Senior Citizen Policies: The Kerala Model

Welcome to all things policy, a daily podcast by the Taksashila institution. We are a bunch of policy nerds based in Bengaluru, and we like bringing fresh perspectives to Indian affairs and Indian perspectives to global affairs. So grab a cup of coffee, sit back and join us for today's chat. Hi and welcome to another episode of all things policy. I'm Malthy Renati from the Taksashila institution, and this would be the first in a series of episodes that I will be hosting on policies in India around senior citizens and active aging. And I would like to actually start with a state that got there before anyone else, and that would be Kerala. So before I introduce my guest, I would like to highlight, as in why I chose Kerala, because I think there are some very important data points that we need to know. So Kerala's population that's above 60, that's the senior citizens, as we call it, was 12.6% in the 2011 census. But by 2021, it had moved to 16.5. So the state's own 20, 26, 27 budget puts it at around 19% today, and the government projections have put it to around 23% by 2036. So nearly one in four residents in Kerala would kind of be at that with 60+ by 2036. So Kerala has had to answer, ahead of everyone else of other states in India, a question that every other state will eventually have to face. So what is the government focus on when a large and growing share of citizens are old and expected to remain active and present in public life for another two or three decades? So, but the most interesting, and this is what I would like us to also think about. Most interesting question isn't quite the numbers, but how we frame it. So most policies still talks about aging as, you know, person in decline, deteriorating health and dependency, but in this series, I wanted to kind of more focus on what changes if we frame it differently, right, as people living longer, living a more active life. So the next two or three decades that they stay active, that they keep contributing maybe to the economy, that they pass on skills and experiences that a younger workforce could benefit from, right? So the health system built around prevention rather than, you know, looking at only at the care aspect. So to help us work through this, I'm joined by Dr. Praveen Pai. He's trained in medicine at KMC Mangalore, then he completed his masters in gerontology at the University of Southampton, and Diploma in geriatrics from the UN International Institute on Aging and in Malta, and the masters in public health from Sreej, et cetera. And so he's got a lot of these degrees associated with his name, and he's the WHO's global networks designated focal point for age-friendly work in Kocchi. So for over a decade, he has led magics, which is an NGO whose center of excellence for developing age-friendly communities, communities rather, that's a C-DAC. It has been the technical partner behind all that work. And he also advises Kerala's social justice department on daycare and dementia programming. So Dr. Pai, welcome to all things policy episode. Thank you, Maldi. It's great to have you here. So before we get into policy, Dr. I just was curious to know that geriatrics isn't the part of medicine most people gravitate towards, you know, when they take up their. So what took you there? I mean, why did you focus on geriatrics? Well, basically, the quick business quite personal to start with, as you've kept it, what took me over there is in every family. It's a generation where I was born when our families had older people living with us. I had my grandmother living in my own house. So I lived in my grandmother, I knew what she wants, how to interact with her. It was not a trouble. It was not a problem for their generation at all. We didn't need any training to how to deal with older people or how to take care of them if something happens suddenly. So all this things didn't require any training. It was a basic life skill which we all had. So probably, that was a continuation during the medical school. I was in a gamesy mangroor where it had one floor there, a geriatric murder, that time. Geriatric is purely taking care of the medical part of aging, geriatric medicine. But rather, the whole science is called gerontology. Gerontology reduces the whole gamut of everything, you know, like politics, a political economy of its social work, sociology or anything. It's like the science of aging, gerontology and geriatric medicine forms a subset of that. But currently what happens is, we are all very much concentrated on geriatric medicine because many of the older people are sick. That's why we are having this. More non-communicable disease as well. Yeah, exactly. So, this is what brought me here. Okay. That's great, doctor. Yeah, thanks. I think, and this is a very important area that I think that you're also working on. And we'll be getting into the details of those, you know, even your injury has been contributing towards. But let's just for our listeners as well, I thought we'll focus our podcast on looking at maybe, let's use the union first, look at what the policies have been, you know, devised at the union level, then look at the state of Kerala, and then maybe you can touch upon the city structure. Okay. So that's how we'll work through this podcast conversation. So just to give a cursory glance at, look at the union policies, we'll start at the very top, right? Where is it mentioned in the constitution? So elder care is a state subject, but it also figures in the concurrent list. And so Article 41 of the Constitution directs the state to ensure that public assistance for citizens in their old age is provided. So that's how, that's where it's mentioned, you know, in the constitution. And over the decades, I just want to touch upon some landmark policies