Friday, May 18, 2018

Where the elderly are vulnerable to abuse

Where the elderly are vulnerable to abuse

A strong rights­based mechanism providing comprehensive support to victims is required

Recent studies, research by HelpAge India and Agewell Foundation, the recently published book Elder Abuse and Neglect in India, to name a few, indicate the increasing number of elder abuse and neglect cases. These numbers are likely to grow with an expanding elderly population.
Elder abuse and neglect, which was until a few years ago seen as a developed world phenomenon, is now visible in developing countries, including in India, where family care and reverence for the elderly is supposed to the norm. Elder abuse is an unacceptable attack on human dignity and human rights. Ignoring the rights of older people makes the senior citizens vulnerable to the risk of abuse, neglect, exploitation and marginalisation.
The World Health Organization (WHO) statistics reveal that around 4-6% of older people experience some form of maltreatment at home, with the numbers being much more in institutional settings. But, there is also acknowledgement by gerontologists and care workers for the aged that elder abuse is often unreported and under- recognised. WHO, in 2002, offered the most consensual definition of elder abuse, being used in many parts of the world since then: “A single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.”
In India, a universal definition of elder abuse and neglect is missing, but in general those working with in this field classify elder abuse in five broad categories: physical, emotional or psychological, financial or exploitation, neglect, and sexual abuse. It refers to actions against elders perpetrated by someone who is trusted. Frequently, besides these five, abandonment, isolation, intimidation, fiduciary abuse, extortion, unreasonable confinement, active versus passive neglect and coercion are also identified as forms of elder abuse.
Across the world ,it is now recognised that while efforts to address elder abuse and neglect are increasing and more resources are being used towards a societal response to combat it, the realities of a rapidly growing older population, along with prevailing attendant ageism, individualism and breakdown of traditional support systems suggest that older adults will continue to be at risk of being abused and neglected, and potentially at younger ages than in previous generations.
With feminisation of ageing, older women are living longer than men and also sex ratios favouring older women, happening in many countries, including India, puts women are at a greater risk of abuse. Especially ageing widows and frail, disabled older people are at a greater risk to abuse and neglect not only by family members but also by non-family members and unknown people. Widows becoming victims of property grabbing and abandonment is common despite various laws to them.
Initially research on elder abuse and neglect by family members indicated caregiver stress as the cause for the problem, but recent studies reveal many other characteristics of the perpetrators, such as mental health and behavioural problems, drug abuse, family disputes, intimate partner abuse, etc. With regard to non-family abusers, untrained and unscrupulous caregivers, financial exploiters and petty criminals are being recognised as people of whom older people have to be careful. At the community level, prevailing ageism is seen to devalue and exploit older people leading to their abuse in various situations and circumstances.
We need effective preventive strategies to reduce the risk to abuse, and strong laws and policies to address these concerns. In the 21st century, many positive developments in different countries have led to the formulation of legislation to protect older people from abuse. But, despite the rights-based perspective in legal reforms, rights-based action in implementing measures is missing. Most national legal systems stipulate punishment for the perpetrators of elder abuse, but have no adequate legal instruments to detect and report abuse of different forms and, more important, to rehabilitate the victims. Many legislative measures deal with maintenance from family members as a recourse to tackle the problem but do not call for inclusive policies for the elderly or for creating enabling environments for older people.
Significantly, when older people report a case of abuse against them by their children, legal recourse helps in getting a monetary sum from the children for meeting daily financial needs, but overlooks their consequent state of loneliness, lack of available caregivers, threat of emotional insecurity, depression, etc.
Rights-based mechanisms to provide comprehensive support to victims of abuse and neglect are missing from a national action plan. The State’s responsibility to combat elder abuse in ageing societies is not only imperative but also pertinent to older people being able to exercise their right to a life of dignity and respect. Mala Kapur Shankardass, a sociologist, and gerontologist, is associate professor, Maitreyi College, University of Delhi

The views expressed are personal

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Comprehensive procedure, guidelines and check list for empanelment of private hospitals – Railway Order

