Long‐term care in India: Capacity, need and future
The family is the dominant player in India’s current long‐term care (LTC) system. Yet informal family‐based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the el...
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| Veröffentlicht in: | International social security review (English edition) Jg. 75; H. 3-4; S. 167 - 186 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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Geneva
Blackwell Publishing Ltd
01.07.2022
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| ISSN: | 0020-871X, 1468-246X |
| Online-Zugang: | Volltext |
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| Abstract | The family is the dominant player in India’s current long‐term care (LTC) system. Yet informal family‐based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non‐familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross‐state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC.
Actuellement, la famille est l’actrice principale du système de soins de longue durée en Inde. Néanmoins, les dispositifs familiaux informels ne suffiront pas à répondre aux besoins croissants en Inde en matière de soins de longue durée, en raison de la longévité croissante et de la mobilité géographique de la population, de la prévalence des maladies chroniques et du handicap chez les personnes âgées, sans compter que la famille élargie vit de moins en moins ensemble. Répondre au besoin croissant en soins de longue durée nécessitera une expansion vigoureuse du système actuel, en particulier en ce qui concerne ses composantes non familiales. Cette réforme nécessitera des investissements dans les infrastructures, les ressources humaines ainsi que le cadre légal et réglementaire. Les objectifs de cette étude sont les suivants: i) fournir un résumé descriptif et une analyse du système de soins de longue durée en Inde, en prêtant attention à l’hétérogénéité entre les états ainsi qu’aux facteurs financiers, sociaux et culturels qui entravent le bon fonctionnement du système; ii) estimer et évaluer les besoins actuels et futurs en la matière, ainsi que leurs contributions humaines et financières essentielles; mais aussi iii) mener une analyse et une discussion critiques sur les institutions et les politiques, les technologies et les comportements nécessaires pour que les capacités soient largement conformes aux besoins en soins de longue durée.
Actualmente, la familia ocupa un lugar central en el actual sistema de cuidados de larga duración de la India. Sin embargo, los arreglos familiares informales no serán suficientes para dar respuesta a las necesidades cada vez mayores de la India en materia de cuidados de larga duración debido al aumento de la longevidad y la movilidad geográfica, la prevalencia de las enfermedades crónicas, la discapacidad entre las personas de edad avanzada y el hecho de que los miembros de la familia extensa viven cada vez menos juntos. Para hacer frente a la creciente demanda de cuidados de larga duración, será necesario mejorar de forma significativa el actual sistema de cuidados de larga duración, sobre todo sus componentes no familiares. Esta reforma precisará inversiones en infraestructuras, recursos humanos y marcos jurídicos y reguladores. El estudio tiene los siguientes objetivos: i) proporcionar un resumen y un análisis descriptivos del sistema de cuidados de larga duración de la India en los que se preste especial atención a la heterogeneidad interestatal y a los factores financieros, sociales y culturales que obstaculizan el funcionamiento de este sistema; ii) calcular y evaluar las necesidades actuales y futuras de cuidados de larga duración y sus contribuciones financieras y humanas fundamentales; y iii) analizar y debatir, desde una perspectiva crítica, las instituciones y las políticas, las tecnologías y los comportamientos necesarios para ajustar la capacidad a las necesidades de cuidados de larga duración.
