elder care will not work. Both institutional and community-based care need to be redesigned around this profile.

Why a differentiated response

• Feminisation: most of the oldest-old are widowed, very old and highly dependent women [1]. They have the least income and the weakest claim on family support.
• Ruralisation and poverty: over 40% of the elderly are in the poorest wealth quintile, and about 18.7% have no income [1].
• Dependency: about 70% of the elderly depend on others for daily needs, and about 75% have a chronic disease [2].

Institutional care: a safety net with gaps

• IPSrC under AVYAY funds 764 Senior Citizen Homes for the indigent. NGOs, States, PRIs and local bodies run them [3].
• Legal base: Section 19 of the MWPSC Act, 2007 empowers States to set up old age homes [4]. A Parliamentary Standing Committee asked for one in every district [5].
• Gaps: there are only 13 Continuous Care Homes [3], so bedridden women get little nursing care. Homes are checked against funding conditions rather than binding care standards [2].

Community-based care: the missing middle

• Only 17 Mobile Medicare Units reach the elderly at home [3]. Without home support, care falls on women in the family as unpaid work.
• Existing levers: SAPSrC funds training for geriatric caregivers. It also lets States spend up to 20% on their own programmes [3].

Way forward

• Gender lens: priority admission for destitute widows and more Continuous Care Homes.
• Rural lens: day-care centres run by PRIs, and trained caregivers sent to homes through the SAPSrC 20% flexi-fund.
• Quality: binding standards and independent inspection, treating senior care as a regulated sector as NITI Aayog recommends [2].

Institutional homes should remain the safety net for destitute elderly women, and community care led by PRIs should become the default for rural elders. This gender- and region-sensitive mix would fulfil Article 41's promise of public assistance in old age and SDG 3's goal of healthy lives at all ages.