Lok Sabha Question No. 263 (UNSTARRED), answered on 2021-07-20
Subject: Care of Senior Citizens
Ministry: SOCIAL JUSTICE AND EMPOWERMENT
Asked by: Navneet Ravi Rana

## GOVERNMENT OF INDIA MINISTRY OF SOCIAL JUSTICE AND EMPOWERMENT LOK SABHA

UNSTARRED QUESTION NO. 263 TO BE ANSWERED ON 20.07.2021

## CARE OF SENIOR CITIZENS

## 263. SHRIMATI NAVNEET RAVI RANA:

## Will the Minister of SOCIAL JUSTICE AND EMPOWERMENT be pleased to state:

- (a) whether it is a fact that the number of senior citizens will be more than 150 million by 2025 in the country and a significant percentage will be older women alone with comorbidities, and many elderly will have no provision for care to meet these challenges; living
- (b) if so, the details thereof; and
- the steps taken/being taken by the Government keeping in mind that there are many challenges in the senior care sector in the country with few resources available for geriatric care, including doctors and other geriatric specialists lack of early detection mechanisms for ailments requiring long-term care; inadequate public infrastructure and policy support and the GST rates on elder care services?

## ANSWER

## MINISTER OF STATE FOR SOCIAL JUSTICE AND EMPOWERMENT (SUSHRI PRATIMA BHOUMIK)

- (a) to (c): Yes; sir: As per the Longitudinal Ageing Study in India (LASI) report, the population of senior citizens will be more than 150 million by 2025. As per the report longetivity is more in respect of female senior citizens.

Ministry of Social Justice and Empowerment; being the Nodal Ministry for welfare of senior citizens, has launched an Umbrella Scheme namely Atal Vayo Abhyuday Yojana   (AVYAY) 01.04.2021. Previous   schemes  namely Integrated Programme  for  Senior Citizens   (TPSrC),   State Action Plan for Senior Citizens (SAPSIC) and Rashtriya Vayoshri Yojana (RVY) have been brought under AVYAY. Apart from these, the following new Schemes have been started under AVYAY:

- Poshan Abhiyan for Elderly
- (ii) Livelihood and Skilling Initiatives for Senior Citizens
- (ii) Promoting silver economy
- (iv) Channelizing CSR funds for Elderly care

## Awareness Generation and Capacity Building for welfare of Senior Citizens

Apart from   Ministry of Social Justice and Empowerment the Government of   India is implementing schemes and programmes through other Ministries/ Departments, too.

The details of the steps taken in the Schemes/Programmes by the Government of India in the Senior Care Sector are at Annexure:

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## raised by Hon'ble\_MPSHRIMATINAVNEET RAVIRANA]

## Details of Citizens\_Sector:

## Department of Social Justice and Empowerment;

## Atal Vayo Abhyudaya Yojana (AVYAY):

AVYAY brings   together   articulation of the current   schemes; future   plans, strategies and targets and maps it with schemes/programmes, accountabilities, financials and clear outcomes  This Plan takes care of the top four needs of the senior citizens viz financial security, food; health care and human interaction Ilife of   dignity. It also includes the facets of safety/protection and general wellbeing of the elderly beginning from awareness generation and sensitization of the society:

- AVYAY is an umbrella scheme, effective since 1st April 2021, has following schemes under it, namely:
- Scheme of Integrated Programme for Senior Citizens (IPSrC): Setting up of Homes to providing basic amenities like shelter, food, medical care and entertainment opportunities and by encouraging productive and active ageing:
- State Action  Plan  for Senior Citizens (SAPSrC): The Government of India perceives a major and critical role of all State Governments in partnering and implementing this Action Plan for welfare of senior citizens. Each StatelUT is expected to plan and strategize taking into account their local considerations and frame their own State Action Plans for the welfare of their senior citizens:
- Rashtriya Vayoshri Yojana' (RVY): A scheme for providing physical Aids and Assisted living devices to Senior Citizens
- Poshan Abhiyan for Elderly
- Livelihood and   Skilling Initiatives  for Senior Citizens Senior Able Citizens for ReEmployment in Dignity (SACRED); Action Groups Aimed at Social Reconstruction (AGRASR Groups) Elderly SelfHelp groups
- Promoting silver economy
- Channelizing CSR funds for Elderly care
- Scheme for Awareness Generation and Capacity Building for welfare of Senior Citizens Training, Awareness, Sensitization, Setting up of National Helpline for Senior Citizens.
3. Under the Scheme of Integrated Programme for Senior Citizens (TPSrC), grants upto 100% of project cost are given for running and maintenance the following projects: -