Die Familie ist der dominierende Akteur in Indiens derzeitigem Langzeitpflegesystem. Dennoch werden informelle Familienmodelle nicht ausreichen, um den wachsenden Bedarf an Langzeitpflege in Indien zu decken, da Lebenserwartung und geografische Mobilität zunehmen, chronische Krankheiten und Behinderungen unter älteren Menschen weit verbreitet und die Lebensgemeinschaft der Großfamilie rückläufig sind. Um dem wachsenden Bedarf an Langzeitpflege gerecht zu werden, muss das derzeitige Langzeitpflegesystem, insbesondere seine außerfamiliären Komponenten, deutlich ausgebaut werden. Diese Überarbeitung wird Investitionen in die Infrastruktur, die Humanressourcen und die rechtlichen und ordnungspolitischen Rahmenbedingungen erfordern. Die Ziele dieser Studie sind i) eine deskriptive Zusammenfassung und Analyse des indischen Langzeitpflegesystems unter Berücksichtigung der Heterogenität zwischen den Bundesstaaten sowie der finanziellen, sozialen und kulturellen Faktoren, die das Funktionieren des indischen Langzeitpflegesystems behindern; ii) den gegenwärtigen und künftigen Langzeitpflegebedarf sowie seinen kritischen finanziellen und personellen Aufwand abzuschätzen und zu bewerten sowie iii) die Institutionen und Politiken, Technologien und Verhaltensweisen kritisch zu analysieren und zu erörtern, die erforderlich sind, um die Kapazitäten bequem mit dem Bedarf an Langzeitpflege in Einklang zu bringen.
Семья — доминирующий субъект в нынешней системе долговременного ухода (ДУ) в Индии. В условиях увеличения продолжительности жизни и географической мобильности, роста количества хронических заболеваний и случаев инвалидности среди пожилых людей, а также в условиях ухудшения уровня жизни многодетных семей реализации только модели семейного ухода будет недостаточно в Индии. Удовлетворение растущей потребности в ДУ потребует активного расширения существующей системы ДУ, особенно её несемейного компонента. Эта реформа потребует вложений в инфраструктуру, человеческие ресурсы и развития законодательства. Задачи данного исследования: i) привести краткое описание и анализ системы ДУ в Индии, уделив внимание внутригосударственной неоднородности, а также финансовым, социальным и культурным факторам, которые препятствуют функционированию системы ДУ в Индии; ii) дать приблизительную оценку и прогноз для текущих и будущих потребностей в ДУ, а также для наиболее важных финансовых и человеческих вложений; iii) критически проанализировать и обсудить учреждения, политику, технологии и модели поведения, необходимые для органичного приведения потенциала в соответствие с потребностями в ДУ.
在印度目前的长期照护体系中, 家庭是主要参与方。但由于寿命不断延长, 地域流动性加大, 老年人慢性病和残疾情况更加普遍, 以及大家庭生活安排减少, 基于家庭的非正规安排将不足以满足印度日益增长的长期照护需求。为了应对日益增长的长期照护需求, 需要大力扩展目前的长期照护体系, 特别是非家庭部分。这种改革需要对基础设施、人力资源以及法律和监管环境进行投资。本研究的目标是:i) 对印度的长期照护体系进行描述性总结分析, 关注跨州差异性以及阻碍印度长期照护体系运转的财政、社会和文化因素；ii) 估计和评估当前和未来对长期照护的需求及关键的财政和人力投入；以及iii) 批判性分析并讨论所需的体制、政策、技术和行为, 使能力更宜适应长期照护需求。
الأسرة هي الطرف المهيمن في نظام الرعاية طويلة الأمد الحالي في الهند. ومع ذلك، فإن الترتيبات العائلية غير الرسمية لن تكون كافية لاستيعاب حاجة الهند المتزايدة للرعاية طويلة الأمد بسبب زيادة طول العمر والتنقل الجغرافي، وانتشار الأمراض المزمنة والعجز بين كبار السن، وتدهور أنماط حياة الأسرة الممتدة. وستتطلب تلبية الحاجة المتزايدة للرعاية طويلة الأمد توسعًا قويًا في نظام الرعاية طويلة الأمد الحالي، وخاصة مكوناته غير العائلية. وسيتطلب هذا الإصلاح استثمارات في البنية التحتية والموارد البشرية والبيئات القانونية والتنظيمية. وتتمثل أهداف هذه الدراسة في: 1) تقديم ملخص وصفي وتحليل لنظام الرعاية طويلة الأمد في الهند، مع الانتباه إلى عدم التجانس عبر الولايات والعوامل المالية والاجتماعية والثقافية التي تعيق عمل نظام الرعاية طويلة الأمد في الهند؛ 2) وتقدير وتقييم الحاجة الحالية والمستقبلية للرعاية طويلة الأمد ومدخلاتها المالية والبشرية الهامة؛ 3) وإجراء تحاليل ومناقشات بشأن المؤسسات والسياسات والتكنولوجيات والسلوكيات اللازمة لجعل القدرات متوافقة بشكل مريح مع الحاجة إلى رعاية طويلة الأمد.