around this that were spelled out, I would say more guidelines that were put across at the union level. So first one was a national policy on older persons, and this came into being in 1991. It was revised later in 2011, but there's not much that was put in, but so the 1991 was in effect for like more than a decade. So here they established a framework of social, economic and health security and encouraged research and old age home development. So this was back in 1999, later on the maintenance and welfare of parents and senior citizens act came in, this was in 2007, and in this mandated that children or as provide for elderly parents, basically offering a legal safety net against neglect and abuse, because we started seeing more of that, you know, from the early 2000s, and so this particular act came into being. So any issue that, I mean, it could be reported, especially the abusers found more common among widowed and uneducated women. So this act came into being in 2007. And then in 2010, we had a national program for healthcare of the elderly. So the focus here was on preventive, curative and rehabilitative care through the public health centers and geriatric wards. And there's also an increase in dementia and so the focus was on dementia and chronic illnesses that arise from that. So this was in 2010, more recently in June 2025, the government and again at the union level, it drafted a national policy for senior citizens, NPSC. And it was focusing more on geriatric health care through the Aishman Barat type models, the financial and digital inclusion. So that came into the purview, a housing support for low income seniors. And the important bit was, which I found interesting was the intergenerational integration through productive aging. So now we're bringing back something that was part and parcel and doctor, you mentioned that as well, where we used to live and join families. And this was something that we used to see on a day-to-day basis. There was no top-down approach that was required, because families were catering to, you know, the other members in the household. But now we're having to actually bring in a policy which spells it out, saying the intergenerational integration, because of the nuclear families and now many migrating to cities and, you know, the challenges that come with it. And of course, India also has a range of savings and pension schemes from the senior citizen savings schemes to the PM schemes, as well as an interesting part, because to improve, to increase awareness, the elder line, which is a #14567, it's a toll-free number, #14567. And this is an online grievance portal that can sort of bridge the gap and, you know, and sort of share information to elders about different schemes that are available out there as well. Okay. So, is there anything here, doctor, that might have been missed out just for you to, if you would like to add on any other overarching policies that will highlight, you know, that you could highlight in the context of our conversation today? Malte, actually, you have highlighted or summarized almost all the policies and the things relevant pertinent. But at the same time, I would also like to take attention to international policy about the plan of action. Okay. That is one was in the 92, which was in Vienna, Vienna, plan of action, and then came 2002. It was a Madrid plan of action, 20 years down the lane. So, you had two plan of action. both had got significant difference between both and just highlight one of them one of them was the the Vienna plan of action was basically on welfare state concept welfare state concept in the sense you know care of older person was a responsibility of the state. And it was more on giving away more on charity more on welfare so it was welfare state concept but the whole world understood it was it didn't work out it took two decades to understand it didn't work out globally and then welfare state is not sustainable so it came yeah it came the matter plan international plan of action rewritten everything everything where older people are seen as resource persons you know they are not just 60 plus there's one category of elderly who are of no use on their towards end of their life with no purpose of life or to the community it's more of resource the wisdom has to be utilized there they have all potential to contribute actively to the community and also to the GDP also of the community and also to the culture and well being of the whole community so this was the change which happened two decades later between two international plan of action then India was also part of it and the I understand our first national policy was drawn basically based on Vienna plan of action not the metric plan of action so that was probably one reason the initial policies were focused more on welfare of older people and not the empowerment part because during that time the whole of India was younger than what it was now the longevity in India at the time of independence in 1947 was you won't believe 32 years and now the recent data around two years ago shows that it has reached on 70.8 so because of the longevity as well the policies also have to be have to evolve because in the past maybe we didn't have this old age problem because people were not living that long so and the other medical you know complications that might come with it but whereas now we because of the highest standards of living the fact that even there's more disposable income people are living longer and they can afford to also live more active life if they're not depending on people so I think that's an important shift that has happened over the last decade or so in India especially thanks doctor for mentioning about the international level policies as well because I think many times one does have to take a leaf off from the