Pre-Standardization Study Report of Concept and Domain Analysis Active Assisted Living, India

Pre-standardization Study Report of Concept and
Domain Analysis Active Assisted Living, India
August2020
Version 1.0
LITD-28:1 Active Assisted Living (AAL)

under
Electronics & Information Technology Division
Bureau of Indian Standards, New Delhi, INDIA
Study Report of Concept and Domain Analysis Active Assisted Living
Acknowledgement
Bureau of Indian Standards places on record its most sincere thanks to Prof. Suptendra Nath
Sarbadhikari, Chairman, Active Assisted Living Sub-committee (LITD 28:1); Col.
Someshwar Singh, Dr.Nirmita Narasimhan, Mr. Puneet Khurana, and,Mr. N Kishor Narang,
Editors of this document and LITD 28:1 Members; for their pro-active contributions with
their respective domain expertise, as well as, critical and in-depth study of the subjects
relevant to this report to help bring out a way forward for standardization in the arena of
Active Assisted Living.
Bureau of Indian Standards also recognizes the efforts made by Mr. Manikandan K, Member
Secretary, LITD 28 and Ms. Reena Garg, Head of Electronics & Information Technology
Department, and Mr Jayanta Roy Choudhary, DDG (Standardization, Products and Methods)
for providing valuable insights to understand the Global Standardization Ecosystem and the
need for harmonizing our national initiatives with Global SDOs.
Bureau of Indian Standards
Disclaimer
This report is the compilation of study, findings and views of the members of the LITD-
28:1AAL (Subcommittee1 on Active Assisted Living) under Electronics and Information
Technology Department of BIS. This report has been prepared as a Pre-standardization Study
by the Members to be considered as a guiding document only. The views/analysis expressed
in this report/document does not necessarily reflect the official view of Bureau of Indian
Standards. Efforts have been taken to ensure the accuracy and authenticity of the information
presented in the report, however, BIS does not guarantee the accuracy of any data included in
this publication, nor does it accept any responsibility for the consequences of its use.
LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 2

1 TABLE OF CONTENTS
List of Members ......................................................................................................................... 5
Foreword .................................................................................................................................... 6
About BIS .................................................................................................................................. 7
Executive Summary ................................................................................................................... 8
1 Introduction ........................................................................................................................ 9
2 AAL Paradigm .................................................................................................................. 10
2.1 The AAL Concept and Technology: .......................................................................... 12
3 AAL Ecosystem ................................................................................................................ 13
4 Stakeholders for AAL ....................................................................................................... 13
4.1 Role of the Government of India in adopting Digital Health .................................... 15
5 Market Dynamics and Potential ....................................................................................... 16
6 Importance of Active Assisted Living in Indian Perspective ........................................... 16
7 AAL for Persons with disabilities and old /elderly persons ............................................. 18
8 Disability and Accessibility .............................................................................................. 18
8.1 Accessibility fosters inclusion and changes social perception .................................. 19
9 India – Disability demographics ....................................................................................... 19
10 Demographic Challenges in EU.................................................................................... 20
11 AAL in EU .................................................................................................................... 21
12 Comparing the EU and the Indian Domains ................................................................. 22
13 AAL in China ................................................................................................................ 23
14 Standardization Imperatives.......................................................................................... 26
15 Policies Imperatives and Initiatives .............................................................................. 27
16 Policy initiatives undertaken by the State and Union Governments of India ............... 28
16.1 Dial 112 (Emergency services digital channel) ..................................................... 28
16.2 Integrating digital inclusion within smart city mission project undertaken by the
Government of Chhattisgarh ................................................................................................ 29
16.3 Atal Nagar Digital accessible system for city Administrations with disability ..... 29
16.4 Notification /circular issued by State & Central Government in India ................. 29
17 Accessibility standards.................................................................................................. 30
17.1 Accessibility Standards for Buildings: .................................................................. 30
17.2 Accessibility Standards for ICT ............................................................................ 30
17.3 EN 301 549 ............................................................................................................ 30
18 AAL - India Specific Issues .......................................................................................... 32
19 Gaps and challenges ...................................................................................................... 36
19.1 Priority ................................................................................................................... 36

19.2 Awareness .............................................................................................................. 36

19.3 Sensitisation ........................................................................................................... 36
19.4 Affordability .......................................................................................................... 36
19.5 Localisation ........................................................................................................... 37
19.6 Training.................................................................................................................. 37
19.7 Availability ............................................................................................................ 37
19.7.1 Availability of appropriate Technologies ...................................................................... 37
19.7.2 Distribution ................................................................................................................... 37
19.7.3 Maintenance ................................................................................................................. 37
19.7.4 Lack of control ............................................................................................................... 37
19.8 Inaccessibility ........................................................................................................ 38
19.8.1 Lack of involvement of AAL users ................................................................................. 38
19.8.2 Lack of involvement of the private sector .................................................................... 38
19.8.3 Ineffective implementation of existing policies and schemes ...................................... 38
20 AAL Use Cases ............................................................................................................. 38
21 National and Global Imperatives in AAL Paradigm ..................................................... 39
22 TRAI Recommendations on Making ICT accessible for Persons with Disabilities ..... 43
23 Relevant Global Initiatives: .......................................................................................... 44
24 Summary and Conclusions ........................................................................................... 44
a) Priority, awareness, affordability, availability, localization, and training are key barriers
affecting the development and deployment of appropriate assistive technologies in India.
Added to this, there is the problem of inaccessibility of mainstream technologies and digital
content which makes it very difficult for people with disabilities to get access to assistive
technologies to effectively use these resources........................................................................ 44
25 Recommendations ......................................................................................................... 46
ANNEX A ................................................................................................................................ 51
References ................................................................................................................................ 51
A-1 References..................................................................................................................... 51
A-2 Informative references .................................................................................................. 52

LIST OF MEMBERS
LITD-28 / Subcommittee-1: Active Assisted Living (AAL)
Convener: Prof. S N Sarbadhikari
Members:
# Name Affiliation
1. Col. Someshwar Singh Personal capacity
2. N Kishor Narang Narnix
3. Dr Nirmita Narasimhan G3ict
4. Mohammed Asif Iqbal PwC India
5. Dr. Mahesh Kulkarni C-DAC, Pune
6. Dinesh Chand Sharma EU project SESEI
7. Puneet Khurana Secure Meters Ltd.
8. Naveen Choudhary ERNET India
9. Anil Mehta Secure Meters Limited
10. Manoj Verma Samsung Electronics
11. Anil Jain Secure Meters Limited
12. NSN Murty PWC India Pvt Ltd.
13. Paryusha Mehta Reliance Infrastructure
14. Shubham Agarwal Secure Meters Limited
BIS Officials:
S.No. Name
1 Mr Jayant Roy Choudhary, DDG (Standardization, Products and Methods)
2 Ms. Reena Garg, Head of Electronics & IT Department, and
3 Mr. Manikandan K, Scientist-D, Electronics & IT Department and Member
Secretary, LITD 28

FOREWORD
Bureau of Indian Standards (BIS) is the National Standards Body of India, established under
the BIS Act 1986, and updated with the BIS Act 2016, for the harmonious development of
standardization, marking and certifying for quality, as well as testing of goods and materials
in India.
During the 14th meeting of the Electronics and Information Technology Divisional Council on
23rd April 2015, the Council had decided to constitute two panels of which one was on Smart
Cities (ICT aspects), Smart Energy, Smart Manufacturing and Active Assisted Living (AAL),
under the Convenorship of Mr. N Kishor Narang, Founder President, Narnixtechnolabs.
Subsequently, LITD28/WG2 of BIS was constituted to cater to the emerging needs for having
Indian Standards for ‘Active Assisted Living’.
The ‘Active and Assisted Living’ concepts, programs, systems and products have evolved to
cater to the challenges thrown by the changing demographic patterns of the European Union
Nations. This has created a new category of novel products which fulfill the needs of the ‘old’
using the Information and Communication Technologies. As novel products find their way in
to the Indian markets, a need was felt to have Indian Standards for ‘Active Assisted Living’ to
safeguard both the National and citizen interests of India.
During the 3rdMeeting of Smart Infrastructure Sectional Committee, LITD 28 of BIS on 21

June 2018 at BIS Headquarter, Mr Dinesh Chand Sharma made a presentation on the
accessibility of Information Communication Technologies (ICTs) and assistive technologies
and requested to broaden the scope of the AAL WG in Indian context in line with the global
efforts. Dr Nirmita explained about the global initiatives in the domain. It was decided that
Prof.Supten Sarbadhikari would convene the group (Working Group 2) to discuss the issue of
broadening the scope and the future course of action on the subject. Subsequently it was
decided to convert it into a Subcommittee (1) under LITD 28.
Scope:
The LITD 28 / SC 1 shall be required to study the International Standards related to Active
Assisted Living (AAL), and, suggest the adoption / harmonization or development of India-
specific standards for AAL.
Liaison with ISO and IEC Committees:
a) IEC SEG 3 – Ambient Assisted Living

b) IEC / SyC AAL – Active Assisted Living
The WG felt that it was pertinent to identify the functional needs, the ‘Active and Assisted
Living’, literal concept could fulfill in the Indian context. It was also felt that there was a
definite need to build consensus on the very basic definition, scope and boundaries for the
subject before moving ahead with it. This pre-standardization report is a humble effort to set
the tone for wider discussions with all the stakeholders in this area.

ABOUT BIS
Bureau of Indian Standards (BIS) is the National Standard Body of India established under the
BIS Act 1986, and updated with the BIS Act 2016, for the harmonious development of the
activities of standardization, marking and quality certification of goods and for matters
connected therewith or incidental thereto.
BIS has been providing traceability and tangibility benefits to the national economy in a
number of ways - providing safe reliable quality goods; minimizing health hazards to
consumers; promoting exports and imports substitute; control over proliferation of varieties
etc. through standardization, certification and testing.
Keeping in view, the interest of consumers as well as the industry, BIS is involved in various
activities as given below:
a. Standards Formulation
b. Product Certification Scheme
c. Compulsory Registration Scheme
d. Foreign Manufacturers Certification Scheme
e. Hall Marking Scheme
f. Laboratory Services
g. Laboratory Recognition Scheme
h. Sale of Indian Standards
i. Consumer Affairs Activities
j. Promotional Activities
k. Training Services, National & International level
l. Information Services
BIS has its Headquarters at New Delhi and its 05 Regional Offices (ROs) are at Kolkata
(Eastern), Chennai (Southern), Mumbai (Western), Chandigarh (Northern) and Delhi
(Central). Under the Regional Offices are the Branch Offices (BOs) located at Ahmedabad,
Bangalore, Bhubaneswar, Bhopal, Coimbatore, Dehradun, Faridabad, Ghaziabad, Guwahati,
Hyderabad, Jaipur, Kochi, Lucknow, Nagpur, Parwanoo, Patna, Pune, Rajkot, Raipur,
Durgapur, Jamshedpur and Vishakhapatnam, which offer certification services to the industry
and serve as effective link between State Governments, industries, technical institutions,
consumer organization etc. of the respective region.
For formulation of Indian Standards, BIS functions through the Technical Committee
structure comprising of Sectional Committees, Subcommittees and Panels set up for dealing
with specific group of subjects under respective Division Councils. The committee structure
of BIS seeks to bring together all those with substantial interest in particular project, so that
standards are developed keeping in view national interests and after taking into account all
significant viewpoints through a process of consultation.

EXECUTIVE SUMMARY
Nations. This has created a new category of novel products which fulfil the needs of the ‘old’
to the Indian markets, a need was felt to have Indian Standards for ‘Active Assisted Living’
to safeguard both the National and citizen interests of India.
Similar activities in other parts of the world, especially the European Union and China have
been outlined and compared with the current Indian scenario.
This pre-standardization study report tried to note the key barriers affecting the development
and deployment of appropriate Assistive Technologies in India. These are summarized in the
section of Summary and Conclusions.
Based on these challenges, the Report tries to recommend the measures that can alleviate
these problems and the agencies concerned can ensure smooth adoption of AAL paradigm in
the everyday activities of elderly and disabled persons.
The work of IEC SyC AAL and other relevant Global/Regional standardization
initiative/work programmes on the subject should be reviewed by LITD28 / AAL WG of BIS
to understand the nuts and bolts of the subject better.
Following this standards environment scan &domain analysis, India specific AAL Strategy,
Roadmap & Standards shall have to be developed, adopted/transposed.
For developing the National AAL Strategy, Roadmap & Standards, comprehensive
engagement and collaboration with major Government Stakeholders responsible for effective
& efficient proliferation of the AAL paradigm is imperative. The major stakeholders in the
Government are:
a) Department of Empowerment of persons with Disabilities, in the Ministry of Social
Justice & Empowerment.
b) National Programme for Healthcare of the Elderly (NPHCE), Ministry of Health &
Family Welfare.

1 INTRODUCTION
Active Assisted Living (AAL) refers to the Concepts, products, services, and systems
combining technologies and social environment with the aim of improving the quality of
people’s lives. While there has been a considerable amount of interest and work in this area
in European and other countries, in India it is yet to gain attention. Moreover, traditionally
healthcare delivery has been catering more to sick-care and not emphasizing on either health
or quality of life. This pre-standardization study report addresses these issues in the following
manner.
Nations. This has created a new category of novel products which fulfil the needs of the ‘old’
to the Indian markets, a need was felt to have Indian Standards for ‘Active Assisted Living’
to safeguard both the National and citizen interests of India.
The BIS Sub-committee, namely “LITD 28:1 Active Assisted Living” was constituted to
study the International Standards related to Active Assisted Living (AAL), to follow and
actively participate in the work of “IEC SyC AAL – Active Assisted Living” and to identify
and suggest AAL standards for India for adoption/harmonization or development of
indigenous standards for India for AAL.
The Sub-committee, LITD 28:1 within the scope of its work, studied the Active Assisted
Living ecosystem in India and the Global scenario; including the demographics, market,
technology development, initiatives, legislations etc. to identify India specific challenges; the
standardization needs; global initiatives in the standardization front and to recommend a
standardization strategy and way forward for India.
The Sub-committee, LITD 28:1 felt that it was pertinent to identify the functional needs, the
‘Active and Assisted Living’, literal concept could fulfil in the Indian context. It was also felt
that there was a definite need to build consensus on the very basic definition, scope and
boundaries for the subject before moving ahead with it. This pre-standardization report is a
humble effort to set the tone for wider discussions with all the stakeholders in this area. This
report gives an overview about the AAL paradigm, AAL ecosystem and various stakeholders
in the ecosystem, , market dynamics and potential of AAL, the importance of AAL in Indian
perspective, disability demographics of India. The report further briefly glance through AAL
in the EU and compare that with the Indian scenario, discuss Standardization imperatives,
policies imperatives and initiatives, elaborates on EN 301 549 ICT accessibility standards
from EU, discusses India specific issues for AAL, identifies some gaps and challenges,
describes some relevant use cases of AAL, discuss our Indian national imperatives in AAL
paradigm, and offer recommendations for developing an inclusive AAL ecosystem in the
country.

2 AAL PARADIGM
“Man is a social animal” Aristotle.
To experience the complete enjoyment of being a human being, we should be able to

participate in all aspects of a social life, whether it be cultural, economic or administrative,
with dignity. To do so, people need to be able to communicate and interact with each other
and have access to all resources.
Hence, the most fundamental principle of inclusion and participation is that of access. People
who have the most access, are often the most empowered, those that do not enjoy access, are
rendered disadvantaged and unable to participate, contribute, live independently and be
heard.
The AAL concept also revolves around the premise of providing access to concepts, systems,
products, and services. Access is required at two levels- (i) access to mainstream information
and resources, and (ii) access to specialized information and services.
Before we come to the moot issue of standards for AAL, IEC defines AAL as ‘Concepts,
products, services, and systems combining technologies and social environment with the
aim of improving the quality of people’s lives’. An AAL user is -any person (of any age)
who uses or benefits from, or uses and benefits from, Active Assisted Living (AAL)
products, services, and systems. The development of AAL happened due to demographic
challenges, however, it now caters to people’s needs for convenience, comfort, active and
independent living. This definition of AAL and AAL users envisages a wide market base of
the industry involved in innovating and developing products based on this concept. In India,
we also need to recognize and support the ideas set out by the IEC that economic/commercial
viability is critical for the sustainability of AAL products and services; and as such supports
the adoption of AAL standards across application of ICTs.
Hence recommended definition of AAL is ‘Concepts, products, services, and systems

combining technologies, people, and social environment with the aim of improving the
quality of life for old persons and persons with disabilities. The recommended definition
of AAL User is ‘Old person or person with disability who uses or benefits from, or uses
and benefits from, Active Assisted Living (AAL) products, services, and systems’. It is
also not possible to exhaustively list AAL services since what may be convenient to one
person may be a necessity for another. [Ref:
https://www.iec.ch/public/miscfiles/sbp/SYCAAL.pdf ]
An ideal world is where every product or service can be an AAL product or service, i.e., it is
available and accessible to a person with disability or an elderly person. While this may
sound like a tall order, it need not be so utopian a notion; countries around the world are
seeking to achieve this through series of legislative, regulatory measures and good practices
as well as procurement and accessibility legislative mandates and standards. This by no
means is an easy process in any country and India as well, where the notion of accessibility
and accessibility sensitivity and awareness are at a very nascent stage. However, this is
critical to ensure sustainability and access for those using specialized products/ services, for
one can only imagine how frustrating it would be for a blind person to acquire and learn to
use a screen-reader and then find that the content on a web site still cannot be read because it
is Web Content Accessibility Guidelines (WCAG) non-compliant, or that despite being in
possession of a Smartphone and a screen reader, it is impossible to use a banking service

because the banking app is not completely accessible. This frustrates the purpose of
technology - which is to enable.
The society where we live is facing a big demographic change. People live longer, therefore
life expectancy is increasing. In 2000, there were already 420 million people with more than
65 years old (which corresponded to about 7% of the world population). In 2050, it is
expected that this number reaches 1500 million (about 16% of the world population). The
number of elder people who need care and assistance is also increasing, surpassing the
number of youngsters who contribute with taxes.
This context brings new challenges to the traditional health care systems, as social security
systems are becoming unable to afford the cost of providing assistance to this growing
number of people. Therefore, there is an increasing necessity to search for new solutions that
will allow people to live in the best possible way, in the last stages of their life. These
systems would allow people to extend their life in their favourite environments, favouring
confidence, autonomy, mobility, and welfare.
Information and communication technologies (ICT) offer new opportunities for the provision
of improved care and assistance services. Active Assisted Living (AAL) is a concept focused
on the use of technology as a way to improve the independence and welfare of aged or
disabled people, at their homes.
Following are some basic areas where it is critical to provide access:
a. Access to Information and Government Services- government notifications on

schemes, news, services, books, digital content on web sites, cultural materials, etc.
Stakeholders: All Government and private agencies putting up information on their
web sites to conform to Guidelines for Indian Government Websites (GIGW) and
EPUB (eBook Style Format), web site developers, newspaper and media houses,
publishers, libraries, specifically Ministry of Culture, Ministry of Human Resources
Development (MHRD), Ministry of Electronics and Information Technology MeITy,
and Registrar of Copyrights under Department of Industrial Policy and Promotion
(DIPP).
b. Access to Healthcare services- hospitals, caregivers, treatment, para-transport

facilities, helplines, emergency services, home-based treatment options, alternative
medicine, etc.
Stakeholders: hospitals, health care service providers, technology professionals,
patients, their families, Ministry of Health and Family Welfare (MoHFW), MeITy etc.
c. Access to Education- enable students in educational institutions to access curriculum

and course materials in accessible formats as well as have inclusive classrooms and
teaching
Stakeholders: Schools, Colleges, universities and other educational institutions,
Governments -specifically MHRD and agencies related to all levels of education,
educational boards, UGC, teachers, students, publishers of educational material.
d. Access to Government schemes for social security and information about that –
enable persons with disabilities to easily avail of social security, pension, banking etc.