A família é o protagonista dominante no sistema atual de cuidados de longa duração (LTC) na Índia. No entanto, os programas de ação informais, de base familiar, serão insuficientes para acomodar a crescente necessidade de LTC na Índia, em razão do aumento da longevidade e da mobilidade geográfica, da prevalência de doenças crônicas e da incapacidade física entre os idosos e do declínio das disposições de vida da família estendidas a esta condição. Atender à crescente necessidade de LTC exigirá uma expansão considerável do atual sistema de LTC, em especial de seus componentes fora do âmbito familiar. Essa reformulação exigirá investimentos em infraestrutura, recursos humanos e ambientes legais e regulatórios. Os objetivos desta análise são i) propiciar um resumo descritivo e uma análise do sistema de LTC na Índia, com atenção à heterogeneidade entre os diferentes estados e aos fatores financeiros, sociais e culturais que impedem o funcionamento do sistema de LTC na Índia; ii) estimar e avaliar a necessidade atual e futura de LTC e de seus insumos financeiros e humanos essenciais e iii) analisar e discutir de maneira crítica as instituições e políticas, tecnologias e comportamentos necessários para propiciar uma capacidade satisfatória conforme a necessidade de LTC. |
|---|---|
| AbstractList | The family is the dominant player in India’s current long‐term care (LTC) system. Yet informal family‐based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non‐familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross‐state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC. The family is the dominant player in India’s current long‐term care (LTC) system. Yet informal family‐based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non‐familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross‐state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC. Actuellement, la famille est l’actrice principale du système de soins de longue durée en Inde. Néanmoins, les dispositifs familiaux informels ne suffiront pas à répondre aux besoins croissants en Inde en matière de soins de longue durée, en raison de la longévité croissante et de la mobilité géographique de la population, de la prévalence des maladies chroniques et du handicap chez les personnes âgées, sans compter que la famille élargie vit de moins en moins ensemble. Répondre au besoin croissant en soins de longue durée nécessitera une expansion vigoureuse du système actuel, en particulier en ce qui concerne ses composantes non familiales. Cette réforme nécessitera des investissements dans les infrastructures, les ressources humaines ainsi que le cadre légal et réglementaire. Les objectifs de cette étude sont les suivants: i) fournir un résumé descriptif et une analyse du système de soins de longue durée en Inde, en prêtant attention à l’hétérogénéité entre les états ainsi qu’aux facteurs financiers, sociaux et culturels qui entravent le bon fonctionnement du système; ii) estimer et évaluer les besoins actuels et futurs en la matière, ainsi que leurs contributions humaines et financières essentielles; mais aussi iii) mener une analyse et une discussion critiques sur les institutions et les politiques, les technologies et les comportements nécessaires pour que les capacités soient largement conformes aux besoins en soins de longue durée. Actualmente, la familia ocupa un lugar central en el actual sistema de cuidados de larga duración de la India. Sin embargo, los arreglos familiares informales no serán suficientes para dar respuesta a las necesidades cada vez mayores de la India en materia de cuidados de larga duración debido al aumento de la longevidad y la movilidad