the book of other systems that have been working and then the guidelines are usually are something that can be implemented in a country and then of course you need to ensure that you are taking into consideration the local challenges that each country and each state also faces yeah so that's the floor I think that's that's what that's at a high level at the union level now Kerala started building on top of it earlier than most states so doctor I just wanted to understand from you what are those important policies that you know Kerala kind of put into effect a few decades ago and how do you see that panel okay we didn't redesign the country when the demographic changed we just kept building on blueprint drawn for a young nation this will be good you know this is where we are we are currently now before I start you know I want to reframe the question itself we keep calling this as an aging policy aging policy but I think in reality it's a design problem also how do we design a country for a longer life every time we frame this as an aging policy we quietly file it under the welfare the welfare department or social justice department even the policy is in India or in Kerala or anywhere to sever being built by the social welfare department or the social justice department something done for a smaller dependent group reframe it as a design question and it becomes a question about the whole country system it can be transport it can be housing it can be work employment or civic participation opportunity it can be health care it can be about communication that single shift in language will change the whole thing it changes who is responsible for the answer now we're looking for an answer so who is responsible for the answer and it stops being one department's job now it shouldn't be yes it's inter ministry it's an inter ministerial responsibility so India built all its institutions with this idea where you know India's retirement age pension structure even the layout of a typical government office everything was set with the configuration and the life expectancy as you said it is barely around 30 or 40 we have extended our life span dramatically since independence for 75 to 80 years but never went back to ask whether the institutions built for that early country will still make sense that is a question we have to ask ourselves and the policy makers who will actually revisit the policies when I say it's a design it's not a slogan but I literally mean it I literally mean if we go around in a city does a bus stop has a bench in many of the bus stop it has a big rod still rod on which we sit it was made in a way that nobody should lie on it nobody should sleep a bus waiting stop you know in a bus stop so there were intentions are different but is it actually required so do we have a bench in a city does a city have enough place to sit between two point is there any shade where they can stand in a sunny day but say hospital queue account for somebody who can't stand for 30-40 minutes or one hour in some of the temples or in some of the churches here in Kerala I don't know in the first of the country but there are the queue system has changed queue is a sitting queue you go throughout end to end queue you don't have to stand at all you can just sit and so similar things has to come so everyone of those is a design decision which has to be made by default for a younger body so this is what we have been thinking over the decades in Kerala so the real question is and it is not just adding life to the I mean adding years to the life you know as always we say when the longevity think it's not longevity it's survival ship it is surviving we are surviving till around 70 years or 80 years but adding life to years it's not that easy but medicine has done it's part very very very you know adding a day's to life is not something very difficult now but the harder one and the more interesting question is adding life keeping people more functionally capable socially connected and economically relevant also that's also very very important to be economically relevant as long as possible so this is the background in which Kerala had been going through over the past decades it's not just because welfare does infested most of the older people are not actually requiring charity or welfare there is a huge population in Kerala who are otherwise independent who are otherwise financially stable but their needs are different so this is where we are yeah no no interesting doctor I'm glad you raised those those points because I think the way any policies looked at and we need to ensure that the current context is also brought into effect so if not we will be trying to fix for a problem that's that's or the problem statement itself is incorrect right so the solution nationally won't be aligned to what's required so that also brings me to to want us to kind of maybe look at the document that the current state has released right there's a draft Kerala state policy for elder persons that was released in 2025 it's been out put out for public consultation but what does it actually do and does it address I mean we have a slew of schemes and programs that usually come out when a policy is you know becomes is in place but how effective are those in does this policy that the Kerala state has put out does it sort of address some of the underlying issues that we've seen over the last maybe a few years well I would say one difference one major difference in the latest policy would be it has been evidence-based it has taken numbers from many national studies and studies which was relevant to Kerala and then in Kerala the most important was a longitudinal aging survey of India and Laasi it is one of the most important studies in India Laasi and the Laasi data and the study reports have been actually considered