Stakeholders: banks, financial institutions, RBI, Ministry of finance, Ministry of

Social Justice and Empowerment (MSJE), departments in charge of the welfare of the
disabled and elderly, etc.
e. Mobility and Access to transport- Key issues include non-existent/ uneven/

completely inaccessible pavements throughout India, pedestrian and road crossings,
public transport, intermediate transport (e.g. how to get to the Metro station from
one’s home), safety and security issues while travelling by cabs, inaccessibility of
public buildings, etc.
Stakeholders: Ministry of Urban development and Planning, Smart cities mission,
Municipal corporations, road transport departments and agencies, police and traffic
police, bus/ train/ airport corporations, Ministry of Railways, Ministry of Civil
Aviation, etc.
f. Independent Living- Shopping, Hotels, Restaurants, Banking, access to a variety of

mainstream and customized services provided by service providers/ entrepreneurs.
Stakeholders: industry, service providers for all variety of services
g. Access to Entertainment- Television and multi-media serials, films, videos, theatres,

cultural shows.
Stakeholders: Film and audio-visual programme producers, television and cable TV
service providers, Device manufacturers, consumer products manufacturers etc. all to
be standards compliant, NGOs, entrepreneurs to provide divers solutions and choice
in these areas, MIB, TRAI, DOT for regulation.
h. Access to places of worship and spiritual events/ writings of one’s faith – access to
religious institutions and places of worship like. Temples, churches, mosques,
gurudwaras, synagogues and any others.
Stakeholders: General Population, Trustees of religious places
i. Political participation – access to information about elections, voting machines and

ability to participate in elections.
Stakeholders: Government, Election Commission, voters
j. Social interaction with friends and family – accessibility of public parks, meeting
places, social fora
Stakeholders: General population
2.1 The AAL Concept and Technology:
Active Assisted Living is a concept in which technology is used as a way to improve the
welfare and independence of elder people or Persons with Disabilities living alone at their
homes. Typically, a variety of sensors and actuators installed at their homes or in their clothes
are used to remotely monitor their wellbeing conditions. Imagine a home and a user, which
contains a number of sensors for remotely monitoring users’ welfare. The operations of these
devices are supported by an infrastructure, usually of wireless type, which provides adequate
connectivity. It is on top of these services that AAL services operate.

Typical services in AAL include home environment services, like home safety and security,
temperature monitoring, gas detection, smoke detection, intruder alert, fall detection. It can
include welfare monitoring for people that are not ill, like monitoring heart rate, blood
pressure, and body temperature. It can also include health support for ill people, like
behaviour monitoring (for people with dementia) and chronicle disease management.
Furthermore, it may also include occupation and recreation services, which support the
involvement of leisure services and the continuation of professional activities.
3 AAL ECOSYSTEM
The AAL ecosystem should be a novel ecosystem to promote the physical, emotional, and
psychic health and well-being of the elderly person. The ecosystem should be ready to add
several services developed to meet the needs of the senior population, namely services to
improve social inclusion and increase contribution to society. Moreover, the solution
monitors the vital signs of elderly individuals, as well as environmental parameters and
behaviour patterns, in order to seek eminent danger situations and predict potential hazardous
issues, acting in accordance with the various alert levels specified for each individual. The
ecosystem should be well accepted and easy to use by seniors.
4 STAKEHOLDERS FOR AAL

The Indian healthcare system is being reshaped by three forces:
a) Increasing health care demand,

b) Technological ubiquity, and,
c) Rising patient awareness
The major stakeholders for healthcare can be categorized into people, policymakers,
providers, and payors, as elaborated below. These can be extrapolated to the Stakeholders for
AAL, and the individual / person / consumer / end user must be considered as the most
important stakeholder.
To make health affordable and accessible, AAL can play a major role, especially if they are
compliant to the Standards for necessary interoperability and there is no lock-in with a
particular vendor or a healthcare provider (hospital or physician).
The AAL service providers have started adopting new technologies and tools to deliver
improved outcomes and experiences to their customers.
a. People. People are typically citizens, and voters, and sometimes taxpayers.
Policymakers have a fiduciary duty to this population, and the country’s policy
framework is established to benefit them. They receive care services from providers
and are the beneficiary customers of the payors. They also may want to access
information about their care via an electronic device (e.g., personal computer, mobile
phone).
b. Policymakers. Policymakers establish the framework within which health care is

provided to the country’s citizens. “Policymaker” is a synonym for “ministry of health
and family welfare” or whatever jurisdictional entity is responsible for the health of the
population. The policymakers aggregate data from patients, providers, and payors to

develop population-level metrics that inform their health and health economic policies.
In this context, policies answer the crucial questions:
c) Who is eligible to receive care?

d) What care services are provided; how; where; by whom?
e) How are services paid for?
f) Are the services being delivered well? Are they accessible?
g) Are the needs of vulnerable or marginalized populations adequately served?
h) What health care concerns do we need to plan for next?
c. Providers. Providers could be individual doctors or hospitals. They operationalize care

delivery within the policy framework. They provide health services to people and
maintain health information about them. The providers coordinate patient care with
other providers as care team members. Many providers are independent businesses that
must manage their own operations and finances.
d. Payors. Payors operationalize the financial elements of the policy framework. Payors
enroll patients as beneficiaries. They procure care services from the providers on behalf
of their beneficiaries. They also must take on the actuarial task of ensuring the financial
sustainability of the care program. They report to policymakers. In India, most often the
payor is the individual doling out the lion’s share as Out of Pocket (OOP) expenses.
Each of these stakeholders plays a different role in relation to others. Each has a different
viewpoint on health care and on the health infrastructure needed to support it.
Policymakers set the context within which the health care system operates. Providers and
payors are regulated by these policies and operate within them. Ideally, the policies are
designed to maximize the health of the population within the country’s financial and resource
constraints.
The payors’ view is dominated by their role as procurers of services on behalf of their
beneficiaries. In financial terms, payors and providers have a customer/supplier relationship.
Of course, in turn, patients may have a choice of payors, and so payors may have a
supplier/customer relationship with their beneficiaries. To be sustainable, payors endeavour
to minimize the costs of funding their portfolios of care services. This incentivizes payors to
encourage and even invest in the uptake of healthy-living initiatives within their beneficiary
population.
The providers’ viewpoint is defined by their care provision relationship with the people and
their supplier relationship with the payors. These relationships exist within the providers’
contextual relationship with policymakers as regulated professionals. In situations where care
must be coordinated, providers also find themselves managing relationships with other
members of the care team, as they collaborate on behalf of a shared patient.
The people’s viewpoint, in times of good health, maybe turned to their role as influencers of
health policy. As consumers, they may be able to exercise purchase discretion regarding their
choice of payors. In times of poor health, they are often powerless consumers. When we are
ill, we want to become healthy again. This is what makes the patient-provider relationship
powerful, and underlies the moral and ethical imperatives that are important to it.

4.1 Role of the Government of India in adopting Digital Health
The Indian Government is enabling the creation of a cross-sector “digital ecosystem” in the
country. The government launched its Digital India program in 2015 aiming to transform the
country into a digitally empowered society and knowledge economy. The program has three
key ambitions: develop digital infrastructure, establish on-demand governance and services,
and empower citizens digitally. Digital health care is one of the key focus areas under the
umbrella of the government’s digital initiatives. The Ministry of Health and Family Welfare
(MoHFW) has several initiatives designed to deliver better health outcomes. In this case,
outcomes are defined in terms of access and affordability of care, quality of care, the ability
to lower the disease burden, and monitoring of health entitlements to citizens.
The National Health Policy (2017) has three distinct goals:
a) Use electronic mediums to gather district-level health data by 2020

b) Reinforce the health surveillance system by establishing registries for specific diseases
by 2020
c) Establish federated national e-health architecture, setting-up of health information
exchanges and National Health Information Network by 2025
To achieve these goals, the government is establishing regulatory bodies (National Digital
Health Authority) and launching new legislations and policies (e.g., Digital Information
Security in health care Act to regulate digital health data and ensure privacy).
The “Ayushman Bharat” program was launched in September 2018 to address holistic
health care delivery:
a) Primary health care: 150,000 health and wellness centres will be created to provide
comprehensive primary health care services
b) Secondary and tertiary care: Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the
world’s largest government-funded health care insurance program that provides ~100
million families support up to INR 0.5 million per family per year. This program will
be driven by the usage of digital technologies and telemedicine services to improve the
quality, affordability, and accessibility of health care.
India has hosted the 4th Global Digital Health Partnership Summit and the International
Digital Health Symposium in the last week of February 2019. This also shows the
commitment of India towards strengthening Digital Health Globally. Here the “Delhi
Declaration” was adopted to accelerate and implement the appropriate Digital Health
interventions to improve the health of the population at national and sub-national levels, as
appropriate according to the national context so that the Sustainable Development Goals
(SDG) can be met easily.
Realizing the country’s potential to lead in and influence the Fourth Industrial Revolution, the
World Economic Forum has partnered with the Government of India to set up the Center for
the Fourth Industrial Revolution in Mumbai. The centre will bring together the
government and business leaders to pilot policy frameworks and protocols for emerging
technologies. AAL can be an area of focus for this centre.
The major stakeholders in the Government responsible for effective & efficient proliferation
of the AAL paradigm are:

a) Department of Empowerment of persons with Disabilities, in the Ministry of Social

Justice & Empowerment.
b) National Programme for Healthcare of the Elderly (NPHCE), Ministry of Health &
Family Welfare.
5 MARKET DYNAMICS AND POTENTIAL

While the UN SDG (Sustainable Development Goals) number 11 is to make Cities and
human settlements inclusive, safe, resilient and sustainable, the SDG 3 aims to ensure healthy
lives and promote wellbeing for all at all ages. In this context, Active Assisted Living (AAL)
becomes very relevant since it will take care of all including old/elderly people and persons
with disabilities.
SDGs:https://www.undp.org/content/undp/en/home/sustainable-development-goals.html
Before dwelling on the Indian AAL Domain, it would be prudent to understand as to why
AAL originated in EU and what kind of problems it is trying to solve for them. The IEC is a
worldwide, independent, not-for-profit membership organization, that develops state-of-the-
art, globally relevant International Standards for electrical, electronic, and information
technologies. The BIS sub-committee, LITD 28:1, on Active Assisted Living mirrors the IEC
SyC Active Assisted Living. The IEC Systems approach having six distinct stages is a
holistic approach for developing standards. The first stage is the ‘Domain Analysis’. This
first stage is critical in identifying the problem domain to be solved and also for crystallizing
the desired outcomes, or objectives that are driven by the stakeholders' needs. Outputs of this
stage set the foundation, scope, and boundary of the system of interest. Outputs of subsequent
stages are then developed with traceability to the needs identified in this first crucial stage.
LITD 28:1 of BIS has been constituted to cater to the emerging needs for having Indian
Standards for ‘Active Assisted Living’. At the onset, it is imperative that ‘Domain Analysis
be carried out to identify what all ‘Active Assisted Living’ could possibly mean in the Indian
context. However, before doing that formally, there is a need to build National consensus on
the very basic definition, scope, and boundaries for the subject.
6 IMPORTANCE OF ACTIVE ASSISTED LIVING IN INDIAN

PERSPECTIVE
In the year 2017, World Population Prospects (WPP) reported that around 13% of the global
population comprising an estimated 962 million in the world are aged 60 or over in the world.
The population aged 60 or above is growing at a rate of about 3% year.
As per the Indian demographic reports, there are nearly 104 million people aged 60 or above
in India which comprises 9% of the total population. Out of this 66 million people are aged
above 65 and above.
As per the Census 2011, In India out of the 121 Cr population, 2.68 Cr persons are ‘disabled’
which is 2.21% of the total population.
Population, India 2011 Persons with disabilities, India 2011
Persons Males Females Persons Males Females

121.08 Cr 62.32 Cr 58.76 Cr 2.68 Cr 1.5 Cr 1.18 Cr
The percentage decadal change in the disabled population during2001 -2011 is 22.4,
whereas, for the total population, the percentage decadal change is 17.7. This shows the
disabled people in India are increasing. This may affect the overall nation’s productivity.
As per a report published in 2016 by the Ministry of Statistics and Programme

Implementation, there are multiple types of disabilities found during census 2011, with the
majority of the disabilities observed in movement(20%), hearing(19%), seeing(19%).
As observed in census 2011, is the number of persons with disabilities are highest in the age
group 10-19 years and one of the more alarming in sight is that 46% of the Indian disabled
population is aged between 10 to 39 years.
In order to alleviate and effectively counter ‘repercussions of soaring aging population’ and
support ‘our disabled population” the need of the hour is to provide ‘appropriate governance

means and mechanisms’ and improve the ‘living condition and provide assisted living
healthcare solutions for of aged and persons with disabilities’.
Here ICT and mechanics based innovations shall help in improving the living scenarios for
aged and better active assisted solutions for the disabled. The government can work on
working on closure of gaps existing within the current policies/schemes/departments to
provide better means and mechanisms to support this active assisted living community.
As there are various types of disabilities that are existing amongst Indians, there are multiple
types of solutions required by a variety of disabled and aged persons. The active assisted
living category shall widely use Internet of Things (sensor technologies, edge computing etc),
Artificial Intelligence (Machine Learning) to create cutting edge assisted living healthcare
solutions. Innovation in ICT (both software & hardware) along with mechanics will empower
people’s abilities and provide them capabilities by means of digital environments that are
sensitive, adaptive, responsive to human needs, habits and gestures, and emotions. This
brings a lot of opportunities & scope for innovation. Over the last few years, considerable
efforts in this segment have been put up and have opened up many new further avenues.
7 AAL FOR PERSONS WITH DISABILITIES AND OLD /ELDERLY

PERSONS
Persons with disabilities and old /elderly persons have long since been excluded from
mainstream development and progress. The failure of common communication channels,
infrastructure, and resources to meet their specific access needs has resulted in them being
dependent on others for their day to day needs. Consequently, society has also been deprived
of their creative and economic contribution to nation building.
Information and communications technologies (ICTs) now offer the means for all persons to
communicate participate and live independently in society. However, we have been unable to
successfully leverage technology to empower and include persons with disabilities and older
persons because of the lack of consideration given to their needs while developing and
deploying ICTs; a problem which can easily be addressed by complying with accessibility
standards. In India especially, the most basic technologies of everyday use such as web sites,
mobile phones and services and television are inaccessible and do not conform to any of the
internationally recognized accessibility standards which are being followed in many countries
around the world. The aim therefore, in this paper, is to identify technology gaps and suitable
standards which may be adopted in India, to ensure that the emerging digital landscape of
India is universally accessible.
8 DISABILITY AND ACCESSIBILITY

Before proceeding further, it is important to come to a common understanding of what is
meant by disability and accessibility and the need for accessibility. The definition of
Disability can be found in Paragraph (e) of the preamble of the UN Convention for the rights
of persons with disabilities (UNCRPD): “Recognizing that disability is an evolving concept
and that disability results from the interaction between persons with impairments and
attitudinal and environmental barriers that hinders their full and effective participation in
society on an equal basis with others”. Article 1 further specifies that: “Persons with
disabilities include those who have long-term physical, mental, intellectual or sensory
impairments which in interaction with various barriers may hinder their full and effective

participation in society on an equal basis with others”. While the scope of disabilities is very
wide, the Rights of Persons with Disabilities Act 2016 specifically recognizes 21 disabilities,
an increase from the 7 which were enumerated under the previous Act. This will lead to a
substantial increase in the number of persons with disabilities living in India. Annexure 1 lists
out the disabilities specified under the RPD Act. Annexure 2 also identifies disabilities which
can easily benefit from developing and deploying inclusive ICTs.
According to the ITU-G3ict e-Accessibility Toolkit for Policy Makers, ‘Accessibility is a

measure of the extent to which a product or service can be used by a person with a disability
as effectively as it can be used by a person without that disability. The concept of
accessibility relates to the diverse needs and abilities of a diverse section of the user
population – people with disabilities – and is expressed in degrees, from “fully accessible,” to
“partially accessible,” to “completely inaccessible,” for a specified user group. Technical
standards help to determine the accessibility of various products and services. most products
can be made accessible to most users by maximizing the basic accessibility, allowing user
configuration, allowing a range of interaction methods, providing outputs in multiple forms
and ensuring compatibility with assistive technologies.
8.1 Accessibility fosters inclusion and changes social perception
Accessibility is a central concept to inclusion; in fact, many of today’s most famous

mainstream technologies such as the telephone and the typewriter were products of attempts
to a means of communication for persons with disabilities. Hence, accessibility as a concept,
cannot be alienated from mainstream communication needs, but has to form an integral part
of mainstream technologies. Along the same vein, it is desirable that accessibility
requirements and standards not be taken as separate requirements or standards, but be
embedded within mainstream design, development and standards to ensure that products,
technologies, services and environments are universally accessible. Not only will this have
the desired effect of having universally designed products, but also work to create a
collectively inclusive mind-set of communities, as consideration for the disabled and elderly
emerge as integral parts of the social landscape. Having more persons with disabilities and
elderly move around and live independently in society will be a significant transformer in the
way in which they are perceived, accepted and respected in society, and the benefit to society
from their participation will be invaluable.
Unfortunately, people tend not to consider usability and accessibility until they are affected
by ageing and/or disability, by which time modifications to infrastructure and technologies
may prove very difficult if not nearly impossible.
In recent decades, ICT has become ubiquitous throughout society. Despite the rapid
development, use and reliance of technologies for our daily needs, there is very less attention
being paid to the accessibility of these devices, products and services, resulting in an ever-
increasing digital and social divide as persons with disabilities and elderly are unable to use
and access technology, information and services. Hence the need to identify, adopt and
implement accessibility standards is a critical one.
9 INDIA – DISABILITY DEMOGRAPHICS

