Health Policy and Programmes Related to Old People

Healthy ageing is defined by WHO as developing and maintaining the functional ability that enables well-being in older age. Pathy’s states that functional ability — retaining autonomy and independence — is the cornerstone of healthy ageing.

Intrinsic capacity is the composite of all physical and mental capacities. Pathy’s lists its domains as cognition, mental health, sensory function, metabolic/vitality, mobility and muscle strength.

Pathy’s notes the WHO Global Strategy and Action Plan on Ageing and Health, whose goals are to create age-friendly environments, align national health systems with the needs of older people, and support research to monitor global ageing.

Historical UK policy: the NHS was created in 1948 with a tripartite structure (hospitals, GP services, local authority services), free at the point of use. Pathy’s criticises it for poor coordination between the three arms and a smaller share of funds for chronic and mental health services.

UK National Service Framework (NSF) for Older People, 2001: its Standard One was “rooting out age discrimination.” Pathy’s stresses that ageism persists, causing older people to be denied beneficial investigations and treatments, and warns against both therapeutic nihilism and therapeutic heroism.

US programmes (Essentials, Ch. 15): Medicare Part A (hospital) and Part B (medical); Medicaid (means-tested, main payer for nursing homes); Title XX Social Services Block Grants; and Title III of the Older Americans Act (congregate meals and meals-on-wheels for all persons >60 years regardless of income). Payment by DRGs works against geriatric goals as it focuses on a single diagnosis.

Constitutional basis: Article 41 (Directive Principle) directs the State to provide public assistance in old age, sickness and disablement; Article 46 protects weaker sections. Ageing is a Concurrent/State subject, so States must frame their own action plans.

National Policy on Older Persons (NPOP), 1999 — India’s first ageing policy. Five thrust areas: income security, health and nutrition, shelter, education, and welfare/empowerment. It proposed a National Council for Older Persons. Goal: the well-being of older persons by strengthening their legitimate place in society so they can live with purpose, dignity and peace.

NPOP 1999 was revised in 2011 as the National Policy on Senior Citizens (NPSrC), which emphasised “ageing in place,” the 80+ “old-old,” and elderly women. Exam point: NPSrC 2011 remains a draft and has never been formally notified.

Maintenance and Welfare of Parents and Senior Citizens (MWPSC) Act, 2007 is the key legislation, making maintenance of parents by children a legal obligation. State governments constitute Maintenance Tribunals presided over by an administrative officer; maintenance may not exceed ₹10,000 per month.

Other key MWPSC provisions: disposal within 90 days; abandonment is punishable (up to 3 months imprisonment and/or fine); transfer of property by gift/deed can be declared void if the transferee fails to provide basic amenities; Chapter IV mandates medical care — separate queues, beds and expanded facilities for chronic, terminal and degenerative disease.

The MWPSC (Amendment) Bill, 2019 proposes to widen the definitions of “children,” “parents,” “maintenance” and “welfare,” to allow priority disposal for those above 80 years, and to remove the ₹10,000 ceiling. It was referred to a Standing Committee and is still pending.

The National Programme for the Health Care of the Elderly (NPHCE) was launched by MoHFW in 2010, based on the recommendations of NPOP and the State’s obligation under the MWPSC Act 2007. It is also an articulation of India’s commitment under the UNCRPD, aiming at accessible, affordable, long-term comprehensive care and the promotion of Active and Healthy Ageing.

NPHCE service ladder (memorise): Sub-centre — health education, domiciliary visits by ANM/ASHA; PHC — weekly geriatric clinic, basic drugs, rehabilitation guidance; CHC — twice-weekly clinic, physiotherapy unit, referral; District Hospital — 10-bedded geriatric ward and dedicated OPD; Regional Geriatric Centre — tertiary care, 30-bedded ward, PG training.

The tertiary component was renamed “Rashtriya Varisth Jan Swasthya Yojana” in 2016–17, delivered through Regional Geriatric Centres in 19 medical colleges across 18 states, plus two National Centres of Ageing — AIIMS New Delhi and Madras Medical College, Chennai.

NPHCE is a centrally sponsored scheme (75% Central : 25% State), now implemented under the National Health Mission NCD flexi-pool. Its eight components are preventive/promotive, primary, secondary, tertiary, home-based care, referral, human-resource development and IEC.

Atal Vayo Abhyuday Yojana (AVYAY) — Ministry of Social Justice & Empowerment. Components: IPSrC (grants to NGOs for old-age and continuous-care homes), SAPSrC (State Action Plan), Rashtriya Vayoshri Yojana (RVY), SCOPE and SAGE (Seniorcare Ageing Growth Engine).