geográfica, la prevalencia de las enfermedades crónicas, la discapacidad entre las personas de edad avanzada y el hecho de que los miembros de la familia extensa viven cada vez menos juntos. Para hacer frente a la creciente demanda de cuidados de larga duración, será necesario mejorar de forma significativa el actual sistema de cuidados de larga duración, sobre todo sus componentes no familiares. Esta reforma precisará inversiones en infraestructuras, recursos humanos y marcos jurídicos y reguladores. El estudio tiene los siguientes objetivos: i) proporcionar un resumen y un análisis descriptivos del sistema de cuidados de larga duración de la India en los que se preste especial atención a la heterogeneidad interestatal y a los factores financieros, sociales y culturales que obstaculizan el funcionamiento de este sistema; ii) calcular y evaluar las necesidades actuales y futuras de cuidados de larga duración y sus contribuciones financieras y humanas fundamentales; y iii) analizar y debatir, desde una perspectiva crítica, las instituciones y las políticas, las tecnologías y los comportamientos necesarios para ajustar la capacidad a las necesidades de cuidados de larga duración. Die Familie ist der dominierende Akteur in Indiens derzeitigem Langzeitpflegesystem. Dennoch werden informelle Familienmodelle nicht ausreichen, um den wachsenden Bedarf an Langzeitpflege in Indien zu decken, da Lebenserwartung und geografische Mobilität zunehmen, chronische Krankheiten und Behinderungen unter älteren Menschen weit verbreitet und die Lebensgemeinschaft der Großfamilie rückläufig sind. Um dem wachsenden Bedarf an Langzeitpflege gerecht zu werden, muss das derzeitige Langzeitpflegesystem, insbesondere seine außerfamiliären Komponenten, deutlich ausgebaut werden. Diese Überarbeitung wird Investitionen in die Infrastruktur, die Humanressourcen und die rechtlichen und ordnungspolitischen Rahmenbedingungen erfordern. Die Ziele dieser Studie sind i) eine deskriptive Zusammenfassung und Analyse des indischen Langzeitpflegesystems unter Berücksichtigung der Heterogenität zwischen den Bundesstaaten sowie der finanziellen, sozialen und kulturellen Faktoren, die das Funktionieren des indischen Langzeitpflegesystems behindern; ii) den gegenwärtigen und künftigen Langzeitpflegebedarf sowie seinen kritischen finanziellen und personellen Aufwand abzuschätzen und zu bewerten sowie iii) die Institutionen und Politiken, Technologien und Verhaltensweisen kritisch zu analysieren und zu erörtern, die erforderlich sind, um die Kapazitäten bequem mit dem Bedarf an Langzeitpflege in Einklang zu bringen. Семья — доминирующий субъект в нынешней системе долговременного ухода (ДУ) в Индии. В условиях увеличения продолжительности жизни и географической мобильности, роста количества хронических заболеваний и случаев инвалидности среди пожилых людей, а также в условиях ухудшения уровня жизни многодетных семей реализации только модели семейного ухода будет недостаточно в Индии. Удовлетворение растущей потребности в ДУ потребует активного расширения существующей системы ДУ, особенно её несемейного компонента. Эта реформа потребует вложений в инфраструктуру, человеческие ресурсы и развития законодательства. Задачи данного исследования: i) привести краткое описание и анализ системы ДУ в Индии, уделив внимание внутригосударственной неоднородности, а также финансовым, социальным и культурным факторам, которые препятствуют функционированию системы ДУ в Индии; ii) дать приблизительную оценку и прогноз для текущих и будущих потребностей в ДУ, а также для наиболее важных финансовых и человеческих вложений; iii) критически проанализировать и обсудить учреждения, политику, технологии и модели поведения, необходимые для органичного приведения потенциала в соответствие с потребностями в ДУ. 