for the policy making in Kerala that is one important thing which has been done and second important thing which Kerala policy has taken into consideration considering the functional capacity of older people as an indicator or as I qualify for any of the schemes or whatever it is though when it comes to social welfare department activity it is mainly for the marginalized or like that. But the policy has also considered functional capability as an important indicator. I mean they have actually the latest action plan is not ready now. It is ready. The draft has been given to the government. But I doubt it is in the public domain now. But I can quickly, I can just put a point because I also also part of it. But most important changes they have divided older people into four different categories. Not based on age, which was there earlier. Earlier we all used to say young old old old old and all those stuff. It is actually very much age stick, which should not be used at all. We just used throughout for decades, but in care, now we are looking into functional capacity or intrinsic capacity. We are divided into four. The first category is the bed bound. Bed bound require more of palliation and different type of care. There are whatever financial background you may be. But one category is bed bound. Second is home bound. Third one is older people with chronic diseases and who are in borderline. And the fourth category is the independent and somebody who don't have much illness going around very happily whatever the age may be. So age is not the criteria, but functional ability becomes the criteria. I would say this is the, these two things would be the most important differentiator, which Kerala has taken. These are very crucial to it. It reminds me, in fact, of even for PWD, when we have para sports events that are conducted in the past, it used to be on a different category. But now they look at the functional aspect and that's brought in before the category. So I think that's a major shift and it's a required shift. So thanks, doctor, for that. So I mean, Kerala can't be compared to most Indian states on the fiscal capacity or literacy, right? Because they're way ahead in terms of literacy as well. And that's one of the reasons why some of the policies are very local and they work also effectively locally. But would there be anything that you would like to highlight that could be transferable to other states, you know, any ideas or thoughts? Yeah, okay. And now I remember your previous question to me was also somewhere, which I didn't properly answer probably, you know, it was on what change was there in Kerala, what changed in Kerala, what actually changed in Kerala and how we are standing. So let me tell you one is migration. Every welfare scheme had this quiet assumption which was baked in it that there is somebody, some adult or somebody nearby to receive the pension book or escort someone to the hospital or notice if something is wrong. That was an assumption, but when that assumption fails, the schemes doesn't fail loudly, but it just quite least stops any scheme because there is no care given nearby this actually happened in Kerala. So we we've seen elderly beneficiaries technically enrolled in every scheme they qualify for and still isolated. They are eligible for a ration, but unless and until somebody get them the ration at home or somebody who can cook for them, it doesn't work out. So there is an entitlement for nutrition or there is an entitlement for pension or whatever, still they remain isolated because enrollment isn't same as someone showing up. At last my last, this was one thing. So again long before any government acted, the gap actually got filled informally to be very frank in Kerala. That is where we have a very good grassroots connectivity. We have a fabric in the grassroots which are mainly by the Asha and the Kudumbachvi. Kudumbachvi is a self-help group which is very well established in Kerala. Every division, every work has got a lot of Kudumbachvi workers or Kudumbachvi activists who are Asha workers are there. They are all trained. That is one important thing. Long before any government department or any department could act, the gap was filled, the gap which I earlier mentioned. A neighbor who checks in every morning, somebody is alone at home. A Kudumbachvi worker who does more than her job description is what we are seeing. Her job description. She is trained also, right? She is trained to know what they are doing. Every almost all of the Kudumbachvi workers, when a woman gets trained in a household, the whole house gets improved. Now, when the women in the household is also responsible in the community or is given respect in the community, when she has a voice in the community, it is more than her job description. She takes it very seriously. That is a nature. It is a feminine gender also working out there. Where care is important. So, the Kudumbachvi worker or the Asha worker, who is becoming a defective family here. That is a very important differentiator. Very crucial. Very crucial. Kerala's real safety net was assembled from the ground up approach. So, that is a real safety net. The first thing would be the household. The first one is a household. Whoever the primary care giver is, they have to be aware about all this. They should have some awareness on what is going to happen next. What to anticipate or what next in dementia is very difficult to handle now. So, what is going to happen tomorrow? That anticipation has to be there. And at the same time, you need somebody to help also. So, the primary would be the household. The family is not a forced one. Nobody has forced somebody with an MWPSC act or some other illegal system where somebody will police and tell you it is your responsibility to take care of the