Eldercare Expert Interview: P S Srikumar

In this interview, I chat with Sri to understand the his experiences and draw key insights from his varied experience.

Sri, you are very passionate about the eldercare space and have traversed different parts of it. Could you give us a short background of the last seven years?

I had a very eventful 7 years in this space. I was lucky to have people who mentored me and gave me opportunities to understand different aspects of senior space that included projects in retirement community (CEO of one of the leading retirement community brands in India), launching and running the top products space in Chennai for a client – where we ran a shop in our office for a year on a build operate and transfer model, handling audit of day-care centres and old age homes funded by the Govt of India – Ministry of Social Justice for their partner, training primary care givers in specific areas of memory care and palliative care,  partnering with the largest and only exhibitions and conferences business in the eldercare space, working on assisted mobility and working with parents with children who had disabilities. Each of these projects were intense and spanned over a year each, as it involved strategy and implementation.

Simultaneously, I worked with senior groups – individuals and communities. In the last five years we have helped over 5000 families find solutions to the day-to-day challenges they face in taking care of their loved ones.

Covid has had a big impact on the sector, particularly the rise in home eldercare and senior living space. What are the fundamental shifts you are seeing among families and elders?

Covid had impacted seniors significantly. It is a paradox that in spite of the family being at home, elders felt lonelier during the last two years, than ever before. Earlier, elders used to have “me time” once the children left for work and grandchildren left for school. This wasn’t available during the “work from home or study from home” situation. Besides this, was the need for silent homes. Absence of home help in most cases had elders finding difficult to manage and maintain homes.  

Covid confined seniors to a space. Walks in the evenings, meeting with friends and relatives became impossible. And everything online was something they were not prepared for. 

This is a time that the demand for senior living and assisted living saw a rise – because of the perceived personal space it offered, besides the safety.  Unlike the west, the number of people affected by Covid in communities was very negligible in India. The communities exchanged ideas on how to protect seniors. Even vaccinations were done at these communities. From groceries to medicines, home banking to housekeeping, seniors woke up to a world that was now looking more secure and comfortable.

Access and affordability of care rose significantly – especially for elders affected with Covid with no one to take care of their daily needs. Cost of care almost doubled for people.

We were able to provide support and help to the elder community during this time. Some challenges that elders faced was to learn smart phone and applications like Zomato, Swiggy or grocery ordering – as they became necessities. Reluctance to learn gave way to necessity. 

Intergenerational bonding increased (grandparents and grandchildren), though elder’s privacy in many cases was lost. Increased opportunities in area of home food catering helped many to overcome these difficulties. For many business it was disruptive time and for many others it was an opportunity.

You were a CEO of Covai Care, a pioneer among India’s retirement communities, and have work with leading players in the broader senior living space. Can you give a glimpse into how senior living offerings have changed over time?

I was fortunate to work with Col. Sridharan – who is a pioneer in the concept and founder of Covai Care. Retirement communities started off as extension of real estate. Till recently, in my opinion, many of them did not anticipate the ageing needs nor were prepared for ageing related requirements. Advertisements flaunted healthy ageing.

(Elder) Care meant an ambulance or a medical station. However, many things changed for better in recent years. From a customer perspective, the awareness and acceptance of senior living (which was often confused with old age home) has certainly increased. People accept this as choice. The taboo around the concept was giving way to acceptance. One good aspect was that different forms of living coming up be it independent living, co-living spaces, assisted living, memory care, palliative care, etc. 

Industry organizations like the Association of Senior Living ( ASLI) and CII’s senior forum played a very important role.  People started recognizing best practices. Eligibilities became entitlements. If you are on social media like Facebook or LinkedIn, it is very common nowadays to see advertisements of such facilities available. The overall understanding of this space has increased. International players have recognized India as one of the key markets, given the demographics.

Today the senior space has spread across segments like affordable senior housing and elite ones.   Now standards for senior care are being looked at.  The South had more than 65 % – 70 % of the market share. However, projects are coming up across the country, as the need for the segment has been felt by its stake holders. The market is surely expanding. Brands like Godrej, Tata Housing, Max, Columbia Pacific, LIC, Shriram Group etc., have forayed into the segment.

During our chat, you mentioned the need for more assisted living spaces and particularly those that cater to dementia and other mobility-related issues faced by elders. How big or small is this opportunity

The opportunity is large and substantial.