According to the census of India 2011, India is home to 26 million persons with disabilities;
however, this number is estimated to be much higher. For instance, A World Bank report
pegs the number at about 5-8% or approximately 55-90 million in India.[2], This will

drastically increase in the next census with the social understanding of disability as per the
Rights of Persons with Disabilities Act 2016 (RPD Act) and the expanded list of 21
disabilities. There are also widely varying estimates of the prevalence of different disability
types in India. For instance, the percentage of deafness varies from 1.7 million to 7 million,
depending upon the definition and methods used for estimation. According to research from
the Maulana Azad Medical College, around 6.3% or approximately 63 million persons in
India have some level of functional hearing loss[3].The number is even higher amongst the
blind and is estimated to be about 8.8 million persons[4], comprising nearly a quarter of the
blind population of the world. The situation is similar amongst other disabilities. There is also
a steady and significant increase in the number of elderly persons above the age of 60 and
was estimated to be 10.3crores [5] in 2011, a 35% jump from the previous decade. This trend
is also likely to continue in India as it is doing globally.
The Telangana Disability Study Group of International Centre for Evidence in Disability,
London, who used Washington Group questions, found the overall prevalence of disability in
Telangana state of India to be 12.2%. This estimate is much higher than predicted in the
Indian Census 2011 and justifies concerns of the disability sector. Gudlavalleti, Murthy
(2014). Telangana Disability Study. 10.13140/RG.2.1.1836.7840.
All these groups are unable to access mainstream media, news, and entertainment due to
challenges in vision, hearing, or comprehension. This results in large scale exclusion on a day
to day basis, and can also have life-threatening consequences in times of disasters and
emergency situations. The RPD Act, in conformance with the UNCRPD, requires all service
providers to make their information technology based services accessible.
10 DEMOGRAPHIC CHALLENGES IN EU
In EU, the baby boom generation (People born between 1945-1960) have started retiring of
late and the same is likely to continue for yet another decade. Trained human resources of
adequate quality as replacements are not available at the same rate at which this generation is
retiring. Also, people are retiring at 65 and almost living up to 84 years of age. This puts
additional pressure on the existing national pension and other social schemes. Most of the EU
countries are spending around10% of GDP on pensions. Highest being by Italy at 16.3%. For
some countries, a part of pensions comes out from their annual budgets. This has forced EU
nations to review their respective pension policies. In some countries, the retirement age has
been increased to 67 as the governments want their old to remain both professionally and
socially ‘Active’ to mitigate the ill effects of the current demographic transition. The
demographic challenge of old age also adds more stress to the existing health care system and
social care costs for the old. The policymakers also expect their elderly to be more physically
‘Active’ to remain fit, as it has a positive effect on bringing down the annual health care
costs.
At the individual level, most of the elderly remain in relatively good health until 75 years of
age. However, after that, they face challenges due to difficulty in locomotion, sensory issues,
and cognitive issues. These issues affect their ability to perform Instrumental Activities of
Daily Living (IADL) and Activities of Daily Living (ADL). Due to policy changes the long
term care is also steadily shifting towards home from hospitals and nursing homes in Europe.
During the last five decades, the fabric of both European societies and families has undergone
a lot of change. As a result, most people cannot avail of family care / social care (Assistance)
when needed. Also, most prefer independent living for as long as possible in the place of their
choice. For some elderly hiring part-time/ full-time help to ‘Assist’ them is not an issue but
for some it is. Old people also slowly start getting socially cut off and become vulnerable to
counts of safety and emergency response situations.
Demographic old-age dependency ratios: Historical and projected values, 1950-2075[6]
1950 1975 2000 2015 2025 2050 2075
EU28 14.8 21.1 24.3 29.3 36.3 52.9 55.2
The old-age dependency ratios have been projected to grow at an alarming rate for EU. It is
estimated that by 2050 for every single retired person there would be only two people in the
working-age group. In such situations, the government expenditure on the old, on counts of
health care, long-term care, pensions, unemployment benefits and education are all likely to
shoot up and become unmanageable. The need was felt by the European Council to arrest
such trends by keeping the elders healthy and independent for as long as possible with
changes in policies to tap the untapped potential of the old. The United Nations Economic
Commission for Europe (UNECE) has defined the term Active Ageing Index (AAI) to
indicate the untapped potential of the older people for more active participation in economic
and social life and for independent living. The AAI index is used further for policymaking.
11 AAL IN EU
Horizon 2020 spread over 7 years (2014 to 2020), is EU’s Research and Innovation
Programme, with €80 billion of funding. The Active and Assisted Living (AAL) programme
runs under the Horizon 2020 umbrella and supports ICT services for ageing well based on
applied research. The programme works to bring up efficiency and productivity in the ageing
societies while extending the time people live in a place of their choice. The programme
supports elderly people, caregivers, and is reducing the costs of health and social care across
Europe. It is also strengthening the international opportunities for SMEs in the area of ICT. In
essence, the programme is catering to the social, economic and people need of EU in view of
the emerging demographic challenges faced by them.
ICT solutions help the elderly to stay healthy, independent, and active at work or in their
community. The various ICT based categories under the AAL are Health and Wellness,
Mobility and transport, Vitality and Ability, Information and communications, Safety and
Security, Building and Living, Culture and Leisure and Work, and Training. Projects are
undertaken by various consortiums based on yearly themes. Till now about 200 projects have
been undertaken since 2008. To name a few, ACCOMPANY project is working on a robot
that provides physical, cognitive, and social assistance for independent living, CommonWell
is working to integrate health and social care with ICT, GiraffPlus is working on smart home
sensors for to bring situational awareness for the safety of elderly.
EUs AAL System, is a collaborative system in which the users, the customers, society, health
providers, social care providers, innovators, entrepreneurs, scientists, SMEs, Industry,
Research Institutions, municipalities, and various Government bodies play the part of active
stakeholders. The approach to the entire program has been top-down, dictated by needs,
guided by laws and policies, and governed through well-defined structures within the EU and
its member nations.

12 COMPARING THE EU AND THE INDIAN DOMAINS

Some basic stats comparing the Indian context with the EU context are given in the table
below.
Criteria India[7] EU
Life Expectancy 60+ (Years) 17.9 24[8]
Old Age / Retirement Age 60 65 / 67
Expected healthy life years on being old - 9.4[9]
Old in Numbers (In Millions 2011) 103.9 98.3 (Approx)

Percentage of old 8.6% 19.2%
old-age dependency ratios 14.2 (2011) 29.9
Share of elderly living alone 5.2% 32.1%
From the table, it is evident that the elders in the EU live relatively longer as compared to
their Indian counterparts. Also, people in India retire at 60, whereas in EU retirement is at the
age of 65/67, which is so due to their demographic compulsions. In EU elders after retirement
almost live for 20 years, out of those 20 years, only for 9.4 years they can expect a healthy
life after which they require some medical care, social care, or other aids to function and
remain independent. Though number wise the population of old seems nearly the same,
however the demographics context is not the same. The percentage of old in EU is much
more than double the percentage of old in India. The same is the case with the old-age
dependency ratio. The share of elderly living alone is almost one-sixth of the elderly living
alone in EU. The reason is that in EU people prefer independent living and most stay alone
because they choose to do so. In India, though the social fabric is gradually changing, still the
majority prefer to stay with their children or close relatives in old age and get looked after.
Though there are some similarities, the different contexts pose a different kind of challenges
for both India and the EU.
In India, majority of the old or their families cannot afford smart homes with smart devices or
costly technology solutions to aid them in their daily living. However, human aid
(Assistance) for nursing care or social care is much cheaper when compared with the EU. The
minimum monthly wage for household help in India is about $140 (As proposed in Domestic
worker draft policy for min wages).In EU the same vary from country to country, the
minimum being in Bulgaria about $310 and the highest being in Luxembourg at $2343[10].
Hiring a household help by people who can afford it is a norm in India. Taking care of the
elderly is not only a tradition but mandated by law in India under the ‘Maintenance and
Welfare of Parents and Senior Citizens Act, 2007’. The levels of literacy and the purchasing
power of the old also differ in the Indian and EU settings.
One of the major demographic challenges for EU is the lop-sided growth of the old-age
dependency ratio. This poses two specific challenges for them at the apex level, the first one
being of finding suitable replacements for the retiring elders to keep EU competitive in global

markets and the second of supporting the ever-growing pool of retired (unproductive) elderly
with severe financial consequences. The broad strategic solutions which are being
implemented by EU are outsourcing jobs to technologies and machines (Cost savings both in
short and long runs) and of keeping the elderly productive (Active) for as long as possible,
even to the extent of forcing them to do so. In India, on the first count, our challenge on the
issue is diametrically opposite, i.e., of finding and creating jobs for the unemployed. On the
second count, we are already feeling a pinch as pensions as percent of yearly Revenue
Expenditure is about 11%. However, the situation is manageable as this percentage has
remained steady for the last few years, owing to the growing GDP and tax collections.
Though in the near future the Indian economy is expected to grow, however, suitable
measures must be identified and implemented gradually to cater to a possible distant
contingency of facing economic stagnation. One such measure could be of identifying ways
to motivate and keep the retired community productive. This can be done by empowering
them with ICT based solutions to keep them as contributing members both for the economy
and society for as long as possible.
13 AAL IN CHINA
In 2013, 132 million people in China, or 9.7% of the general population were over 65 years
old, and the elderly dependency ratio had increased to 13.32% from 11.17% in 2007.
According to a forecast by the Population Division of the UN Department of Economic &
Social Affairs, China’s elderly population is expected to grow by more than 8 million per
year, accounting for 30.8% of China’s total population by 2050. Over 100 million out of the
approximately 430 million elderly people will be over eighty years old (Figure 1). Compared
to a global aging rate of 2.5% annually, China is aging at a rate of 3.3%.
One of the factors for the increasing number of old age pensioners is the improvement of life
level and health care and average life care expectancy is increasing. The average life
expectancy of Chinese grew from 68 in 1996 to 73.5 in 2011. The second reason is Chinese
one child policy from 1979, which reduced the younger population in the last 30 years, make
“421” (four elderly, two adults and one child)
The second factor is its rapid economic growth. The reform and opening-up started in the
early 1980s brought double-digit growth—“China’s economic miracle”—which has greatly
improved living standards and health conditions so people can live healthier and longer.

Demographic, economic, and social changes have resulted in small family sizes and eroded
the role of family support for the elderly.
Policy Framework, Strategy, and Institutional Arrangements

The Chinese government has accelerated the establishment of a comprehensive elderly care
system, with government support that prioritizes the poor, disabled, and partially disabled
elderly. In the 12th Five-Year Plan period, China has drafted development plans and
amended laws and regulations to promote the establishment of the elderly care system.
According to the relevant policy documents, the elderly care system will have three integral
components: home-based care as bedrock, supported by community-based care and
supplemented by institution-based care. The government has also introduced numerous
policy measures to guide the development of the elderly service industry.
25 ministries have independently or jointly issued about 30 circulars, notices, guidelines,

standards, and administrative measures to push forward the establishment of China’s elderly
care system in different aspects covering almost all the elements of an elderly care system,
which includes a land provision, financial support and credit, workforce, information system,
government subsidy, tax preference, licensing, standards, monitoring and assessment, and
management.
Policy Evolution of China’s Elderly Care System in the Reform Era

Date Topic Government bodies
12/14/1994 China’s Seven-Year Development Plan on MOH(Ministry of
Aging housing), MOCA (Ministry

(1994–2000) of Civil Affairs),

MOL(Mini of
labor),MOLSS(Ministry of
Labor and Social Security),
MOF(Ministry of Finance)
,MOE( Ministry of
Education) NCA(National
Committee on Aging)
10/01/1996 Law on Protection of the Rights and Interests of NPC(National People’s
the Congress)
Elderly
10/20/1999 Circular on Establishing the National Working State Council
Commission on Aging
10/08/2000 Decisions on Strengthening the Work on Aging CPC (Central Committee
and State
Council)
10/01/2000 Circular on the Tax Policy Issues for Elderly MOF(Ministry of Finance),
Care SAT(State Administration
Institutions of Taxation)
07/22/2001 10th Five-Year Development Plan of State Council
Undertakings on Aging (2001–2005)
05/31/2001 Circular on the Implementation Plan of the MOCA
Starlight
Program of Community Welfare Services for the
Elderly
11/16/2005 Opinions on Supporting Social Forces to Invest MOCA
in Social Welfare Institutions
03/05/2005 Circular on Carrying out the Demonstration of MOCA
Social
Service Activities for the Elderly
02/09/2006 Opinions on Accelerating the Development of State Council
Social
Services for the Elderly
08/16/2006 11th Five-Year Development Plan of NCA(National Committee
Undertakings on Aging (2006–2010) on Aging)
09/25/2006 Circular on Establishing Demonstration Units MOCA
That Have Carried out Social Services for the
Elderly
01/29/2008 Opinions on Comprehensively Promoting the NCA, NDRC(National
Work of Home-Based Care Services Development and Reform
Commission), MOE,
MOCA, MOLSS,
MOF, MOC, MOH, PFPC
(Population and Family
Planning Commission),
SAT
09/17/2011 12th Five-Year Development Plan of State Council
Undertakings on Aging (2011–2015)
12/16/2011 Development Plan of the Elderly Service System State Council

(2011–2015)
12/28/2012 Law on Protection of the Rights and Interests of NPC
the
Elderly (Amended)
12/12/2013 Some Opinions on Accelerating the State Council
Development of
Social Services for the Elderly
11/18/2015 Guidance on Combining Medical Services with State Council
Elderly Care Services
06/24/2016 13th Five-Year Development Plan for China’s MOCA, NDRC
Civil Affairs Sector
As a result, investors from a wide range of industries have entered the senior housing market
in recent years. Over eighty elder care facility programs whose information has been
disclosed to the public are located in the cities of Beijing and Shanghai, and the provinces of
Zhejiang, Hainan, Shandong, Sichuan, and Guangdong. In addition to real estate developers,
insurance companies, and specialized elder care service institutions have invested in the
construction and operation of elder care facilities. In terms of product structure, a variety of
care facilities and services have been designed to meet the different needs of the elderly at
different ages. Regardless, the development of profit models is still in the initial stages.
With more than 1.4 billion people senior population in China is among the fastest-growing
demographic.
Although China’s great potential in the senior housing market has attracted investors interest,
the entire market is at the preliminary stage facing challenges such as insufficient effective
demand, mismatch between supply and demand, under micro policies financing channel
restraints. 6.7% of the senior population lives in community-based senior living and 3.4% of
the senior population lives in institutional housing. China will need 4.0- 5.2m senior units by
2020.
14 STANDARDIZATION IMPERATIVES
Accessibility prevents or removes barriers to the use of mainstream products and services. It
allows the perception, operation, and understanding of those products and services by persons
with functional limitations, including people with disabilities, on an equal basis with others.
Standards are powerful tools to integrate and strengthen accessibility aspects by providing a
framework, requirements, and specifications for accessible products and services.
The ‘Universal Design’ approach needs to be adopted by Nations, which means design for
human diversity, inclusion, and equality. Its aim is to enable maximum use of products,
goods, and services.
Standards Organizations’ endeavours need to include accessibility following a ‘Universal

Design’ approach in relevant standardization activities for products and services. The
government needs to achieve long-standing policy objectives surrounding inclusion and
equality.

‘Accessibility’ needs to be referred to as “the extent to which products, systems, services,

environments or facilities can be used by people from a population with the widest range of
characteristics and capabilities to achieve a specified goal in a specified context of use”.
People with disabilities and ageing population, among others benefit directly from a product,
good or service when it is easy to access, understand and use.
15 POLICIES IMPERATIVES AND INITIATIVES

India has signed and ratified the United Nations Convention on the Rights of Persons with
Disabilities (UNCRPD) which recognizes access to ICTs, transportation, and the physical
environment as basic human rights. Accessibility is one of the basic principles underpinning
the treaty. The CRPD also deals extensively with the states parties’ obligation to promote the
development of accessible and assistive technologies and promulgation of accessibility
standards.
Over the past decade, a few attempts have been made to adopt and implement ICT
accessibility. However, these have met with little success. In 2009, the NIC notified the
GIGW (Guidelines for Indian Government Websites), which also included some guidelines
from the W3C accessibility standard WCAG 2.0 (Web Content Accessibility Guidelines).
However, these remained advisory in nature and there was very little awareness amongst
government webmasters on how to implement these standards. These guidelines also did not
fully adhere to the corresponding WCAG 2.0 standard which they pertained to. Hence web
developers were also unable to make good use of the W3C resources, tutorials and other
documentation on implementing web site accessibility standards.
Thereafter the next important development was under the Department of Electronics and
Information Technology (now MeITy), which brought out a policy called the ‘National
Policy on Universal Electronics Accessibility’. However, almost no progress was made after
this, to the extent that for many years, there was not even much public knowledge about this
policy. One of the serious criticisms of this policy was that it did not clearly specify any
standard pertaining to ICT accessibility which was to be followed, hence not much action
could be taken. Consequently, even the launch of the Digital India campaign saw little
attention given to accessible technologies and hence, a majority of government apps and web
sites continued to be completely inaccessible, significantly hampering the goal of digital
inclusion and participation.
In 2016, the Rights of Persons with Disabilities (RPWD) Act came into force, which was
more in line with India’s commitments under the UN Convention on the Rights of Persons
with Disabilities (UNCRPD) and requires that service providers have to make products and
services to be made available in accessible formats. The accessibility standards to be notified
by the Central Government. Specific provisions of the Act which are relevant impose the
following obligations on the appropriate government departments:
• To take measures to ensure that all content available in audio, print and electronic media
are in accessible format;
• To ensure that persons with disabilities have access to electronic media by providing
audio description, sign language interpretation and close captioning;
• To ensure that electronic goods and equipment which are meant for everyday use are
available in Universal Design;

• To take measures to promote development, production, and distribution of universally

designed consumer products and accessories for general use for persons with disabilities.
The appropriate Government departments shall take suitable measures to provide,