## ANNEXURE

- Senior Citizens' Homes for 25 destitute Senior Citizens to provide food, care and shelter:
- (iii) Continuous Care Homes and Homes for senior citizens afflicted with Alzheimer's diseasel Dementia for a minimum of 20 Senior Citizens who are seriously ill requiring continuous nursing care and respite or those who are afflicted with Alzheimer's diseasel Dementia
- (ii) Senior Citizens' Homes for 50 Elderly Women including those under Sansad Adarsh Gram Yojana (SAGY) to provide food, care and shelter:
- (iv) Mobile Medicare   Units to provide  medical care to the Senior Citizens in rural, isolated and backward areas. living
- (vi) Regional Resource and Training Centres (RRTCs) monitors and provides  technical support, advocacy, networking, training and capacity building for effective delivery of service by the Centres for Senior Citizens, funded by the Ministry.
- Physiotherapy Clinics for Senior Citizens for a minimum of 50 Senior Citizens per month.
- 4 Under the Scheme; assistance is sanctioned to the following agencies subject to the terms and conditions laid down by this Ministry -
- Priority to be given to the State Governments UT Administrations for supporting the projects under the Scheme of IPSIC through Registered Societies/ Panchayati Raj Institutions (PRIs) Local bodies, in the vicinity of Hospitals, as far as possible;
- Institutions or Organizations set up by Government as autonomous/ subordinate bodies;
- Non-Governmental/ Voluntary Organizations;
- Government Recognized Educational Institutions, Charitable Hospitals/ Nursing Homes; and recognized youth organizations such as Nehru Yuva Kendra Sangathan (NYKS)

5 Under State Action Plan for Senior Citizens (SAPSrC), the Government of India perceives a major and critical role of all State Governments in partnering and implementing the Action Plan for welfare of senior citizens. Appreciating the critical and significant role of States/UTs, each State/UT is expected to plan and strategize taking into account their local considerations and frame their own State Action Plans for the welfare of their senior citizens. This State Action Plan may  comprise a long-term  strategy for five years as well as Annual Action Plans and this Department   shall release funds to the States/UTs for formulation and implementation of their State Action Plans.

## 6\_ Rashtriya Vayoshri   Yojana (RVY): Scheme for providing   Physical Aids and Assisted-Living Devices for Senior Citizens

The Scheme of Rashtriya Vayoshri  Yojana (RVY) has been  formulated by Ministry of Social Justice and Empowerment with an objective to provide aids and assisted living devices viz. walking sticks, elbow crutches, walkerslcrutches, tripodslquadpods, hearing aids, wheelchairs, artificial dentures and spectacles, free of cost to senior citizens belonging to BPL category who suffer from age related disabilitieslinfirmities such as low vision, hearing impairment, loss of teeth and loco-motor disabilities. The Scheme has been revised W.e.f: F.Y. 2020-21. Under the revised Scheme, the criteria of selection of beneficiaries have been extended to include not oly those senior citizens belonging to BPL category but also senior citizens with monthly income not more than Rs: who suffer  from age related disabilitieslinfirmities as  mentioned above.

Under the revised Scheme of RVY, the number of devices hitherto provided has been increased. At present; following are the items that have been included for distribution:

- Tripods/Quadpods (5) Hearing Aids (6) Artificial Dentures, and
- (1)Walking sticks (2) Elbow crutches (3) Walkers/Crutches;
- Spectacles:

(a) Generic Items:

- (6) Special Items:
- (1) Wheelchairs; (2) Wheel Chairs with Commode, (3) Chair/Stool with Commode, (4) Silicon Foam Cushion, (5) Knee Brace, (6) Spinal Support;
- (11) Foot Care Kit:- () Flexi Gel Socks, (ii) Socks Cusion Sandal, (iii) Silicon Insole (Complete Foot/Ankle) and (iv) Insole with Pressure Point Relief:
- (7) Cervical Collar; (8) Lumbosacral Belt (LS); (9) Walker/Roalator with Brakes, (10) Walking Stick with Seat;
5. 7 \_ Poshan Abhiyan for the Elderly:This is a new Scheme to address the nutritional deficiencies in the senior citizens, especially indigent elderly: The objective of the Scheme is to provide one nutritious, hot and cooked meal during the (mid-day), through Gram Panchayats and Urban Municipalities. day
6. 8\_ Livelihood and  Skilling  Initiatives for Senior CitizensA new scheme with   following two components:-
7. Senior\_ Able Citizens for Re-Employment in Dignity\_(SACREDL Many senior   citizens have experience, time and energv which can be used by the business enterprises looking for stable employees with experience: The Human resources cells of many private enterprises seek experienced but stable persons in certain positions The portal allows bringing these people together by virtual matching of preferences:
8. (ii) Action Groups Aimed at Social Reconstruction (AGRASR Groups): Elderly Self Help groups The Senior Citizens are encouraged to form Self-Help Groups (SHGs), which will provide them with a platform to share the time constructively with each other: To attain financial assistance under the scheme SHGs will function as Action Groups Aimed at Social Reconstruction (AGRASR Groups)' . Assistance under this Scheme to any SHG will be independent of assistance under any other scheme of the Ministry and an SHG can choose to avail assistance under any one or more Scheme(s):
9. Promoting Silver Economy This is also a new scheme launched with an objective to encourage the entrepreneurs for to think about the problems of the elderly and come out with innovative solutions The Government aims to achieve the objective by providing upto Rs: 1 crore as financial assistance through equity participation, through an open invitation on a portal namely Seniorcare Ageing Growth Engine (SAGE):
10. Channelizing CSR funds for Elderly careThis is also a new scheme with an objective to channelize the CSR funds in an appropriate manner for elderly care projects  Under Schedule VII of Section 135 of the Companies Act, setting up old age homes, care centres and such facilities for Senior Citizens is an approved item for CSR funding: day
11. Scheme for Awareness Generation and   Capacity  Building for welfare of Senior for Senior  Citizens, Research,  awareness, sensitization etc  for the welfare of senior citizens, spreading awareness and sensitizing the and other sections of the society towards the issues related to the elderly: youth
1. National  Policy on Older Persons (NPOP); 1999: National  Policy o Older Persons (NPOP) had been announced in January 1999 to reaffirm the commitment to ensure the wellof the older persons: The Policy envisaged State  support to ensure financial and food being

security, health care, shelter and other needs of older persons, equitable share in development, protection against abuse and exploitation, and availability of services to improve the quality of their lives The primary objectives were to encourage individuals to make provision for their own as well as their spouse's old age; to encourage families to take care of their older family members; to enable ad support  voluntary ad non-governmental  organizations to supplement the care provided by the family; to provide care and protection to the vulnerable elderly people; to provide adequate healthcare facility to the elderly; to promote Iesearch and training facilities to train geriatric care givers and organizers of services for the elderly: and to create awareness regarding elderly persons to help them lead productive and independent live

2. The Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007: The MWPSC Act; 2007 had been enacted in December 2007 to ensure need based maintenance for parents senior citizens and their welfare. The Act provides for Maintenance of Parents/ senior citizens by children/ relatives made   obligatory and justiciable through Tribunals, Revocation of transfer of property by senior citizens in case   of neglect by relatives; Penal   provision   for abandonment of senior citizens, Establishment of Old Age Homes for Indigent Senior Citizens, Adequate medical facilities and security for Senior Citizens: and

In order to make the Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act; 2007 more contemporary to the needs of senior citizens at amendments,  such as, adoption  of  uniform age   criteria to  define a senior  citizens registration and  prescribing minimum standards of service, infrastructure, manpower etc. in Senior Citizens Care HomesMMulti-service Care Centres, rating of agencies providing Home Care services to senior citizens etc. have been proposed. The Maintenance and Welfare of Parents and  Senior Citizens (Amendment) Bill, 2019 has been introduced in the Lok Sabha on 11.12.2019. large, Day