person. Further, in Kerala, what has happened is we have empowered and we have given more freedom and awareness to caregivers who can take care of their older people wherever possible. And whenever it is not possible, Kerala has a wonderful network of our share and good machinery and other NGOs including the palliative care network which is extremely huge. It is very huge. Every person, every individual has an access to palliative care in Kerala. So, the remoteest tribal family, there is palliative care accessibility. So, every palliative care I have a trained person is also trained in taking care of older people who is actually a bit bound or a homebound. So, that is what we just say. So, the de facto family system had worked. So, that is the first safety net. So, it starts with the household, the first safety net outside is a neighborhood. And again, from the community, the Punjayat or the municipality, the second level of support comes in. State comes beyond them. That is why it should be a bottom approach always in age care. It cannot be a policy, a national policy or a superbly written state policy cannot do anything in the grassroots. Unless you may have something in the grassroots. Yes. Very true, Dr. Anand. I am glad you mentioned this also because it touches upon the very fact that the social fabric itself, right, people should be sensitized to the fact that now we have different demographics and we are living together. How do we ensure that it is a healthy neighborhood? That we are kind of watching each other's back. And that is the most sustainable because in the long run, whether it is a small community or there is a city that remains healthy and active, is one that is growing and thriving as well. In fact, this is where I would like to segue sort of maybe into how Koti has been as a city has acted upon this. And it is a clearest case of policy becoming more, where you see the physical infrastructure also catering to it. So, Koti is an age-friendly city. It has also been identified by the WHO. It is the first city in India. In fact, the second only to WHO is in the Southeast Asia region. I believe after a city in Sri Lanka to join this network. So, it looks at the WHO also looks at different domains, eight in particular, like from the walking footpaths, you know, the right curb height. Like, as you mentioned, even the bus stops ensuring the bus stops are functional, mapping public toilets, testing whether things like bank forms and hospital signage is legible for someone with low vision and someone, you know, who is older. So, maybe throw some light on how Koti has figured this out because it is eventually a local, you know, something that locally you need to device solutions for rather than at the top down as you had mentioned. So, could you please throw some light on this? Actually, global network for Asian cities and communities of World Health Organization, it gives a good framework where it clearly says it's not just a health or welfare, which is most important, but they are important. But at the same time, there are seven other domains also, as you mentioned, the transport housing and all those. So, what is more interesting than the, it's not a certification though, it's a membership. So, whatever we say, it's more interesting than the membership is how it happened. It wasn't just a government we decided. Or, it was a coalition. It was walking through WHO's four step process together over years, over institutions. each institution bringing different kind of authority on the table. So, everything we learned over the process, we are documented rigorously, that became more longevity-ready, careless, reference series, then that's what happened initially. So, there was a consensus throughout in the city where age friendliness is not just providing welfare and charity, it's much more than that. So, we could actually lobby and get all the NGOs together, the Indian Medical Association, the Geeliatic Society of India, and several NGOs, including ours. You know, we all could come together and meet the mayor of Kuchee and describe to him, where very readily, not only the mayor, the whole counsellors were agreeable. You know, they all understood, this is really needed. But we won't be able to be absolutely the same, which has been prescribed by WTO, because the roads are already been built, the buildings are already being built, there is already a structure here. So, the most important thing is the commitment. So, what made Kuchee and Cori Kodan all the age friendliness different from other cities is, there is a commitment from the local self-government. There is a commitment that in coming years or whatever anything we do, we will also consider all these eight domains, which are important. So, that commitment was the first thing which happened. So, it was a coalition. And now, you know, we are not deliberately extending that beyond the cities. You know, it's not only cities, we had a recent discussion with the WTO officials. So, we understood, it's not just the smart cities or cities which has to take up this idea. So, Kerala is not, you cannot divide into urban and rural Kerala. Most of the Kerala is semi-urban or either urban. So, we are now deliberately extending that beyond cities. We are now many panchayafs and principalities have been given the cup. So, now, we are deliberately extending all our service and the idea beyond the cities. Because Kerala cannot be divided into urban and rural very strictly. And within urban cities and semi-urban, it's not possible. Kerala is either urban or semi-urban. There is no rural Kerala very little. So, now, there are many principalities and panchayafs who are giving their commitment. There are more than 12 cities and communities. Panchayafs and principalities now, who has given the commitment and very soon will