(a) facilities for persons with disabilities at bus stops, railway stations and airports
conforming to the accessibility standards relating to parking spaces, toilets, ticketing
counters and ticketing machines;
(b) access to all modes of transport that conform the design standards, including retrofitting
old modes of transport, wherever technically feasible and safe for persons with
disabilities, economically viable and without entailing major structural changes in
design;
(c) accessible roads to address mobility necessary for persons with disabilities
The Act further requires the Central Government to notify relevant accessibility standards
and for service providers to ensure that all their products and services are accessible within 2
years of notification of standards. The RPWD rules require relevant Government ministries
and agencies to notify accessibility standards pertinent to their domain. Standard for public
buildings as specified in the Harmonised Guidelines and Space Standards for Barrier-Free
Built Environment for Persons with Disabilities and Elderly Persons as issued by the
Government of India, Ministry of Urban Development in March 2016.
As of today, we only have standards for accessible web sites (Guidelines for Indian
Government Websites ‘GIGW’, which was updated in 2017-18). For all other domains of
ICTs, which are used on a daily basis such as telecommunications, broadcasting,
procurement, and consumer products and services, standards are yet to be developed/adopted
and notified.
To ensure compliance, there is also a requirement of new or revamp of agencies or additional

requirements for agencies (for certification) who can check the standardized artifacts/tools /
media.
The Manual of Procurement of Goods 2017 references ‘accessibility’ as follows: under the
‘Broader obligation Principles’ (to which all procuring authorities must abide by and be
accountable for), the following two points have been added about accessibility, “(a)
Facilitating administrative goals of other Departments of Government (for example, ensuring
tax or environmental compliance by participants, Energy Conservation, accessibility for
People With Disabilities etc. to the extent specifically included in the ‘Procurement
Guidelines’) and (b) Procurement policies and procedures must comply with accessibility
criteria which may be mandated by the Government from time to time.”[11]
Hence there is an urgent need to notify standards in this regard.
16 POLICY INITIATIVES UNDERTAKEN BY THE STATE AND

UNION GOVERNMENTS OF INDIA
16.1 Dial 112 (Emergency services digital channel)
Dial 112 is a single number assigned for reporting emergency by citizens in the state of
Chhattisgarh. This number is one-stop for reporting emergency by citizen and access instant
services of police, ambulance, and fire department. This digital channel has incorporated text
chatting and video chatting features for citizens with hearing-impaired to report an

emergency in case of fire, medical emergency, etc. The operators in the help centre are
trained to interact with hearing-impaired and other citizens with disabilities while receiving
calls in stress.
16.2 Integrating digital inclusion within smart city mission project undertaken by the
Government of Chhattisgarh
Raipur Smart city app and portal launched by city administrations which integrated universal
design enabling citizens with disabilities to access eServices regarding grievance
management through this digital channel. Citizens with disabilities in spite of their mobility
constraint can access various information discriminated by Government (i.e. traffic, school &
hospital, citizen charter and description of services, etc). Citizens with disabilities can also
access seamlessly services such as issuance of birth certificate, death certificate, construction
permit, shop license, trade license, etc. with ease. Various taxes such as property tax,
professional tax, and payment of utility bills such as water, electricity, etc can be paid with
ease by citizens with disabilities through these digital channels. These initiatives have
resulted in ease of convenience for citizens with disabilities to file various applications online
in order to avail government services from the comfort of their home, such as water, trade
license, etc. It also empowers citizens with disabilities to access the schedule of public
transport and route details, and to pay /refill their smart card online. Citizens with disabilities
would be able to be independent and use curve end footpath, audio beep based traffic signals,
etc. It further empowers citizens with disabilities to access self-service Kiosks, smart meter,
and other emerging devices.
Under this smart city project, educational platforms are also incorporating the principal of
universal design enabling students with disabilities to attend virtual classroom and accessible
eLearning contents through the usage of their assistive technology. Citizens with disabilities
would also be inactive stakeholders by participating in various online dialog initiated by the
concerned government agency.
16.3 Atal Nagar Digital accessible system for city Administrations with disability
Current ERP application system empowers city administrators with disabilities to access
dashboard/ MIS report with ease. City Administration with disabilities can access all
components of the system including workflow; navigate the entire system through a
keyboard, etc.
16.4 Notification /circular issued by State & Central Government in India
The central government along with state government has initiated measures to facilitate AAL
through various government circular and notifications. Few of these notifications which truly
has potential to promote AAL and inclusion is notification by Ministry of Urban development
mandating all vendors to develop digitally accessible ICT components as part of smart city
mission project resulting in equal access for all including citizens with disabilities.
Department of IT, Government of Maharashtra issued notification mandating all vendors to
incorporate universal design and comply with international digital accessibility standard
WCAG2.1 Level AA in addition to the government of India web guidelines while delivering
final ICT solutions for the entire state of Maharashtra.

17 ACCESSIBILITY STANDARDS
17.1 Accessibility Standards for Buildings:
The RPDA 2016 mandates Central Government, in consultation with the Chief
Commissioner, to formulate rules for persons with disabilities laying down the standards of
accessibility for the physical environment, transportation, information and communications,
including appropriate technologies and systems, and other facilities and services provided to
the public in urban and rural areas.
The central Rules 2017 specifies standards for public buildings as specified in the
“Harmonized Guidelines and Space Standards for Barrier-Free Built Environment for Persons
with Disabilities and Elderly Persons” as issued by the Government of India, Ministry of
Urban Development in March 2016.
Section 44 (1) of the RPDA 2016 warns that no establishment shall be granted permission to
build any structure if the building plan does not adhere to the rules formulated by the Central
Government under section 40 of the Act. The service providers whether Government or
private shall provide services in accordance with the rules on accessibility formulated by the
Central Government under section 40 within a period of two years from the date of
notification of such rules:
17.2 Accessibility Standards for ICT
Accessibility standards for specific product types often attempt to quantify accessibility in
measurable ways by listing required attributes, objective tests and pass/fail criteria. A good
example is the Web Content Accessibility Guidelines (WCAG 2.0) which specifies testable
“success criteria” for three compliance levels (A, AA, or AAA), so it is possible to state
objectively whether a given web page is accessible to a recognized level. The question of
whether a website is “accessible” can then be answered by stating whether it complies to an
agreed level (A, AA, or AAA) of the WCAG 2.0 guidelines.
17.3 EN 301 549
Another prominent Accessibility standard is the European Standard EN 301 549

“Accessibility requirements for ICT products and services”[12]. Along with three technical
reports (TR 101 550, TR 101 551 and TR 101 552), it sets out accessibility requirements that
can be applied to a wide range of products and services related to ICT, including computers,
smartphones and other digital devices, ticketing machines, websites, and emails. The
requirements are based on functional performance criteria, which specify what the ICT needs
to enable people to do, irrespective of the nature of their disability. Any ability impairments
may be permanent, temporary, or situational.
The following clauses outline the functional requirements specified by the standard:
1. Generic requirements: This section covers the requirements of ICT with closed
functionality (i.e., the product is self-contained and users cannot add peripherals or
software to access that functionality). In such cases, the ICT should be operable without
needing the use of assistive technology and should have provisions such as non-visual
access, visual output for auditory confirmation, operation without keyboard interface. If

the ICT has assistive technology it should be possible to activate it without relying on a
method that does not support that need. The standard also provides for accessibility in
the case of biometrics, preservation of accessibility requirements during conversion,
operable parts, locking or toggle controls, key repeat, double strike key acceptance, and
simultaneous user actions.
2. ICT with two way voice communication: This clause calls out recommendations for real-
time text functionality, Caller ID, Alternative to voice-based services, video
communication, and alternatives to video-based services.
3. ICT with video capabilities: This clause covers Caption processing technology, audio
description technology and user controls for captions and audio description
4. Hardware: This clause covers generic requirements such as standard connections and
colour, as well as hardware products with speech output, physical access to ICT,
mechanically operable parts and tactile indication of speech mode
5. Web: This clause specifies accessibility requirements for web pages or software that is a
web page and, documents or software that are embedded in web pages and that are used
in the rendering or that are intended to be rendered together with the web page in which
they are embedded. They are required to adhere to WCAG 2.0 accessibility guidelines
level AA.
6. Non-web documents: This clause applies to documents that are not web-pages and the
success criteria set out in this clause are intended to harmonize with the Working Group
Note [i.26] produced by the W3C's WCAG2 ICT Task Force.
7. Software: This clause applies to platform software; software that provides a user
interface including content that is in the software, authoring tools and software that
operates as assistive technology. The success criteria set out in this clause are intended to
harmonize with the W3C Working Group Note [i.26] produced by the
W3C'sWCAG2ICT Task Force.
8. Documentation and support services: This clause specifies the accessibility requirements
for product documentation and support services
9. ICT providing relay or emergency service access: This clause outlines the accessibility
requirements for different types of relay services, access to relay services and access to
emergency services.
EN 301 549 is notable in that it mentions biometrics, an area of ICT that is not largely
explored by other accessibility guidelines. Specifically, EN 301 549 states that any ICT using
“biological characteristics” (fingerprints, voice recognition, face recognition, eye patterns
etc.) for user identification or control of ICT, shall allow for other methods too, either another
type of biometric or a non-biometric means of identifying the user or operating the device.
The EN 301 549 Standard itself also draws upon several other standards such as ETSI ETS
300 381: "Telephony for hearing impaired people; Inductive coupling of telephone earphones
to hearing aids”, W3C Recommendation (11 December 2008)/ISO/IEC 40500:2012: "Web
Content Accessibility Guidelines (WCAG) 2.0, ISO 9241-171:2008: "Ergonomics of human-
system interaction - Part 171: Guidance on software accessibility".
A complete list of standards that are essential for the application of EN301 549 as well as
provide assistance to understand its provisions is also provided on
thewebsitehttp://mandate376.standards.eu/standard/referencesand are given in the Reference.

18 AAL - INDIA SPECIFIC ISSUES

To understand the problems which the Indian AAL should attempt to solve, let us examine
the key settings in which the Indian old age citizen lives and the kind of challenges they face.
Percent distribution of 60+ by urban / rural living [A-3.2.]
Urban / Rural Percentage of 60+

Urban 29%
Rural 71%
In 2011, about 30 million, elderly were living in urban areas, whereas,the majority, 74
million were living in rural areas. The people in urban areas have better access to health care,
whereas that is not the case for the majority living in rural areas. AAL solutions for health
and wellness could be planned and provided to old people. As per the 2011 census, the total
population of the proposed Smart Cities is about 35 percent of the country’s total urban
population. Hence smart cities would have about 10.5 million, about one-tenth of the elderly
living in them as an approximation.
Percent distribution of 60+ by marital status [A-3.2.]
Marital Status 60-64 65-69 70-74 75-79 80+
Married 75.8 69.3 58.9 54.9 42.9
Widowed 21.8 27.8 38.8 42.8 50.8
Divorced / Separated 0.6 0.5 0.4 0.4 0.4
Never Married 1.8 2.4 1.9 1.9 5.9
Till 64 years of age about 76% of the Indian old have their spouse living with them.
However, as they age this percentage keeps going down, at age 80, this percentage is down to
almost 43%. The elderly, when living together, look out for each other and assist each other
till the time they can. However, single elderly have to depend on their children, close
relatives or household help to take care of them. Also, they miss a companion especially at
the stage of life when they need one, which depresses them too.AAL solutions that provide
personal care or companionship could help such elderly.
Per cent distribution of persons aged 60 + by type of living arrangement
Living Arrangement Percentage
Alone 5.2
With Spouse only 12.0
With Spouse and other members 44.8

With Children 32.1
With other relations and non-relations 4.4
Though the AAL solutions could be used by all elderly depending upon their specific
requirements, however, the elderly who live alone and at least half of those living with their
spouse could actually benefit from a variety of AAL solutions. Approximately, this figure
would be about 12.5 million. Out of which 3.6 million would be in urban areas and 1.3
million in smart cities.
Percent distribution of 60+ persons living alone or with spouse only by location of
residence of child /grandchild or sibling
Location of residence of child / grandchild / sibling Percentage
Within the same building 18.5
Within the village / town 36.9
Outside the village / town 29.4
Not applicable 11.9
For the people living alone or with spouse, theoretically, about 18.5% could get a quick
response to emergency situations and almost 55% could get temporary assistance for IADL
or ADL from their children or relatives in times of need. This implies that the majority of the
old could benefit from social support. Hence this aspect needs to be factored while designing
the Indian AAL.
Percent distribution of households by the number of aged members
Number of 60+ in the household Percentage
None 68.7
1 21.6
2 9.3
3 0.4
4 or more 0.1
The total elderly population in India lives in about 31.3% of the households. The local
authorities, governments in all areas should identify such households and plan special
schemes, services or programmes which benefit the elderly living in them.

The physically disabled among 60+, per hundred thousand is 5177.If we convert it to
percentage it comes to about 5.2% of the elderly population. The percentage breakdown as
per disability is given in the table.
Percentage distribution of persons with disabilities by type of disability in each age-

group
60-69 70-79 80-89 90+
Movement 26 26 24 22
Seeing / Vision 25 26 24 21
Speech 19 19 20 19
Hearing 5 3 2 3
Intellectual disability 2 1 1 1
Mental Illness 2 1 1 1
Multiple Disabilities 8 13 19 25
Any Other 14 10 8 9
The major disabilities are to do with locomotive issues, sight, and speech in the elderly.
Smart infrastructure, smart devices or services which could help such people with their work,
IADL and ADL should be planned as part of AAL India. As per the Census 2011, 2.21% of
the total Indian population has disability. Out of the total disabled people, elderly disabled
constitute only 21% of the total disabled at all India level. Hence, the scope of AAL India
should also include persons with disabilities, who may not be old but can benefit from AAL
Solutions. The AAL end-user devices and services would need to be accessible to people
with disabilities.
Percentage distribution of confined elders due to physical mobility
Confinement Due to Physical Mobility Percentage
Confined to Bed 60+ ( Urban) 1.7%
Confined to Bed 60+ ( Rural) 1.3% (Approx)
Confined to House 60+ ( Urban) 6.7% (Approx)
Confined to House 60+ ( Rural) 6.5% (Approx)
People who are confined to the house would usually require assistance for some of the IADL
tasks. People who are confined to bed require medical care, long term care, and assistance for

many activities of both IADL and ADL. Such care, should be planned to be provided under
the AAL India umbrella.
Number of persons aged 60 + reporting a chronic disease (per 1,000 persons)
Chronic Disease Rural Urban
Heart disease 80 164
Urinary problem 57 63
Cancer 26 56
Hypertension 36 54
Diabetes 40 53
Problem of joints 34 35
Ulcer 44 27
Whooping cough 7 3
Elderly people, who have chronic diseases, require constant medical care, medication, check-
ups, and activities to keep the chronic conditions under check. e-Health, wellness services
could be delivered to them through the AAL India route.
Gauzing the true purchasing power of the old people in India is a complicated issue.
However, some general approximations can be made based on the Ministry of Statistics and
Programme Implementation (MoSPI) report, ‘Elderly in India, profile and programmes
2016’.
Financial power of persons aged 60 +
Dependence on others for day-to-day maintenance (Financial) 65%

Monthly Per capita Consumer Expenditure (Urban, 2004) 1500+ 18% (Approx)
65% of the old depend on others partially or fully for their day-to-day sustenance. About 18%
of older persons living in urban areas are the ones who may spend money on affordable AAL
devices. What percentage of those would be actually willing to convert their houses into
smart homes and at what costs is a guess best left for a survey to get the answer.
The changing context impacting likely proliferation of AAL
The literacy in India, in 1951 was 18.33%, in 1981 43.57%, in 2001 64.83% and in 2011 it
was74.04%. Over the years the literacy graph has shown a positive trend. Each year the
percentage of literate people in India has only gone up. We can safely assume the same to be
the case for old people. Also, by the end of Jun 2017, there were 1, 186.84 million mobile
phone users in India. Approximately, 58% of those were in urban areas and 42% in rural
areas. In the same period, there were 431.21 million Internet users out of which Wireless
Internet subscribers were 409.55 million[21]. By the end of Dec 2017, under phase I of

Bharat Net Scheme, more than one lakh Gram Panchayats (GP) were connected with high-
speed optical fibre network. The plan is to connect 2 lakh and 50,000 Gram Panchayats with
broadband network by Mar 2019[22].
19 GAPS AND CHALLENGES

There are several factors affecting the adoption and effective use of technology for
independent living by persons with disabilities and the elderly in India.
Priority, awareness, lack of sensitisation, affordability, availability, localisation, and training
are key barriers affecting the development and deployment of appropriate Assistive
Technologies in India.
19.1 Priority
Accessibility and independent living have not so far been a priority issue for the Government
to actively implement along the same scale as other initiatives. This is evidenced by the fact
that even minimum targets of the Accessible India campaign remain unmet and that there is
still no integration of accessibility requirements into mainstream policies, programmes, and
initiatives. There is a fragmented approach to deploying ATs. Accessibility does not get
included in mainstream policies, even where it is directly relevant. A good case in point is the
commencement of the ‘Digital India', ‘Accessible India campaign’, and the ‘Smart Cities
Mission’ at approximately the same time. Despite the national stated commitment of
Accessible India, still m-governance and e-governance infrastructure which were procured or
developed under the other two government initiatives did not include accessibility as a key
requirement.
19.2 Awareness
This is a gap extending to all stakeholders. There is less information amongst persons with
disabilities and their family members and care givers, educators, employers, etc. especially in
rural areas, media houses, and the public at large as to the technology solutions which exist
and information on how to get and use them. Hence technologies are not reaching end-users.
19.3 Sensitisation
There is often a deplorable lack of sensitivity and respect for the needs of persons with
disabilities and the elderly. There is a need to create a more sensitive society in India which
is more accepting, accommodative, and friendly towards the diverse needs of people.
19.4 Affordability
Historically, ATs have been expensive for Indians, since most of them were being developed
outside India. However, of late, with development taking place under a few projects within
our country, the cost has been brought down successfully in many instances. For example, the
cost of refreshable braille displays has been brought down from INR 2 Lakhs earlier to INR
30-40,000 today. Braille Me is an Indian product created by Innovision, a start-up incubated
within the Indian Institute of Technology (IIT) Mumbai which has features similar to Orbit
and is being sold worldwide. Such assistive products were earlier only made in Japan,
Canada, Australia, South Korea, China, etc. Similarly, the cost of Daisy players, especially
those connected to the internet and content in digital libraries has come down to the range of
INR 10,000 -20,000 in India, from INR 45,000 a few years ago. DotBook is a Braille display/
note taker- created by IIT-Delhi and released by Saksham which costs approximately INR
50,000. However, despite this progress, even the present costs are unaffordable to many

Indians with disabilities and there is a need to make them available under different schemes.
Also, these are just a few examples - there is still a need for larger-scale development of ATs
for different disabilities.
19.5 Localisation
Given the linguistic diversity of India, the need to have solutions in all local languages is a
fundamental and unmet one, often for very critical technologies. Linguistic diversity also
makes technology sharing difficult, except in cases where these are in English and even these
are available to a limited number of people. This has to be a prime focus for us going forward
if we are to empower persons with disabilities and the elderly with technological solutions.
19.6 Training
It is important to ensure that there are adequate training and skill development for different
stakeholders to enable them to promote AT use; for trainers to train persons with disabilities
in the use of technologies, for persons with disabilities, their family members and caregivers,
educators etc. to use ATs and be connected with resources such as digital libraries and other
service providers to maximise unfettered and active use of their technologies, for developers
to develop ATs and technology products and services which are based on universal design,
for government officials, procuring officers, employers, and others who deploy/administer
schemes or employ persons with disabilities etc.
19.7 Availability
There are multiple factors affecting the availability of assistive technologies including the
existence of appropriate solutions, distribution of available solutions as well as maintenance
and upkeep of the technologies over time.
19.7.1 Availability of appropriate Technologies

Appropriate technologies are not always available for all persons with disabilities/ elderly.
There is a need for more technology development catering to their specific needs. These
should be affordable, easy to use, and available in different languages.
19.7.2 Distribution
Existing government schemes for the distribution of ATs are not always effective. The camp
approach to distributing often results in people not getting the relevant technology which they
require for their disability type, or may result in them getting part of a solution while the
other part goes to another person. It is important to connect the technology assessment with
distribution and training for a person with disability to be equipped with and use technology
19.7.3 Maintenance
There is no provision for maintenance of accessibility whether in products or services; for
instance, ATs are distributed under a scheme, there is no follow up to see if they are being
used by the person concerned, or if it needs any repair/ maintenance etc.
19.7.4 Lack of control

The end-user does not have control over the purchase. The user cannot ask for the device
from a government source. The user must wait for a camp to be organized.