- 3\_ Senior Citizens' Welfare Fund (SCWF): In pursuance of the Budget Announcement; 2015-16,a "Senior Citizens' Welfare Fund" has been created to be utilized for such schemes, for promoting financial security of senior citizens, healthcare and nutrition of senior citizens, welfare Care of senior citizens etc. for the promotion of the welfare of senior citizens: The Fund comprises of the   unclaimed amounts transferred  by every institution fund in the Schemes including Small Savings and other Saving Schemes of the Central Government such as Post Office   Savings  Accounts, Post Office Recurring Deposits   Accounts etc-, Accounts of Public Provident Funds and Accounts of Employees Provident Fund, that remain unclaimed for a period of seven years from the date of the account being declared as inoperative account Day
- 4\_ National Council for Senior Citizens (NCSrC): In pursuance of the National Policy for Older Persons (NPOP); 1999, a National Council for Older Persons (NCOP) was constituted in 1999 to oversee implementation of the Policy ad to advise the Government in the formulation and implementation of policy and programmes for the The National Council for Older Persons (NCOP) has been  reconstituted and renamed as National Council of Senior Citizens (NCSrC) in 2012. The mandate of NCSIC is to advise Central and State Governments on the entire gamut of issues related to welfare of senior citizens and enhancement of their quality of life. The Hon'ble Minister; Social Justice and Empowerment, is the Chairperson of the Council
5. National Award <Vayoshreshtha Samman Every year, this Ministry confers National Award * Vayoshreshtha Samman to eminent senior citizens and institutions in recognition of their contribution to the society: This is in order to showcase the Government'$ concern for senior citizens and its commitment towards senior citizens with the aim of strengthening their legitimate place in the society: The Vayoshrestha Samman award started since 2005, which Was upgraded to the status of National Award in 2013. The Awards are given under thirteen categories. Mementos, certificates and cash awards are presented to the awardees.
- 6 Observance of International of Older Persons (IDOP): On lst October every year; this   Ministry observes   International for   Older  Persons by  conferring  National Award Vayoshreshtha Samman to  eminine senior citizens and   institutions involved in  rendering distinguished services for the cause of elderly persons, especially indigent senior citizens: Further; participation of Senior Citizens, Youth, Celebrities and Media-persons etc. Day Day

## SchemesProgrammes\_Concession\_and\_Benefits\_provided\_by\_other\_Ministries/Department

## 1. Ministry of Rural Development;

National Social Assistance   Programme  (NSAP) is a Centrally   Sponsored Scheme of Ministry of Rural Development NSAP is a social security/social welfare programme applicable to belonging to below poverty line household Old age pension is provided under Indira Gandhi National Old Age Pension Scheme (IGNOAPS) to persons belonging to below poverty line (BPL) household. Central assistance of Rs. 200/- per month is provided to the persons of 6079 years of age and Rs. 500/- per month to the persons of age of 80 years Or more. This Scheme is implemented by the  StatesMUTs: Identification  of beneficiaries, sanction and  disbursement of benefit  under the schemes is done by the  States/UTs A total of 221 lakh is the targeted beneficiaries under IGNOAPS. The Scheme is implemented in all States/ UTs in rural as well as urban areas: aged

## 2. Ministry of Health and Family Welfare:

'National Programme for the Health Care of Elderly" (NPHCE) launched during 2010-11 is State oriented program with the basic thrust to provide comprehensive and dedicated health care facilities t the elderly persons above 60 year of age at various level of primary, secondary and tertiary health care.

I Primary & Secondary Geriatric Care Services The program commenced with 100 districts in the 11 421 districts and in 2019-2020, 114 districts were additionally sanctioned to provide dedicated geriatric OPD, IPD, Physiotherapy and lab services. Presently all 713 Health districts have been sanctioned for geriatric primary & secondary care services of OPD, 10 bedded Geriatric Ward, Physiotherapy and laboratory services. period renamed as 'RashtriyaVaristh Jan Swasthya Yojana' in 2016-17. As on date, 19 Regional  Geriatric Centres (RGCs) in selected Medical Colleges of 18 States, are sanctioned for tertiary care service delivery under NPHCE in the form of specialized OPD$, 30 bedded wards in RGC including earmarking beds in various specialties like urology, orthopedics, ophthalmology etc, manpower development & research activities Presently OPD services are being provided through 18 RGCs, inpatient services in 16 RGC'$, Physiotherapy in 14 centers & laboratory services in 13 centers