Comprehensive procedure, guidelines and check list for empanelment of private hospitals – Railway Order
New Delhi, dated 25.4.2018
The General Managers,
All Indian Railways & Production Units,
Sub: Comprehensive procedure, guidelines and check list for empanelment of private hospitals.
Ref:- SER’s letter no.CMD/SER/Hosp. Tie-up/2303 Dated 14.11.2017.
PCMD/SER vide their letter under reference had sought necessary guidelines to be followed while empanelling private hospitals in consequence of powers delegated to the GMs for empanelment of private hospitals vide Railway Board letter no. 2017/Trans/01/Policy dated 18/10/17 and to the DRM’s for divisions and CWMs for workshops vide letter no.2017/Trans/01/Policy/Pt 1 dated 30/11/17. Such powers are to be exercised by the delegated officers in person and shall not be delegated below. Hence now no proposal for empanelment is required to be sent to Railway Board.
A comprehensive guideline for procedure and checklist to be followed while empanelling private hospitals are being issued as per Annexure enclosed. Any new guidelines issued from MoH & FW as and when issued shall be duly incorporated and advised.
This is in surprise of all earlier guidelines issued from Railway Board on this subject.
This issues with the concurrence of the Finance Directorate of the Ministry of Railways.

(Mrs. H.K. Sanhotra)
Joint Director-II/Health
Railway Board
Comprehensive Procedure Guideline & Check List
For Empanelment of Private Hospitals
The empanelled hospitals have been broadly categorised into two groups:-
A. CGHS / E$l / ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL, BHEL, Coal India, etc.
B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI nor are run by Government of India Public Sector Unit. (PSU).
The following guide lines and check list are to be kept in consideration while empanelling hospitals by Railways. The point common to both these types of hospitals are given below:-
1. Justification for the proposal mentioning the present status of Railway Hospital i.e. number of Doctors & Paramedical on roll vis. a vis. sanctioned strength, services provided by it, any future plan for expansion, no. of Honorary Consultants/Visiting Specialists (specialty wise) & CMPs and despite existing facilities why referral services are still required.
2. Justification for empanelment with technical aspect i.e. number of beds / facilities/specialties/services offered/medical set up etc. at the proposed hospital.
3. Total number of Railway beneficiaries catered by the Railway Hospital.
4. In the Specialties Specialties for which Railway hospital do not have facilities if there are any reputed Government Hospitals rendering services in those specialties.
5. In CGHS covered states/cities, hospitals should be empanelled only at CGHS rates (in case of Government of India, PSU hospital their own rate) or even lower or some discount etc offered by them. Names of the hospital empanelled by CGHS / ECHS /ESI can be obtained from respective website. Even in places not covered by CGHS, all out efforts should be made to empanel hospital on CGHS (city-specific) rates only. In case of any deviation from CGHS rates, justification to be given by MD / CMS / CMO in charge, duly concurred by Associate Finance before being approved by Competent Authority.
6. Comparative statement of package rates as well as diagnostic charges of the proposed hospital with (i) other empanelled hospitals in the city and (ii) the CGHS rates of that city or the nearest city in tabulated form.
7. Two copies of rate list of hospital duly verified by competent authority. After approval, one copy along with sanction letter to be sent to HQ for uploading on Zonal website.
8. Concurrence of the Associate Finance as applicable along with their verbatim comments
9. Proposal to be sent for approval of GM /DG (RDSO) /DRM /CAO /CWM as the case may be (both for the first time and as well as further renewals).
10. Validity of empanelment will be two years or till it is empanelled or revoked by CGHS / ECHS /.ESI whichever is earlier and for Government of India PSU hospitals too it will be for two years, Same for non CGHS / ECHS / ESI hospitals too. Overall performance of the hospital, patient’s feedback etc. to be kept in mind while extension
11. Further extension may be done with mutual consent of both parties, arid will be sanctioned by GM /DG (RDSO) /DRM /CAO /CWM as the case may be (also see para A((a) & B(d)).
A. CGHS / ESI/ ECHS empanelled hospitals and Government of India / Public Sector Undertaking hospitals like of SAIL’ 3HEL, Coal India, etc. –
(a) In case of CGHS / ECHS / ESI empanelled & Government of India/PSU run hospitals, a letter of willingness from the hospital be obtained and can be empanelled any time Rates as and when revised by CGHS can be agreed to.
B. Other private hospitals which are neither empanelled by CGHS, ECHS & ESI
a) An open advertisement should be floated once a year or as per requirement for empanelment of private hospitals.
b) Empanelment of such hospitals should be considered only if there is no other CGHS/ ECHS / ESI nor any hospital run by Government of India – Public Sector Undertaking like SAIL, BHEL, Coal India etc. empanelled hospital, preferably within a vicinity of 5kms from the hospital already empanelled.
c) Search committee should be constituted by MD / CMS / CMO, consisting of 3 doctors of at least JAG level and they may co-opt another doctor of particular speciality when required. They will visit the hospitals and give clear justification for approving this hospital.
d) For any increase in rates, at the time of extension same should be justified by MD/CMS/CMO and concurred by Associated Finance and accepted by the concerned competent authority. If such increase in rates is more than 5%, the proposal duly justified by medical in charge and vetted by associate finance and approval of DRM /CWM in case of Division and workshops to be sent to Headquarters for sanction of General Manger. In case of headquarter controlled Central hospitals and Pus, General Manager / DG*(RDSO) will approve such proposals. However, no enhancement in rate is permissible during that period of recognition of two years..

