Building knowledge base on Population Ageing in India Working Paper: 7

Living Arrangements of Elderly in India

Policy and Programmatic Implications

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

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 Social and 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. Giridhar
Expert

Frederika Meijer
United Nations Population Fund (UNFPA), New Delhi

Moneer Alam
Institute of Economic Growth, Delhi

K.S. James
Institute for Social and Economic Change, Bangalore

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

Sanjay Kumar
United 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 a wider 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.

Living Arrangements of Elderly in India: Policy and Programmatic Implications

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

Institute for Social and Economic Change, Bangalore United Nations Population Fund, New Delhi Institute of Economic Growth, Delhi
September 2012

Living Arrangements of Elderly in India

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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Living Arrangements of Elderly in India

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 elderly spent 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 nonrelatives (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,

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

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 generation may 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 in activities of daily living tend to live in joint families rather than living alone or in nuclear families.

Living Arrangements of Elderly in India

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.

Objectives
The 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

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 NFHS6

4.1. Social and Demographic Aspects of the Elderly

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

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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Living Arrangements of Elderly in India

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 later ages, 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 similar over 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.

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

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

Living Arrangements of Elderly in India

The percent of the elderly who had studied more than primary school has increased threefold 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 about three 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 that not 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 living arrangements 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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K.M. Sathyanarayana, Sanjay Kumar and K.S. James

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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Living Arrangements of Elderly in India

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

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 in 2005-06 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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Living Arrangements of Elderly in India

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

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 socioeconomic 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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Living Arrangements of Elderly in India

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

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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Living Arrangements of Elderly in India

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

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Context of Changing Families, July 25-27, Bangkok, organised jointly by the United Nations Economic and Social Commission for Asia and the Pacific, United Nations Population Fund and United Nations Department of Economic and Social Affairs. Tyagi, R P (2010). Living Arrangement of the Older Persons in India: Pattern, Trends and Differentials. Paper presented in a Conference on Building Knowledge Base on Population Ageing in India, at Institute of Social and Economic Change, Bangalore, during August 31-September 01, 2010 (unpublished). United Nations. (2001). Living Arrangements of Older Persons, Population Bulletin of the United Nations Special Issue No. 42/43. United Nations (2005). Living Arrangement of Older Persons around the World, New York: United Nations (ST/ESA/STAT/SER.A/240).

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About the Project

The United Nations Population Fund - UNFPA supported project BUILDING KNOWLEDGE BASE ON POPULATION AGEING IN INDIA (IND7P41G) aims at contributing and further expanding the existing knowledge base on the emerging population dynamics in India which are resulting in the significant shifts in the age structure towards higher proportions of older persons aged 60 years and above. The project supports the preparation of a series of thematic studies using existing secondary data sources as well as the collection and analysis of new primary data. Dissemination of the findings to various stakeholders is a key objective of the project to help enhance the overall understanding of the situation of elderly in the country for further research and policy analysis on the growing numbers of Indias senior citizens. The project is a partnership between the Institute for Social and Economic Change (ISEC), Bangalore, the Institute of Economic Growth (IEG), Delhi and UNFPA, New Delhi More information on the project can be obtained from http://www.isec.ac.in/prc.html or www.iegindia.org or www.indiaunfpa.org The first phase of the project includes several commissioned papers prepared by experts using existing secondary data sources such as the National Sample Survey Organisation and the National Family Health Surveys. The second phase of the project involves an updated situation analysis through the collection of primary data from seven states in India which have relatively higher proportions of elderly. These are Himachal Pradesh, Kerala, Maharashtra, Odisha, Punjab, Tamil Nadu and West Bengal. The survey data includes socio-economic characteristics, Family dynamics, living arrangements, health and awareness of social security programmes of the elderly The papers prepared by experts in India under the project are listed on the back cover of the series of working papers. The project invites the readers to provide feedback.

About the Authors

K M Sathyanarayana is a National Programme Officer on Population and Development at the United Nations Population Fund (UNFPA) in India. He has over two decades of work experience in the development sector and has published and presented papers in several national and international conferences. His current area of interest includes population dynamics and development with a specific focus on emerging development issues. Sanjay Kumar is a National Programme Officer on Monitoring and Evaluation at the United Nations Population Fund (UNFPA) in India. He has over two decades of work experience in monitoring and evaluation of development projects besides working in the area of population and development interlinkages. He has written and published many articles in reputed journals. K S James is a professor and head of the Population Research Centre, Institute for Social and Economic Change, Bangalore. He works on issues relating to demography and health in India and has published extensively in national and international journals.

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 Implementation

S 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

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