19.8 Inaccessibility
Inaccessibility of mainstream technologies and digital content makes it very difficult for
people with disabilities to have access to assistive technologies to effectively use these
resources.
Often mainstream technologies can readily cater to the needs of persons with disabilities/
elderly persons, however, the fact that they do not conform to accessibility standards makes
them useless as a technology solution. Hence accessibility of all ICT, digital and electronic
consumer products will immediately go a long way in making AAL an easy goal to meet.
In addition to the inaccessibility of solutions and content, persons with disabilities also need
to contend with the inaccessibility of physical infrastructure, processes, communication all of
which make independence a challenge. Most public buildings and infrastructure such as
roads, pavements, parks, etc. are all inaccessible and make it difficult and often impossible
for persons who are elderly or have disabilities to travel on their own. Inaccessible
communication channels such as announcement systems without alternate information
options also increase the difficulty for persons who are solely dependent upon any sense-
hearing/ sight to access information.
19.8.1 Lack of involvement of AAL users

Persons with disabilities and the elderly are not involved at all stages in the discussion and
framing of policies and solutions, which could result in solutions that do not effectively meet
their needs.
19.8.2 Lack of involvement of the private sector

The private sector is a key stakeholder not only in terms of developing assistive technologies
that commercially viable and bringing them to market but also as an employer of persons
with disabilities who are users of AT. The involvement of the private sector to bring
innovative solutions and make them commercially available is very important.
19.8.3 Ineffective implementation of existing policies and schemes

Finally existing policies, notifications, campaigns, etc. have not been acted upon with the
energy, priority, and attention given to other national policies. There is a lack of
communication amongst different government agencies and departments themselves, and the
communication between the private sector and the public is almost non-existent. Policies like
the National Policy on Universal Electronic Accessibility has seen no traction since its
notification in 2013. There are still standards of accessibility which need to be notified and
made mandatory for both the public and private sector, as prescribed under the Rights of
Persons with Disabilities Act 2016 and its accompanying rules. Similar actions are also
required in many areas of ICT such as a general law on ICT accessibility relating to software,
hardware, etc. Similar to the Section 508 in USA, procurement, broadcasting, etc. In cases
such as Guidelines For Indian Government Websites(GIGW), the standard has been updated
and notified, however, most government agencies and the private sector are largely unaware
of the fact.
20 AAL USE CASES

Some of the relevant and pertinent use cases are listed in Appendix 3.

A more exhaustive list is collated in the following sources:
a) IEC TS 63134:2020 IEC SyC AAL: Active Assisted Living (AAL) Use
Cases
b) http://www.aal-europe.eu/wp-
content/uploads/2015/02/AAL_JP_Interop_D7_Use_Cases.pdf
IEC SyC AAL use cases are more focused on Old age people. More cases have been added to
include people with disabilities and also to include few lifestyle related use cases, which will
be a pain point in future for India. The other use cases apart from the IEC AAL use cases, are
also classified into "User category and domain" as per IEC definition.
The use cases are mostly from the following perspectives:
a) Old people
b) People with disabilities
c) Automation
d) Specific diseases
e) Mobility
f) Entertainment
g) Infotainment
h) Accessibility
i) Security
21 NATIONAL AND GLOBAL IMPERATIVES IN AAL PARADIGM

The need for Mission AAL India exists to enhance the overall quality of life of the aged, the
disabled, and their caregivers. Mission AAL India would have to be built on the very core of
the Indian way of life, incorporating its traditional values, factoring the needs of the Nation,
the old, and the disabled. Yet there would be a need to cater to a changing society which
believes in independent living to keep it holistic and inclusive. The solutions would not only
be technology driven but people and system driven too. The program would use ICT based
concepts, systems, services, products, and devices in sync with other elements to enhance the
overall quality of life of the target population. The technology-based solutions would have to
be well researched, tested , and certified/licensed by appropriate authorities within India. The
solutions would be required to confirm to the AAL India ecosystem requirements, the
existing laws and policies on various associated aspects. Most of the solutions would have to
be available at affordable/subsidized rates to be of use for the masses. Most of the ICT
services would have to be smart phone-based or web-based to ensure holistic coverage of the
entire population.
The core services would have to cater to the health, wellness, mobility, care, and social
aspects of the day-to-day lives of the old and the disabled. The solution areas could be
categorized as Health and Wellness, Mobility and Communication, IADL and ADL Care,
Social and Spiritual Living, Safety and Security. The solutions would be multi-sectoral and
would require to be taken from concept development, to system harmonization, to
production, to implementation, and through improvement cycles. To ensure success, a lot of
collaborative synergies would be required. This would call for lead agencies at the National
and State levels, to coordinate issues with the various stakeholders. The system would have to
be conceptualized top down. The issue being a multi-sectoral strategic issue, the strategic
vision, scope and policy guidelines would ideally be required to be worked out by the NITI

Aayog. A mission office would also be required to be opened under a suitable ministry to
work out the details of National ecosystem, the implementation details and to coordinate with
other stake holders. Each state in turn would be required to have its own mission office.
At the national level the ministries and departments which could contribute positively are,
Ministry of Social Justice and Empowerment, Ministry of Health and Family Welfare,
Ministry of Electronics and Information Technology, Ministry of Communications, Ministry
of Information and Broadcasting, Ministry of Commerce and Industry, Ministry of Consumer
Affairs, Food and Public Distribution, Ministry of Culture, Ministry of Finance, Ministry of
Home Affairs, Ministry of Shipping, Road Transport and Highways, Ministry of Human
Resource Development, Ministry of Personnel, Public Grievances and Pension, Ministry of
Rural Development, Ministry of Science and Technology, Ministry of Statistics and
Programme Implementation and Ministry of Urban Development. Some ministries could plan
various services for the old and disabled at the National level. Some ministries could help
with their valuable inputs and some others with the mission implementation. Their
counterparts at the state level would be required to play a similar role. Municipal corporations
and municipalities too would have to play an active role in the entire process.
Some government missions/initiatives/programmes/developments which could be of

immense value for AAL India are, Integrated Programme for Older Persons, National
Council Of Senior Citizens, National Programme for the Health Care for the Elderly,
Ayushman Bharat, National Health Mission, National Digital Health Authority (proposed as
of now), Insurance Regulatory Development Authority, Longitudinal Aging study in India
(LASI), Central Drugs Standard Control Organization, Bureau of Indian Standards, Atal
Innovation Mission, Council of Scientific Industrial Research, Indian Council of Medical
Research, National Health Stack (Strategy and approach), Smart City Mission, DigiLocker,
Jeevan Pramaan, Research and Academic Institutes within India. The other stakeholders for
development and implementation of the concept would be like the old people, disabled
people, families, societies, volunteers, NGOs, start-ups, MSMEs, Industries, Hospitals,
Insurers, Law firms,etc. To speed up the entire process, collaboration with the AAL program
of EU is also recommended at the apex level.
To start with, the AAL Mission, in phase 1 could streamline and deliver the existing services
being offered to the old and the disabled with requisite tweaks as part of the national
ecosystem. The central ecosystem would consist of central registries for the people, smart
homes, AAL Products, and AAL Services, Service Providers. Some possible steps are as
follows.
1. Create a centralized database for AAL users, Categorize them based on levels of
assistance requirements like IEC SyC AAL does. Create the online platform for them to
get registered edit/delete the details etc.
2. Online/physical Survey for the services they have been using, the services that are
needed to be added, deleted or modified in the existing system
3. Create/Update the Policy and Create Programs that help deliver products/services to
AAL users
4. Create A sustainable ecosystem and regulations that help every identified stakeholder to
easily and actively participate to perform their functions
5. Do a Pilot for a City. Implement the Pilot Feedback in 5 different cities and expand it to
State and to multiple states.

In phase 2 the AAL Mission could roll out new services (use cases) developed by various
departments and ministries. A similar ecosystem could be identified for the states or even
down to the city level based on the actual federal functioning. The states/cities in turn could
provide the services based on multiple languages, dialects, tastes, or customs prevalent within
their areas. The devices, smart homes, and services would be required to share/ host data at
the National, State, or City level for real-time interventions, monitoring, analysis, audits,
legalities, scientific research, and policymaking.
There would be broadly three implementation models, Smart Home Based, Smart Device
Based and Institution Based. In the first model (Smart Home Based), the various AAL
devices/ services would be controlled by the smart home ecosystem. Smart home would be
the only interface for communicating with the city, state, or national ecosystems. Smart home
would synergize the functioning of various AAL devices and services to achieve smart and
green outcomes. The smart home would carry out the functions of sensing, monitoring,
analysing, acting, reacting, communicating etc, using the various devices connected to it. In
the second model, for people who may not have smart homes but some smart AAL Devices
(Like mobile phone), would be served the possible services through that smart device. In such
cases, the device would directly interact with the city, state, or national ecosystem through
the authorized applications. The third model (Institution based), would function through AAL
service points having computers and community AAL devices at selected places throughout
the country. The elderly there would be assisted by AAL service providers’ representatives.
This would ensure that the mission stays ‘Inclusive’.
India has a strong National need for AAL; this is the right time to crystallize the Indian vision
and approach towards the subject as per our national requirements. This is so because if we
don't do so, in future, we risk ending up with multiple vendor-defined ecosystems within the
country, which may or may not be in sync with our National or people's needs. This is so
because novel foreign products definitely find entry into the Indian markets with time. Some
key issues which would require clarity would be like, level and mechanics of participation of
foreign governments, Industries, consortium's in our National AAL Mission. Whether the
AAL ecosystem would be government owned and controlled or it would be vendor driven.
However, the latter is not recommended, as it could create interoperability issues due to
different ecosystems and would hamper the AAL India Mission from reaching its true
potential. Some other pertinent issues to deliberate would be the location of cloud
Infrastructure for data storage, data ownership, record ownership, data transfer to third
parties/countries, data use, privacy, security, audit trails and redundancy guidelines.
AAL India should not get driven and get guided by requirements of SmartCities alone, as the
missions target population transcends the population of the smart cities. AAL India has to be
planned and implemented for the old and disabled of the entire nation. National consensus on
key definitions, scope, and vision AAL India has to be built by Niti Aayog. However, the
importance of smart cities, municipalities, and municipal corporations in the entire process
would be that they would be the pioneers not only for conceptualizing the city based
ecosystem and use cases but also for implementing the Mission AAL India first.
Now finally coming to the issue of making standards for AAL, it is strongly recommended
that the IEC Systems approach be followed for developing standards. This document is a
pioneer attempt at carrying out the ‘Domain Analysis’ as part of the same process. The
document broaches on some pertinent issues beyond the domain too, because as of today,
there is no AAL India Mission, no National lead agency, and certainly no National Concept
or Vision on the subject. However, it is the necessity of the time at this stage, to come out

with Indian standards for AAL to safeguard the interests of the Indian consumers as slowly
the AAL products and services are likely to trickle into the Indian Markets from the countries
which have pioneered the concepts and products in this field.
To liaise with relevant Sectional Committees in the BIS and other SDOs in India to share the
perspective of the Global SDOs with System Oriented Approach.
Instead of looking at AAL in isolation, it may be better to put it within the Reference Model
that is approximately covered by the value view. The reference architecture is approximately
covered by the value view, big picture view and some models (primarily describing
management frameworks) from other views.
Figure: Big Picture view of the Reference Model
The National Health Policy 2017 advocates extensive deployment of digital tools for
improving the efficiency and outcome of the healthcare system. The policy aims at an
integrated health information platform or system which serves the needs of all stake-holders
and improves efficiency, transparency, and citizen experience. Delivery of better health
outcomes in terms of access, quality, affordability, lowering of disease burden and efficient
monitoring of health entitlements to citizens, is the goal. The Policy states that recognizing
the integral role of technology (eHealth, mHealth, Cloud, Internet of Things or IoT,
wearables) in the healthcare delivery, a National Digital Health Authority (NDHA) will be set
up to regulate, develop and deploy digital health across the continuum of care. The first task
that the proposed NDHA will need to carry out is the formulation of a robust National Digital
Health Strategy, in consultation with all the stakeholders, for the smooth adoption of digital
health throughout India.
While doing so it has recommended a domain definition, identified the broad scope for the
domain, done a crisp domain analysis to identify some of the key problems and challenges in
the Indian context, pointed at some key areas to develop solutions and has also recommended
the way forward for moving ahead on the subject.
The study says that the system would have to be conceptualized top down. The strategic
vision, policy guidelines would have to be spelt out centrally. The core services would have
to cater to the health, wellness, mobility, care and support for ADL (Activities of Daily

Living) and IADL (Instrumental Activities of Daily Living), safety and security issues. To
ensure success, the AAL end user devices / services would need to be accessible to people
with disabilities. Accessibility can again be for two broad categories of (a) mobility and (b)
communication (Information and Knowledge). The various AAL categories could be:-
a) Health and Wellness,

b) Mobility and Communication,
c) IADL and ADL Care,
d) Social and Spiritual Living
e) Safety and Security.
f) Access to information and knowledge
22 TRAI RECOMMENDATIONS ON MAKING ICT ACCESSIBLE FOR

PERSONS WITH DISABILITIES
TRAI has proposed the following crucial recommendations on the subject
(https://main.trai.gov.in/sites/default/files/RecommendationsICT09072018, _0.pdf):
i) The Authority recommends that the Government should mandate the device
manufacturers/ importers not to curtail the accessibility features available in popular
operating systems in any manner from their devices (manufactured or imported in
India). An undertaking to this effect may be taken from them when their device
models come for certification in the Government approved labs. [Para 2.35]
j) Every mobile manufacturer who produces 5 or more different models of mobile
handsets should provide at least one mobile handset satisfying the accessibility
criteria for PwDs as enumerated in the recommendations. This may be achieved by
the end of 2020. [Para 2.55]
k) Accessibility Standards for Mobile Phones:
i. grips for improved stability;
ii. audio/voice interaction with user interface through voicedialling/response
and third-party apps;
iii. voice dialling, voice recorder, and voice commands withan integrated
hands-free speaker;
iv. Special provision where speaker’s voice is automaticallyplayed through
the phone’s loudspeakers;
v. pre-recorded voice command facility for popular functions
vi. fully accessible touch screen technology
vii. magnification and zoom functions
l) Accessibility Standards for Landline Phones:
i. Large button phones
ii. Voice controlled calling
iii. Stored number calling on specific memory keys with opportunity to have
pictures of the destination on the keys
iv. Extra loud ringing tone
v. Flash on incoming calls
vi. Programmable dialer with possibility to have pictures on the buttons
vii. Self voicing function that allows use of all features and functions without
vision

viii. Ability to use full phone without vision or gesture (directly or via
connected device)
ix. Ability to connect a Braille reader
x. Ability to install or activate a screen reader
xi. Standardized external interfaces so that it is possible to connect
standardized attachments and assistive devices
23 RELEVANT GLOBAL INITIATIVES:

EN 301 549 “Accessibility requirements for ICT products and services” It is the
most comprehensive standard encompassing all aspects of ICTs and has gained wide
acceptance internationally, even amongst countries outside of the EU now wishing to
adopt a national accessibility technical standard. It is harmonised with US sec. 508,
include WCAG 2.1, ISO Standards and is the most up to date and inclusive standard and
has extensive documentation and implementation support.
ITU-T Study Group 16 ‘Multimedia’ developed the ITU-T Recommendation F.790
‘Telecommunications accessibility guidelines for the elderly and people with
disabilities’.
The ITU-T Recommendation on telecommunication accessibility guidelines is intended

to provide general guidelines for standardizing, planning, developing, designing and
distributing all forms of telecommunications equipment and software and associated
telecommunications services, to enhance their accessibility for older persons and
persons with permanent or temporary disabilities, ensuring accessibility for people with
the widest possible range of abilities.
Since persons with disabilities in India are as yet largely dependent upon the global
market for their assistive technology needs, it is critical that the Indian technology
ecosystem follows global standards and accommodates seamless interoperability and
efficiency; otherwise persons with disabilities will find themselves with even bigger
access barriers than before.
Adopting the Global standards and growing the Indian capacity to develop globally
standards compliant goods and services will open up huge market opportunities for the
Indian technology industry, since from past experience, it is evident that Indian products
cost a fraction of the cost of those products globally.
24 SUMMARY AND CONCLUSIONS

A) Priority, awareness, affordability, availability, localization, and training are key
barriers affecting the development and deployment of appropriate assistive
technologies in India. Added to this, there is the problem of inaccessibility of
mainstream technologies and digital content which makes it very difficult for people
with disabilities to get access to assistive technologies to effectively use these
resources.
b) Appropriate technologies are not always available for all persons with disabilities.
There is a need for more technology development catering to the specific needs of
persons with disabilities. These should be affordable, easy to use, and available in
different languages.

