Beyond loneliness: Keralam’s ambitious bet on ‘aging in place’ and the silver economy

Ghost town

By 2051, almost one in three people in Keralam will be a senior citizen. The PFI-IIMD study puts the number at 30.6%. In comparison, the India average will be 20.4%.

“Two shifts are causing this rapid demographic transition in the state: one, low fertility levels and two, longer life expectancy,” said S. Irudaya Rajan, chair, IIMD.

According to state government data, the total fertility rate of Keralam is just 1.5 children per woman, as against the replacement level (the average number of children per woman needed for a population to replace itself from one generation to the next) of 2.1 children. Life expectancy is also higher at 75.1 years compared to the India average of around 72 years.

What complicates the process for Keralam is its high level of migration, especially among the younger population. As per the 2023 Kerala Migration Survey, 2.2 million people have migrated to other countries and another 0.5 million have done so to other parts of India. This means senior citizens are left behind.

This is most obvious as one drives into Kumbanad, a wealthy town in the Pathanamthitta district. The town’s main thoroughfare is busy. What is striking is that for a town of just 8,000 people, there are 17 bank branches and many more finance companies. Turn into the inside streets and the reality becomes obvious. While the houses are large and tastefully constructed, they appear either unkempt or uninhabited.

“Senior citizens live alone in 50% of the houses,” explained Varghese Eapen, president, Koipuram Panchayat (Kumbanad is in this panchayat). “As many as 15% of the houses are locked,” he added. About 40% of the town’s population are senior citizens.

In the 1950s, Kumbanad trailed behind much of Keralam economically, yet its residents were exceptionally well educated thanks to the early presence of Christian missionaries. Armed with degrees but facing a barren local job market, generations were driven abroad. The initial wave migrated to Myanmar, Malaysia, Kenya, Sri Lanka and Uganda, before subsequent tides turned toward North America, Europe, Australia, and the booming Gulf economies of the 1970s. The resulting stream of remittances—evident in the town’s dense cluster of banks—fuelled a land rush and funded rows of palatial family homes.

But the younger generation abroad or in other Indian cities doesn’t intend to return.

“We are left to fend for ourselves,” said Varghese Jacob, 80, a retired brigadier in the Indian army. His elder son is in the US while a younger son is in the Indian navy and lives in Mumbai.

“I live with my wife now. My biggest concern is what will happen if one of us dies,” he said.

Most of Jacob’s senior neighbours have died; the children of those dead are selling their property. Such is the selling pressure that real estate prices in the area have crashed.

“An acre used to fetch ₹8 crore earlier. Today, it has fallen by more than 50%,” Jacob said.

Japanese model

The new Keralam government has adopted an ‘aging in place’ model that allows elderly citizens to live in their neighborhood and social environment rather than shift to an institutional facility or an oldage home. It is the Japanese model and Keralam is studying it closely.

“It is a good idea to look at Japan,” said Poonam Muttreja, executive director, PFI. “We can learn a lot from its community-based public longterm care insurance system, which links home, medical and social care.”

State government officials pointed out that they are also researching the policies of Denmark, Sweden, the UK and Germany.

The UDF government is readying a multi-pronged strategy. The first step will be a grassroot level survey to profile each senior citizen, their state of health, their needs (medical and otherwise) and the expertise they possess. “Once the data is ready, we plan to sit with experts and arrive at various policies,” Ratan U. Kelkar, secretary, department of elderly welfare, said.

The policies would focus on care management—bringing in certified programmes for caregivers to ensure a systemic approach to care giving. Treatment protocols would be defined and include all systems of medicine, not allopathy alone. Community care and independent living would be supported.

Most importantly, the data on the expertise senior citizens possess could be used to engage them economically. Not all senior citizens are unhealthy. Many of them lead an active life, Kelkar explained.

Some of the existing initiatives that are working well will be expanded too. This includes the call centres that tackle loneliness (they get as many as 1,000 calls a month); Pakalveedu (the plan is to have one of them in each ward); and the exclusive geriatric facilities at local public health centres.

A ‘Dementia Friendly Keralam’ initiative is being planned for memory screening of senior citizens.

The ‘time bank’

Elikulam, a town nestled among the rubber plantations of Kottayam district, has come up with an innovative idea. Called the ‘Time Bank’, it involves people volunteering to spend time with senior citizens and help them with their chores. For doing so, they get a credit which can be encashed in different ways.

The digital platform to implement the programme is almost ready. Once tested at Elikulam, it will be rolled out across the state.

“We are even looking at whether credits, in terms of marks, can be given,” Kelkar said. That should encourage students to participate.

“We want to drive this entire exercise through philanthropy and corporate social responsibility funds,” he explained.

Experts have praised Keralam’s efforts.

“The state deserves a shout out for recognizing aging as a major governance issue,” said PFI’s Muttreja. But not all agree with its approach.

IIMD’s Rajan feels that excessive focus on elderly care paints senior citizens as a burden. “Our focus should instead be on the silver economy,” he said. “The silver economy offers Keralam a second demographic dividend. Senior citizens are an asset, not a liability. We should empower them and make them productive,” he added.

He suggests creating an employment exchange for the elderly.

Lessons for India

Keralam’s efforts have important lessons for the rest of India. By 2051, one in five Indians will be above 60 years of age. India’s median age, which was 29 years in 2021, will be 40 by 2051. The working-age population will peak in 2031 and then start to decline. “All these will have significant implications in terms of healthcare, pension, and the overall care economy,” explained IIMD’s Rajan.

The government is beginning to act. Niti Aayog, the federal think tank, has proposed a national framework to standardize training, certify caregivers and provide social-security support. It has proposed a National Caregiving Council to provide institutional leadership and coordination. This is because the rising elderly population, which is set to touch 347 million by 2050, is likely to put unprecedented pressure on the existing care ecosystem.

A national policy, however, may not work everywhere. This is because the demographic transition is not uniform across India. Some states are aging faster while some, like Uttar Pradesh and Bihar, will remain young for a while. “A single national policy will not work. Policies will have to be tailored for each state,” Muttreja said. “Keralam is a bellwether state when it comes to these initiatives.”

Meanwhile, some states have taken a different approach. The Andhra Pradesh government recently announced incentives for having more children. Last week, the Tamil Nadu government announced one-year paid leave for employees having a third child.

“Tackling the demographic transition by increasing birth rates has not worked anywhere in the world,” Muttreja said. “The more effective way is to prepare for healthy aging like Keralam.”