join the global network. So, Kerala in another few months, we will have at least 10 or 15 communities like Kocchi. So, that is not, so aging is not just a city thing all over. Thanks, thanks, doctor. I think that's a wonderful example of how city like Kocchi has kind of devised its own way of addressing this. And I think this is where each city has to figure out. Because, like you mentioned, sometimes the physical infrastructure is already in place. So, how do we then modify that or redesign it? The times when you can't just break something down and build it up from scratch, right? It's not feasible, it's not practical. So, one has to also look at the society, how it can integrate and make that change. It should not just be by the infrastructure alone, but it should also be the people who are using it. So, just before we close, I'll hand it over to your doctor for the final thoughts. I'd like to just sum up some of the key takeaways of the Kerala model that we learnt in this conversation. Just also for the interest of those who are listening in, and then those who might want to kind of implement this for their respective states as well. First things first is that we need to keep in mind that the one thing that every other state should take from Kerala is that we don't wait for that old age question to be forced upon us, right, from a policy angle. That's one good, one first thing that we need to keep in mind. And some of the guiding principles that it comes down to and there are five ideas that are just like lists. The first is to start planning, planning both the financial and in terms of skills as well, well before the old age kind of arrives and not after. Second is that treating aging as a continued growth and not as a winding down phase. So, this again can contribute towards the economy, towards GDP as you mentioned also doctor. So, I think keeping that in mind, so framing off it as active and aging and not so much in the deterioration. Building, the third would be building health policies around prevention and palliative care together and not one instead of the other. The fourth would be to make a pension and insurance. We didn't touch upon it, but that's something that maybe in future episodes I would like to bring in when we look at the markets. He's on the insurance, looking at insurance as more universal rather than only one starts aging. And to apply an equity lens so that we reach out to the vulnerable first, you know, when we're thinking about this. So, I'm the ground that would essentially translate to screening for chronic diseases from your maybe mid-30s and not wait till you're much older. So, you can catch things early and then you can kind of readjust your lifestyle and the way you kind of approach your day-to-day. K-givers who are trained and certified, that's going to be important. We have financial tools like reverse mortgages, maybe real support from family members, already doing unpaired care work. That's what it might translate to on the ground. There's urban planning. We touched upon it like things from housing, transportation, digital systems built for people who move and see things differently at that age. And of course, a legal protection that might will have to be looked into because when we have abuse and other things that we hear about. So, these are some things that it translates to on the ground. But Dr. Any closing thoughts that you have? So, the first thing, which I would say none of what Kerala has done can simply be lifted or dropped into another state. This is one important thing which I wish. So, Kerala model is good. We have a Kerala model, but Kerala model cannot be replicated as such. The programs and projects which have been carrying on in Kerala cannot be implemented in most of the states. But the logic behind it, the underlying design logic can be transferred. What actually transfers is the design logic and how it happened. Not the specific program and the this thing which you can see in the social welfare, the social justice website, there are a lot of projects available. So, that is one thing. That is the most important thing which I would say. Next would be neighborhood first. What I was always telling the bottom-up approach. The first principle is sequencing any state or any community. The principle of sequencing is very important. The neighborhood has to be the first in line of response. Most policy design currently run on the opposite direction. It is the programs and projects first. We design a program because we find a problem in the community. So, we try to solve it. But now we had to do a root cause analysis now. Do a root cause analysis and see what caused that problem. Not the solution for the problem. So, firefighting is important. We had to fight. We had to fight the fire. No doubt about it. It is most important. But at the same time, we had to sit down, put our foot down and say ask ourselves what caused it. How can we mitigate it. So, this is one. So, the second principle would be the principle of sequencing where neighborhood should come first. Then the third one would be that the aging literacy shouldn't be limited to families currently caring for the older people. That is where the firefighting happens. Actually, when somebody becomes cognitively impaired or with dementia, suddenly we start training the caregivers or giving them more information on managing caregivers stress and not. But it doesn't work that way. So, by the time you are already in that situation, you are already reacting to a crisis of anticipating it. So, this should sit alongside basic health literacy as something everyone carries. Then another one, you are already told but I would reiterate it again like aging is a continuum. It doesn't start at a particular point of 60 years or 65 years. Aging starts very long back. Even