c) Linguistic diversity makes technology sharing difficult, except in cases where these
are in English and even these are available to a limited number of people.
d) Often mainstream technologies can readily cater to the needs of persons with
disabilities/ elderly persons, however, the fact that they do not conform to
accessibility standards makes them useless as a technology solution. Hence
accessibility of all ICT, digital and electronic consumer products will immediately go
a long way in making AAL an easy goal to meet.
e) Existing government schemes for distribution of ATs are not always effective. The
camp approach to distributing often results in people not getting the relevant
technology which they require for their disability type, or may result in them getting
part of a solution while the other part goes to another person. It is important to
connect the technology assessment with distribution and training for a person with
disability to be equipped with and use technology. Hence training should be a critical
component of any technology deployment programme.
f) The capacity building aspect is also a must for other stakeholders; in educational
curriculum for the next generation of developers and ICT engineers, for educators, for
government officers to be sensitised to ensure a universal design approach in all their
programmes and communication, for procuring officers and the product and service
providers on both general sensitisation, as well as technical compliance etc.
g) There is no provision for maintenance of accessibility whether in products or services;
for instance, ATs are distributed under a scheme, there is no follow up to see if they
are being used by the person concerned, or if it needs any repair/ maintenance etc. It is
important to also connect users with helplines to ensure that they can easily get
assistance for their technical issues / lodge complaints etc. which can get addressed
within 3working days on a priority basis since without their technologies, persons
with disabilities can be completely out of action. In the case of services like web sites,
once a web site is made accessible, it comes back to the care of people who are not
trained in accessibility, so it lapses into inaccessibility as more content gets added.
Hence, constant audit and monitoring, is a critical aspect of a successful accessible
ICT eco-system.
h) Involvement of AAL users is critical in all aspects – from development to deployment
of accessible technologies- both to ensure that the technologies, platforms on which
they are built, design etc. are accessible, as well as to ensure that they reach the end
users who also get trained to use them. Open and accessible technologies such as the
text to speech synthesiser e-Speak or screen reader NVDA enable opportunities for
improvement, adaptation, and customisation.
i) Involvement of the private sector to bring innovative solutions and make them
commercially available is very important. Government can play a huge role in
stressing the importance of accessibility amongst the private sector. A rethink as to
how accessibility can be integrated into existing government projects or independent
accessibility related projects can be successfully launched, is needed. Perhaps a mixed
approach such as regulation or tying up accessibility commitments with mainstream
projects / targets or other options could be explored. In 2012, the Universal Service
Obligation Fund announced a pilot project for persons with disabilities and use of
ICT. The scope of the pilot project was very wide. However, there never were any
applications made from the private sector and the pilot project scheme just lapsed.
There is a need for collective ownership and prioritisation of this issue, for if reaching
the unreached is left only to civil society, it will take a very long time indeed for this
to become a reality.

j) Finally existing policies, notifications, campaigns, etc. have not been acted upon with
the energy, priority and attention given to other national policies. There is a lack of
communication amongst different government agencies and departments themselves,
and the communication between private sector and public is almost non-existent.
Policies like the National Policy on Universal Electronic Accessibility has seen no
traction since its notification in 2013. There are still standards of accessibility which
need to be notified and made mandatory for both the public and private sector, as
prescribed under the Rights of Persons with Disabilities Act 2016 and its
accompanying rules, in many areas of ICT such as a general law on ICT accessibility
relating to software, hardware etc. similar to the Section 508 in USA, procurement,
broadcasting etc. In cases such as GIGW, the standard has been updated and notified,
however most government agencies and all of the private sector are largely unaware
of the fact. Hence, adoption of relevant standards, and making all stakeholders aware
of compliance requirement needs serious and immediate attention.
25 RECOMMENDATIONS
Sr. Barrier/ Gap Issue Recommendations Stakeholders
No involved
1 Priority Accessibility and The Accessible India Accessible India
independent living campaign, DePD and campaign, Ministry of
has not so far been all ministries, Social Justice and
a priority issue for departments and Empowerment1,
the Government to agencies, need to DEPD2, Rehabilitation
actively implement work together to Council of India3,
along the same ensure that Ministry of Health and
scale as other accessibility becomes Family Welfare,
initiatives. a cross-cutting issue People with lived
which is consciously experiences of
included in all disability
existing and
upcoming policies,
programmes and
initiatives.
2 Awareness Low awareness Targeted awareness Ministry of Social
amongst persons raising amongst Justice and
with disabilities family members and Empowerment, DEPD,
and their family elderly and persons Rehabilitation Council
members and care with disabilities of India, Ministry of
givers, educators, about technology Health and Family
employers etc. as to solutions which are Welfare, Persons with
the technology available and can be disabilities, family
solutions which used, amongst members, care givers,
exist and government officials, employers, educators,
information on how procuring agencies, Media
to get and use them educators, employers,
1
http://socialjustice.nic.in/
2
http://disalityaffairs.gov.in/content/
3
http://rehabcouncil.nic.in/

developers of
technology and all
other relevant
stakeholders that
technology solutions
exist and can/ should
be made available
and accessible.
3 Lack of Lack of sensitivity Government may Ministry of Social
sensitization and respect for the step up activities, Justice and
needs of persons engagement and Empowerment, DEPD,
with disabilities approach of the Rehabilitation Council
and elderly Accessible India of India, Ministry of
campaign to include Health and Family
sensitization trainings Welfare, DPOs
and camps and
advertisements
through popular and
social media, artwork
and posters etc
4 Affordability Unaffordability of Government to Ministry of Social
Assistive actively encourage Justice and
Technologies (AT) and promote AT Empowerment, DEPD,
due to lack of development by Rehabilitation Council
indigenous providing subsidies, of India, Ministry of
solutions incentives, schemes Health and Family
or other financial Welfare, DPOs
support for such
projects
5 Localization Due to the Government and Ministry of Social
linguistic diversity private sector Justice and
of India, the need organizations Empowerment, DEPD,
to have solutions in creating technologies Rehabilitation Council
all local languages may cater to multiple of India, Ministry of
is a fundamental language needs Health and Family
and unmet one, Welfare, private sector
often for very
critical
technologies
6 Training It is important to Run targeted training Ministry of Social
ensure that there is programmes for Justice and
adequate training different Empowerment, DEPD,
and skill for stakeholders, Rehabilitation Council
different encourage training of India, Ministry of
stakeholders to and compliance as Health and Family
enable them to part of procurement Welfare, DPOs
promote AT use contracts etc.
7 Availability a) Appropriate a) Support Ministry of Social
technologies technology Justice and
are not always development to Empowerment, DEPD,

available for all provide solutions Rehabilitation Council

persons with to specific of India, Ministry of
disabilities/ disability Health and Family
elderly challenges. Welfare, DPOs,
b) Existing b) Training should Educators
government be a critical
schemes for component of any
distribution of technology
ATs are not deployment
always programmes.
effective c) Accessibility
c) There is no maintenance
provision for should be part of
maintenance of all procurement
accessibility contracts. In case
whether in of technology
products or distribution, it is
services important to also
d) Lack of end connect users
user control with help lines to
over sourcing ensure that they
AT can easily get
assistance for
their technical
issues
d) Leverage
eGovernance for
fair distribution
of ATs, set up
experience zones
and access points,
align with health
system, look at
insurance scheme
for AT
maintenance
8 Inaccessibility Inaccessibility of Immediately notify Ministry of Social
mainstream and implement Justice and
technologies and accessibility Empowerment, DEPD,
digital content standards compliance Rehabilitation Council
make it very as prescribed under of India, Ministry of
difficult for people the Rights of Persons Health and Family
with disabilities with Disabilities Act Welfare, private sector
having access to 2016. Take stringent
assistive steps to implement
technologies to accessibility
effectively use standards across all
these resources. In areas of development.
addition to Bureau of Indian
inaccessibility of Identify, Standards (BIS),

solutions and adopt/transpose Telecom Engineering

content, persons global/regional Center (TEC) and
with disabilities standards suitable for Telecommunications
also need to Indian requirements Standards
contend with such as EN 301 549, Development Society,
inaccessibility of ITU-T India (TSDSI)
physical Recommendation
infrastructure, F.790 etc. (part of
processes, reference) and inform
communication all the Ministry to Notify
of which make them for
independence a implementation
challenge.
9 Lack of Persons with Involvement of AAL Ministry of Social
involvement of disabilities and the users is critical in all Justice and
AAL users at elderly are not aspects – from Empowerment, DEPD,
every stage involved at all development to Rehabilitation Council
stages in the deployment of of India, Ministry of
discussion and accessible Health and Family
framing of policies technologies- both to Welfare, DPOs
and solutions, ensure that the
which could result technologies,
in solutions that do platforms on which
not effectively they are built, design
meet their needs etc. are accessible, as
well as to ensure that
they reach the end
users who also get
trained to use them.
10 Less private The private sector Government can play Ministry of Social
sector is a key stakeholder a huge role in Justice and
engagement not only in terms of stressing the Empowerment, DEPD,
developing importance of Rehabilitation Council
assistive accessibility amongst of India, Ministry of
technologies that the private sector. A Health and Family
commercially rethink as to how Welfare, Private
viable and bringing accessibility can be Sector
them to market but integrated in existing
also as an employer government projects
of persons with or independent
disabilities who are accessibility related
users of AT. projects can be
successfully launched
is needed. Perhaps a
mixed approach such
as regulation or tying
up accessibility
commitments with
mainstream projects /
targets or other

options could be
explored.

ANNEX A
REFERENCES
A-1 References
The following referenced documents are necessary for the application of the present document.
[1] Standard to be followed as mandated is the National Building Code, available at

https://bis.gov.in/?page_id=117159
[2]
Please see
http://mospi.nic.in/Mospi_New/upload/disablity_india_statistical_data_11mar2011/Chapter%
204-Dimension_Disability.pdf
[3] https://www.verywell.com/deaf-community-india-1048923
[4] http://indianexpress.com/article/india/8-8-million-blind-in-india-in-2015-says-study-in-
lancet-4781368/
[5]http://indianexpress.com/article/india/8-8-million-blind-in-india-in-2015-says-study-in-
lancet-4781368/
[6]OECD (2015), "Old-age dependency ratio", in Pensions at a Glance 2015: OECD and G20
indicators, OECD Publishing, Paris, https://doi.org/10.1787/pension_glance-2015-23-en.
[7]Ministry of Statistics and Programme Implementation (MoSPI), ‘Elderly in India, profile
and programmes 2016’ .
[8]Eurostat, Life expectancy by age and sex (2016),
http://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do
[9]Eurostat, http://ec.europa.eu/eurostat/cache/infographs/elderly/index.html
[10]Eurostat, Monthly minimum wages - bi-annual data(2018),
http://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=earn_mw_curandlang=en
[11] Manual for Procurement of Goods 2017 Ministry of Finance Department of Expenditure
5 Chapter – 1, Page 7, 1.7 (iii) (d), (e) accessed
athttp://doe.gov.in/sites/default/files/Manual%20for%20Procurement%20of%20Goods%202
017_0_0.pdfon 8th July 2017.
[12] European Telecommunications Standards Institute, EN 301549,
http://www.etsi.org/deliver/etsi_en/301500_301599/301549/01.01.01_60/en_301549v010101
p.pdf
[21]TRAI, The Indian Telecom Services Performance Indicators April-June, 2017,

http://trai.gov.in/sites/default/files/Performance_Indicator_Reports_28092017.pdf
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Planning and Focused
Implementation at Ground Level,http://pib.nic.in/newsite/PrintRelease.aspx?relid=175462
A-2 Informative references
The following referenced documents are not necessary for the application of the present document
but they assist the user with regard to a particular subject area.
1. ANSI/IEEE C63.19 (2011): "American National Standard Method of Measurement of

Compatibility between Wireless Communication Devices and Hearing Aids".
2. ANSI/TIA-4965: "Receive volume control requirements for digital and analogue
wireline terminals".
3. European Commission: "Standardization Mandate to CEN, CENELEC and ETSI in
support of European accessibility requirements for public procurement of products and
services in the ICT domain".
4. ETSI EG 201 013: "Human Factors (HF); Definitions, abbreviations and symbols".
5. ETSI ES 202 975: "Human Factors (HF); Harmonized relay services".
6. ETSI ETS 300 767: "Human Factors (HF); Telephone Prepayment Cards; Tactile
Identifier".
7. CEN/CENELEC/ETSI TR 101 550: "Documents relevant to EN 301 549 "Accessibility
requirements suitable for public procurement of ICT products and services in Europe".
8. CEN/CENELEC/ETSI TR 101 551: "Guidelines on the use of accessibility award criteria
suitable for publicly procured ICT products and services in Europe".
9. ETSI TR 102 612: "Human Factors (HF); European accessibility requirements for public
procurement of products and services in the ICT domain (European Commission
Mandate M 376, Phase 1)".
10. ETSI TS 126 114: "Universal Mobile Telecommunications System (UMTS); LTE; IP
Multimedia Subsystem (IMS); Multimedia telephony; Media handling and interaction
(3GPP TS 26.114)".
11. ETSI TS 122 173: "Digital cellular telecommunications system (Phase 2+); Universal
Mobile Telecommunications System (UMTS); LTE; IP Multimedia Core Network
Subsystem (IMS) Multimedia Telephony Service and supplementary services; Stage 1
(3GPP TS 22.173)".
12. ETSI TS 134 229: "Universal Mobile Telecommunications System (UMTS); LTE;
Internet Protocol (IP) multimedia call control protocol based on Session Initiation
Protocol (SIP) and Session Description Protocol (SDP); User Equipment (UE)
conformance specification (3GPP TS 34.229)".
13. IETF RFC 4103 (2005): "RTP Payload for Text Conversation".
14. ISO/IEC 17007:2009: "Conformity assessment - Guidance for drafting normative
documents suitable for use for conformity assessment".
15. ISO 9241-11:1998: "Ergonomic requirements for office work with visual display
terminals (VDTs) - Part 11: Guidance on usability".
16. ISO 9241-110:2006: "Ergonomics of human-system interaction - Part 110: Dialogue
principles".
17. ISO 9241-171:2008: "Ergonomics of human-system interaction - Part 171: Guidance on
software accessibility".
18. ISO 26800:2011: "Ergonomics - General approach, principles and concepts".

19. ISO/IEC 13066-1:2011: "Information technology - Interoperability with assistive

technology (AT) - Part 1: Requirements and recommendations for interoperability".
20. Recommendation ITU-T E.161 (2001): "Arrangement of digits, letters and symbols on
telephones and other devices that can be used for gaining access to a telephone network".
21. Recommendation ITU-T G.722 (1988): "7 kHz audio-coding within 64 kbit/s".
22. Recommendation ITU-T G.722.2 (2003): "Wideband coding of speech at around 16
kbit/s using Adaptive Multi-Rate Wideband (AMR-WB)".
23. Recommendation ITU-T V.18 (2000): "Operational and interworking requirements for
DCEs operating in the text telephone mode".
24. TIA-1083-A (2010): "Telecommunications; Telephone Terminal equipment; Handset
magnetic measurement procedures and performance requirements".
25. US Department of Justice: "2010 ADA Standards for Accessible Design".
26. W3C Working Group Note 5 September 2013: "Guidance on Applying WCAG 2.0 to
Non-Web Information and Communications Technologies (WCAG2ICT) ".
27. W3C Recommendation (11 December 2008)/ISO/IEC 40500:2012: "Web Content
Accessibility Guidelines (WCAG) 2.0 ".
28. IEC, SyC AAL Strategic Business Plan:
https://www.iec.ch/public/miscfiles/sbp/SYCAAL.pdf
29. Smart Cities For All:http://smartcities4all.org/
30. ETSI EN 301 549 :http://mandate376.standards.eu/standard
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32. IEC TC 100: Audio, video and multimedia systems and equipment, prepares
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improving-quality-of-life
33. ITU-D, Study group 16:https://www.itu.int/en/ITU-T/Pages/default.aspx
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36. Ministry of Statistics and Programme Implementation (MoSPI), ‘Elderly in India, profile
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38. Eurostat, http://ec.europa.eu/eurostat/cache/infographs/elderly/index.html
39. Draft ETSI EN 300 743: Digital Video Broadcasting (DVB); Sub-titling systems
40. ETSI EN 300 468: Digital Video Broadcasting (DVB); Specification for Service
Information (SI) in DVB systems
41. Draft ETSI EN 300 401: Radio Broadcasting Systems; Digital Audio Broadcasting
(DAB) to mobile, portable and fixed receivers
42. Draft ETSI EN 303 560: Digital Video Broadcasting (DVB); TTML subtitling systems
43. ETSI ES 202 975: Human Factors (HF); Requirements for relay services
44. ETSI ES 202 076: Human Factors (HF); User Interfaces; Generic spoken command
vocabulary for ICT devices and services
45. ETSI ES 202 642: Television systems; Specification of the domestic video Programme
Delivery Control system (PDC)

46. ETSI ETS 300 381: "Telephony for hearing impaired people; Inductive coupling of
telephone earphones to hearing aids".
47. ETSI ES 200 381-1: "Telephony for hearing impaired people; Inductive coupling of
telephone earphones to hearing aids Part 1: Fixed-line speech terminals".
48. ETSI ES 200 381-2: "Telephony for hearing impaired people; Inductive coupling of
telephone earphones to hearing aids; Part 2: Cellular speech terminals".
49. ETSI - TS 101 154: DIGITAL VIDEO BROADCASTING (DVB); SPECIFICATION
FOR THE USE OF VIDEO AND AUDIO CODING IN BROAD CAST AND
BROADBAND APPLICATIONS
50. ISO/IEC 13818-1:2018 Information technology -- Generic coding of moving pictures
and associated audio information -- Part 1: Systems
51. ISO/IEC 15948:2004 Information technology -- Computer graphics and image
processing -- Portable Network Graphics (PNG): Functional specification
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Infrastructure,http://www.bis.org.in/other/USR_ICT_FSI_V_1_0.pdf(Accessed 7th
February 2018)
54. Standards Knowledge Management Tool, Joint Initiative for Global Standards
Harmonization
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http://www.skmtglossary.org/
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programme-aal-jp
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EHR Standards:https://www.nhp.gov.in/electronic-health-record-standards-for-india-
helpdesk_mty(Accessed 7th February 2018)
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2017:https://www.nhp.gov.in//NHPfiles/national_health_policy_2017.pdf (Accessed 7th
February 2018)