The recently-notified Finance Act 2018, which is applicable from 1st April 2018, has done away with exemption for transport allowance and medical reimbursement for salaried employees. How will you get impacted now? By: Sanjeev Sinha May 18, 2018  11:27

The recently-notified Finance Act 2018, which is applicable from 1st April 2018, has done away with exemption for transport allowance and medical reimbursement for salaried employees. How will you get impacted now?
By: Sanjeev Sinha  May 18, 2018  11:27

Tax experts say that employers need to understand the mechanism of tax deduction at source while providing the benefit of standard deduction to the employees.
If you are a salaried employee working in any organisation, then most probably you would have by now received a mail from your HR department that with the recent changes in the Finance Act, both medical reimbursement and transport allowance have become taxable with effect from 1st April 2018, and accordingly, both these allowances have been merged with your special allowance. This has left many employees wondering, will they now have to pay tax on these two allowances? If yes, then what about standard deduction? Has this already been taken into account by their employers while computing taxes or will they have to claim the tax so deducted by filing their income tax return?

However, before knowing the impact of these changes on you and your salary income, let us first take a look at what has changed.

What has changed?

According to tax experts, the recently-notified Finance Act 2018, which is applicable from 1st April 2018, has done away with exemption for transport allowance and medical reimbursement for salaried employees. In lieu of these, a standard deduction of Rs 40,000 has been introduced.

What does this mean?

Up to the preceding financial year (FY), an employee was allowed to structure his/her salary for claiming exemption for transport allowance of Rs 1,600 per month (Rs 19,200 per annum) and a medical expense reimbursement of Rs 15,000 per annum by selecting these components in the salary structuring sheet. Further, to claim medical reimbursement as non-taxable benefit, the employee had to submit original medical bills as proof to the HR department.

However, “with the introduction of amendments made in the Finance Act, 2018, transport allowance and medical reimbursement exemption are no more available. Hence, an employee would no longer be able to select these components as part of his/her salary structure,” says Akhil Chandna, Director, Grant Thornton India LLP.


Now a total of Rs 34,200 (i.e. Rs 19,200 and Rs 15,000) would be added to the special allowance component of the employee. This amount would be paid to the employee on monthly basis after deduction of applicable taxes.

“It should, however, be noted that while computing the payroll taxes, standard deduction of Rs 40,000, which has been introduced from FY 2018-19, would be given effect for. Hence, it will provide a relief of income up to Rs 5,800 per annum,” says Chandna.

Thus, it is wrong to believe that employers will deduct taxes on these two allowances now, which may have to be claimed later by the employees.

In fact, “the introduction of standard deduction has provided the salaried class additional benefit in tax by reducing their taxable income by Rs 5,800 besides reducing administrative hassles in maintaining documentary records to claim medical reimbursements,” says Ashok Shah, Partner, N.A. Shah Associates LLP.

What is more, differently-abled employees can claim both standard deduction of Rs 40,000 as well as transport allowance of Rs 38,400.

Organisations implement new provisions

These new provisions have already been implemented by most organisations across the country. For instance, Edelman India has merged these two allowances into the special allowance as, it says, retaining them without any corresponding tax benefits may create confusion in the minds of its employees. And the tax impact of the same has been fully offset by the standard deduction which has been brought back into the Finance Act.