Two National Centre for Ageing (NCA) has also been developed as centre of Excellence for Geriatric Care services. 200 bedded NCA at Madras Medical College, Chennai has been developed and operational for Covid ward and another NCA at AIIMS, New Delhi is in advance state of Construction OPD services are expected to initiate by October 2021. A 250 Bedded Geriatric Care and Rehabilitation Centre is sanctioned at PGI chandigarh:

(As per Progress Report- April to December, 2020)

| No   | Institutions                                          | Sanctioned   | Operational   | Operational   | Operational            | Operational         |
|------|-------------------------------------------------------|--------------|---------------|---------------|------------------------|---------------------|
| No   | Institutions                                          | Sanctioned   | OPD           | Indoor wards  | Physiotherapy services | Laboratory services |
| 1    | RGCs                                                  | 19           | 18            | 16            | 14                     | 13                  |
| 2    | District hospitals                                    | 718          | 584           | 507           | 445                    | 539                 |
| 3    | CHCs                                                  | 4869         | 3111          |               | 1131                   | 2408                |
| 4    | PHCs                                                  | 18407        | 10180         |               |                        |                     |
| 5    | SCs providing   home based care supportive appliances | 90719        | 14201         | 14201         | 14201                  | 14201               |

Daily Geriatric OPD services are being provided in 584 DH, 3111 CHCs and 10180 PHCs along with special OPDs in 18 507 DH, along with 16 RGCs. Physiotherapy services are being provided in 445 DH, 1131 CHCs with 14 services are being provided in 539 DHs, 2408 CHCs, with 13 RGCs. along along

## Geriatric care service provision in 2019-20

(As per Annual Progress Report- April 2019- March 2020)

| S_ N.   | Services                                    | RGCs   |   Distt. Hospitals |    CHCs | PHCs    | SCs     | Total       |
|---------|---------------------------------------------|--------|--------------------|---------|---------|---------|-------------|
|         | OPD care services                           | 133545 |            7567744 | 7016670 | 9032922 | 2843211 | 2,65,94,092 |
| 2       | In-door admissions                          | 9992   |             688966 |  269286 |         |         | 9,68,244    |
| 3       | Physiotherapy care                          | 34637  |             754186 |  744964 |         |         | 15,33,787   |
|         | Lab Tests                                   | 230749 |            4215883 | 2348922 | 2275600 |         | 90,71,154   |
| 5       | No of Elderly Screened & given Health card  |        |             599908 |  719021 | 526754  | 273850  | 21,19,533   |
| 6       | No of Elderly Provided Home care services   |        |              11157 |   92657 | 68674   | 68783   | 2,41,271    |
|         | No of   Elderly Provided supportive devices |        |               4820 |   18006 | 7256    | 17502   | 47,584      |
| 8       | Cases referred                              |        |              32017 |   59202 | 65057   | 64119   | 2,20,395    |
|         | Cases died in hospitals                     |        |              17026 |    2156 | 384     |         | 19,566      |

Overall 265 lakhs elderly have been provided OPD, 9.68 lakhs Indoor admissions, 15.33 lakhs Rehabilitation and 90.71 lakhs Leb. services respectively by all the operational District Hospitals and below.

- V Training Modules: Three sets of Training modules for Medical Officers, Nurses and Community based workers to deliver   Comprehensive Geriatric care has been developed. State   level   Training   of Trainers of  Medical Officers for   Comprehensive Geriatric Care has been conducted at Chhattisgarh, Meghalaya, Haryana, Punjab Tamil Nadu & Maharashtra generating approx 236 States level Master Trainers and 85 National Master\_Trainers: 27 for Medical Officer Module, 26 for Staff Nurses Module and 32 for module developed to train Community based workers
- VI NPHCE Website: An interactive and dynamic website cum MIS of the NPHCE program has been   initiated  through Center for Health Informatics   (CHI) to  provide comprehensive   information   along with data   regarding Geriatric   facilities  and services

