Consider palliative care for the elderly as a right
Longterm care must enable their participation in cultural, economic and social life, with support for rehabilitation
Older persons face a number of problems in accessing long term palliative care (LTPC) and end of life care. There are few support services available for them in order to access quality and affordable palliative care as part of available LTPC facilities. In addition there are few mechanisms to redress their concerns related to abuse and violation of rights. An important human rights agenda is emerging: strengthening the provision for affordable and quality LTPC with an emphasis on home and community care, especially when life expectancies are increasing. This is particularly pertinent for older age groups, especially the 70 plus and 80 plus older people, whose number is the fastest growing and who need more LTPC. In India, according to the last census in 2011, the 70 plus population was 28,441,345 and the 80 plus 11,289,005. Further, the proportion of females is more in older age groups.
Family caregivers provide the bulk of LTPC. It is unpaid work and often the quality can be very patchy. In our country, formal and institutional LTPC facilities are few and expensive, unaffordable to most women. A majority of older women have limited or negligible social security benefits but greater morbidity and chronic health problems. An Agewell survey revealed that over 62% elderly didn’t get any LTPC care and one third of the elderly find LTPC services unaffordable. Approximately 29% older persons, deprived of long-term or palliative care, acknowledged that they need maintenance in old age, so that their basic needs can be met and they can lead a comfortable and peaceful life in old age. India needs to develop universal coverage to social protection in old age that will enable meeting health care costs in later years.
Long term care of the elderly should include care for enabling participation in cultural, economic and social life, fulfilment of their right to life of dignity as well as support for rehabilitation and prevention of old age problems. The National Health Policy 2017 seems promising with its specific mention of improving health status through concerted policy action in all sectors and expanding preventive, curative, palliative and rehabilitative services provided through the public health sector with the focus on quality. It is imperative that LTPC are made an important component of primary health care and be the responsibility of frontline health workers across the country. The National Programme for the Healthcare for the Elderly is a step in the right direction but much more remains to be done so that old age becomes a productive and fulfilling time for people.