As a result of this, there is no action requir

Thursday, May 17, 2018

The Illness Within-Courtesy Indian Express 14.05.2018

The Illness Within

Doctors, barring exceptions, are complicit in the commercialisation of healthcare.

Written by Sanjay Nagral | Updated: May 14, 2018 1:05:56 am
pm narendra modi, parliament, budget session 2018, rajya sabha, lok sabha adjourned, bjp govt, indian expressModi was of course playing to the gallery in London, but there was a design to his comment about doctors. (Express photo/Praveen Jain)
Prime Minister Narendra Modi’s recent remark in London about unethical practices by Indian doctors has predictably raised the hackles amongst the medical community. Even an organisation known to curry favour with the powers that be, like the Indian Medical Association (IMA wrote a congratulatory letter to the Union home minister on the action against JNU students), wrote an unusually strident letter accusing PM Modi making frivolous remarks in a “foreign” country. Studied commentary, like Shah Alam Khan in these columns, attempted to say it was state policies more than doctor behaviour that was responsible for the mess Indian healthcare is in. The truth lies in between.
Modi was of course playing to the gallery in London, but there was a design to his comment about doctors. Over the past few years, sensing the growing discontent amongst citizens about healthcare practices, Modi has been increasingly taking a public stand on issues like the high cost of drugs and stents. He has also used them in the electoral arena. He even wrongly claimed credit for bringing down the costs of implants when it was a Delhi-based lawyer, Birender Sangwan, who fought a long battle with regulatory authorities — a PIL filed by him in the Delhi High Court finally led to price capping.
Much of this is in keeping with Modi’s style. But if one temporarily overlooks the intentions and populism in his approach and critically examines the role of doctors in the current crisis in healthcare in India, what is the reality? Are doctors mere innocent bystanders? Are they pawns in a larger game?
As someone who has witnessed the changes of the last few decades, it is obvious to me that large sections of the medical profession in India have blindly welcomed marketisation with open arms. They have willingly got entangled with the market by investing in hospitals, starting healthcare companies, participating in dubious clinical trials and colluding with managements in implementing many questionable trade practices. When it comes to drugs, many doctors prescribe costlier brands when cheaper generics are available. There has been no large-scale opposition from bodies including the IMA to corrupt practices including doctors’s involvement in kickbacks, irrational prescription of drugs and private medical colleges. The Medical Council of India, on the debris of which the National Medical Commission is being built, was for long led by a clique of doctors, many of whom were office-bearers of the IMA.
Thus, it is disingenuous for us to put the ball entirely in the government’s court. We have to reflect why things have come to this pass that when the prime minister makes a casual remark about questionable practices of doctors, it strikes a chord with the citizens. The medical community will need to be self-critical and introspective, without being protective of our colleagues’ misdeeds, to gain the credibility to expose the doublespeak of governments. It is true politicians often accuse doctors of playing footsie with corporates, pharmaceuticals and private medical colleges, but this is nothing new. Also, we will need to display courage and decry medical professionals who have joined the hate brigade. Many years ago, when some of us lodged a complaint in the Gujarat Medical Council against then VHP leader Pravin Togadia, a practising oncosurgeon, for his role in the communal riots, many professionals, including the IMA, refused to support it. In fact, doctors are often found fawning over local political satraps during inaugural functions in medical conferences.
If the PM Modi is being superfluous, let us as professionals trained in critical analysis go beyond posturing in our response. Agreed, there has been a colossal state failure in the delivery of healthcare in independent India. But there is also a huge conspiracy of silence, even collusion, that the medical profession is guilty of. Are we willing to think independently of state power, remove cobwebs of the medicine market and assert the primacy of our patients’ interests and ally with the rising number of courageous individuals, who while facing personal tragedies are taking on some of the bad practices of Indian healthcare? After all, the health of ordinary people is too important an issue to be left to the PM.
The writer, a Mumbai-based surgeon, is chairperson, Indian Forum for Medical Ethics

Eligibility of permanently disabled unmarried son of a CGHS beneficiary to avail CGHS facility