the latest understanding is aging starts from a healthy mother. A healthy mother gives birth to a healthy child and the healthy child is aging over years. So, something was 80 years today. If he or she is very healthy, then just means his or her mother had a somewhat healthy practice during their younger age. That's what. So, aging is a continuum and it is not an issue. Many a times we in policy lines or policy discussion, we use the terminology as an issue. It shouldn't or we shouldn't be calling it as an issue at all. Aging is not an issue. It only reads as a crisis because policy was never rebuilt for the new demography. We built it 80 years back. We started building it 80 years back and we are building over it. So, that is another thing and continuing to that. Again, aging isn't uniform. When we say it's a policy for a state or a district, it is not in some pockets in Kerala, you know in Tiruvilla or Patanthi, in that area, some pockets already have almost 25 to 30 percent of their population above 66-65 years, while there are several other states where they are demographically very young, if you see the Northeastern states and they are even young, so a single central scheme sized for a national average will be wrong for almost everyone, at every point, so it has to be bottom-up approach and it should be individualized, that is another one, and not every person over 60 is elderly, that word elderly, the terminology elderly is globally being classified as being ageist, so in many of our literature, if you write elderly, they will return it, they will return it, ask us to rewrite it, give it, the term elderly is ageist, so we should not be using the world elderly, putting all the people who are above a particular age in one basket or one box, so that is one thing in the welfare state, so again another one would be the gender lens, in the same continuum, a gender lens is good, but after an age when biology declines when the human biology declines, then gender lens has to be very different, we don't have much time to discuss all those, but I'll just put one point, an 80-year-old man who is having some cognitive impairment, living alone, who don't have much support, who doesn't have any skills in his life, maybe because of his previous ages, he don't know to cook probably, he don't know to take care of himself, so that is a minority, so gender lens has to be redefined in our community, and in the generation also in similar layer, like older people who have been taking care of older people now, if you say 60-plus is older, somebody who is 80-plus, their caregiver is going to be 60-plus, most often, so now generation also has to be taught, so these are the summary things which I would take up, and to close, if you ask me what are the recommendations quickly, you know, 3 or 4, you'll say if there is one line, I want policy makers to live with, it is this, you know, don't try to copy Kerala, as I told first, copy the process that let Kerala design its own, so whenever we say Kerala model, take what is the starting point and what the process was, this is number one recommendation which I would say, as a georologist, with 20 years of experience, going through many states in India, secondly, concretely, that start with shifting the whole policy frame from pensions and welfare to what WHO would call as intrinsic capacity, pensions and welfare is required, I'm not against it, it should be there, it's a right, but WHO calls for intrinsic capacity, actively screening for and catching functional decline very, very early, early detection of functional decline, because in older age above 60 or 70, once there is a functional decline, it is non-negotiable, you will never be able to regain it, any functional decline is decline for life, so if we miss that opportunity, it's a missed opportunity for life for that person, so that is a human right, that should be considered as a human right or social justice, so social justice gets redefined as there right or justice to get access to early detection, but they don't know, who has to do it, so state policy or the community policy has to give access to all these early detection and all, so last elder abuse, which I think I forgot to mention care in our discussion, but the last thing I would insist on naming directly is that elder abuse needs to be understood as a governance failure, MWPSE Act, which Malati you had described earlier, also we had to link with this, what I'm saying now, elder abuse needs to be understood as a governance failure, not simply a private family shame that has to be quietly managed, the whole policy or the MWPSE Act put all the burden over the legal hair of the property or the wealth of their birth, so that is what the whole direction goes to it, there is a state's responsibility also in being built, I'm not saying it's not there, but still there is a governance failure also, that reframing is what puts it on the state's accountability ledger, you know with reporting and response system should be there, instead of leaving it entirely inside a family and then later on some reconciliation will be there and close the case, so elder abuse the cause for elder abuse also has to be identified, again a design problem, so this is what I had to tell, that's great, I think unfortunately we are running out of time, but the very fact that what kind of resonates from what you've told me as well is that the policy is a design problem that comes into effect and each state has to figure out what design works for them. So thank you so much, thank you so much Dr. Prye for your time, it is wonderful having this conversation. Thank you very much, thanks a lot for giving this opportunity, thanks a lot, thanks Dr, and for all our listeners, thank you and till next time this is all things policy and I'll talk to you later.