Appendix 1
List of disabilities specified under the Rights of Persons with Disabilities Act, 2016
1. Physical disability—
A. Locomotor disability (a person's inability to execute distinctive activities associated with
movement of self and objects resulting from affliction of musculoskeletal or nervous
system or both), including—
a) "leprosy cured person" means a person who has been cured of leprosy but is
suffering from—
i. 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;
ii. manifest deformity and paresis but having sufficient mobility in their hands and
feet to enable them to engage in normal economic activity;
iii. extreme physical deformity as well as advanced age which prevents him/her
from undertaking any gainful occupation, and the expression "leprosy cured"
shall construed accordingly;
b) "cerebral palsy" means a Group of non-progressive neurological condition affecting
body movements and muscle coordination, caused by damage to one or more
specific areas of the brain, usually occurring before, during or shortly after birth;
c) "dwarfism" means a medical or genetic condition resulting in an adult height of 4
feet 10 inches (147 centimeters) or less;
d) "muscular dystrophy" means a group of hereditary genetic muscle disease that
weakens the muscles that move the human body and persons with multiple
dystrophy have incorrect and missing information in their genes, which prevents
them from making the proteins they need for healthy muscles. It is characterised by
progressive skeletal muscle weakness, defects in muscle proteins, and the death of
muscle cells and tissue;
e) "acid attack victims" means a person disfigured due to violent assaults by throwing
of acid or similar corrosive substance.
B. Visual impairment—
a) "blindness" means a condition 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; or
iii. limitation of the field of vision subtending an angle of less than 10 degree.
b) "low-vision" means a condition where a person has any of the following conditions,
namely:—
i. visual acuity not exceeding 6/18 or less than 20/60 upto 3/60 or 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 person having 60 DB to 70 DB hearing loss in speech
frequencies in both ears;

D. "Speech and language disability" means a permanent disability arising out of conditions
such as laryngectomy or aphasia affecting one or more components of speech and
language due to organic or neurological causes.
2. Intellectual disability, a condition characterised by significant limitation both in

intellectual functioning (reasoning, learning, problem solving) and in adaptive behaviour
which covers a range of every day, social and practical skills, including—
i. "specific learning disabilities" means a heterogeneous group of conditions wherein
there is a deficit in processing language, spoken or written, that may manifest itself
as a difficulty to comprehend, speak, read, write, spell, or to do mathematical
calculations and includes such conditions as perceptual disabilities, dyslexia,
dysgraphia, dyscalculia, dyspraxia and developmental aphasia;
ii. "autism spectrum disorder" means a neuro-developmental condition typically
appearing in the first three years of life that significantly affects a person's ability
to communicate, understand relationships and relate to others, and is frequently
associated with unusual or stereotypical rituals or behaviours.
3. Mental behaviour:-
"Mental illness" means a substantial disorder of thinking, mood, perception, orientation or
memory that grossly impairs judgment, behaviour, capacity to recognize reality or ability
to meet the ordinary demands of life, but does not include retardation which is a condition
of arrested or incomplete development of mind of a person, specially characterized by
subnormality of intelligence.
4. Disability caused due to—

a) Chronic neurological conditions, such as—
i. "multiple sclerosis" means an inflammatory, nervous system disease in which
the myelin sheaths around the axons of nerve cells of the brain and spinal cord
are damaged, leading to demyelination and affecting the ability of nerve cells
in the brain and spinal cord to communicate with each other;
ii. "parkinson's disease" means a progressive disease of the nervous system
marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly
affecting middle-aged and elderly people associated with degeneration of the
basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
b) Blood disorder—
i. "Haemophilia" means an inheritable disease, usually affecting only male but
transmitted by women to their male children, characterised by loss or
impairment of the normal clotting ability of blood so that a minor would may
result in fatal bleeding;
ii. "Thalassemia" means a group of inherited disorders characterised by reduced
or absent amounts of haemoglobin.
iii. "Sickle cell disease" means a hemolytic disorder characterised by chronic
anemia, painful events, and various complications due to associatedTissue and
organ damage; "hemolytic" refers to the destruction of the cell membrane of
red blood cells resulting in the release of hemoglobin.
5. Multiple Disabilities (more than one of the above specified disabilities) including deaf
blindness which means a condition in which a person may have combination of hearing

and visual impairments causing severe communication, developmental, and educational

problems.
6. Any other category as may be notified by the Central Government.

Appendix 2
Disability Types that can be addressed by Inclusive ICTs and Assistive Technologies
Source: Body of Knowledge, Certified Professional in Accessibility Core Competencies,

International Association of Accessibility Professionals
1. Vision
a. Color Blindness
b. Blindness
c. Low Vision
2. Auditory Disabilities
a. Deafness
b. Hard of Hearing
3. Deaf-blindness
4. Mobility, Flexibility, and Body Structure Disabilities
a. Manual Dexterity/Fine Motor Control
b. Ambulation
c. Muscle Fatigue
d. Body Size
e. Body Shape or Form
5. Cognitive Disabilities
a. Intellectual Disabilities
b. Memory
c. Reading and Dyslexia
d. Math and Computation
e. Attention Deficit
f. Learning
g. Language
h. Autism Spectrum Disabilities
6. Speech Disabilities
a. No Speech
b. Articulation
7. Seizures
a. Photosensitive
b. General Seizure Disorders
8. Psychological or Psychiatric Disabilities
a. Social Disabilities
b. Emotional Disabilities
c. Behavioral Disabilities
9. Multiple/Compound Disabilities

Appendix 3
Use Cases
1. Remote Health Monitoring
2. Advanced Medication Monitoring
3. Enable Social Interaction
4. Guidance to return home with wheeled walker
5. Health care senior citizen welfare center Intelligent Apartment for the Elderly
(Smart Home)
6. Personal Trainer
7. Behavior Monitoring / Fall Detection
8. Shopping and Nutrition Planner
9. Tele-monitoring
10. Environmental Health Monitoring and Alarm
11. One stop emergency service
12. Controlled information sharing Information Security
13. Privacy, data protection, information security Data Protection
14. Enable upload of measurement data on the WAN interface Enable the upload of vital
measurement data on the WAN interface
15. Standardized Data Exchange of Regular Medical Check-up Record
16. Intelligent Lighting Fixtures
17. Home assistant robots
18. Exoskeleton robots
19. Care service provided by trained working person
Remote Health Monitoring:
Sunita is a 73-year-old woman, living independently with her husband. She wears a small
body sensor that monitors her conditions. The detected biometric measurements including
vital signs are sent to a healthcare service centre and stored there so that medical doctors can
analyze the data. The doctors generate a monthly health report for Sunita. The reports are

shared with her family chemists at a drugstore near Sunita’s house. The chemists give advice
to Sunita based on the health report as well as her health conditions.
In this use case, the person actors are Sunita, medical doctors and chemists. Sunita is an AAL
care recipient, while medical doctors and chemists are healthcare professionals. The AAL
care recipient is maintaining independent living. The data is stored in a cloud server so that
other AAL actors can share it and make professional intervention when necessary.
Advanced Medication Monitoring:
Asha is 74 years old and lives on her own. Her doctor has prescribed multiple medications for
various ailments. She uses a medication monitoring system that reminds her when to take the
proper medication at the proper time. The system also records her adherence to medication
intake schedule. Her daughter, one of her informal carers, may be notified when her mother’s
medication non-adherence is detected.
The advanced medication monitoring (AMM) system sends reminders to the AAL care
recipient, provides physicians with information on medication and the patient’s compliance,
and can send notification to relevant informal carers when irregularities are detected. The
AMM may be programmed by trained AAL operator.
Enable Social Interaction:
Asha lives on her own and has medical, physical and cognitive issues. The problems limit her
mobility and it is difficult for her to visit other people to interact with and maintain
connections with them. Her problems sometimes prevent her from attending regular medical
appointments. She can maintain social interaction with family members, friends, and care
providers through text-based interaction (instant messaging), as well as voice and audio
interaction.
The use case mainly focuses on AAL users, where many people have difficulty going out of
their homes. In such situations, maintaining social interactions becomes a challenge. Lack of
social connection should be avoided as much as possible, as it could lead to depression and
have further negative impacts on physical or cognitive abilities of the older person.
Guidance to return home with wheeled walker:
The Smart Wheeled Walker “helps Mrs. Appletree to stabilise her walk but also guides her
around the flat and the residence, along her preferred routes and to her chosen destinations
(and back), and even outside in the park where she usually finds it difficult to distinguish one
tree from another. Her personal assistant always knows where they are and never gets lost.”
Health care senior citizen welfare centerIntelligent Apartment for the Elderly (Smart
Home):
Anwar lives in an intelligent apartment equipped with a tele-monitoring system that helps
him monitor his biometric data. Routine monitoring ranges from health checks to house
security. An intelligent drug cabinet monitors medication adherence as well, In case of
irregularities, alarms go off and inform both his family and the head office of the living
quarters.

The user needs assistance with IADL (instrumental activities of daily living), in many areas
of daily life. In the intelligent apartment, where his activities are monitored, he can manage
his appointments, home security, etc. Household chores are also managed by the staff at the
apartment house. He can consult with healthcare professionals via video conferencing.
Many actors appear in this use case: AAL users along with AAL care recipient, AAL service
providers, and various kinds of devices, etc. This is because the setting (intelligent apartment
for the elderly) comprehensively takes care of all kinds of daily life activities of senior
citizens.
Personal Trainer:
Frieda is becoming a little weaker these days. It is harder for her to be active during the day.
Housework tasks are sometimes a big burden for her. Her doctor gave her a little wearable
device that tracks her physical activity, along with a small box. Her son connected the box to
her PC at home. The box shows videos that give tips to simplify household tasks and daily
activities. It also suggests tailored workout training for her. A few months later, Frieda finds
herself fitter and safer when she performs her daily activities.
The user gets some hints to make household tasks easier for her. At the same time, regular
exercise helps her stay fit. A body activity sensor collects data and the AAL application
determines appropriate activities and exercises for the user. As it is difficult for the AAL care
recipient to set the device herself, an informal carer, her son, comes in to help her.
Behavior Monitoring / Fall Detection:
Jane Sushila is 65 years old and suffers from mild cognitive impairments. She uses an AAL
system which detects potentially dangerous situations and changes in her behaviour patterns.
For example, if Jane leaves a pan on the stove in the kitchen unattended for a certain period
of time, the system notifies her alerting on her smart phone. Should she ever fall at home and
unable to get up, the system automatically notifies an emergency call service. When her daily
activity patterns change, a notification will be sent to her daughter so that she can look for
appropriate support.
The AAL care recipient maintains independent living though she is getting forgetful and
needs reminder and notification assistance for some of the daily activities. Sometimes she
fails to do what is necessary to keep herself and her residence safe and secure. Various
sensors are utilized to monitor home safety and the user’s body movement, so that formal and
informal carers can respond to the situation and/or change.
Shopping and Nutrition Planner:
Michael is 72 years old and lives alone. He suffers mild cognitive impairment and often has
problems with healthy diet and related shopping tasks. That’s why his son installed a new
shopping assistant on Michael’s smart phone. Michael can use the system to organize his
shopping list. For example, the assistant recommends him to add more fruits to his shopping
list. He can use the system for online ordering, too. The items he bought are delivered to his
home. The system also knows that the stock of sparkling water is running out and adds some
bottles to the shopping cart as well.

The AAL care recipient lives alone but needs assistance in managing healthy diet, as well as
doing grocery shopping. His son, an informal carer, installed a system that helps the AAL
care recipient assemble shopping lists, as well as arranging on-line shopping with door-to-
door delivery service. Connected with intelligent storage system, it can report low stock of
certain foodstuff similar to an intelligent refrigerator.
Tele-monitoring:
A tele-monitoring system is installed in the Sunil's home post-hospitalization and prompted

him to measure blood pressure, pulse, oxygen saturation and weight daily at a pre-specified
time. Data is transmitted to a central monitoring station. A trained professional reviews the
data within few hours. They can provide instructions on when a physician should be
contacted or how to respond to abnormal data.
Environmental Health Monitoring and Alarm:
EMS monitors environmental factors like light, sound, temperature, humidity, power, water
leakage, airflow, smoke and much more. EMS prevents calamitous situations resulting from
climate related issues within monitored environment. This can prevent life threatening
accidents.
One stop emergency service:
Mr. Kim, aged 75 years old, recently had a heart attack. Since the day he experienced a heart
attack, he has been wearing an emergency tag which was to prepare the emergency situation.
One day, when he was talking a walk, he accidently fell from the stairs. As he was not able to
move, someone called the emergency service. When this call was received, SEMS(Smart
Emergency Medical Services) immediately recorded the information on transport process
including crews’ ID, vehicle number, and time of response based on Beacon. With the E-
triage which enabled the classification of severity of Mr. Kim’s situation, staffs at nearby
hospitals were able to decide whether Mr. Kim could be delivered to their hospitals. Once
Mr. Kim was loaded into the ambulance, the emergency tag that he was wearing on his wrist
allowed crews to obtain additional information such as Mr. Kim’s full name, contact
information, and medical history. With this information, crews were able to give Mr. Kim a
proper first-aid inside the ambulance. After Mr. Kim has been successfully arrived at
emergency room, the emergency medical activity logs were transmitted to target hospitals’
system so that continuous care for Mr. Kim could be offered.
Controlled information sharing:
On its journey through a number of open and interoperable systems, sensitive health data
should be used only for the purpose(s) that the patient has consented to. Furthermore, the data
should be used according to privacy laws and ethical norms defined by privacy and security
policies of related countries and healthcare providers. Therefore, techniques that help and/or
ensure the enforcement of patient’s/organization’s privacy and security policies are of utmost
importance.
Privacy, data protection, information security:

Privacy is the value underpinning our ability to control the flow of information about
ourselves. It also covers the definition of the extent to which we as individuals interact with
society and the point at which society has no need to know about us and what we do.
In the AAL sphere, personal information may be collected face-to-face, in writing, or

electronically, and before any AAL system or service is introduced, it should be the subject
of a privacy impact assessment.
There is a distinction between privacy principles which are there to protect the person.
Security measures are there to protect the data.
AAL can be expected to contain huge numbers of devices (including wearable smart devices
and smart textiles) and sensors collecting and passing on data about environmental conditions
and personal information related to health, behaviour, etc. Most communications will occur
automatically. Objects will automatically exchange and process personal data with e.g. care
providers, doctors, potentially without the user being aware of it.
Enable upload of measurement data on the WAN interface:
Enable the upload of measurement data (or alarms) from the home/mobile to one or more
services in a generic way that works across the different domains (HF, AI, DM), that is
scalable and puts minimal constraints on the home side of the connection. As well as enabling
the download of commands and alerts from the remote server to the home/mobile AHD.
Special attention is needed for security and privacy since we will be transferring personal
health data across a very insecure medium.
Intelligent Lighting Fixtures:
An intelligent lighting system is installed in Sachin’s house. The intelligent lighting system
operates according to the time and the output of the human sensors installed in each room,
corridor and stairway. Specifically, when the person is present and the room becomes dark,
the lights are turned on automatically. Residents can also use the smartphone application
software to control the lighting of each light on / off. A normal ON / OFF switch for lighting
is installed but it is used as an auxiliary.
Heat stroke prevention system in home:
Chisato, an 80-year-old woman, has become less sensitive to changes in the room
temperature due to aging.One early summer night, the room temperature rose sharply while
Chisato was asleep.
Thanks to the “heat stroke prevention” system installed in her house, Chisato could avoid
getting heat stroke. The room temperature management system mainly for the elderly people
to prevent them from heatstroke by an air conditioner, automatic opening and closing
windows, and a ceiling fan.
Home assistant robots:
HAR (home assistant robots) has the function of picking up and transporting objects. People
can tell HAR what they want by voice or smart phone. HAR can memorize the location of
objects in the house, find them accurately, bring them and put them back in place after they

are used. Sometimes, HAR can also rely on this function to help the people find what they
have forgotten. During the moving, infra-red sensors around the chassis can ensure that HAR
does not bump into any person or object.
Exoskeleton robots:
With the help of an exoskeleton robot, a patient with lower limb dysfunction can stand, walk
and sit doing some housework as he can to regain confidence in life in a daily home
environment with little change. He can also carry out rehabilitation training to promote
sensory function, motor function recovery and muscle strength, etc. His training and activity
data can be stored in the cloud and sent to doctors to assess training effectiveness and adjust
personalized treatment plan.
Care service provided by trained working person:
Stella is a well trained professional formal caregiver.
Cathay, the 78-year-old woman with chronic illness and mental tension to her health state,
has changed her life quality through the help of an AAL system and Stella’s high quality care
service.
Personal health checkup (Wearable sensor based devices)
Mrs. Chiyoko , 73 years old residents of Suburb of Tokyo, Japan, lady, likes walking and
tries to go out every day. At 9:00 her husband left for a day-care service facility and he will
return at about 16:30. At 9:30, she went to her Pharmacy store for her health checking. Mrs.
Chiyoko attaches some very small wearable vital sensors that remotely/wirelessly monitor
her conditions. The detected vital signs are sent to a healthcare service center and stored for
her health checking. A medical doctor analyzes her vital data. In his analysis, oral health
check sheets created at the Pharmacy store are also used for his analysis. The medical doctor
generates Chiyoko’s monthly health check report. At the Pharmacy store, her chemist who
has knowledge and license of health consultation reads Chiyoko’s monthly health check
report and gives advices to her about her health conditions. The chemist may suggest her to
go to the doctor if necessary. After the health consultation, she purchased a package of cold
medicine and left the Pharmacy store.
E_enabled social interaction with care
Bernice K. is dealing with a number of health challenges that have begun to stand in the way
of her leading a full and active social life. She is no longer able to attend her weekly bridge
games and dance classes and has lost contact with several long-standing friends. Bernice lives
on her own but with a daughter living elsewhere in the same city and son and grandchildren
in a distant city, and faces increasing isolation.
The 84-year-old grandmother is a former lab technologist and travel agent so, while not
overly knowledgeable, is comfortable with the use of information and communications
technology.

She has two artificial knees, copes with atrial fibrillation and arthritis; recently she has begun
to show minor cognitive impairments and has recently had to deal with a bout of skin cancer.
Each condition requires ongoing visits to specialists, including a dermatologist,
rheumatologist, orthopaedic surgeon, cardiologist and respirologist however Bernice has
begun to miss appointments recently due to her mobility limitations.
Jane, a second person and potential AAL User and AAL Beneficiary, has recently been
diagnosed with skin cancer which has left her with a difficult time dealing with her new life
as she undergoes treatment. She needs treatment every few days and in the beginning didn’t
know what to expect. Luckily her Health Care Service provider has a support group that can
not only meet in person but can connect over the internet to get help, share stories or just chat
when she is feeling down or lonely. Jane no longer feels alone as she is going through
treatment, and can share her experiences, both good and bad, with others in real time or by
posting messages.
As potential AAL Users and AAL Beneficiaries, the Social interaction for both Bernice and
Jane can be enabled through:
• Text interaction in non-real-time (e.g. email, chat boards);
- For interaction with friends and family
- For interaction with formal care providers which includes the secure exchange of
personal health information
• Text interaction in real-time (e.g. instant messaging)
• Voice/audio interaction in real-time
• Video and Audio interaction one-on-one in real-time (e.g. video conferencing)
• Video and audio interaction with several parties in real-time (e.g. multi-party video
conferencing).