As living spaces become smaller, providing care for a person with mental health (Alzheimer’s or Dementia) or terminal illness (including Palliative Care), or for persons with disabilities becomes a major challenge. Post-operative care, step-down care or care continuum is a huge area that needs attention and prioritization.  

The options available are very limited and information is also not readily available to the common man. At a stage, a person may not be in a position to manage a property by himself.  Besides will need assistance for day to day activities. Affordability and access become a challenge. Even in a retirement community a person may have to move from an independent state to a dependent state. The community may not be equipped to handle the requirement.  With less than 1 % of the elder population in a formal community environment, the challenges for the rest 99 % are humongous.

Memory care is another area which is very acute. We have had situations where except for the patient with dementia, the near family is not in India and a normal assisted living or senior community will not admit such a person. Parkinson’s, muscular dystrophy, terminal illness, visual impaired elders…the need is just huge and there is not much offer available today.

I work with the visually impaired, it is sad when one of my customers told me that after 60, they are considered a burden by the family (many of them don’t marry) and they don’t have a place to opt for. The Government runs a few facilities, but it does not suit many. It is time the society, business and government come together to address this issue. Besides a huge business opportunity, it is also a humanitarian need.

Carefinder.in is one of your digital products and you have assisted over 4000 customers make informed decisions about on a variety of aspects. How big of a challenge is lack of quality and reliable information in making decisions around living arrangements, etc?

Access to reliable information is still a challenge. But this is changing as the sector is moving into an organized set up. Very slowly. The share of unorganized market is almost 70% of the inventory that is available.

Web searches takes people to a number of options. But many sites provide information that have not been updated. And a lot of information is also obsolete so reliance is still on experienced people for suggestions. One of the biggest challenges is the fact that a choice of a community depends on many factors, specifically the social and economic background of the resident.

When one makes a decision, it is important to understand perspectives and the age of entry. A normal retirement community is wonderful if you enter at around 60 or 65 years of age. It helps you build friends for the next twenty years and adapt to the living.   However, as you age, it becomes more difficult to accept and adapt to a community.  Background of the promotors, organization structure, continuity of service and exit options are all key factors. There are hidden costs like a onetime non-refundable deposit or a medical deposit, and all this will have to be kept in mind while deciding on selecting a place.

Apart from working closely with businesses, you also provide 1-on-1 consultations to families seeking support for their parents and elders. Can you expand on the common queries, and how you think one should go about planning for later life living arrangements?

Many people are still not clear what type of living they need. All our consulting is on a 1 – 1 business. We do not believe that “one shoe fits all”. We probe. We put our understanding in writing and send it to the customer to validate our understanding. The common query is can you suggest a retirement community. This is an open-ended question. We need to understand their budgets, we need to understand and advice on buy vs. rent options, health and financial background of the persons, access to near blood relative in case of extreme situations. Some retirement communities have age barriers for entry and some others have health barriers. For example, not many communities accommodate elders with mental health issues or elders with children with disabilities. As a consultant, we need to know what to suggest and what would be a good fit. In many cases, the solutions we give are very different to what they came to us initially for. And to offer solutions, we need to understand the business also and hence, there is a B2C and a B2B connect here when we provide solutions. 

For many seeking help on home health care, we have suggested assisted living – considering the support and economic reasons of these persons. We suggest people who are apprehensive to do a short stay in the communities and decide only when they are convinced that this is the best option.

It is important to plan a retirement living when you are around 45 years of age. 50 to 60 years is a very vulnerable age and this is where many businesses cash in. In this age group, one is into a midlife situation. Senior position in organization with work pressure and priorities, growing up children, ageing parents and personal health and hence a getaway to a distant place is what many think of. However, above 70, the need reverses. They like to hear noise; they like to meet with younger lot and not live in secluded places (most of them).  This is one of the reasons that stand-alone communities are giving way to integrated living formats now.

You are active in many forums – CII, ASLI, Tamil Nadu govt, etc. What are three takeaways from that vantage point?

• Understanding the industry and needs better
• Understand other issues affecting the senior community in large, than just living
• Prioritising requirements of a larger community and working on policy level suggestions to the government.

You can check out Sri’s work here, connect on LinkedIn or write to him directly at srikumar@carefinder.in.

---

Silver Angels Newsletter

The Silver Angels newsletter brings you news, stories and trends from the silver economy in India, in a short, easy-to-read format. Businesses, brands, investors, startups, researchers and analysts following this space are likely to find it interesting.