Eligibility of Permanently Disabled Unmarried Son of a CGHS Beneficiary to avail CGHS facility
Ministry of Health & Family Welfare
Department of Health & Family Welfare
EHS Section
Nirman Bhawan, New Delhi
Dated: the 7th May, 2018
Subject: Eligibility of Permanently Disabled Unmarried Son of a CGHS Beneficiary to avail CGHS facility – Reg.
The undersigned is directed to refer to this Ministry’s Office Memoranda of even number dated 31.05.2007, 29.08.2007 and 02.08.2010 vide which the entitlement of the son of a CGHS beneficiary beyond the age of 25 years was conveyed. As per the two Office Memoranda under reference, it was indicated that an unmarried son of a CGHS beneficiary suffering from any permanent disability of any kind (physical or mental) will be entitled to CGHS facility even after attaining the age of 25 years.
2. Since then this Ministry is in receipt of several representations for inclusion of more conditions in view of modification to the PwD Act, 1995 by “The Rights of Persons with Disabilities Act, 2016 (Act No. 49 of 2016)” as notified by Mlo Law and Justice, Govt. of India on 27.12.2016. The matter has been reviewed by the Ministry and it is now decided that for the purpose of extending the CGHS benefits to dependent unmarried son of CGHS beneficiary beyond 25 years of age , the definition of `Permanent Disability’ shall include the following conditions :
I. Physical disability:
A. Locomotor disability including
a) Leprosy cured person- suffering from loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity or suffering from manifest deformity and paresis or having extreme physical deformity as well as advanced age which prevents him/her from gainful occupation
b) Cerebral palsy – caused by damage to one or more specific areas of the brain usually occurring before, during or immediately after birth.
c) Dwarfism- a medical genetic. condition resulting in an adult height of 147 ems or less;
d) Muscular dystrophy- a. group of hereditary genetic muscle diseases characterized by progressive skeletal muscle weakness
e) Acid attack victims – disfigured due to violent assaults by throwing acid or similar corrosive substance
B. Visual impairment:
a) Blindness- where a person has any of the following conditions after best correction:
(i) Total absence of sight or
(ii) Visual acuity less than 3/60 or less than 10/200(Snellen) in the better eye with best possible correction
(iii) Limitation of field of vision subtending an angle of less than 10 degree
b) “Low vision” means any of the following conditions:
(i) visual acuity not exceeding 6/18 or less th.an20/60 upto 3/60 upto 10/200 (Snellen) in the better eye with best possible corrections; or
(ii) limitation of the field of vision subtending an angle of less than 40 degree up to 10 degree
C. Hearing Impairment
(a) “deaf’ means persons having 70 db hearing loss in speech frequencies in both ears;
(b) “hard of hearing” means persons having 60 db to 70 db hearing loss in speech frequencies in both ears;
D. “Speech and Language disability” permanent disability arising out of conditions such as Laryngectomy or aphasia affecting one or more components of speech and language due to organic or neuronal causes.
II. Intellectual disability- characterized by significant limitation both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior , which cover a range of every day, social and practical skills , including-, social and practical skills , including
(a) “Specific language disabilities” – a heterogeneous group of conditions wherein there is deficit in processing language, spoken or written, that may manifest itself as a difficulty to comprehend., speak, read, write, spell, or to do the mathematical calculations and includes conditions such as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia.
(b) “Autism spectrum disorder” –– a neuro-developmental disorder typically appearing uz the first three years of life that significantly affects a person’s ability to communicate, understand relationships and relate to others, and frequently associated with unusual or stereotypical rituals or behaviour.
III. Mental behaviour
“Mental illness”- a substantial disorder of thinking, mood, perception, orientation or memory that grossly impairs judgement, behaviour, capacity to recognize reality or ability to meet the ordinary demands of life, but does not include retardation.
IV. Mental Retardation
V. Disability caused due to
(a) Chronic neurological conditions such as
(i) Multiple Sclerosis
(ii) Parkinson’s disease
(b) Blood disorder
(iii) Sickle Cell Disease
3. Bench Mark Disability- unmarried permanently disabled and financially dependent sons of CGHS beneficiaries suffering 40% or more of one or more disabilities as certified by a Medical Board shall be eligible to avail CGHS facilities even after attaining the age of 25 years.
4. This OM will be effective from the date of its issue.
(Rajeev Attri)
Under Secretary to the Govt. of India
Signed Copy