RVY provides free assisted-living devices (spectacles, hearing aids, dentures, walking sticks, wheelchairs, walkers) to seniors who are BPL or have monthly income up to ₹15,000; devices are made by ALIMCO and given through camps. Elderline (14567) is the national toll-free helpline for information, guidance, emotional support and field intervention in elder abuse and rescue.

Financial and social security: IGNOAPS (₹200/month for 60–79; ₹500/month for 80+, central share), SCSS, PMVVY, Atal Pension Yojana, Senior Citizens’ Welfare Fund, income-tax relief under Sec 80D and 80TTB, and rail/air travel concessions.

Health insurance: Ayushman Bharat has two pillars — Ayushman Arogya Mandir (formerly HWCs) for comprehensive primary care with population-based NCD screening from age 30 using the CBAC form, and PM-JAY giving ₹5 lakh per family per year for secondary and tertiary hospitalisation.

Ayushman Vay Vandana Card — the single biggest Indian policy change (October 2024). Launched 29 October 2024 under AB PM-JAY, it gives ₹5 lakh of free annual health cover to every citizen aged 70 years and above, irrespective of income, with no waiting period for pre-existing conditions. Seniors aged 70+ already in a PM-JAY family receive an additional ₹5 lakh top-up for themselves. It covers about 1,961 procedures across 27 specialties including dialysis, knee and hip replacement and cancer care; enrolment is via the Ayushman App with Aadhaar e-KYC. 9.67 million cards issued by 31 December 2025. (NHA, 2024; MoHFW Lok Sabha reply, 2026)

WHO ICOPE Handbook, 2nd edition (January 2025). Shifts from a disease-oriented to a holistic approach focused on intrinsic capacity and functional ability, detailing four steps — basic assessment, in-depth assessment, personalised care plan, implementation/monitoring — screening six domains: cognition, mobility, vitality, vision, hearing and psychological capacity, with a new urinary incontinence care pathway. (WHO, 2025)

UN Decade of Healthy Ageing (2021–2030) — mid-decade progress. Four action areas: combating ageism, age-friendly environments, integrated care, long-term care. The first progress report (November 2023, 136 countries) found a >20% rise in countries with anti-ageism legislation and age-friendly city programmes, but fewer than one-third of countries have adequate resources; only 1 in 4 have sufficient resources for integrated care and 1 in 3 for long-term care, and only 16% of low-income countries have training programmes for informal caregivers. (WHO, 2023; WHO, Oct 2024)

NITI Aayog — “Senior Care Reforms in India” (February 2024). Groups interventions under four core areas: Health, Social, Economic/Financial and Digital empowerment and inclusion. Recommends health literacy for seniors and caregivers, extending primary care through AB-HWCs, expanding home health care, mental health services and Poshan Abhiyan for seniors, amending the MWPSC Act to cover abuse and harassment, elderly-friendly housing reforms, a national portal for senior care, formal recognition of the care economy and care workers, and a regulatory base interest rate on senior citizen deposits. (NITI Aayog, 2024)

India Ageing Report 2023 (UNFPA–IIPS). 60+ share rises from 10.5% (2022) to 20.8% (2050) — 149 million to 347 million; elderly outnumber children by 2046; 80+ grows 279%; >40% of the elderly are in the poorest wealth quintile and 18.7% have no income; 71% live in rural areas. (UNFPA India, 2023)

Research infrastructure. The Longitudinal Ageing Study in India (LASI) under NPHCE, Wave-1 (2017–18), covered 30 states and 6 UTs, 72,250 adults aged 45+, including 31,464 persons aged 60 and above. (IIPS/MoHFW, 2020)

“India’s ageing policy rests on three pillars: a policy (NPOP 1999), a law (MWPSC Act 2007) and a programme (NPHCE 2010) — the second and third both flow directly from the first.”

“The Ayushman Vay Vandana Card of October 2024 is India’s first universal, age-based rather than means-tested health entitlement.”

“The National Policy for Senior Citizens 2011 was drafted but never notified; India therefore still operates on a policy written in 1999.”

“Delivery is fragmented across at least five ministries — MoHFW, MoSJE, MoRD, Labour and Finance — with no single accountable authority.”

“Pathy’s gives the ethical and conceptual framework; the Government of India documents give the delivery architecture. A complete answer needs both.”

Article 41 is the constitutional anchor — quote it in every policy answer.

MWPSC Act: ₹10,000 cap • 90 days • abandonment punishable • property transfer void • Chapter IV = medical care.

NPHCE bed numbers: District Hospital 10 (of which 2 respite); Regional Geriatric Centre 30.

Two National Centres for Ageing: AIIMS New Delhi and Madras Medical College Chennai.

Elderline = 14567 (MoSJE). RVY income ceiling = ₹15,000/month. Devices made by ALIMCO.

Four action areas of the UN Decade: ageism • age-friendly environments • integrated care • long-term care.