在印度目前的长期照护体系中, 家庭是主要参与方。但由于寿命不断延长, 地域流动性加大, 老年人慢性病和残疾情况更加普遍, 以及大家庭生活安排减少, 基于家庭的非正规安排将不足以满足印度日益增长的长期照护需求。为了应对日益增长的长期照护需求, 需要大力扩展目前的长期照护体系, 特别是非家庭部分。这种改革需要对基础设施、人力资源以及法律和监管环境进行投资。本研究的目标是:i) 对印度的长期照护体系进行描述性总结分析, 关注跨州差异性以及阻碍印度长期照护体系运转的财政、社会和文化因素；ii) 估计和评估当前和未来对长期照护的需求及关键的财政和人力投入；以及iii) 批判性分析并讨论所需的体制、政策、技术和行为, 使能力更宜适应长期照护需求。 الأسرة هي الطرف المهيمن في نظام الرعاية طويلة الأمد الحالي في الهند. ومع ذلك، فإن الترتيبات العائلية غير الرسمية لن تكون كافية لاستيعاب حاجة الهند المتزايدة للرعاية طويلة الأمد بسبب زيادة طول العمر والتنقل الجغرافي، وانتشار الأمراض المزمنة والعجز بين كبار السن، وتدهور أنماط حياة الأسرة الممتدة. وستتطلب تلبية الحاجة المتزايدة للرعاية طويلة الأمد توسعًا قويًا في نظام الرعاية طويلة الأمد الحالي، وخاصة مكوناته غير العائلية. وسيتطلب هذا الإصلاح استثمارات في البنية التحتية والموارد البشرية والبيئات القانونية والتنظيمية. وتتمثل أهداف هذه الدراسة في: 1) تقديم ملخص وصفي وتحليل لنظام الرعاية طويلة الأمد في الهند، مع الانتباه إلى عدم التجانس عبر الولايات والعوامل المالية والاجتماعية والثقافية التي تعيق عمل نظام الرعاية طويلة الأمد في الهند؛ 2) وتقدير وتقييم الحاجة الحالية والمستقبلية للرعاية طويلة الأمد ومدخلاتها المالية والبشرية الهامة؛ 3) وإجراء تحاليل ومناقشات بشأن المؤسسات والسياسات والتكنولوجيات والسلوكيات اللازمة لجعل القدرات متوافقة بشكل مريح مع الحاجة إلى رعاية طويلة الأمد. A família é o protagonista dominante no sistema atual de cuidados de longa duração (LTC) na Índia. No entanto, os programas de ação informais, de base familiar, serão insuficientes para acomodar a crescente necessidade de LTC na Índia, em razão do aumento da longevidade e da mobilidade geográfica, da prevalência de doenças crônicas e da incapacidade física entre os idosos e do declínio das disposições de vida da família estendidas a esta condição. Atender à crescente necessidade de LTC exigirá uma expansão considerável do atual sistema de LTC, em especial de seus componentes fora do âmbito familiar. Essa reformulação exigirá investimentos em infraestrutura, recursos humanos e ambientes legais e regulatórios. Os objetivos desta análise são i) propiciar um resumo descritivo e uma análise do sistema de LTC na Índia, com atenção à heterogeneidade entre os diferentes estados e aos fatores financeiros, sociais e culturais que impedem o funcionamento do sistema de LTC na Índia; ii) estimar e avaliar a necessidade atual e futura de LTC e de seus insumos financeiros e humanos essenciais e iii) analisar e discutir de maneira crítica as instituições e políticas, tecnologias e comportamentos necessários para propiciar uma capacidade satisfatória conforme a necessidade de LTC. |
| Author | Bloom, David E. Agarwal, Arunika |
| Author_xml | – sequence: 1 givenname: Arunika surname: Agarwal fullname: Agarwal, Arunika organization: Harvard T. H. Chan School of Public Health – sequence: 2 givenname: David E. surname: Bloom fullname: Bloom, David E. email: dbloom@hsph.harvard.edu organization: Harvard T. H. Chan School of Public Health |
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| Notes | The authors thank Dr Rainer Kotschy for thoughtful comments and suggestions on the manuscript. The authors were supported by Harvard’s Social Technology for Global Aging Research Initiative, funded by the Jiangsu Industrial Technology Research Institute, China; and were also funded by NIA/NIH grants to Harvard University (Longitudinal Aging Study in India – 5R01AG042778 and Program on the Global Demography of Aging – P30AG024409). ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 |
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