VII: material-folder; posters etc. have been developed  The regional language version of IEC material is developed. https IInphce nhpgov in/video-spotl print being

## 3. MINISTRY OF FINANCE:

Ministry of Finance has launched a scheme namely Pradhan Mantri Vaya Vandana Yojana' (PMVVY) to provide social security during old age and to protect elderly persons 60 and above a future fall in their interest income due to uncertain market conditions The Scheme enables old age income security for senior citizens through provision of assured pension/ return linked to the subscription amount based on Government guarantee to Life Insurance Corporation of India (LIC) against aged

- 2 PMVVY is open for subscription upto March 2023 and offers an assured rate of return of annum for the year  2020-21 for   policy duration of 10 years. In subsequent years, while the Scheme is in operation full month 2023, there will be annual reset of assured rate of return with effect from April 1st of the financial year in line with applicable rate of return of Senior Citizens Saving Scheme (SCSS) upto a ceiling of 7.75% with fresh appraisal of the scheme on breach of this threshold at any 31st point.
- 4 The Scheme is being implemented through Life Insurance Corporation of India (LIC) total number of 5,83,208 subscribers are being benefited under the scheme December; 2020. 31st
3. The differential return; i.e. the difference between return generated by LIC and the on an  annual basis. Pension is payable at the end of each period during the policy tenure of 10 years aS per the as  chosen by the subscriber at the time of purchase. Minimum  purchase under the  scheme is Rs.  1,62,162/-  for a minimum is Rs. 15 lakh per senior citizen for getting a pension amount of Rs. 9,250/price price

## GST Rates on Elder Care Services:

The phrase "elder care services" has not been defined in GST as such, there are services which are related to care of elders: For instance Central Government; State Government or by an entity registered under section 12AA of the Income-tax Act; 1961 (43 of 1961) to its   residents   (aged 60   years or   more) against consideration upto twenty-five thousand rupees per month per member, provided that the consideration charged is inclusive of charges for boarding, lodging and maintenance" is exempt from GST vide S.No. 9D of notification No. 12/2017-CTR dated 28.06.2017.

- Few more services which may cover care of elders aS well are also exempt-
- Services provided by rehabilitation professionals recognised under the Rehabilitation Council of India Act; 1992 (34 of 1992) by way of rehabilitation; therapy or counselling and such other activity as covered by the said Act at medical establishments, educational institutions, rehabilitation centers established by Central Government; State Government or Union   territory or an entity registered under section 12AA of the Income-tax Act; 1961 (43 of 1961) vide S.No. 74A of notification No. 12/2017-CTR dated 28.06.2017.
- Health care services by a clinical establishment, an authorised medical practitioner or para-medics vide S.No. 74(a) of notification No. 12/2017-CTR dated 28.06.2017.

## MINISTRY OFHOUSINGANDURBAN AFFAIRS:

Ministry of Housing and Urban Affairs, Department of Urban Development has issued the Model  Building Bye Laws, 2016 (MBBL) prescribing standards for creation of elder friendly barrier free environment with reference to buildings, toilets etc Urban Local Bodies shall implement the Policy by adopting the Model Building Bye Laws, 2016. Further; under Urban Bus Specification-II issued in 2013, the emphasis on buses financed   by the Department of Urban Development is on procurement of floor buses with proper ramps for easy access of the passengers and proper space for wheelchair to be placed in the bus for the benefit of disabled persons and senior citizens: All metro rail projects implemented/under  implementation in the country are having disabled and elder friendly infrastructure such as proper rampsllifts to the stations. There is a provision for reservation of seats in metro rail coaches for differently-abled persons and senior citizens. Further; Housing for All Mission/Pradhan Mantri Awas Yojana Guidelines have been circulated to State{UTs to meet the demand of housing in their States/UTs, which interalia incorporates that while making the allotment, families with senior citizens should be given priority for allotment on ground floor or lower floors' . low

National Urban Livelihoods Mission (DAY-NULM) with the aim to reduce poverty andvulnerability of urban poor households on sustainable basis. The Mission; inter-alia, aims at phased manner under the component of Shelters for Urban Homeless, irrespective of age.

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