The Social Interaction platform(s) are designed for use by the AAL User but some AAL
Users may not be capable of configuring the system (e.g. finding, entering friends account
names to place a call) and/or have difficulty setting up connections. so several supporting
features are suggested:
• A designated informal Carer and (secondary) AAL User would take on the role of
AAL Assistant and be able to set-up a directory of people the AAL Beneficiary can call
• The designated informal Carer/AAL Assistant may limit who can communicate with
the AAL
Accessing care services through smart TV

Peter is an 83 year old person living in the suburbs of a big German city. His wife died 4
years ago and his son Michael has moved to another city about 200 km away. He is suffering
from lung cancer, frailty and is not good on feet anymore. In the past he never got used to
computers and mobiles but since the new generation of smartphones and tablets with touch
screen have been available, he is keener on technology. In addition he owns a new smart TV
with some additional functions like video conferencing, internet browsing and online gaming.
His smart phone is connected to the TV and can be used as remote control, game controller
but also has a “panic button app” installed, which he can use in emergency situations inside
and outside his home. A nursing service nearby is hosting this service.
Peter loves to use video conferencing in the evening to chat with his son Michael and his wife
Julia as well with his three grandchildren. Sometimes he calls his good friend Horst who has
moved to Spain, and they talk about the good old times or play cards.
Today Peter has a video call with his general practitioner to talk about his latest lab results.
Since there is no need for any other examination they both agreed on this video call. After the
call Peter decides to buy some food in the supermarket up the road. He picks up his walker
and uses the elevator. As the weather is very good today, he takes the route through the park.
While he is walking along the little lake he is feeling dizzy and he decides to take a rest on
his walker. He takes out his smart phone and presses the panic button. After a few seconds a
carer responds his emergency call. As the smart phone has a localisation application installed,
the carer can see where Peter is and speaks to him. Since Peter is complaining of dizziness
and seems to start panicking, the carer sends out an ambulance to pick him up. As he is
already feeling better by the time the ambulance arrives, they bring him back home. With the
help of his smart TV he orders his food from the supermarket's shopping service. In the
evening Peter calls his son Michael and tells him about the incident in the morning. Michael
decides to give his father a visit at the weekend.
Artificial based Personal Assistance device Guidance to return home on wheeled

walker(Smart Walker - Mobility aid with guidance)

Wheeled walker equipped with sensors, internet connection and attached smart user front-
end, which serves as a digital assistant is truly a liberating device for senior citizens living
alone.
The Smart Wheeled Walker “helps Mrs. Appletree to stabilise her walk but also guides her
around the flat and the residence, along her preferred routes and to her chosen destinations
(and back), and even outside in the park where she usually finds it difficult to distinguish one
tree from another. Her personal assistant always knows where they are and never gets lost.”
“Mrs Appletree sometimes forgets things, if only little things. Recently, however, when she
was visiting her friend, Mrs Peach, in the residence where both their apartments are, she had
trouble finding her way back to her flat and had to ask Mr. Scrub for directions. She felt
embarrassed and thought he might go around telling everyone that she is getting old. Every
now and then Mrs Appletree has a bad day where she runs the risk of stumbling and falling.
This only happens occasionally. As such, it amounted to something of a welcome miracle
when her daughter Heather presented her with a special wheeled walker that would become
her personal assistant. It not only helps her to stabilise her walk but also guides her around
the flat and the residence, along her preferred routes and to her chosen destinations (and
back), and even outside in the park where she usually finds it difficult to distinguish one tree
from another. Her personal assistant always knows where they are and never gets lost. She
remembers how her daughter once called her during her morning walk and she subsequently
didn’t know where she was. Mrs Appletree has decided to call her new little helper “Max”.
He is like a friend with whom she can talk; he answers back, offers information and advice,
clarifies queries, and occasionally even reminds her to visit Mrs Peach, like today at 5
o’clock, as she had promised her. Last week, when her favourite walking path in the park had
been blocked by a fallen tree, Max showed her a new route which she had never before
walked, leading her just as well to the pavilion by the lake. Max also helps her at the
neighbourhood shopping centre. How confusing it is when new shops seem to spring up
every two weeks and familiar ones suddenly disappear! In the supermarket, she often
wonders how difficult it is to find the things one is looking for (and how embarrassing it is to
always have to ask). Max guides her to the right product shelves. He even takes a particularly
short route which he has calculated beforehand with reference to the shopping list compiled
in advance by her. This saves her on walking distance, which is crucial because of her weak
knee. Max reminds her not to forget to get her favourite brand of coffee which she often finds
tough to recognise as all the packets look so similar from the outside and it seems she may
have forgotten her reading glasses this time. Max even advises her on which brand is cheaper
today or why a certain new brand is supposed to be better (though he also can’t say what
“improved crema” means!). In his basket, all her shopping can be comfortably carried home,
on her (his) very own wheels!”
which serves as a digital assistant;
Healthcare Senior citizen welfare Center

Ms M.’s father lives around 200 km away. In recent times, Gabriele M. has been increasingly
worried about his health. Her father, Konrad N., has been suffering from diabetes mellitus
and severe circulatory disorders in his legs for several years. For this reason, his gait has
become increasingly unstable. Moreover, Ms M. feels that he seems to become increasingly

forgetful. Indeed, his doctor has diagnosed him with an early stage dementia, an additional
health challenge for Mr. N. as well as an added responsibility for Gabriele M.
She is happy that her father moved to an area with a comprehensive and well-organised living
quarters concept five years ago. As part of this concept, residents can receive assistance by
means of modern technology and a wide range of services. His apartment has state-of-the-art
technology, equipped with fall recognition sensors, motion detectors, intelligent lighting
systems and much more. In case of irregularities, alarms go off and inform both Ms M. and
the head office of the living quarters.
The head office of the living quarters is located in a service centre of a senior citizens’
welfare provider which offers an extensive and easily accessible range of services around the
clock. These services include everything from sports and fitness to housekeeping services
such as laundry service and gastronomy. The offered services can be used independently to
meet the individual needs. Short response times can be guaranteed by the excellent
organizational infrastructure. If Konrad N. wishes, he can also contact a digital nutritionist
who advises him on an individually tailored diet.
Thanks to the technical assistance systems, both the residents of the service centre as well as
persons in need of help and care in the wider domestic sphere can be cared for. Services
include everything from routine health checks to security functions. Thanks to these services,
elderly persons such as Ms M.’s father can live with a high degree of security and
independence at home. Telemedicine and telecare make this possible. Technical assistance
systems also play a major role in prevention and rehabilitation. Due to his early stage
dementia, Mr. N. needs more and more help to manage activities of daily living. This is why,
for example, he gets a “morning call” from the residential headquarters on his television set
every morning. Nurse Hildegard from the headquarters appears on the monitor and inquires
about his well-being. She also checks whether he takes his medicine. The reason to check his
adherence to his medication regime is to ensure that Mr. N. regularly takes his medication but
does not overdose. However, this he doesn’t need nurse Hildegard to check on him because
his intelligent drug cabinet also serves this function. The residential headquarters merely
serve as a second line of verification to ensure his safety. His health parameters such as blood
sugar levels and type of medication are saved in his electronic file.
Nurse Hildegard also reminds him that he has a video conference appointment with his doctor
today at 11 o’clock. She asks Mr. N. whether he wants her to join the video session because
she has noticed that his blood sugar levels have been fluctuating considerably in the recent
period. Mr. N. agrees to that. The virtual appointment also serves to discuss other issues, such
as the recommendation to exercise to enhance the blood circulation in Mr. N.’s legs. This is
why the doctor prescribes physiotherapeutic treatment. Mr. N.’s homework includes
gymnastic exercises which can be observed and analysed by specialists in real time. New
types of training visualisations derived from classic video analyses including analysis and
feedback in real time offer entirely new possibilities. Trainees can check themselves whether
they are performing the exercises correctly and are not excessively exhausting their bodies.
They also have the option of having their therapist join the video session, either as a discreet
observer or as a virtual guest coach. The exercises at home can then be discussed and
evaluated during the next therapy session. Like many other people, Mr. N., however, also
suffers from another chronic disease which has become rather common these days: pollen

allergy. Because he only has a light pollen allergy, it can be managed by a simple feature of
his intelligent housekeeping system: Sensors in his flat detect pollen in the air and
automatically initiate a closing of the windows if allergic irritants in the air reach a certain
maximum value which is predefined by the doctor.
Personal trainer. (Wearable Sensor)
Frieda has become a little fragile in the last years. She feels that it is harder to be really active
during the day. Many household activities slowly became a big burden for her. Her Doctor
said that she should continue her activities as long as she can. So, the doctor gave her a little
device that she wears on her wrist and that tracks her physical activity. Her Doctor also gave
her a small box which is connected to her TV. She doesn’t know anything about this
technical stuff, but her son Hubert installed the box for her. Hubert told her that the box helps
her to get help whenever she needs it. The box also shows her videos with little tricks which
she can apply to simplify the performance of household activities and her activities of daily
living (e.g. dressing herself). It also suggested special workout training. She already bought
herself a bicycle ergometer which she can now use to drive her personal training plan. Also,
the box plays some small games with her, which is exhausting but fun. She tried this stuff a
few months and soon she realized that she became fitter and even more secure when she
performs her daily activities.
Tele-Monitoring
Mrs. Chiyoko likes walking and tries to go out every day. At 9:00 her husband left for a day-
care service facility and he will return at about 16:30. She walked for lunch to a restaurant
near her house at 12:00. She ordered a lunch plate and enjoyed it. At 13:30, she left the
restaurant and went to the Japanese traditional poem (thirty-one syllabled verse) class. She
composed some poems and read them in a loud voice. She arrived at her house at 16:00.
When she entered the door, she suddenly felt sick. A wearable vital sensor, attaching her
body and monitoring her physical conditions, detected rapid changes of her vital signs and
sent an emergency signal to the monitoring center. An operator at the monitoring center
received Mrs. Chiyoko’s emergency signal. The operator made a phone call to Mrs.
Chiyoko’s daughter living in Yokohama and tells her the fact that an emergency signal was
received at the monitoring center and that an emergency team of the monitoring center was to
arrive at Mrs. Chiyoko’s house within 10 minutes. The emergency team including a medical
doctor confirms her vital data and daily health check sheets generated by daily detected vital
signs on their way to her house. On arriving her house, they check her condition and make a
medical treatment if necessary.
Epileptic Detection Device
For many years user lived a normal and independent life until one day user woke up in the
back of an ambulance to learn he experienced an epileptic seizure.
From that day on user was issued medication to minimise the risks of recurring seizures
however there was no guarantee that they wouldn't happen again.
Mother contacted the local telecare service to enquire about technological solutions that could
help in day to day life. Issued with a belt worn fall detector that could automatically alert
someone in the event that of a seizure and fell to the floor.

User now 34 years old and is able to live independently in his own home without family or
friends having to keep a watch at all times.
At the age of 11, AAL user was knocked down by a car, spent 6 months in hospital and was
left with an acquired brain injury, broken hip, broken right leg and fractured left arm.
Recovery is still ongoing but in the years since the accident AAL user had to re-learn how to
breathe, eat, walk and talk. “User” still a bit unsteady and struggles to use the right hand side
of body but telecare has enabled “user” to be more independent in own surroundings with the
knowledge that someone is always there should help be needed.
Not only has the service supported user’s recovery but it also provides a great amount of re-
assurance and peace of mind to user’s family who can also go about their day to day activities
without having to worry about user being home alone
Fall Detection Device
Married mother of two young boys with FND (Functional Neurological Disorder) living at
home. It's not a well understood condition but it falls under the umbrella of ME, chronic
fatigue syndrome, movement disorder and collapses.
The aim of the telecare in the home is to assist user with the area of collapses and for that
reason smoke detector installed and fall detector linked to home alarm unit.
In addition to auto alarm through arm worn fall device, both of user’s sons are trained to use
the button on the fall detector in the event of a collapse so they can request assistance from a
local neighbour or carer. Voice communication is available between sons and carers while
assistance is awaited all times.
Accessing Emergency services (Wearable sensor)
Emergency situation such as car accidents, falls, and heart failure might occur; and, more
efficient management system for transporting a patient to nearby hospitals can be achieved by
using SEMS(Smart Emergency Medical Services) which provides E-triage tags, recording
system, and accurate information of a patient.
Mr. Kim, aged 75 years old, recently had a heart attack. Since the day he experienced a heart
attack, he has been wearing an emergency tag which was to prepare the emergency situation.
One day, when he was talking a walk, he accidently fell from the stairs. As he was not able to
move, someone called the 119 for emergency situation. When this call was received, SEMS
immediately recorded the information on transport process including crews’ ID, vehicle
number, and time of response based on Beacon. With the E-triage which enabled the
classification of severity of Mr. Kim’s situation, staffs at nearby hospitals were able to decide
whether Mr. Kim could be delivered to their hospitals. Once Mr. Kim was loaded into the
ambulance, the emergency tag that he was wearing on his wrist allowed crews to obtain
additional information such as Mr. Kim’s full name, contact information, and medical
history. With this information, crews were able to give Mr. Kim a proper first-aid inside the
ambulance. After Mr. Kim has been successfully arrived at emergency room, the emergency
medical activity logs were transmitted to target hospitals’ system so that continuous care for
Mr. Kim could be offered.
Home robot Assistance

For the old adults lived alone, whose legs and arms are less flexible, home assistant robots
can perform the function of helping to delivery objects, do some housekeeping tasks as well
as monitor their health, and connect with others.
Meanwhile, HAR can help the Alans communicate with Sam. Mr. and Mrs. Alan can use
HAR to call Sam through voice input or phone number input, and communicates with Sam
through the screen on HAR. Of course, HAR can help the Alans communicate with any
others they want to talk in the same way.
Through the robots, the old couple can live alone more conveniently.
Diabetic management device (Wearable sensor)

Tom, once an active individual in his twenties, is now 52 and he has been recently diagnosed
with Type II diabetes and must begin to manage his lifestyle and his obesity (BMI of 37) if he
is going to be able to simply cope with the additional condition, with hopes of reversing the
onset and effects of the disease on his body. He is clear both that he must generally get his
lifestyle under tighter control and his weight down to help minimize the impact of diabetes on
his life, and that the details of how he changes his lifestyle may matter considerably how
much his condition is held at bay or even reversed. He needs help with both generally
changing his lifestyle and the specifics of how his choices and behaviours affect his body
states and his long term outcomes.
Tom’s employer has an offer open to all of its employees that it will cover 90% of the cost of
just such a system to help Tom under the sole condition they (the employer) receive quarterly
reports that Tom is at least using the system regularly. Tom feels he is ready to use such a
system regularly for an extended period of time and ready to pay the last 10% himself. This
system provides him with a wearable body monitor, a glucose meter that is wireless
integrated with the wearable body monitor, a website that clearly lays out for him how he is
doing and what he can focus more on or do better at. And it provides him with up to a once
monthly online or phone session with a diabetes case worker. Though it is not required, Tom
will also be sharing his discoveries and reports from this program with his family doctor and
nurse who is a diabetes specialist every 6 months as he works to reverse or control his
diabetes.
Sam is a diabetes care worker. Sam works for a disease management company that has a
service arrangement with a body monitoring company for its diabetes management
application. When a company buys a program of use from the body monitoring company, the
new user is enrolled through the body monitoring company’s software and the person’s
information then automatically becomes a part of her case load and her company receives a
monthly payment for having her availability for this new person.
Jack is Tom’s family doctor, and though he is not an endocrinologist, he knows that in Tom’s
current condition, what he really needs to do is lose some weight, get as much moderate
activity as possible, reduce his stress, and cut out his habitual sleep deprivation. All of these
things are monitored and analyzed by the system that Tom is going to engage in and though
Jack is not reimbursed directly for looking at this information, it is presented so succinctly
that it actually saves him time with Tom, cutting right to the heart of Tom’s issues when he
comes for a visit. And for future reference, because Tom has given his permission, all of the

system’s details about Tom are automatically added to his Physical health record (PHR) at
Jack’s office.

Pre-Standardization Study Report of Concept and Domain Analysis Active Assisted Living, India

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Pre-standardization Study Report of Concept and

Domain Analysis Active Assisted Living, India

LITD-28:1 Active Assisted Living (AAL)

Bureau of Indian Standards

LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 2

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19.2 Awareness .............................................................................................................. 36

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Convener: Prof. S N Sarbadhikari

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During the 3rdMeeting of Smart Infrastructure Sectional Committee, LITD 28 of BIS on 21

Liaison with ISO and IEC Committees:

a) IEC SEG 3 – Ambient Assisted Living

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LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 7

LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 8

LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 9

To experience the complete enjoyment of being a human being, we should be able to

Hence recommended definition of AAL is ‘Concepts, products, services, and systems

LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 10

Following are some basic areas where it is critical to provide access:

a. Access to Information and Government Services- government notifications on

b. Access to Healthcare services- hospitals, caregivers, treatment, para-transport

c. Access to Education- enable students in educational institutions to access curriculum

LITD-28:1 Active Assisted Living, Bureau of Indian Standards Page 11

Stakeholders: banks, financial institutions, RBI, Ministry of finance, Ministry of

e. Mobility and Access to transport- Key issues include non-existent/ uneven/

f. Independent Living- Shopping, Hotels, Restaurants, Banking, access to a variety of

g. Access to Entertainment- Television and multi-media serials, films, videos, theatres,

i. Political participation – access to information about elections, voting machines and

Stakeholders: General population

2.1 The AAL Concept and Technology:

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4 STAKEHOLDERS FOR AAL

a) Increasing health care demand,

b. Policymakers. Policymakers establish the framework within which health care is

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c) Who is eligible to receive care?

c. Providers. Providers could be individual doctors or hospitals. They operationalize care

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4.1 Role of the Government of India in adopting Digital Health

The National Health Policy (2017) has three distinct goals:

a) Use electronic mediums to gather district-level health data by 2020

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a) Department of Empowerment of persons with Disabilities, in the Ministry of Social

5 MARKET DYNAMICS AND POTENTIAL

6 IMPORTANCE OF ACTIVE ASSISTED LIVING IN INDIAN

Population, India 2011 Persons with disabilities, India 2011

Persons Males Females Persons Males Females

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121.08 Cr 62.32 Cr 58.76 Cr 2.68 Cr 1.5 Cr 1.18 Cr

As per a report published in 2016 by the Ministry of Statistics and Programme

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7 AAL FOR PERSONS WITH DISABILITIES AND OLD /ELDERLY

8 DISABILITY AND ACCESSIBILITY

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According to the ITU-G3ict e-Accessibility Toolkit for Policy Makers, ‘Accessibility is a

8.1 Accessibility fosters inclusion and changes social perception

Accessibility is a central concept to inclusion; in fact, many of today’s most famous

9 INDIA – DISABILITY DEMOGRAPHICS

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Demographic old-age dependency ratios: Historical and projected values, 1950-2075[6]

1950 1975 2000 2015 2025 2050 2075